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Biomedical subjects

M A Chesney

Publications and source records attributed to M A Chesney.

At least 19 recordsLinked to original sources
PubMed1995

The consequences of a positive prenatal HIV antibody test for women.

As more women of childbearing age are affected by the human immunodeficiency virus (HIV), many providers have demanded routine perinatal HIV screening, arguing that the medical benefits of testing outweigh the socioeconomic, medical, and psychological risks of a positive HIV test for women. In this primarily urban poor population, we used a semistructured interview to evaluate differences in health care discrimination, economic losses, risk behaviors, relationships changes, and psychological status in 20 HIV-positive and 20 HIV-negative mothers matched for HIV risk, race, income, and delivery date. Many (35%) seropositive and no seronegative women cited health care discrimination due to HIV status. Although seropositive women reported greater satisfaction with social support from friends (100%) and family (80%), many women had not disclosed their HIV status to any friends (65%) or family (25%), indicating fear of abandonment. Only 56% of HIV positive and 44% of seronegative women knew their partners' HIV status, and many HIV-positive and HIV-negative women reported having sex without condoms after the HIV test. Mean standardized anxiety (p < 0.05) and depression scores were higher in seropositive women. Despite added social support and medical treatments, HIV-positive women showed higher levels of health care discrimination, personal isolation, and psychological sequelae than their seronegative counterparts. As the medical benefits to prenatal HIV testing increase, we will need to develop focused medical, social, and mental health services addressing the needs of HIV-positive women.

Adult↗
PubMed1995

How do medical residents discuss resuscitation with patients?

OBJECTIVE: To describe how medical residents discuss do-not-resuscitate (DNR) orders with patients. DESIGN: Prospective observational study. SETTING: Inpatient medical wards of one university tertiary care center, one urban city public hospital, and one Veterans Affairs medical center. PARTICIPANTS: Thirty-one medical residents self-selected 31 of their English-speaking, competent patients, with whom they had DNR discussions. MEASUREMENTS: Three independent observers rated audiotaped discussions about DNR orders between the medical residents and their patients. Ratings assessed whether the physicians met standard criteria for requesting informed consent (e.g., disclosed the nature, benefits, risks, and outcomes), addressed the patients' values, and attended to the patients' emotional concerns. MAIN RESULTS: The physicians often did not provide essential information about cardiopulmonary resuscitation (CPR). While all the physicians mentioned mechanical ventilation, only 55% mentioned chest compressions and 32% mentioned intensive care. Only 13% of the physicians mentioned the patient's likelihood of survival after CPR, and no physician used a numerical estimate. The discussions lasted a median of 10 minutes and were dominated in speaking time by the physicians. The physicians initiated discussions about the patients' personal values and goals of care in 10% of the cases, and missed opportunities to do so. CONCLUSIONS: Medical ethicists, professional societies, and the public recommend more frequent discussions about DNR orders. Even when housestaff discuss resuscitation with patients, they may not be accomplishing the goal of increasing patient autonomy. Research and education must focus on improving the quality, as well as the quantity, of these discussions.

Adult↗
PubMed1995

Adherence to zidovudine (AZT) among HIV-infected methadone patients: a pilot study of supervised therapy and dispensing compared to usual care.

Twenty-seven HIV-infected methadone maintenance patients who demonstrated problems adhering to zidovudine (AZT) were randomly assigned to a group that received eight weeks of weekday supervised therapy and dispensing of AZT or a group that received usual care of the clinic. Adherence was assessed by self-report, erythrocyte mean corpuscular volume (MCV), Medication Event Monitoring Systems (MEMS), and pill counts. Subjects in the intervention group demonstrated significantly higher MCV levels during the intervention period than usual care subjects, with similar but non-significant trends for the three other adherence measures. MEMS percent indicated significant group differences on weekdays, but not weekend days. There were no differences at a one-month follow-up. Results suggest supervised therapy and dispensing may be an effective strategy for improving AZT adherence, but only while provided. Further research is needed to establish the effects of larger and longer lasting interventions.

Adult↗
PubMed1992

Hostility and health behaviors in young adults: the CARDIA Study. Coronary Artery Risk Development in Young Adults Study.

Hostility has been associated with coronary heart disease mortality. To assess possible mechanisms linking hostility to coronary heart disease risk, the authors conducted analyses in a cross-sectional study from data collected in 1985 and 1986 on 5,115 young adults, aged 18-30 years, black and white, male and female, in four large urban areas of the United States. The results show that higher levels of hostility as determined by the Cook-Medley Hostility Scale were strongly associated with tobacco and marijuana smoking, increased alcohol consumption, and greater caloric intake in both blacks and whites and in both men and women. The increased caloric consumption was evident in the higher waist/hip ratios, particularly in men (p less than 0.05). The associations were particularly strong (p less than 0.001) for tobacco cigarette smoking and marijuana smoking, with roughly a 1.5 times higher prevalence in the top hostility quartile compared with the bottom quartile after adjusting for age and education. Hostility levels were not related to the percentage of calories from fat or from sucrose intake, to plasma cholesterol levels, or to physical fitness (except for a weak association in the latter in white women). The results describe relations between hostility and health behaviors that may be detrimental to health. The findings provide a possible explanation for the association between hostility and coronary heart disease mortality.

Adolescent↗
PubMed1992

Stress, coping, and high-risk sexual behavior.

We examined the relation between stress, coping, and a high-risk sexual behavior (unprotected anal intercourse) in 398 nonmonogamous gay and bisexual men from the AIDS Behavioral Research Project in San Francisco. Unprotected anal intercourse during the previous month, the amount of stress experienced during the previous month in each of 10 domains, six types of coping (self-controlling coping, escape-avoidance, distancing, planful problem-solving, seeking social support, and positive reappraisal), and spiritual beliefs and spiritual activities were assessed through self-report. There was no relation between stress and unprotected anal intercourse. However, there was a relation between coping and unprotected anal intercourse. Subjects who reported unprotected anal intercourse used sex more of the time to help cope with stressful situations than did subjects who did not report unprotected anal intercourse. Unprotected anal intercourse was negatively associated with seeking social support and spiritual activities and positively associated with self-controlling coping, which involves keeping one's feelings to oneself, and positive reappraisal. The findings suggest that social aspects of coping may be a key to understanding differences between those who engage in high-risk sexual behavior and those who do not.

Adaptation, Psychological↗
PubMed1991

Integrating behavior and cardiovascular responses: the code.

The next revolution in biology is predicted to be in the integrative domain, and the need to involve physiologists in this kind of research has been recognized. This paper represents an approach to providing some of the tools required for dealing with integrative physiology at the behavioral level. Video tape recordings are made of the activities of a group of five baboons (Papio hamadryas) while simultaneous recordings of arterial blood pressure, heart rate, renal blood flow, and mesenteric or iliac blood flow are telemetered from two of the members of the group. The telemetered cardiovascular information is recorded on the two audio channels of the videotape. Subsequently the videotape is viewed, and a two-dimensional code is used to record the behavior of the two animals with the telemetry equipment. The first dimension of the code categorizes the behavior changes precisely regarding those aspects of behavior that are related to cardiovascular dynamics and does so with an accuracy of 16 ms. The second dimension codes relevant environmental changes. The paper describes the code and presents illustrations of how the code reflects the cardiovascular dynamics associated with the behavioral changes.

Animals↗
PubMed1991

Sex differences in high density lipoprotein cholesterol among low-level alcohol consumers.

The purpose of this study was to examine high density lipoprotein cholesterol (HDL-C) levels in a sample of community-living women and men who consumed 1 drink of alcohol/day or less. Self-reports of alcohol consumption and clinical assessments of plasma lipid and lipoprotein levels were obtained twice, at 12 months apart. Among men, consumption of 1 drink/day or less was unrelated to levels in HDL-C. In contrast, among women alcohol consumption throughout this relatively low consumption range was positively associated with HDL-C levels. These findings indicate that the association of alcohol and higher levels of HDL-C may occur at lower intakes of alcohol in women than in men.

Adult↗
PubMed1989

Biobehavioral aspects of cardiovascular disease: progress and prospects.

Cardiovascular disorders pose a major health problem for industrialized societies in terms of excess morbidity and mortality. Hypertension (HT) is a major risk factor for coronary heart disease (CHD) and cerebrovascular disease. The impact of psychosocial factors, personality traits, genetic-behavioral interactions, sodium sensitivity, obesity, insulin metabolism, and psychophysiology on HT status is discussed. An understanding of pathophysiologic processes is needed to provide a better basis for risk factor reduction and other aspects of treatment. The study of myocardial ischemia appears to provide an important link between the development of coronary artery disease and the occurrence of CHD. Further studies are needed to assess the clinical significance of stress-induced myocardial ischemia as well as whether mental stress is predictive of future CHD. Associations have been made between behavioral risk factors and CHD, but the exact nature of the relationship remains to be clarified. Hostility has been identified as an important aspect of coronary-prone behavior, but considerable research will have to be completed before a comprehensive understanding of coronary-prone behavior and the manner in which it has an impact on disease can be fully understood.

Behavior↗
PubMed1987

Stability of the type A structured interview and related questionnaires in a 10-year follow-up of an adult cohort of twins.

Associations between initial and 10-year follow-up assessment of the Type A behavior pattern (TABP) were examined in a sample of adult male twins using a broad range of instruments. When assessment is made by the Structured Interview and limited to the dichotomous Types A and B rating, 67% of the subjects received the same rating on both occasions. Spearman rank correlations between repeated self-report measures of TABP ranged from .55 to .70. Overall the stability among the self-report measures was greater than between the self-reports and the Structured Interview. Utilizing the twin design the relationship of genetic and environmental factors to tracking of TABP was examined and compared between monozygotic and dizygotic twin pairs. The implication of these results to the TABP construct is discussed.

Adult↗
PubMed1986

Cardiovascular responses in type A and type B men to a series of stressors.

Fifty-six healthy adult males were administered the Type A Structured Interview and assessed as exhibiting either Type A (N = 42) or Type B (N = 14) behavior pattern. They were monitored for systolic (SBP) and diastolic blood pressure (DBP) and heart rate (HR) responses during a series of six challenging tasks: Mental Arithmetic, Hypothesis Testing, Reaction Time, Video Game, Handgrip, and Cold Pressor. The results indicated that Type A subjects exhibited greater cardiovascular responses than did Type B subjects during some (Hypothesis Testing, Reaction Time, Video Game and Mental Arithmetic) but not all (Handgrip and Cold Pressor) of the tasks. These results are discussed in terms of previously reported findings on conditions that do and do not produce differences in Type A/B cardiovascular stress responses.

Adult↗
PubMed1986

Behavioral treatment of borderline hypertension: an overview of results.

The evidence for blood pressure reduction by behavioral interventions based on relaxation, biofeedback, and related approaches is reviewed. The majority of controlled investigations indicate that behavioral treatments results in greater reductions in blood pressure than no-treatment control conditions, particularly for higher levels of blood pressure. Behavioral interventions are also effective as an adjunct to pharmacotherapy when blood pressure remains elevated despite antihypertensive medication. Results with borderline and mild hypertensives are mixed. Nonspecific factors, such as positive expectancy and habituation to repeated blood pressure monitoring, play a significant role in blood pressure change and have important clinical implications. A stepped approach for the treatment of borderline hypertensives is advanced, entailing systematic monitoring with positive expectancy followed by behavioral treatments for individuals whose blood pressure remains elevated. Next comes combined behavioral and pharmacological interventions in those still not showing adequate blood pressure decreases. Recommendations for future research on behavioral interventions are presented.

Behavior Therapy↗
PubMed1985

Reducing the confounding effects of environment and diet on saliva thiocyanate values in ex-smokers.

This study focuses on the use of saliva thiocyanate to corroborate self-report in 391 adult ex-smokers who claimed abstinence from cigarettes for a minimum of 3 months. Results indicated significant thiocyanate confounders, such as using and inhaling nontobacco organic substances, working in a "smoky" environment (i.e., tobacco smoke), and consuming varieties of Brassica oleracea (e.g., cabbage), that could be identified and adjusted for in order to clarify classification of smoking status. Before adjustment for confounders, 18% of subjects reporting abstinence had saliva thiocyanate values greater than the standard cut-off point of 100 micrograms/ml, which would classify them as current smokers. After adjustment, only 12% of subjects still had values greater than 100 micrograms/ml.

Adult↗
PubMed1985

Twin similarity in cardiovascular stress response.

Cardiovascular (CV) responses to laboratory stressors were measured in 12 pairs of identical and 21 pairs of fraternal adult male twins. For this study, blood pressure and heart rate were measured during a mental arithmetic task and the Cold Pressor Test. The analyses of cardiovascular responses to these stressors were designed to test for the presence of a genetic component in cardiovascular reactivity in an adult sample of twins aged 54-64 years. The results suggest that certain measures of cardiovascular reactivity to laboratory stressors may be heritable for both physical and psychological stressors. The possible role of this genetic component in the etiology and course of coronary heart disease is discussed.

Blood Pressure↗