PubMed Health⌕ Search

Biomedical subjects

M D Smith

Publications and source records attributed to M D Smith.

621 records · Page 35Linked to original sources
PubMedDate not supplied

Fear & loathing: why Californians are concerned about health care.

A larger percentage of Californians than Americans overall lack insurance, and a poll of state residents shows a greater level of concern about health care costs and access. Among the reasons: a recognition that the uninsured face serious barriers to care and a fear among middle-class Californians that insurance and medical care costs could make coverage unaffordable.

Attitude to Health↗
PubMedDate not supplied

Seeking common ground.

Explore the source record for details and available documents.

Certificate of Need↗
PubMedDate not supplied

Genomic instability in scleroderma.

Scleroderma is an enigmatic rheumatic disorder of uncertain etio-pathogenesis. Cancer has an approximately two-fold higher incidence in scleroderma patients than in the general population. There are preliminary data of acquired genetic damage in scleroderma but the significance of these observations are uncertain. To determine somatic mutation frequency at the glycophorin-A (GPA) locus in patients with limited and diffuse cutaneous scleroderma. The GPA assay measures the total somatic mutation frequency (Vf), composed of gene inactivating mutations (NO) and mutations arising from mitotic recombination (NN) in individuals heterozygous for the GPA MN blood group. Mutation frequency was determined using a validated GPA flow cytometric assay using fluorescent labeled monoclonal antibodies specific for the GPA blood groups M and N. This assay detects and enumerates progeny of red blood cell (rbc) precursor cells which have acquired genetic damage resulting in a loss of expression of one of the GPA alleles. It was found that patients with scleroderma (n = 23) had significantly elevated Vf as compared with young healthy controls (p < 0.001) and elderly controls (p = 0.03). Patients with diffuse scleroderma had higher mean Vf as compared with limited scleroderma (p = 0.055). In comparison with controls, patients with scleroderma exhibit a higher proportion of mitotic recombinant mutations than inactivating mutations (p < 0.002). There was no correlation between Vf and disease duration, age at onset or autoantibody status. We have documented evidence of acquired genetic damage at the GPA locus in scleroderma. Evidence of acquired genetic damage in this disorder may be importance in explaining both the etio-pathogenesis of scleroderma and the association of scleroderma with cancer.

Adolescent↗
PubMedDate not supplied

Response of soluble IL-2 receptor levels during gold therapy for rheumatoid arthritis.

Soluble IL-2 receptor (sIL2R) levels were measured at week 0 and week 24 in the sera of 27 patients with active rheumatoid arthritis who had taken part in a chrysotherapy study. At entry (wk 0) although sIL2R levels were significantly elevated in the rheumatoid patients there was no significant correlation with a clinical disease activity score, C reactive protein (CRP) or rheumatoid factor (RF). After 24 weeks of chrysotherapy there was no significant change in sIL2R levels although the clinical activity score, CRP and RF were significantly reduced. However, measurement of sIL2R in 7 patients who had obtained clinical remission following 38-73 months of gold treatment showed significantly lower levels of sIL2R than patients with continuing active disease.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Public knowledge and perceptions about unplanned pregnancy and contraception in three countries.

A 1994-1995 survey of men and women aged 18-44 in the United States, Canada and the Netherlands revealed considerable differences in public knowledge and perceptions about unplanned pregnancy and contraception. The proportion who believe that unplanned pregnancy is a "very big problem" is 60% in the United States, 36% in Canada and 6% in the Netherlands. Americans are more likely than their Canadian or Dutch counterparts to cite societal problems as significant factors in the rate of unplanned pregnancy; higher proportions of Americans also cite the cost of contraceptives (52% vs. 46% of Canadians and 34% of Dutch men and women) and an inability to obtain methods (66%, 51% and 33%, respectively). In all three countries, adults are generally well informed about the relative effectiveness of commonly used contraceptives, but Americans are more skeptical about method safety and effectiveness. For example, 17% think the pill is "very safe," compared with 21% of Canadians and 40% of the Dutch; and whereas 64% of Americans consider the pill "very effective," 73% of Canadians and 90% of Dutch men and women give it this rating. Health care professionals are the most frequently cited source of contraceptive information, but only 51-63% of adults have ever discussed contraception with such a practitioner.

Adolescent↗
PubMedDate not supplied

Decreased nailfold capillary density in limited scleroderma with pulmonary hypertension.

Approximately 20% of patients with the limited form of scleroderma will develop pulmonary hypertension which is generally a late stage fatal complication. Why pulmonary hypertension occurs in this subset of patients is unknown and it has not been possible to predict which patients are at risk. Nailfold capillary dilatation, distortion and drop occurs universally in patients with scleroderma and is generally an early finding. The present study was conducted to investigate whether quantitative nailfold capillaroscopy could distinguish those limited scleroderma patients who have established pulmonary hypertension. Quantitative nailfold capillaroscopy was performed by Visual Image Analysis in 10 healthy subjects and 20 patients with limited scleroderma (18 centromere +ve), of whom 8 had established pulmonary hypertension. It was found that scleroderma patients with pulmonary hypertension had a significant reduction in capillary density compared with patients lacking this complication (p < 0.01). Patients with scleroderma have significantly more dilated capillaries than controls although no significant differences were observe between the two patient subgroups. The finding of reduced nailfold capillary density in scleroderma patients with established pulmonary hypertension has possible pathogenic significance and may allow detection of this subgroup at an early stage in their disease progression.

Adolescent↗