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Biomedical subjects

M Hardin

Publications and source records attributed to M Hardin.

At least 19 recordsLinked to original sources
PubMed2001

Effects of withdrawal of inhaled steroids in men with severe irreversible airflow obstruction.

Inhaled corticosteroid therapy has proven efficacy for asthmatics, but the benefit for patients with chronic obstructive pulmonary disease (COPD) is less well supported. We hypothesized that withdrawal of inhaled steroids in elderly patients with severe irreversible airway obstruction would not lead to a deterioration in respiratory function. We designed a prospective, double-blind, randomized, placebo-controlled, crossover study to follow spirometry, quality of life questionnaire, six-minute (6-min) walk test, and sputum markers of inflammation during a 6-wk placebo treatment period and a 6-wk treatment period with beclomethasone dipropionate (BDP), 336 microg/d. There were 24 men receiving BDP who entered the study; 15 completed the study. Their mean age was 66.9 +/- 1.9 yr, and mean FEV(1) was 1.61 +/- 0.1 L (47% of predicted). There was a significant decrease in the mean FEV(1 )while using the placebo inhaler (1.70 L versus 1.60 L, baseline versus placebo: 95% CI, 0.002 to 0.195; p < 0.05). There was a decrease in the mean percentage change in FEV(1) for the study subjects during the placebo treatment period as compared with the BDP treatment period (-6.28 versus 5.03%, placebo versus BDP: 95% CI, -23.38 to 0.76; p = 0.06). Six-minute walk test results and sputum analysis for cell count and differential were not significantly different during placebo and BDP treatment periods. Borg scale assessment of dyspnea after exercise was increased while using the placebo inhaler as compared with baseline, and decreased during the BDP treatment period. Chronic Respiratory Disease Questionnaire (CRQ) scores revealed no significant difference between placebo and BDP. This study has demonstrated that in elderly patients with severe irreversible airway obstruction, withdrawal of inhaled corticosteroid therapy leads to a deterioration in ventilatory function and increased exercise-induced dyspnea.

Administration, Inhalation↗
PubMed2000

What is the Word at Logos College? Homosocial ritual or homosexual denial in Don Delillo's End Zone?

"What Is the Word at Logos College? Homosocial Ritual or Homosexual Denial in Don Delillo's End Zone?" investigates the homoerotic desire that, despite being culturally repressed, periodically surfaces in foothall. Given the highly closeted nature of American foothall, it is necessary to look at the puns, allusions, and interactions between the players to see how Don DeLillo has created a text that subtly exposes the homoerotics of male sport. In order to strengthen the connection between homoeroticism and football, I will show how football's invention and organization in America coincides with the construction of the homosexual subject. Football and other arenas for male-male play become enforced at the same time as desire begins to express itself; thus, football is the logical place in America to look for unresolved (and resolved) male homosexuality, and DeLillo does this skillfully.

Culture↗
PubMed1998

Ethnic disparities in patient recall of physician recommendations of diagnostic and treatment procedures for coronary disease.

Despite the proven benefits of many cardiac procedures, some are used less frequently for African Americans than for white patients with known or suspected coronary disease. This study explored differences between ethnic groups that may affect patient recall of physician recommendations of cardiac procedures. Also examined were patients' responses when asked about adhering to those recommendations. The data examined were collected from interviews with 1,333 African American and white hospital inpatients with known coronary disease admitted to the Birmingham-Black Health Seeking for Coronary Heart Disease Project (1989-1990) in Alabama. Respondents were asked to recall previous health care encounters, physician recommendations of cardiac procedures, and adherence to those recommendations. Compared with whites, fewer African American patients recalled physicians recommending some cardiac procedures. If procedure recommendations were recalled, no ethnic differences were found in patient recall of adhering to those recommendations. Predictors of recall of the recommended procedures were identified by multivariate logistic regression. Patients' knowledge of having coronary disease was the common factor that predicted their recall of all cardiac procedures. Other predictor variables included some cardiac risk factors and symptoms, socioeconomic status, and ethnicity. Although health care practice is influenced by many factors, it is important to examine variables that may lead to a reduction in ethnic disparities in coronary disease morbidity and mortality.

Black or African American↗
PubMed1997

Nutritional status of urban homebound older adults.

The purposes of this study were to assess comprehensively the nutritional status of frail older adults living in an urban area and to identify factors associated with nutritional insufficiency. Subjects were 49 adults aged > or = 65 y followed by the Jefferson County Home Health Department. Twenty-nine percent of the women and 63% of the men had a body mass index (BMI; in kg/m2) < 24. Nineteen percent had serum albumin concentrations < 35 g/L (3.5 g/dL). More than one-half of the subjects reported symptoms of oral health problems. The key dependent variables were serum albumin concentration and BMI. In univariate analyses, a lower BMI correlated with oral symptoms, male sex, increased age, and less education. Lower serum albumin concentrations were associated with advanced age, increased dependence in Activities of Daily Living (ADL), oral symptoms, and presence of a caregiver. A stepwise multiple-regression model for BMI and serum albumin showed that predictors of low BMI were increased age, less education, difficulty in chewing, and absence of dentures. Variables in the model for lower serum albumin concentrations were sex, increased age, increased dependence in ADLs, and wearing of dentures. In a secondary analysis that controlled for age, education level, functional status, and sex, oral symptoms remained associated with lower BMI but not with lower serum albumin concentrations. This study found a high prevalence of undernutrition in urban homebound older adults and suggests that oral health disability may affect nutritional status in this population.

Black or African American↗
PubMed1996

Responsibilities and effectiveness of the juvenile court in handling dependency cases.

The juvenile court's role in handling child abuse and neglect cases changed and expanded greatly after the passage of the federal Adoption Assistance and Child Welfare Act in 1980 and following the enactment of many similar state laws. These federal and state "permanency planning" laws require child welfare agencies to make reasonable efforts to avoid the break-up of families, where safe and practical, and direct the courts to monitor these efforts. The laws also require both agencies and courts to establish timely permanent new homes for children when preservation of families is not possible. The effectiveness of juvenile courts in fulfilling the laws' mandates has been uneven because of variations in judicial workload, court management, and relationships between the courts and the child welfare agencies. The quality of legal representation of children, parents, and agencies is often compromised by high caseloads, low status and pay, lack of experience, and rapid turnover. Courts vary in their capabilities to monitor agencies' permanency planning efforts and in their power to order specific placements and services. The proper role of the court and the agency in this regard is a matter of continuing debate. The author concludes that efforts currently under way in the states to reform the juvenile court's handling of abuse and neglect cases are cause for optimism.

Child↗
PubMed1995

The use of children's drawings in the evaluation and treatment of child sexual, emotional, and physical abuse.

Primary care physicians can be instrumental in the initial identification of potential sexual, emotional, and physical abuse of children. We reviewed the use of children's artwork as a method of communicating individual and family functioning. A quantitative method of analyzing children's artwork provides more reliability and validity than some methods used previously. A new scoring system was developed that uses individual human figure drawings and kinetic family drawings. This scoring system was based on research with 842 children (341 positively identified as sexually molested, 252 positively not sexually molested but having emotional or behavioral problems, and 249 "normal" public school children). This system is more comprehensive than previous systems of assessment of potential abuse.

Art↗
PubMed1994

Enhanced stress responsivity of Tourette syndrome patients undergoing lumbar puncture.

Tourette's syndrome (TS) is a complex inherited neuropsychiatric disorder that is characterized by multiple motor and phonic tics. Stress-related fluctuations in symptom severity and medication responsiveness are common, and patients often report that tics are worsened by fatigue, emotional trauma, and anxiety. We examined the effects of lumbar puncture (LP) stress on plasma adrenocorticotropin (ACTH) and cortisol, urinary catecholamines, and self- and clinician ratings of anxiety in 13 medication-free TS patients and 10 normal controls, ages 17 to 41 years. The TS patients secreted significantly more ACTH than the normal controls in response to the stress of the lumbar puncture. Compared to the controls the TS patients had significantly greater postLP mean and postLP peak ACTH levels. The TS patients also excreted significantly more norepinephrine in the 20 hr preceding the lumbar puncture and reported higher levels of anxiety before and during the procedure than the controls. In addition, urinary norepinephrine excretion of the TS patients was significantly correlated with clinician ratings of tic severity. The results were not related to current levels of depression and anxiety. Taken together, these findings suggest that a subset of TS patients may be characterized by heightened reactivity of the hypothalamic-pituitary-adrenal axis and related noradrenergic sympathetic systems.

Adrenocorticotropic Hormone↗
PubMed1994

A comparison of two methods to ascertain dietary intake: the CARDIA Study.

Data on dietary intake were collected in the Coronary Artery Risk Development in Young Adults (CARDIA) Study at the baseline examination in 1985-86 and again at the second examination 2 years later. At baseline, a diet history questionnaire developed for the CARDIA study was used; at the second exam the NCI (Block) food frequency questionnaire was used. The purpose of the present report is to compare the estimated nutrient intakes obtained with the two instruments; to compare correlations of nutrient intakes obtained at the two exams with those observed for other lifestyle and physiological variables also measured 2 years apart; and to assess ability to test hypotheses relating 2-year changes in risk factors to between-exam differences in reported nutrient intakes. Mean levels of reported intake were generally greater for both blacks and whites on the CARDIA diet history than on the Block food frequency. Rank order correlations of reported nutrient intakes between the two questionnaires indicated greater consistency between instruments for whites (r's ranging between 0.35 and 0.52) than for blacks (r's ranging between 0.29 and 0.45). Correlations over time for nutrients were smaller than those observed for body size measures and lipid levels but were similar in magnitude to those for blood pressure, physical activity, and life events. At both exams, total caloric intake was positively associated with physical activity (range of r's for CARDIA were 0.07 for white women to 0.23 for black men, the range of r's for Block were 0.06 for women to 0.11 for white men). Using data from the two examinations, 2-year changes in total plasma cholesterol were significantly related to 2 year changes in Keys scores. The results of this comparison are useful in that they show similarities and differences between two instruments developed to gather dietary intake data. The study also illustrates the need to monitor young adults during a time when rapid changes occur in many lifestyle and physiologic factors.

Adult↗
PubMed1994

Diagnoses, symptoms, and attribution of symptoms among black and white inpatients admitted for coronary heart disease.

OBJECTIVES: This study examined health care-seeking behaviors to elucidate factors that contribute to differences in patterns of coronary heart disease between African Americans and Whites. The prevalence of diagnosed coronary heart disease, patients' perceptions of symptoms and attribution of symptoms, and predictors of painful symptoms and attribution of cardiac symptoms were examined. METHODS: The study involved 2416 patients admitted with diagnoses of coronary artery disease, ischemic heart disease, or myocardial infarction or to rule out myocardial infarction. Structured interview questions were used to obtain demographic information, symptoms precipitating admission, and patients' attribution of their symptoms. Discharge diagnoses were obtained from hospital records. RESULTS: Acute myocardial infarction, unstable angina, nonacute ischemic heart disease, and atherosclerosis were more frequent in White patients. For Blacks, the odds of reporting painful symptoms were only 64% of the odds found for Whites when other factors were controlled, and the odds of attributing symptoms to cardiac origins were almost 50% lower for Blacks than for Whites. CONCLUSIONS: The tendency of Blacks to report fewer painful symptoms and to attribute their symptoms to noncardiac origins may contribute to differences in care-seeking and in medical management of heart disease in Blacks.

Black or African American↗
PubMed1993

Rose Questionnaire responses among black and white inpatients admitted for coronary heart disease: findings from the Birmingham-BHS Project.

Evidence of higher coronary heart disease mortality rates among blacks than among whites raises questions concerning differences in health care-seeking for heart disease between blacks and whites. As part of a larger project evaluating health care-seeking behavior for coronary heart disease, we interviewed hospitalized patients who had diagnoses of coronary artery disease, ischemic heart disease, chest pain, or myocardial infarction, or who were admitted to rule out myocardial infarction. The sample included 1140 white men, 347 black men, 574 white women, and 355 black women. The interview included demographic information, usual care, access to usual care, and chest pain items. Demographic and medical care access differences emerged between African-American and white participants. We also compared the prevalence of Rose Questionnaire angina between blacks and whites. Among patients who scored positively for Rose angina, black men reported more recent onset of their angina and fewer episodes during the past 6 months compared to all other groups, and they sought medical care less often compared with white men. Multiple logistic regression analyses suggest that African-American respondents were less likely to score positively for Rose angina and were less likely to seek treatment for their symptoms among those who had angina, when controlled for demographic, risk factor, and access to care variables. Blacks and whites in our sample also differed in factors associated with scoring positive for angina and seeking medical care for their symptoms, among those who reported angina. We interpret these findings as suggesting that promoting routine usual care among whites may be an important approach for increasing care-seeking for coronary heart disease symptoms. For blacks, improved coronary heart disease case identification and/or educational approaches to promote greater awareness of symptoms and of the need for seeking treatment for symptoms may be important to increase the likelihood that they will seek medical care for their symptoms.

Black or African American↗
PubMed1992

The expression of proliferating cell nuclear antigen in paraffin sections of peripheral, node-negative non-small cell lung cancer.

Cell proliferation of 40 peripheral, node-negative non-small cell lung cancers (NSCLC) treated with surgery alone was investigated by immunohistochemical analysis with the monoclonal antibody (MoAb) PC10, which recognizes a proliferating cell nuclear antigen (PCNA) in formalin-fixed and paraffin-embedded material. Results were correlated with DNA ploidy and S-phase fraction (SPF) analyzed by DNA flow cytometric study. Mitotic count (MC) was analyzed by light microscopic study and histopathologic features. PCNA immunoreactivity was seen in all samples and confined to the nuclei of cancer, but not to the surrounding, tumor-negative cells; its frequency ranged from 0-70% (median, 15%), and tumors expressed either a low (0-25%, n = 25) or intermediate (26-75%, n = 15) proliferative activity. There was no relationship between PCNA immunoreactivity and tumor stage or among size, histologic type, and mitotic count (MC). Tumors with intratumoral blood vessel invasion (BVI) showed a significantly higher (P less than 0.005) PCNA immunoreactivity than BVI-negative tumors. PCNA scores were significantly higher (P less than 0.005) in DNA aneuploid (n = 22) than in DNA diploid (n = 18) tumors and correlated significantly with the SPF of DNA aneuploid tumors (r = 0.825, P less than 0.0001), but not with diploid tumors (r = 0.002, P = 0.9). Intermediate proliferating tumors had a significantly higher (P less than 0.01) MC than their counterparts. In univariate analysis, significant predictors of survival were tumor classification (T1 versus T2), tumor size (less than or equal to 2.6 cm versus more than 2.6 cm), BVI (BVI-negative versus BVI-positive), MC (less than or equal to 8 versus more than 8), and PCNA immunoreactivity (low versus intermediate). DNA ploidy and SPF did not influence survival significantly. Only PCNA immunoreactivity retained its independent level of significance (P = 0.02) by multivariate analysis. It was concluded that PCNA immunostaining is a simple and clinically useful method for estimating cell proliferation in formalin-fixed, paraffin-embedded tissue of resected peripheral, node-negative NSCLC.

Adult↗
PubMed1991

Results and prognostic factors of surgery in the management of non-small cell lung cancer with solitary brain metastasis.

Between 1975 and 1988, 37 patients with resectable non-small cell lung cancer (NSCLC) and synchronous (within 1 month, n = 10) or metachronous (n = 27) solitary brain metastasis (SBM) underwent combined excision of their lesions. Overall 5-year and median survival were 30% and 27 months (range, 3 to 125+ months), respectively. Twenty-seven patients had a relapse, and their median disease-free interval (DFI) was 17.5 months (range, 1 to 108 months). The most frequent (78%, n = 20) site of first recurrence locally was either the ipsilateral thorax (n = 14) or brain (n = 6). In univariate analysis, age, primary tumor and lymph node status; tumor histology, size, and side; type of pulmonary resection; side and location of SBM; and onset of presentation did not affect survival and DFI. By contrast, the interval (less than or equal to versus greater than 12 months) between the two operations significantly affected survival (P = 0.0096) and DFI (P = 0.046). The DFI was also affected by the administration of adjuvant chemotherapy (AC) for the primary tumor (P = 0.02). Using the Cox model, AC was the most independent predictor of DFI. These data support the inclusion of surgery in the therapeutic armamentarium for patients with NSCLC and SBM.

Adult↗
PubMed1991

Surgery plus adjuvant chemotherapy for T1-3N0M0 small-cell lung cancer. Rationale for current approach.

Between January 1980 and December 1986, 42 patients with histological confirmed small-cell lung cancer (SCLC) staged pathologically as T1-3N0M0 disease entered a prospective study of surgery plus adjuvant chemotherapy including six courses of i.v. cyclophosphamide (1 g/m2, day 1), epirubicin (60 mg/m2, day 1), and etoposide (120 mg/m2, days 1, 3, and 5), at 3-week intervals. No thoracic or prophylactic cranial irradiation was given. With a 52.5-month median follow-up, estimated 5-year survival was 36% and median survival was 32.7 months (range, 5-100+) for all patients. Seven patients (17%) are currently alive and disease-free at 63 to 100 months. In univariate analysis, baseline characteristics significantly influencing survival and disease-free interval (DFI) were the tumor stage (T1 and T2 versus T3), tumor histology (oat and intermediate versus combined cell type), and type of resection (lobectomy versus pneumonectomy). However, in multivariate analysis, only the tumor stage (T1-2 versus T3) maintained its level of significance. There was a significant correlation (p less than 0.0001) between the pathological tumor size (maximum tumor diameter [(MTD) cm] and survival and DFI; once the MTD (less than versus greater than median value, 3.9 cm) was included in univariate and multivariate analysis, the tumor stage no longer appeared to maintain its level of significance. Treatment was generally well-tolerated and toxicity was acceptable. This study demonstrates the effectiveness of surgery and adjuvant chemotherapy in yielding impressive long-term survival for T1 and T2N0M0 SCLC and provides evidence that the MTD can be used as a powerful and independent prognostic factor for stratification of patients in further trials.

Adult↗
PubMed1991

Long-term evaluation of intrapleural bacillus Calmette-Guerin with or without adjuvant chemotherapy in completely resected stages II and III non-small-cell lung cancer.

Between January 1979 and December 1980, 52 patients with completely resected stages II and III non-small-cell lung cancer (NSCLC) were randomly assigned to receive either adjuvant chemotherapy (cyclophosphamide, doxorubicin, and vincristine--CAV) plus intrapleural bacillus Calmette-Guerin (BCG) (n = 26) or adjuvant CAV alone (n = 26). Careful intraoperative staging was performed in all patients, and stratification for histology (squamous versus nonsquamous) and stage (II or III) ensured a balanced randomization for these factors. With a median follow-up time of 111 months, overall 10-year and median survival were 21% and 20 months (range 2-127 + months), respectively. Thirty-four (95%) patients relapsed in extrathoracic sites, and five (5%) developed loco-regional recurrence; their overall median disease-free interval (DFI) was 10 months (range 1-73 months). There was a 9% and 2.5 month difference in survival (p = .76) and disease-free interval (p = .67), respectively, favoring the BCG arm. There were no significant differences in the sites and patterns of first recurrence comparing the two treatment arms. In conclusion, there is no suggestion of a significant therapeutic advantage from intrapleural BCG in conjunction with adjuvant chemotherapy for completely resected stages II and III NSCLC.

Adjuvants, Pharmaceutic↗
PubMed1991

Adjuvant chemotherapy for T1-2NOMO small cell lung cancer: single-agent or combination chemotherapy?

In an attempt to address the schedule of adjuvant chemotherapy in surgically resected T1 or T2NOMO small cell lung cancer, 12 patients were randomized to receive 6 courses of either single-agent (high-dose epirubicin) or combination (cyclophosphamide, epirubicin, and etoposide) chemotherapy, at 3-week intervals. No thoracic radiotherapy was administered while prophylactic cranial irradiation (30 Gy/10 fractions/2 weeks) was given. With a 25-month median followup, overall estimated 2-year and median survival were 83% and 26.5 months (range 16-34+), respectively. Ten patients are currently alive and disease free. No significant difference in 2-year survival was observed between the two adjuvant treatment modalities and median survival was 28 months (range 13-34+) for combination and 21 months (range 14-29+) for single-agent chemotherapy. Although at high doses, epirubicin resulted in a moderate clinical and histological cardiotoxicity and a remarkably reduced incidence of severe (WHO grades 3 and 4) treatment-related morbidity compared with the combination regimen. These preliminary results suggest that comparable survival and reduced toxicity might be expected with an active single-agent as adjuvant chemotherapy in T1 or T2NOMO small cell lung cancer.

Adult↗
PubMed1990

Intellectual, academic, and adaptive functioning of Tourette syndrome children with and without attention deficit disorder.

The intellectual, academic, and adaptive strengths and weaknesses of 30, medication-free children (M = 10.5 years) with Tourette syndrome (TS) were assessed with a battery of standardized psychoeducational measures and the Vineland Adaptive Behavior Scales. Results indicated significant relative weaknesses in mental and written arithmetic, and relative strengths in reading achievement and abstract, logical thinking. Socialization skills emerged as a significant weakness in adaptive functioning. Comparisons between TS children with attention deficit disorder with hyperactivity (ADD-H) (n = 19) weakness in both groups in all areas assessed, but significantly lower performance IQs in TS subjects with ADD-H. These findings are discussed in relation to future research with TS children.

Achievement↗
PubMed1989

The influence of adaptive seating devices on vocalization.

This study examined the relationship between receipt of adaptive seating devices (ASD) and sophistication of early vocalizations/verbalizations. Eight nonverbal children with cerebral palsy were studied prior to and following receipt of an ASD. Total speech tokens increased for 7 of the 8 subjects and diversity of speech sounds increased for 6 subjects. A concomitant improvement in feeding independence was observed for those subjects who demonstrated the greatest increase in speech sound diversity.

Cerebral Palsy↗