Patrick Bradshaw

The association of body mass index and prostate-specific antigen in a population-based study

Recent studies of men with prostate carcinoma suggest that obesity may be associated with more advanced‐stage disease and lower overall survival rates. One possible link between body mass index (BMI) and prostate carcinoma prognosis may be disease ascertainment. Prostate‐specific antigen (PSA) is widely used to screen for prostate carcinoma.

Relationships Between Welfare Status, Health Insurance Status, and Health and Medical Care Among Children With Asthma

OBJECTIVES This study evaluated the relationships between health insurance and welfare status and the health and medical care of children with asthma. METHODS Parents of children with asthma aged 2 to 12 years were interviewed at 6 urban clinical sites and 2 welfare offices. RESULTS Children whose families had applied for but were denied welfare had more asthma symptoms than did children whose families had had no contact with the welfare system. Poorer mental health in parents was associated with more asthma symptoms and higher rates of health care use in their children. Parents of uninsured and transiently insured children identified more barriers to health care than did parents whose children were insured. CONCLUSIONS Children whose families have applied for welfare and children who are uninsured are at high risk medically and may require additional services to improve health outcomes.

Incidence of Clostridium difficile-associated diarrhea before and after autologous peripheral blood stem cell transplantation for lymphoma and multiple myeloma.

Diarrhea is a major cause of morbidity and discomfort for patients undergoing high-dose chemotherapy and autologous peripheral blood stem cell transplantation (APBSCT). There are multiple causes of diarrhea in patients undergoing transplantation including antineoplastic chemotherapy, antimicrobials and infection, including Clostridium difficile as the most common pathogen involved. The purpose of this study was to determine the incidence of C. difficile-associated diarrhea (CDAD) 1 week before and 30 days after APBSCT, and to identify risk factors for the development of CDAD including diagnosis. Two hundred and forty-two patients underwent APBSCT for multiple myeloma and lymphoma between October 1996 and October 2001 in two teaching hospitals. Diarrhea was reported in 157 (64.9%) subjects. One hundred and thirty-five out of the 157 subjects were tested for the presence of C. difficile toxin A. These subjects constitute the study group. The incidence of CDAD was 15%. Two thirds of the patients who developed CDAD had multiple myeloma and one third had lymphoma; this difference did not attain statistical significance. The use of cephalosporins (P=0.03) and the use of intravenous vancomycin (P=0.02) were the only identified risk factors associated with the development of CDAD. Patients treated with paclitaxel as part of the mobilization regimen had a lower incidence of CDAD than patients who received hematopoietic growth factor only (P=0.01).

Early Prostate-Specific Antigen (PSA) Kinetics following Prostate Carcinoma Radiotherapy Prognostic Value of a Time-and-PSA Threshold Model

The goal of the current study was to analyze the prognostic value of early prostate‐specific antigen (PSA) kinetics, with PSA assessed as reaching or failing to reach discrete threshold values at fixed time points during follow‐up after external‐beam radiotherapy (EBRT) for prostate carcinoma.

The association of psychiatric disorders and HIV infection in the correctional setting

PURPOSE Psychiatric disorders, such as bipolar disorder, schizophrenia, and depression, have been associated with both HIV-associated risk behaviors and HIV infection. While the US prison population is reported to exhibit elevated rates of HIV/AIDS and most psychiatric disorders, scarce information currently exists on the association of these conditions in the prison setting. The present study examined the association of six major psychiatric disorders with HIV infection in one of the nations largest prison populations. METHODS The study population consisted of 336,668 Texas Department of Criminal Justice inmates who were incarcerated for any duration between January 1, 1999 and December 31, 2001. Information on medical conditions and sociodemographic factors was obtained from an institution-wide medical information system. RESULTS Inmates diagnosed with HIV infection exhibited elevated rates of major depression, dysthymia, bipolar disorder, schizophrenia, schizoaffective disorder, and non-schizophrenic psychotic disorder. These rates persisted in stratified analyses and in a multivariate analysis that statistically adjusted for gender, race, and age category. CONCLUSION The present cross-sectional studys finding of a positive association between HIV infection and psychiatric diagnoses among inmates holds both clinical and public health relevance. It will be important for future investigations to prospectively assess the underlying mechanisms of these associations in the correctional setting.

Time and PSA threshold model prognosticates long-term overall and disease-specific survival in prostate cancer patients as early as 3 months after external beam radiation therapy

The specific aim of this analysis was to evaluate the capability of a time and prostate-specific antigen (PSA) threshold model to prognosticate overall survival (OS) and disease-specific survival (DSS) based on early PSA kinetics after radiotherapy for prostate cancer by retrospective review of outcomes in 918 patients. Crossing below analyzed PSA thresholds at specific defined time points reduced disease-specific death hazard ratios to relative to the cohort above threshold. The time and PSA threshold model demonstrates the ability to prognosticate OS and DSS as early as 3 months post-radiotherapy for prostate cancer.

The Association of Infectious Disease Diagnoses With Incarceration-related Factors Among Prison Inmates

Prison inmates present with higher rates of infectious disease than the general population. Decisions on how to manage and treat infectious diseases in the prison setting are often contingent upon factors such as the length of the inmates prison sentence, the type of facility in which the inmate is housed, and factors associated with the inmates compliance with prescribed treatment regimens. Little information is available regarding how infectious disease rates vary according to these factors. The study population consisted of 336,668 Texas Department of Criminal Justice inmates who were incarcerated for any duration between January 1, 1999, and December 31, 2001. Information on medical conditions, incarceration factors, and sociodemographic factors was obtained from an institutionwide medical information system. The findings indicate that the prevalence of five major infectious diseases varied substantially according to type of criminal offense, prison facility type, and comorbid psychiatric disorder. Inmates who were incarcerated for violent offenses, who were incarcerated in a prison facility, and who exhibited at least one major psychiatric disorder all exhibited elevated rates of disease. It will be important for future studies to assess the driving forces behind these disease patterns. This information may ultimately help correctional administrators and clinicians more efficiently deliver clinical care to inmates with infectious diseases.