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Biomedical subjects

A S Robbins

Publications and source records attributed to A S Robbins.

At least 37 records · Page 2Linked to original sources
PubMed1993

Passive smoking and chronic respiratory disease symptoms in non-smoking adults.

A prospective study was conducted to investigate the possible effects of environmental tobacco smoke (ETS) on the development of definite symptoms of airway obstructive disease (AOD) in a non-smoking adult population. In all 3914 subjects completed a standardized respiratory symptoms questionnaire in 1977 and 1987 and a computerized algorithm was used to identify new cases of definite symptoms of AOD during the follow-up period. In multivariate logistic regression models which adjusted for age, gender, income, educational level, years smoked in the past, and concentrations of ambient air pollutants, ETS exposure during childhood only was associated with a relative risk (RR) of 1.09 (95% confidence interval [CI]: 0.69-1.79), during adulthood only with an RR of 1.28 (95% CI: 0.90-1.79), and during both childhood and adult life with an RR of 1.72 (95% CI: 1.31-2.23). Results were not significantly changed when only lifetime never-smokers were used in analyses, and no interaction between ETS exposure and concentrations of ambient air pollutants was observed.

Air Pollution↗
PubMed1993

Controversies in measles immunization recommendations.

Controversy in medicine is inevitable, but it becomes problematic when the issue is a serious public health problem requiring a clear plan of action. In recent years measles has made a major resurgence in this country, with provisional figures showing 89 measles-related deaths in 1990. The Immunization Practices Advisory Committee of the US Public Health Service, the Committee on Infectious Diseases of the American Academy of Pediatrics, and the US Preventive Services Task Force have all issued recommendations for measles immunization. Most of these recommendations are in agreement, but they conflict on the age at which vaccination should be given and the number of doses. To assist physicians in disentangling this complex web, I review the history of measles immunization in the United States and give the rationale for particular positions wherein the groups disagree. I describe protocols for routine vaccinations, endemic areas, outbreak control, colleges and universities, and international travel.

Age Factors↗
PubMed1992

Workaholism: definition, measurement, and preliminary results.

Questionnaires were developed to assess the concept of workaholism, defined in terms of high scores on measures of work involvement and driveness and low scores on a measure of enjoyment of work, and to contrast this profile with work enthusiasm, defined as high work involvement and enjoyment and low driveness. Additional scales were devised to test several predictions about the correlates of workaholism. A test battery including these scales was given in a mail survey to a national sample of male (n = 134) and female (n = 157) social workers with academic positions. The psychometric properties of the scales are described. Cluster analyses for each sex revealed groups who corresponded to the workaholic and work enthusiast profiles as well as several other profiles. As predicted, workaholics were higher than work enthusiasts (among other groups) on measures of perfectionism, nondelegation of responsibility, and job stress. They were also higher on a measure of health complaints. Investigations are being initiated to determine the association of workaholism and other score profiles with objectively diagnosed cardiac disorders and with measures of occupational performance.

Journal Article↗
PubMed1991

Psychological determinants of health and performance: the tangled web of desirable and undesirable characteristics.

Correlations were determined for male (n = 225) and female (n = 242) college students between sets of undesirable personality traits (anxiety, stress reactivity, anger, and alienation) and desirable personality traits (instrumentality, achievement strivings, and optimism measured by the Scheier-Carver [1987] Life Orientation Test), and a series of outcome variables related to health (self-reported health complaints and health maintenance behaviors and beliefs) and academic performance (academic expectations and actual grade point average). Significant correlations were found between many of the personality variables and the outcome variables. However, partial correlations revealed different relationships for the various criteria. With other variables held constant, health complaints were related to several undesirable characteristics, whereas health maintenance behaviors and beliefs were related to several desirable attributes. Only achievement strivings made an independent contribution in both sexes to the 2 measures of academic performance. The theoretical and methodological wisdom of using measures of multiple personality constructs and outcome variables is discussed.

Achievement↗
PubMed1991

Status report on ambulatory care and education in the VA Western Region and western medical schools.

Since the initial 1988 Ambulatory Care and Education (ACE) conference, reported in the October 1989 supplement to Academic Medicine, the Western Region Veterans Health Administration and its 11 affiliated western medical schools have established several programs and related activities that implement strategic ACE recommendations. This report gives an update on the ACE Advisory Group; the Pilot Ambulatory Care and Education (PACE) Center at the VA Medical Center, Sepulveda, California; other innovative ambulatory care and education projects; the second ACE Development Conference; and future activities in the expanded Western Region of the Department of Veterans Affairs.

Ambulatory Care↗
PubMed1990

The value of assessing falls in an elderly population. A randomized clinical trial.

OBJECTIVE: To measure the effects of a specialized postfall assessment intended to detect causes and underlying risk factors for falls, and to recommend preventive and therapeutic interventions. DESIGN: Randomized, controlled trial. SETTING: A long-term residential care facility for elderly persons. SUBJECTS: Within 7 days of a fall, 160 ambulatory subjects (mean age, 87 years) were randomly assigned to receive either a comprehensive postfall assessment (intervention group, n = 79) or usual care (control group, n = 81). INTERVENTION: The postfall assessment included a detailed physical examination and environmental assessment by a nurse practitioner; laboratory tests; electrocardiogram; and 24-hour Holter monitoring. Probable cause or causes for the fall, identified risk factors, and therapeutic recommendations were given to the patient's primary physician. MEASUREMENTS AND MAIN RESULTS: Through use of the assessment, many remediable problems (for example, weakness, environmental hazards, orthostatic hypotension, drug side effects, gait dysfunction) were detected. At the end of the 2-year follow-up period, the intervention group had 26% fewer hospitalizations (P less than 0.05) and a 52% reduction in hospital days (P less than 0.01) compared with controls. Patients in the intervention group had 9% fewer falls and 17% fewer deaths than controls by 2 years, but these trends were not statistically significant. CONCLUSIONS: Our study suggests that falls are a marker of underlying disorders easily identifiable by a careful postfall assessment, which in turn can reduce disability and costs.

Accidental Falls↗
PubMed1989

The value of Holter monitoring in evaluating the elderly patient who falls.

Ambulatory cardiac (Holter) monitoring is often recommended in the routine evaluation of patients who fall; however, the prevalence of arrhythmias in old people is high, and the usefulness of such monitoring is unproven. As part of a large study of institutionalized elderly fallers, we compared Holter findings of fallers (N = 51) with a group of nonfallers (N = 27) having similar medical and demographic characteristics. Prevalence of ventricular arrhythmias was 82% in each group, and all patients had supraventricular arrhythmias. The mean number of ventricular and supraventricular couplets and runs did not differ between groups. There was no difference in severity of arrhythmias between fallers and nonfallers; in fact, fallers had slightly fewer Lown 4B arrhythmias than nonfallers (10% vs 18%, NS). Prevalence of heart disease was 78% in both groups and was associated with increased ventricular ectopy in the form of runs and couplets (P less than .05). No symptoms were reported during the Holter monitoring. We conclude that Holter monitoring should not be a routine part of the work-up of the patient who falls.

Accident Prevention↗
PubMed1989

Predictors of falls among elderly people. Results of two population-based studies.

A study was performed to identify and rank risk factors for falling among populations of institutionalized (fallers, N = 79, nonfallers, N = 70) and noninstitutionalized (fallers, N = 34, nonfallers, N = 34) elderly persons. Fallers were matched by age, sex, and living location to nonfaller control subjects. A nurse practitioner performed a comprehensive physical assessment in all subjects using a standardized protocol and physician consultation. Fallers in both populations were significantly more physically and functionally impaired than control subjects. Logistic regression identified hip weakness, poor balance, and number of prescribed medications as factors most strongly associated with falling among institutionalized subjects. A fall prediction model was developed from these findings yielding 76% overall predictive accuracy (89% sensitivity, 60% specificity). Using the model, the predicted 1-year risk of falling ranged from 12% for persons with none of the three risk factors to 100% for persons with all three risk factors. Findings among noninstitutionalized subjects were similar. These data support the concept of performing focused fall risk assessments to identify elderly patients at high risk for falling.

Accidental Falls↗
PubMed1989

A study of ambulatory care education in medical schools and U.S. Department of Veterans Affairs health care facilities.

A study of ambulatory care and education was conducted by sending questionnaires to U.S. Department of Veterans Affairs hospitals (75) and medical schools (65) prior to the Conference on Ambulatory Care and Education. Responses from 48% of medical schools indicated that there was little required clinical time in ambulatory care (15-20%), as well as faculty resistance and lack of medical school commitment to ambulatory care education. VA respondents (35% sample) also documented relatively little training in ambulatory care at the undergraduate and graduate levels. Numerous barriers to ambulatory care education are mentioned and strategies for overcoming the problems found are discussed.

Ambulatory Care↗
PubMed1989

Hypothermia and heat stroke: protecting the elderly patient.

Temperature regulation disorders in the elderly are both common and life-threatening, yet often go unrecognized. Diagnosis and appropriate management depend largely on a clinician's high index of suspicion. Reviewed are the reasons why the elderly are more susceptible to such disorders, important diagnostic clues, restorative treatments and, most important, practical measures to prevent elderly patients from being exposed to the extremes of heat and cold.

Aged↗
PubMed1988

Effect of age and posture on human lymphocyte adenylate cyclase activity.

1. A number of age-related changes have been reported in the catecholamine-adrenoceptor-adenylate cyclase system. Most of the data available on these alterations come from resting subjects; the response to acute stress may provide additional insights into the age effect on these responses. 2. We measured supine and 10 min upright plasma noradrenaline and lymphocyte adenylate cyclase activity in ten healthy elderly subjects (age 66-80 years) and seven healthy young subjects (age 27-34 years). 3. Isoprenaline stimulation of lymphocyte adenylate cyclase activity was not significantly different between supine and upright positions or between elderly and young subjects. There was a marked increase in forskolin-stimulated adenylate cyclase activity in the upright posture in both elderly and young subjects. The increment over supine levels was 70% in the elderly (P less than 0.025) and 73% in the young (P less than 0.05). This enhanced forskolin activity was not seen in two young subjects who became syncopal. 4. These data suggest that enhanced forskolin-stimulated adenylate cyclase activity occurs after 10 min of upright posture in both elderly and young subjects, and may be relevant to immediate blood pressure regulation. We were unable to demonstrate any age-related differences in these acute adrenergic responses.

Adenylyl Cyclases↗
PubMed1986

Comprehensive health screening of well elderly adults: an analysis of a community program.

We examined the yield of a health screening program in a free-standing community senior citizen center and identified factors associated with patient compliance with referral recommendations. Of elderly individuals screened, 94% had some positive finding requiring advice or intervention, and 54% were referred to a physician for further evaluation. The most prevalent findings were skin disorders (52%), genitourinary disorders (44%), and eye-ear-nose-throat disorders (33%). Of individuals referred to a physician, 70% complied with the referral. Of those who complied, 38% reported receiving treatment for the referred condition--15% of the entire group of clients screened. Factors positively associated with compliance with physician referral included the specific type of referred problem, the perceived seriousness of the problem, and absence of financial barriers to medical care. Though controlled trial data are lacking, this and other published studies indicate that many remediable problems can be identified among apparently healthy elderly individuals in community geriatric screening programs.

Aged↗
PubMed1984

Postural hypotension in the elderly.

Postural hypotension is a common and important clinical disorder in the elderly population. The pathogenesis is multifactorial but is probably often due to changes in the autonomic nervous system, as well as to age-related changes in the cardiovascular and endocrine systems. In addition, the presence of multiple diseases and medications are common contributing factors. Standardized measurement of postural blood pressure and recording of heart rate and assessment of associated symptoms are essential for the clinical diagnosis. Evaluation and management depend on an initial thorough clinical review of problems. Usually elimination of offending medications and treatment of contributing medical disorders are adequate. Occasionally, use of volume expanders and newer experimental agents is indicated. Postural hypotension can be seen as a prototypical clinical disorder of the elderly. It reflects impaired homeostasis; its etiology is multifactorial and due to the effects of both age and disease; it is clinically protean; and it can result in falls, injury, and progressive decline if not recognized and treated early.

Aged↗