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Biomedical subjects

A Schork

Publications and source records attributed to A Schork.

At least 37 records · Page 2Linked to original sources
PubMed1994

Glutathione and morbidity in a community-based sample of elderly.

This study examined the association of blood glutathione level, a potential marker of physiological/functional aging, with a number of biomedical/psychological traits in a subgroup (N = 33) of a representative sample of community-based elderly. Higher glutathione levels were associated with fewer number of illnesses (p < 0.05), higher levels of self-rated health (p < 0.01), lower cholesterol (p < 0.05), lower body mass index, and lower blood pressures. Subjects with diagnoses of arthritis, diabetes, or heart disease (as assessed by physicians) had at least marginally significant lower glutathione levels than those who were disease free. Glutathione, together with age and a measure of suppressed anger, accounted for 39% of the variance of an index of morbidity. Glutathione, by itself, accounted for 24% of the variance. To our knowledge, this is the first evidence of an association of higher glutathione levels with higher levels of physical health in a sample of community-based elderly. Further studies in large samples are needed to investigate glutathione as a potential overall health risk factor for morbidity among the elderly.

Aged↗
PubMed1993

Psychosocial factors, alcohol use, and hangover signs among social drinkers: a reappraisal.

To reappraise a prior study of hangover signs and psychosocial factors among a sample of current drinkers, we excluded a subgroup termed Sobers, who report "never" being "tipsy, high or drunk." The non-sober current drinkers then formed the sample for this report (N = 1104). About 23% of this group reported no hangover signs regardless of their intake level or gender, and the rest showed no sex differences for any of 8 hangover signs reported. Using multiple regression, including ethanol, age and weight, it was found that psychosocial variables contributed independently in predicting to hangover for both men and women in this order: (1) guilt about drinking; (2) neuroticism; (3) angry or (4) depressed when high/drunk and (5) negative life events. For men only, ethanol intake was also significant; for women only, being younger and reporting first being high/drunk at a relatively earlier age were also predictors of the Hangover Sign Index (HSI). These multiple predictors accounted for 5-10 times more of the hangover variance than alcohol use alone: for men, R = 0.43, R2 = 19%; and for women, R = 0.46, R2 = 21%. The findings suggest that hangover signs are a function of age, sex, ethanol level and psychosocial factors.

Age Factors↗
PubMed1992

Familial transmission of alcohol use: V. Drinking patterns among spouses, Tecumseh, Michigan.

This study examined concordance and discordance of self-reported alcohol consumption in 184 spouse pairs drawn from a representative sample of the Tecumseh, MI community. A significant association (tau B = .57, p less than .001) between self-reported alcohol consumption of husbands and that of wives was observed. Drinking daily and high maximum drinking were also significantly correlated between spouses, as were church attendance, smoking, impulsivity, and sociability. A significant association between the drinking of wives and that of their mothers-in-law was noted. The relationship between husbands' drinking and that of their fathers-in-law was marginally significant. However, three-quarters of daughters of heavy-drinking fathers (21 of 28) married abstemious men (never drank or drank lightly), while only 7% married heavy-drinking husbands. These findings lend support to the idea that a network of familial influences--both primary and secondary assortative mating--contributes to regulating adult drinking behavior.

Adult↗
PubMed1992

Safety and efficacy of metoprolol in the treatment of hypertension in the elderly.

OBJECTIVE: To assess the short-term efficacy and safety of metoprolol in the treatment of hypertension in a large population of older patients. DESIGN: Prospective, open-label surveillance study. SETTING: Multicenter outpatient offices. PARTICIPANTS: 21,692 patients with mild-to-moderate hypertension between the ages of 50 to 75 years. Patients were excluded if they had a contraindication to beta-blocker therapy. INTERVENTION: Patients were treated with 100 mg of metoprolol once daily for 4 week. If the blood pressure was controlled, therapy was continued for an additional 4 weeks. If adequate blood pressure was not achieved after 4 weeks, 25 mg of hydrochlorothiazide was added. At the end of 8 weeks, final therapy decisions were recorded. If the blood pressure was controlled, therapy was continued for an additional 4 weeks. MAIN OUTCOME MEASURES: Blood pressure, heart rate and side-effects. RESULTS: After 4 weeks of therapy, mean systolic and diastolic blood pressures decreased significantly from 162/95 to 148/87 mm Hg (P less than 0.001). Fifty-eight percent of the patients had satisfactory blood pressure control. At the end of 8 weeks, mean systolic and diastolic blood pressure decreased to 143/84 mm Hg. Blood pressure response was similar in all age groups. At the termination of the study, 50% of the patients were continued on monotherapy, and 27% were continued on combined therapy. Overall, there was less than a 5% incidence of medical problems, and excellent or good tolerability was noted for 94% of the patients. CONCLUSIONS: Metoprolol administered as monotherapy or in combination with hydrochlorothiazide was effective in normalizing blood pressure in a majority of elderly hypertensive patients. Both drug regimens were well tolerated.

Age Factors↗
PubMed1992

A randomized comparison of external and internal cardioversion of chronic atrial fibrillation.

BACKGROUND: Delivery of shocks within the right atrium has been reported to be more effective than conventional external shocks in converting atrial fibrillation (AF), but these two cardioversion techniques have never been compared prospectively. The purpose of this study was to compare the efficacies of external and internal cardioversion in patients with chronic AF unresponsive to prior attempts at electrical and/or pharmacological cardioversion. Low-dose amiodarone was used in all patients after cardioversion to suppress recurrences of AF. METHODS AND RESULTS: One hundred twelve patients with AF of at least 1 month in duration were randomly assigned to undergo external cardioversion with 300-360-J shocks or internal cardioversion with 200-300-J shocks delivered through a standard electrode catheter within the right atrium. The patients were treated with amiodarone (200 mg/day 5-7 days/week) for 1 month before electrical cardioversion and afterward if the cardioversion was successful. The patients were evaluated at regular intervals during 1 year of follow-up. The efficacy of internal cardioversion was significantly greater than that of external cardioversion (91% versus 67%, p = 0.002). The only variable that was associated with the outcome of cardioversion was body weight. Among patients in whom sinus rhythm was restored, AF recurred as often after internal and external cardioversion; at 1 year of follow-up, 37% of patients in whom external or internal cardioversion had been effective were still in sinus rhythm. Patients who had undergone an attempt at electrical cardioversion before entry into this study were less likely to remain in sinus rhythm after cardioversion. The only complications of cardioversion were one instance of cerebral thromboembolism after external cardioversion and one instance of transient pulmonary edema after internal cardioversion. Therapy with amiodarone was discontinued because of an adverse drug effect in only three patients. CONCLUSIONS: Internal cardioversion is more effective than external cardioversion in restoring sinus rhythm and is as safe as external cardioversion in patients with chronic AF. The recurrence rate of AF is the same after both types of cardioversion. If conventional electrical cardioversion is ineffective, internal cardioversion should be attempted. The combination of low-dose amiodarone and external or internal cardioversion may result in maintaining sinus rhythm long-term in patients with refractory AF.

Amiodarone↗
PubMed1992

Preoperative risk factor assessment in liver transplantation.

BACKGROUND: Despite the increasing success of liver transplantation, there is lack of objective data defining appropriate candidate suitability. This study was undertaken to determine preoperative risk factors that independently or in combination affected outcome after orthotopic liver transplantation. METHODS: We reviewed data on 229 consecutive adult liver transplant recipients. Thirty-one preoperative risk factors recorded at the time of listing and immediately before transplantation were analyzed. Outcome variables included hospital mortality rates, bacterial or fungal sepsis, and the need for renal support. RESULTS: The overall hospital mortality rate was 15.7%. Patients who were in the intensive care unit immediately before transplantation had the highest hospital mortality rate (32.6%; p = 0.006), incidence of bacterial sepsis (51%; p = 0.001), fungal infection rate (27.6%; p = 0.001), and need for renal support (38.7%; p = 0.001). Preoperative renal dysfunction was significantly associated with sepsis and was reflected in higher hospital mortality rates (29.5%; p = 0.011). Child-Pugh class C was associated with higher mortality rates (23.9%; p = 0.017), an increased incidence of bacterial (37.2%; p = 0.020) and fungal infection (20.3%; p = 0.049), and a 30.4% requirement for postoperative renal support (p = 0.004). CONCLUSIONS: These results emphasize the need for earlier referral and transplantation in patients with advanced liver disease. Further studies are needed to refine identified risk profiles and devise strategies to decrease morbidity and mortality rates.

Adult↗
PubMed1991

Comparison of rubidium-82 positron emission tomography and thallium-201 SPECT imaging for detection of coronary artery disease.

The diagnostic performance of rubidium-82 (Rb-82) positron emission tomography (PET) and thallium-201 (Tl-201) single-photon emission-computed tomography (SPECT) for detecting coronary artery disease was investigated in 81 patients (52 men, 29 women). PET studies using 60 mCi of Rb-82 were performed at baseline and after intravenous infusion of 0.56 mg/kg dipyridamole in conjunction with handgrip stress. Tl-201 SPECT was performed after dipyridamole-handgrip stress and, in a subset of patients, after treadmill exercise. Sensitivity, specificity and overall diagnostic accuracy were assessed using both visually and quantitatively interpreted coronary angiograms. The overall sensitivity, specificity and accuracy of PET for detection of coronary artery disease (greater than 50% diameter stenosis) were 84, 88 and 85%, respectively. In comparison, the performance of SPECT revealed a sensitivity of 84%, specificity of 53% (p less than 0.05 vs PET) and accuracy of 79%. Similar results were obtained using either visual or quantitative angiographic criteria for severity of coronary artery disease. In 43 patients without prior myocardial infarction, the sensitivity for detection of disease was 71 and 73%, respectively, similar for both PET and SPECT. There was no significant difference in diagnostic performance between imaging modalities when 2 different modes of stress (exercise treadmill vs intravenous dipyridamole plus handgrip) were used with SPECT imaging. Thus, Rb-82 PET provides improved specificity compared with Tl-201 SPECT for identifying coronary artery disease, most likely due to the higher photon energy of Rb-82 and attenuation correction provided by PET. However, post-test referral cannot be entirely excluded as a potential explanation for the lower specificity of Tl-201 SPECT.

Adult↗
PubMed1991

Familial transmission of alcohol use: IV. A seventeen-year follow-up on the relationships between parent and adult offspring alcohol use; Tecumseh, Michigan.

The sample for this study comprised 190 three member sets of father, mother, and adult son or daughter who were first interviewed in 1960 as part of Cardiovascular Examination I of the Tecumseh Community Health Study. At that time, alcohol data were collected from self-reports for both parents and offspring. In 1977 alcohol data were again collected for the adult offspring only, from self-reports. In 1960 offspring's drinking was significantly related to both fathers' and mothers' drinking and remained so in 1977 despite shifts over time in the proportions of offspring across five alcohol use categories. The majority of offspring did not fall into their parents' category, but the mode by and large reflected the parent category. The majority of offspring of non-drinkers did drink, but at low and not high volume; the majority of offspring of high volume drinkers drank at lower levels than their parents, and were not likely to be life-long abstainers, although they may have become past drinkers. Two non-drinking parents reinforced non-drinking in their adult offspring and two drinking parents reinforced the early onset and persistence of high volume drinking. Among offspring who changed their drinking level between 1960 and 1977, those who had drunk less than their parents were the most likely to have increased their drinking, and those who had drunk more than their parents were the most likely to have decreased their drinking. Patterns observed in this study may be viewed as intrafamilial sources of drinking stability transmitted across generations in a single community.

Adolescent↗
PubMed1990

Familial transmission of alcohol use, III. Impact of imitation/non-imitation of parent alcohol use (1960) on the sensible/problem drinking of their offspring (1977).

Imitation/non-imitation by adult offspring of alcohol-related parent behavior was examined in the context of the 'fall-off effect' and of sensible/problem alcohol use, two processes which tend to constrain drinking. Evidence indicates there is more imitation by adult offspring of abstemious parents (both abstainer and low volume) than of high volume parents. Adult offspring drink significantly less, on the average, than their high volume parents, a phenomenon here termed 'fall-off effect' for both men and women with respect to either their fathers or mothers. This fall-off among social drinkers appears when the mother approaches or the father consumes at or more than a typical daily drinking level (greater than or equal to 1 drink per day). More sensible drinking occurs among adult offspring when (1) the parent has no drinking problem-signs than when the parent has drinking problems (this pattern appears at all levels of offspring consumption), and (2) when parents drink at high volume and have no problems for those offspring who do not imitate parent volume. Drinking 'sensibly' appears to be associated directly with the level of parent alcohol use and offsprings' own drinking levels (considered as imitation or non-imitation of parents), and indirectly with offspring recall of problematic intake by parents. Drinking sensibly is a medical, education and public health issue.

Adult↗
PubMed1990

Familial transmission of alcohol use: II. Imitation of and aversion to parent drinking (1960) by adult offspring (1977)--Tecumseh, Michigan.

The "fall-off" effect, when offspring respond to parental high-volume levels by moderating their own drinking, appears highly predictable across generations and is mediated both by subsequent parent drinking level and offspring's perception of problematic intake by their parents. This fall off by adult offspring appears to follow community norms; it occurs, on the average, at the level of daily drinking by fathers, and when the mother approaches daily-drinking levels. An aversion effect holds more to cross-sex parents with problems; thus, both sons and daughters show a nonimitation and fall off to their cross-sex parents who are high-volume problem drinkers. Conversely, however, daughters often imitate a high-drinking father with no problems. For high-drinking mothers, without problems or with problems (numbers are small), daughters' drinking appears "polarized": most (60%) are abstemious, but a higher number than expected (about 35%) show high volume thus imitating the mother's volume, compared to about 17% of the total sample of daughters who were high-volume drinkers. Maximal offspring imitation is strongest for abstemious parents, especially for abstaining parents, and stronger for fathers abstaining than for mothers.

Adult↗
PubMed1989

Quantification of periodontal attachment at single-rooted teeth.

The measurement process of attachment loss has been criticized in recent years. Problems with clinical interpretation, precision of the measurement, and statistical manipulation of the obtained data, are some of the problems associated with the present methodology. The purpose of the present study was to propose an alternative measurement process which addresses some of the existing problems by estimating the lost attachment surface area (LAS) and the remaining attachment surface area (RAS) from a combination of clinical measurements. The results show that a linear combination of several sources of clinical information can be used to predict RAS and LAS. A diagnostic model for LAS (R2 = 81.5%) predicts the square root of LAS with information obtained from bucco-lingual attachment level measurements, the radiographic lost attachment area, the gingivitis index and the radiographic tooth length. This model increases the precision of the estimate of LAS by a factor of 1.86 when compared to the estimate of LAS using only attachment level measurements. A diagnostic model for RAS (R2 = 75.5%) predicts the square root of RAS with the information obtained from the remaining radiographic attachment area, the gingivitis index and the mobility index. Both linear inference models are constructed with measurements of anatomical landmarks to avoid the discrepancy between anatomical and clinical measurements in the produced estimates. It is concluded that modeling of periodontal data provides a simple, inexpensive, and precise diagnostic tool for predicting the lost and the remaining periodontal attachment of single-rooted teeth. Measurement processes of this type could provide a convincing basis for the evaluation of clinical decisions and research questions.

Cuspid↗
PubMed1989

Acute neurobehavioural effects of toluene.

An acute inhalation chamber study of 42 college students was performed to investigate the relation between exposure to 0, 75, and 150 ppm of toluene and changes in central nervous system function and symptoms. Paid subjects were exposed for seven hours over three days. Verbal and visual short term memory (Sternberg, digit span, Benton, pattern memory); perception (pattern recognition); psychomotor skill (simple reaction time, continuous performance, digit symbol, hand-eye coordination, finger tapping, and critical tracking); manual dexterity (one hole); mood (profile of mood scales (POMS]; fatigue (fatigue checklist); and verbal ability were evaluated at 0800, 1200, and 1600 hours. Voluntary symptoms and observations of sleep were collected daily. An analysis of variance and test for trend was performed on the difference and score for each concentration reflecting an eight hour workday where each subject was their own control. A 3 x 3 Latin square study design evaluated toluene effects simultaneously, controlling for learning across the three days and the solvent order. Intersubject variation in solvent uptake was monitored in breath and urine. A 5-10% decrement in performance was considered significant if it was consistent with a linear trend at p less than 0.05. Adverse performance at 150 ppm toluene was found at 6.0% for digit span, 12.1% for pattern recognition (latency), 5.0% for pattern memory (number correct), 6.5% for one hole, and 3.0% for critical tracking. The number of headaches and eye irritation also increased in a dose response manner. The greatest effect was found for an increasing number of observations of sleep. Overall, no clear pattern of neurobehavioural effects was found consistent with the type 1 central nervous system as classified by the World Health Organisation. Subtle acute effects, however, were found just below and above the ACGIH TLV of 100 ppm toluene, supporting the position that the guideline be lowered since the biological threshold of behavioural effects may be comparable with the TLV.

Adolescent↗
PubMed1989

Familial transmission of alcohol use: I. Parent and adult offspring alcohol use over 17 years--Tecumseh, Michigan.

A sample of 420 three-member sets of father, mother and adult offspring was drawn from a list of respondents from two rounds of a longitudinal health study in Tecumseh, Michigan. Parents' self-reported drinking practices in 1960 were compared with those of their adult offspring 17 years later in 1977. A positive association between the drinking level of parents and their adult offspring was evident; however, this association varied according to: (1) the drinking level of the parent, (2) the gender of the offspring and (3) the gender of the parent. There is a tendency for offspring to drink abstemiously (i.e., abstain or drink low volume) when their parents were life-long abstainers. High-volume drinking by adult offspring was associated with the parents' same drinking pattern, especially among daughters. Throughout the spectrum of drinking, sons' drinking was more similar to fathers' drinking level than to mothers'. The relationship between one parent's drinking and his/her offspring's was dependent upon the drinking status of the other parent. These data support the hypothesis that parents' drinking patterns may influence the drinking patterns of the offspring as adults.

Adult↗
PubMed1988

The Safety After Fifty Evaluation trial: evaluation of the safety and efficacy of antihypertensive therapy with metoprolol in patients 50 to 75 years of age: study design.

Hypertension increases in prevalence with advancing age and is a major risk factor for the development of cardiovascular disease in elderly patients. However, the presence of coexisting illness, altered drug metabolism, enhanced susceptibility to drug side effects, and physiologic changes such as reduced plasma volume and lower plasma renin levels make treatment of hypertension in elderly patients more difficult. Nonetheless, several studies have now demonstrated the beneficial effects of antihypertensive drug therapy in older patients. The Safety After Fifty Evaluation trial was designed to determine the short-term efficacy and tolerability of once-daily therapy with the cardioselective beta-blocker metoprolol alone or in combination with hydrochlorothiazide in the treatment of mild hypertension in patients 50 to 75 years of age. A total of 24,816 patients were enrolled in the trial by 2821 practicing physicians from across the United States. This article describes the details of the Safety After Fifty Evaluation study design. Results of the trial will be reported separately.

Aged↗
PubMed1988

Sympathetic hyperactivity in early stages of hypertension: the Ann Arbor data set.

Patients with borderline hypertension frequently have a hyperkinetic circulation that is neurogenic and can be normalized with autonomic blockade of the heart. The abnormality is of central nervous system origin and due to increased sympathetic stimulation and decreased vagal inhibition of the heart. A subset of patients characterized by high plasma renin and norepinephrine values clearly has a neurogenic hypertension since their blood pressure becomes normal after cardiac blockade and vascular alpha-adrenergic blockade. Since many patients with borderline hypertension have a high cardiac output, and the majority of patients with more advanced hypertension have increased vascular resistance, two questions arise. Is the "hyperkinetic state" a special condition unrelated to established hypertension or is there, in the course of hypertension, a transition from "high output" to "high resistance" state? The literature strongly suggests that patients with hyperkinetic borderline hypertension later proceed to develop the established high resistance form of hypertension. The most likely mechanism for this transition is a change in cardiac and vascular responsiveness due to prolonged excess sympathetic stimulation combined with structural pressure-induced changes in these organs. This analysis of the events in the course of hypertension is of necessity based on an arbitrary definition of the hyperkinetic state usually set at a cardiac index at least two standard deviations above the normal mean. A bivariate analysis of our data (268 normotensive and 186 patients with borderline hypertension) suggests that there indeed are two different populations in this data set. Based on this commingling analysis, the occurrence of a hyperkinetic state was five-fold as frequent in patients with borderline hypertension than in the normotensive population.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1987

Fluoride supplements. Changes in physicians' attitudes and practices following an intensive, multifaceted educational program.

Results of a 1981 survey of randomly selected primary care physicians with pediatric patients were compared with the results of a similar survey conducted in 1978. In general, the 1981 survey respondents were more knowledgeable on the subject of fluoride and dental caries, had more positive attitudes about the effectiveness of fluoride supplementation, were more likely to prescribe fluoride supplements, and more closely followed the current guidelines for appropriate use of fluoride supplements. An intensive, multifaceted educational program on fluoride and childhood dental caries sponsored by the Wayne State University School of Medicine, Detroit, which started shortly after the first survey, may have contributed to these changes.

Attitude of Health Personnel↗
PubMed1987

Insulin and blood pressure during weight loss in obese adolescents.

The role of insulin in the regulation of blood pressure was evaluated in 50 obese adolescents before and after a 20-week weight loss program. When compared with 10 nonobese adolescents, the obese subjects had significantly higher systolic, diastolic, and mean arterial pressures (p = 0.005), an elevated 24-hour urinary sodium excretion (p = 0.002), an elevated fasting insulin concentration (p = 0.001), and an abnormal insulin response to an oral glucose tolerance test (sum of the insulins at 0, 1, and 2 hours post-oral glucose load; p = 0.001). We also observed a significant correlation between systolic and diastolic blood pressure (age and sex normalized) and body weight (r = 0.57, p less than 0.01 and r = 0.7, p less than 0.01), fasting insulin (r = 0.49, p less than 0.01 and r = 0.54, p less than 0.01), and sum of insulins (r = 0.42, p less than 0.01 and r = 0.46, p less than 0.01). To study the effect of weight loss on the relationship between blood pressure and insulin, the obese subjects were randomly assigned to three groups: 15 to a diet and behavior change group, 18 to a diet, behavior change, and exercise group, and 17 to an obese control group. Compared with the obese control group, the two weight loss groups each experienced a significant decrease in insulin (p less than 0.01), sum of the insulins (p less than 0.01), and blood pressure (p less than 0.01). The decrease in blood pressure during the weight loss program significantly correlated with the change in both insulin and body weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗