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Biomedical subjects

A Stein

Publications and source records attributed to A Stein.

At least 235 records · Page 13Linked to original sources
PubMed1991

The relationship between post-natal depression and mother-child interaction.

The study was based on an index group of 49 mothers who had had depressive disorders in the post-natal year, and 49 control mothers who had been free from any psychiatric disorder since delivery. Nineteen months after childbirth, the interaction between mother and child was assessed by blind assessors using defined observational methods. Compared with controls, index mother-child pairs showed a reduced quality of interaction (e.g. mothers showed less facilitation of their children, children showed less affective sharing and less initial sociability with a stranger). Similar but reduced effects were seen in a subgroup of index mothers and children where the mother had recovered from depression by 19 months. Social and marital difficulties were associated with reduced quality of mother-child interaction.

Adolescent↗
PubMed1991

Assessment of elderly people in general practice. 3. Confiding relationships.

Little is known about the importance of confiding relationships in elderly people. Associations between lack of confiding relationships and depression, lifestyle characteristics, medication use, and contacts with doctors were studied by interviewing a random sample of 235 elderly people aged 75 years and over registered with nine general practices in inner London. It was found that men were not significantly more likely than women to report lack of confiding relationships. Married people of both sexes were more likely to have confiding relationships than those who were single, separated, divorced or widowed. Depression was not associated with lack of a confiding relationship, but those lacking such relationships were significantly more likely to smoke, and were prescribed significantly more medicines than those with confiding relationships. Individuals without a confiding relationship were significantly less likely to admit to any alcohol consumption in the previous three months, suggesting that alcohol consumption in this age group is largely a social phenomenon. Confiding relationships do not appear to confer strong protection against depression and a question on confiding relationships should not therefore be routinely incorporated into surveillance programmes for elderly people in the community.

Aged↗
PubMed1990

Human T-lymphotropic virus (HTLV I-II) infection among patients in an inner-city emergency department.

OBJECTIVE: To determine the seroprevalence and epidemiologic features of human T-lymphotropic virus (HTLV I-II) among an emergency department patient population with a high rate of human immunodeficiency virus (HIV-1) infection. DESIGN: Prospective survey using identity-unlinked consecutive sampling during a 6-week period in 1988. SETTING: Inner-city teaching hospital. PATIENTS: Sequential sample of 2544 adult patients with sufficient excess sera for analysis. MEASUREMENTS AND MAIN RESULTS: Twenty-eight (1.1%) (95% CI, 0.7% to 1.5%) serum samples were seropositive for HTLV I-II whereas 152 (6.0%) (CI, 5.1% to 6.9%) were seropositive for HIV-1. The age distribution of HTLV I-II was similar to the study population while HIV-1 was concentrated among younger (25 to 44 years) age groups (P less than 0.05). Only 16 (57.1%) HTLV I-II infected patients had identified risk factors; 11 were intravenous drug users, 4 received transfusions, and 1 had heterosexual exposure to a high-risk partner. None of 39 identified homosexual men had HTLV I-II antibodies although 29 (74.3%) were HIV-1 seropositive. CONCLUSION: HTLV I-II infection may be more prevalent among certain segments of the U.S. population than previously realized and appears to have a different demographic distribution than HIV-1 infection. Although HTLV I-II may represent a nosocomial risk to health care providers, the risk of occupational transmission is probably less than for hepatitis B virus and even HIV-1. Adherence to universal precautions should minimize the risk.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Preparation of 35S-labeled polyphosphorothioate oligodeoxyribonucleotides by use of hydrogen phosphonate chemistry.

The title compounds were chemically synthesized as their 5'-dimethoxytrityl derivatives by base-catalyzed reaction of 35S-enriched elemental sulfur with support-bound hydrogen phosphonate oligomer. This was derived from adamantane carbonyl chloride-activated coupling of nucleotide hydrogen phosphonate monomers, and similarly activated capping with isopropyl phosphite. A convenient, disposable, reversed-phase cartridge was utilized to purify and isolate the 5'-dimethoxytrityl derivative for subsequent in situ detritylation and elution of the final product. The specific activity obtained for the title compounds was ca. 10(7) cpm/mumols-eq P(O)S-. The procedure should be readily adaptable to appropriate syntheses of other P-S containing analogs of DNA and RNA.

Base Sequence↗
PubMed1990

Falloposcopy: a microendoscopic technique for visual exploration of the human fallopian tube from the uterotubal ostium to the fimbria using a transvaginal approach.

A transvaginal microendoscopic technique has been developed for safely exploring the human fallopian tube from the utero tubal ostium to the fimbria and adjacent peritoneal cavity. Falloposcopy was performed without complication or evidence of endotubal damage in 44 women, 38 of whom also underwent a concurrent laparoscopy. Eight women with normal tubes served as controls and 36 women with tubal damage underwent falloposcopy in an attempt to document endotubal defects. Previous salpingectomy in 13 women and ostial obstruction in 4 cases left 71 tubes available for falloposcopy. Technical failures, defined as an inability to negotiate the tubal lumen in the absence of obstructive disease occurred in 8 of 71 (11%) procedures. In 63 successful procedures, the tubal lumen was considered to be falloposcopically normal in 28 cases (44%) and contained defects ranging from partial to total obstruction secondary to intraluminal fibrosis within the intramural, isthmic, and ampullary segments in the remaining 35 tubes (56%). Falloposcopy provides a nonincisional modality for defining the normal and abnormal surface anatomy of the tubal epithelium.

Endothelium↗
PubMed1990

Prognosis of patients with stage D1 prostate carcinoma following radical prostatectomy with and without early endocrine therapy.

Early endocrine therapy after radical retropubic prostatectomy was compared to radical prostatectomy alone (nonearly endocrine therapy) for the treatment of carcinoma of the prostate with lymph node metastases. Our retrospective analysis demonstrated that the 2 cohorts were similar with respect to patient age, Gleason sum score, seminal vesicle invasion, lymph node involvement, tumor volume and pathological stage of the primary tumor. The cause-specific survival of the entire group was 84% at 60 months and 78% at 98 months. The cause-specific curves for the early and nonearly endocrine therapy group were not significantly different (p less than 0.194), although the estimated 9-year survival rates were 91 and 71%, respectively. Survival free of disease was significantly prolonged in the early endocrine therapy group (p less than 0.030), with a 9-year estimated rate free of disease of 67% versus 32% in the nonearly endocrine therapy group. Followup prostate specific antigen serum levels were analyzed and the value as a progression marker is discussed. These data suggest that a radical operation plus early endocrine therapy is effective palliation in selected patients with low volume lymph node metastases, producing clinical survival free of disease in most patients.

Antineoplastic Agents↗
PubMed1990

Clinical evaluation of flexor tendon function in the small finger.

Patients frequently present to the emergency department with hand injuries. Standard examination includes testing each digit for flexor function. The flexor digitorum superficialis (FDS) to the small finger has been shown to have variable anatomy and clinical examination. We prospectively examined 100 subjects (200 hands) for small finger FDS function by standard and modified testing. We found that 70 small flexors (35%) showed absent FDS by standard testing, whereas only eight fingers (4%) had absent FDS by modified testing. FDS function to the small finger is frequently unilateral. We conclude that modified testing is the only way to accurately test for small finger FDS function and that the use of this simple clinical examination may prevent unnecessary referral to a hand surgeon.

Adult↗
PubMed1990

Mandibular arch length increase during the mixed dentition: postretention evaluation of stability and relapse.

Increasing mandibular arch length to resolve crowding has long been debated as a treatment method. Twenty-six patients with records obtained before treatment, after treatment, and a minimum of 6 years out of retention were assessed. All the patients showed a loss of treatment arch length increase with only 6 of 26 patients showing any gain over pretreatment dimensions. Width constriction was a consistent finding, as was crowding of anterior teeth after retention. In 89% the postretention record demonstrated clinically unsatisfactory alignment. Lateral cephalometric superimposition of mandibles showed variable molar and incisor change after retention. As teeth erupted after treatment, mesial molar movement and lingual tipping of incisors were the most common cephalometric findings.

Adolescent↗
PubMed1990

[A new method of surgery of nystagmus blockage syndrome].

Structural surgery is based on a model in which eye movements follow the ball-joint principle, i.e., there is absolute freedom of movement in all possible directions. Nystagmus blockage or convergence excess is regarded as a surplus of the medial rectus muscle. The relation between the weight of the globe and the muscle mass is taken into account. The medial rectus muscle is weakened by splitting it into 3 parts. The central part remains in its physiologic anatomic position in order to preserve normal convergence and binocularity, while the upper and lower portions prevent divergence. Additional prior weakening is accomplished by performing a tenonectomy.

Child↗
PubMed1990

Adherence to Universal (barrier) Precautions during interventions on critically ill and injured emergency department patients.

In a study undertaken to determine compliance with Universal Precautions, we observed 129 personnel performing 1,274 interventions on 151 consecutive critically ill and injured patients in an emergency department setting in July 1988. Barrier precautions were fully adhered to 44.0% of the time. During interventions in patients with profuse bleeding, adherence was only 19.5% in contrast to 44.7% for those who were not bleeding. Adherence was 56.4% during minor interventions but only 16.7% during major procedures. Adherence rates varied among health care providers: residents, 58%; emergency staff physicians, 38%; consultant physicians, 43%; emergency nursing staff, 44%; paramedics, 8%; radiology technicians, 14%; and housekeeping, 91%. In a follow up questionnaire that ascertained reasons for lack of compliance, 47% of providers indicated that there was not always sufficient time to put on protective material, 33% felt that precautions interfered with skillful performance of procedures, and 23% stated that materials were uncomfortable. Only 2.7% felt that Universal Precautions did not work. Since there is no proven postexposure prophylaxis for human immunodeficiency virus, Universal Precautions must be rigorously followed until such time as they are shown not to be effective or an alternate approach is developed. Strategies to improve compliance and improvements in barrier technology need to be developed.

Allied Health Personnel↗
PubMed1989

[Intravenous versus oral treatment of endogenously depressed patients with doxepin--a double-blind study with plasma level determination].

A double-blind study was conducted involving 45 "therapy-resistant" endogenous depressive inpatients who were treated with Doxepin intravenously or orally. After a period of 3 weeks there was no significant difference in the clinical ratings (HRSD, SDS). In the parenteral treatment group, however there was a statistically significant quicker onset of action (day 3). Compared to oral application higher Doxepin plasma concentrations during day 1 to 6 could be obtained by drip-infusion in spite of lower dosage.

Administration, Oral↗
PubMed1989

Imparting the diagnosis of life threatening illness in children.

The parents of children with life threatening or terminal illnesses were interviewed about their experiences of the way in which they were told the diagnosis. The interview was piloted on 25 families and then administered in a semistandardised manner to a further 45 families. Parents were asked how satisfied they were with the initial discussion about the diagnosis: 23 families were satisfied with how much information they were given; 22 with the information concerning prognosis; 20 with the pacing of the information; 33 with who was present; 32 with arrangements for follow up; and 26 were satisfied overall with the initial discussion. Clear patterns emerged about which elements of the discussion parents appreciated or resented. For example, they valued an open, sympathetic, direct, and uninterrupted discussion of the diagnosis in private that allowed sufficient time for them to take the news in and for doctors to repeat and clarify information. They disliked evasive or unsympathetic brief interviews. All parents remembered vividly the manner in which the diagnosis was imparted, and some were still preoccupied with this many years later. Analyses were carried out to test the possibility that reports of satisfaction and dissatisfaction were a function of current depression and anxiety, but no evidence was found for this.

Attitude of Health Personnel↗