Biomedical subjects

B Foxman

Publications and source records attributed to B Foxman.

At least 55 records · Page 3Linked to original sources

PubMed1997

Condom use and first-time urinary tract infection.

We evaluated the effects of condom use, lubricated condom use, and spermicide use on risk of acquiring first urinary tract infection in a case-control study of sexually active college women ages 18-39 years. Cases (N = 144) were women with first urinary tract infection that was confirmed by culture recruited at the student health service; controls (N = 286) were women without a history of urinary tract infection who were randomly sampled from all women enrolled at the university. Participants completed a self-administered questionnaire regarding type and frequency of condom use during the previous 2 weeks. Condoms and spermicides usually were used in combination with each other or oral contraceptives. After adjusting for frequency of vaginal intercourse, using unlubricated condoms compared with using no birth control method strongly increased the risk of first urinary tract infection (odds ratio = 29.1; 95% confidence interval = 3.1-1,335). Using a lubricated condom (with or without spermicide in the lubricant) or a spermicidal cream or gel with an unlubricated condom was associated with two- to eightfold risk of first urinary tract infection. Unlubricated condom use was strongly associated with risk of first urinary tract infection, but this effect was largely neutralized by using a spermicidal cream or gel with the unlubricated condom or by using a lubricated condom.

Adolescent↗

PubMed1997

Distribution of drb genes coding for Dr binding adhesins among uropathogenic and fecal Escherichia coli isolates and identification of new subtypes.

The Dr family of related adherence structures, some fimbriated and others afimbriated, bind to decay-accelerating factor molecules on human cells. Dr is associated with recurring urinary tract infection (UTI), but the distribution of Dr subtypes among uropathogenic Escherichia coli causing UTI among otherwise healthy women has yet to be described. A total of 787 UTI and fecal E. coli isolates from college women were screened for the presence of Dr sequences (drb). Fifteen percent of UTI strains were drb positive, compared to 5% of fecal strains. The adhesin (E gene) subtype of each drb-positive strain was determined by type-specific PCR followed by restriction enzyme analysis. Among 78 drb-positive strains, we found 14 (18%) afaE1, 1 (1.3%) afaE2, 1 (1.3%) afaE3, 9 (12%) draE, 9 (12%) draE-afaE3 hybrid, 1 (1.3%) daaE, 32 (41%) afaE5, 4 (5.1%) F131 E gene-like, and 7 untypeable strains. All untypeable E genes were cloned and sequenced, revealing four additional new classes of E genes, including two similar to the previously identified nonfimbrial E series. While a great range of diversity exists among the E genes, restriction fragment length polymorphism analysis demonstrated that all of these drb operons share a highly conserved gene structure. The most common subtype, afaE5, occurred three times as often among UTI than fecal strains. Over half of the drb-positive strains and 80% of those positive for afaE5 have the same virulence signature (positive for aer, kpsMT, ompT, and fim), suggesting an association of this profile with UTI pathogenesis.

Adhesins, Escherichia coli↗

PubMed1996

Prevalence of possible undiagnosed asthma and associated morbidity among urban schoolchildren.

OBJECTIVE: The extent to which urban children endure the symptoms and consequences of asthma without a physician diagnosis has not been well studied. Our objective was to obtain an estimate of the prevalence of possible undiagnosed asthma in a population of urban schoolchildren. DESIGN AND METHODS: A population-based cross-sectional study was conducted in urban schoolchildren, grades 3 to 5. Undiagnosed asthma was defined as caretaker report of symptoms and/or bronchial hyperresponsiveness, defined as a 15% or greater drop in baseline forced expiratory volume in 1 second, after exercise challenge. RESULTS: A total of 230 children (61% of those eligible) participated in the study. Forty children (17.4%; 95% Confidence interval (CI) = 12.5% to 22.3%) had reports of a physician diagnosis of asthma. Of these, 33 (14.3%; (95% CI = 9.8% to 18.9%) reported wheezing in the past 12 months. Among the remaining 189 eligible children, 11 (5.8%; 95% CI = 2.5% to 9.2%) met study criteria for undiagnosed asthma based on bronchial hyperresponsiveness (BHR). Another 16 (8.5%; 95% CI = 4.5% to 12.4%) met study criteria for undiagnosed asthma through modified American Thoracic Society symptom criteria. Overall, 27 children (27/189; 14.3%) fulfilled criteria for undiagnosed asthma. Children identified as having undiagnosed asthma were compared with children who had no BHR and no symptoms and who did not report a physician diagnosis of asthma (children without asthma). Children with BHR were more likely to have a report of allergies and eczema than children without asthma, odds ratios (OR) = 8.5 (95% CI = 2.4 to 30.7) and 6.4 (95% CI = 1.1 to 38.1), respectively. Children meeting symptom criteria were more likely to have a report of allergies, OR = 6.2 (95% CI = 2.0 to 19.1), and bronchitis, OR = 6.7 (95% CI = 2.0 to 22.4), and were also more likely to report sleep disruption, OR = 7.1 (95% CI = 2.3 to 21.8) and missed physical education classes, OR = 15.0 (95% CI = 4.8 to 46.7), compared with children without asthma. CONCLUSIONS: We estimated a prevalence of 14.3% for possible undiagnosed asthma among urban schoolchildren, grades 3 to 5, through caretaker report of symptoms or BHR postexercise challenge. Children with undiagnosed asthma reported more atopic disease than children without asthma. In addition, children meeting symptom criteria for asthma reported more bronchitis, sleep disruption, and missed physical education classes than did those without asthma. These results suggest that rates of undiagnosed asthma may be high in this predominantly black school-age population.

Asthma↗

PubMed1996

The cost-effectiveness of placing urinary tract infection treatment over the counter.

We use cost-effectiveness analysis to estimate the economic and health implications of approving the over-the-counter sale of oral antibiotics for treatment of urinary tract infection (UTI). We consider two alternatives for over-the-counter availability and examine the reduced economic cost from avoided doctors' visits, along with the potential additional costs associated with higher over-the-counter treatment prices or increased use due to greater access. We also consider important noneconomic costs such as reduced symptom days, restricted activity days, and growing resistance to antibiotics. Our analysis covers a 20-year time horizon to capture the long-term effects, from a societal perspective, of a policy decision to place UTI treatment over the counter today. In addition, we present sensitivity analyses to test the effects of the assumptions in our model. We estimate that the economic costs of placing UTI treatment over the counter outweigh the benefits, unless there is extensive patient education and a mechanism for allowing patients to properly self-diagnose to reduce markedly the number of doctors' visits, mistreated symptoms, and threat of resistance to antibiotics. Only if doctors' visits were reduced to 64.6% of current levels would the economic benefits of over-the-counter treatment begin to be realized. UTI is one of the most common complaints among women and accounts for a large number of doctor visits each year. However, the costs of over-the-counter distribution of UTI treatment, particularly those due to the risk of decreasing the time until standard treatments become ineffective due to bacterial resistance, outweigh the short-term gains of decreased symptom days and increased access to treatment.

Adolescent↗

PubMed1996

Employee drug use, demographic characteristics, work reactions, and absenteeism.

Employees in a large work organization participated in an investigation of relationships between drug use and absenteeism and tardiness. Specifically, the study investigated the extent to which both self-reported and urine-screened drug use accounted for variance in several types of absenteeism, as well as tardiness, above and beyond that accounted for by demographic and work reaction variables. The results showed that employee drug use accounted for additional statistically significant variance in overall absenteeism and in absenteeism due to injuries and suspensions, as well as days tardy. Implications of these findings for organizational drug testing are discussed.

Absenteeism↗

PubMed1996

Risk factors for vulvovaginal candidiasis: a case-control study among university students.

Vulvovaginal candidiasis (VVC) is a common inflammatory condition caused by vaginal overgrowth of Candida albicans. Typical symptoms include pruritus and discharge. To test the association between several hypothesized risk factors and VVC, we conducted a case-control study among university students, with both clinic and population controls. Symptomatic, culture-proven VVC was associated with receptive oral sex twice or more in the previous 2 weeks [vs not at all, odds ratio (OR) = 3.5; 95% confidence interval (CI) = 1.7-7.0]; oral contraceptive use (OR = 1.8; 95% CI = 0.95-3.6); spermicide use (OR = 3.3; 95% CI = 1.6-6.8); a prior diagnosis of VVC in the previous year (OR = 3.0; 95% CI = 1.5-5.9); and black (OR = 6.8; 95% CI = 3.1-15) and "other" race (OR = 2.2; 95% CI = 1.0-4.6). Estimates are from a cases vs population controls logistic regression model including all five variables; results for cases vs clinic controls were similar. After adjusting for these factors, many other hypothesized risk factors, such as antibiotic use, menstrual hygiene practices, and vaginal intercourse, had little association with VVC.

Adult↗

PubMed1995

Vitrectomy techniques in late-stage Coats'-like exudative retinal detachment.

Retinal telangiectasia is the hallmark of Coats' disease. In the late stages, leakage from these abnormal vessels can result in a total, bullous exudative retinal detachment with cholesterol-laden subretinal fluid. Secondary angle-closure glaucoma may result in a blind and painful eye which may require enucleation or evisceration. Surgical reattachment of the retina and destruction of the retinal telangiectasia may preserve these eyes. We have found that vitrectomy, internal drainage of subretinal fluid and cholesterol, direct treatment of the retinal telangiectasia with intraocular diathermy and intravitreal gas or silicone oil injection are effective surgical techniques for salvaging these severely damaged eyes.

Adult↗

PubMed1995

Bacterial virulence characteristics of Escherichia coli isolates from first-time urinary tract infection.

The frequency of nine potential Escherichia coli urinary tract infection (UTI) virulence factors was investigated among 216 isolates from 208 women 18-40 years old with first-time UTI. Factors were afimbrial adhesions I-IV and F1845 pili (drb), aerobactin (aer), group II capsules (kpsMT), cytotoxic necrotizing factor 1 (cnf1), alpha-hemolysin (hly), outer membrane protease T (ompT), Pap and Prs pili (prf), S fimbriae (sfa), and type 1 pili (fim). Women were enrolled at two sites. Pairwise comparisons found 14 statistically significant associations between virulence genes after correcting for multiple comparisons. This is the first report of five associations: aer and drb, kpsMT and ompT, ompT and cnf1, ompT and sfa, and prf and ompT. As ompT is not closely linked genetically to kpsMT, cnf1, prf, or sfa, ompT may be functionally linked with one or more of these other virulence factors.

Adult↗

PubMed1995

Virulence characteristics of Escherichia coli causing first urinary tract infection predict risk of second infection.

Escherichia coli causes most urinary tract infections (UTIs) in ambulatory populations. Several bacterial virulence factors occur more frequently among urinary E. coli isolates than among fecal isolates, but none have been reported to predict risk of second UTIs. DNA hybridization was used to characterize the bacterial virulence profiles of urinary E. coli isolates from 174 women with first UTI and compared for risk of second UTI. Of the women, 28 (16%) had a culture-confirmed second UTI within 6 months of a negative test-of-cure. Three virulence factors were associated with a significantly lower risk of second UTI: cytotoxic necrotizing factor (relative risk [RR] = 0.0; 95% confidence interval [CI], 0.0, 0.42); hemolysin (RR, 0.10; 95% CI, 0.01, 0.69), and S fimbrial adhesin (RR, 0.25; 95% CI, 0.06, 1.00). Dr binding was associated with a 2-fold increased risk of second UTI (RR, 2.30; 95% CI, 1.23, 4.29). Half of all paired first and second UTI isolates from the same subject were apparently the same.

Adult↗

PubMed1995

First-time urinary tract infection and sexual behavior.

We studied the relation between sexual and health behaviors of women and first-time urinary tract infection (UTI). The study population was women using a university health service who were unmarried, had no UTI history, and who had engaged in sexual activity at least once. We found 86 cases of UTI, defined as one or more urinary symptoms and > or = 1,000 colony-forming units per ml urine of a known pathogen. We randomly sampled 288 controls from the student body. Vaginal intercourse increased the risk of UTI; this risk was further increased with condom use. After adjusting for vaginal intercourse with other birth control methods and recentness of current sexual partnership, a single sex act with a condom in the past 2 weeks increased UTI risk by 43%. Having a sex partner for less than 1 year vs 1 year or more, after adjustment for frequency of vaginal intercourse and birth control method, was associated with about twice the risk of UTI [odds ratio (OR) = 1.97; 95% confidence interval (CI) = 1.04-3.74]. After adjusting for frequency of vaginal intercourse, regular drinking of cranberry juice was protective against UTI (OR = 0.48; 95% CI = 0.19-1.02), whereas drinking carbonated soft drinks appeared to be associated with increased risk (OR = 2.37; 95% CI = 0.75-7.81). Using deodorant sanitary napkins or tampons was associated with a slight increase in risk of UTI (OR = 1.51; 95% CI = 0.74-3.06). Blacks had five times greater risk of UTI than whites after adjusting for frequency of vaginal intercourse (OR = 5.2; 95% CI = 1.89-24.63). We observed only modest differences in health behavior between racial groups.

Case-Control Studies↗

PubMed1995

Chronic vulvovaginal candidiasis: characteristics of women with Candida albicans, C glabrata and no candida.

INTRODUCTION: Although as many as 5% of all women complain of chronic vulvovaginitis, little is known about these women. They may often be misdiagnosed and the role of vaginal yeast culture in diagnosing vulvovaginal candidiasis (VVC) among them has not been clearly defined. METHODS: To address these deficiencies, we tabulated initial diagnoses among new patients and conducted a medical record-based, unmatched case-control study among women reporting a history of chronic vulvovaginitis (four or more episodes in the past year) at a vulvovaginitis specialty clinic. Clinical presentation and medical history were compared for women who had a positive vaginal yeast culture for either Candida albicans or C glabrata, or who had a negative culture. RESULTS: One-third of the women had no apparent vulvovaginal disease at their initial visit. All women reported similar symptoms, except for an increased prevalence of painful sexual intercourse in women with C albicans (chi 2 p = 0.014 versus women with C glabrata and p < 0.001 versus women with no candida). Women with C glabrata were more likely to be non-white (chi 2 p = 0.071 compared with women with C albicans) and to report an underlying medical condition (chi 2 p < or = 0.001 versus both women with C albicans and women with no candida). Physical examination was normal only in women with no candida. C albicans cases were more likely to have positive potassium hydroxide microscopy (chi 2 p = 0.016) and a pH < or = 4.5 (chi 2 p = 0.011) than were C glabrata cases. CONCLUSIONS: These results suggest that reliance on symptoms and signs alone will result in significant misdiagnosis of chronic vulvovaginitis. Among women with VVC, subtle differences in clinical presentation do not reliably distinguish women with C albicans from those with C glabrata. Our study also indicates that vaginal yeast cultures, while not necessary for every patient, are valuable in confirming negative diagnoses, detecting microscopy false-negatives, and identifying non-C albicans isolates.

Candida↗

PubMed1995

The epidemiology of vulvovaginal candidiasis among university students.

Vulvovaginal candidiasis affects approximately 20% of women annually, but it is not well characterized epidemiologically. Of 1027 respondents to two mailed cross-sectional surveys at a large university, 37.5% reported a prior clinical diagnosis of vulvovaginal candidiasis. The frequency of first diagnosis increased rapidly after age 17, with an estimated 54.7% of women experiencing the condition by age 25. In a proportional hazards model of age at first diagnosis, vulvovaginal candidiasis was associated with initiation of sexual activity (rate ratio [RR] = 2.9; 95% confidence interval [CI] = 2.2, 3.8), oral contraceptive use (RR = 1.7; CI = 1.4, 2.2), and White (RR = 3.1; CI = 1.7, 5.7) and Black (RR = 5.9; CI = 3.0, 11.5) race vs Asian.

Adolescent↗

PubMed1994

Breastfeeding practices and lactation mastitis.

Clinical impression suggests that lactation mastitis is associated with inexperienced nursers, improper nursing techniques, stress and fatigue. A pilot study was conducted to describe the frequency of self-reported breastfeeding practices during the first week post partum among 100 breastfeeding women delivering at a freestanding birthing center or participating in an early discharge program. Nine cases of lactation mastitis were identified from the survey population and an additional 8 from the target population for the survey. Seventeen controls matched by delivery date were identified from survey participants. The frequency of self-reported breastfeeding practices, the presence of fatigue and stress during the week prior to the mastitis date in the case was compared among cases and controls. In the first week post partum, most women fed their babies every 2-3 hr for approx. 20 min a feeding. The cradle or Madonna position was the most frequently used nursing position. Nine percent reported supplementing feedings with formula. Women with mastitis were more likely than controls to report a history of mastitis with a previous child. In the week prior to the mastitis date of the case, women with mastitis were more likely than controls to report breast or nipple pain and cracks or breast fissures. They were less likely to report being able to take a daytime nap. Future studies should focus on the relative importance of and interrelationships among these factors.

Adult↗

PubMed1994

Potential pitfalls in interpreting maps of stabilized rates.

There have been many advances in the mapping of disease mortality and morbidity rates in recent years. An increasingly common approach is to calculate "stabilized" rates for individual geographic areas by incorporating information from the entire set of data. One such method, adopted by the Environmental Protection Agency [corrected] for its mortality maps, is described and applied to national end-stage renal disease data. Some possible difficulties in interpretation are noted, resulting from: (1) insufficient shrinkage, (2) highly skewed rate distributions, (3) different denominator distributions, and (4) variations in population density.

Aged↗

PubMed1993

How well do prediction equations predict? Using receiver operating characteristic curves and accuracy curves to compare validity and generalizability.

Although morbidity and mortality prediction equations are widely used in planning, clinical practice, and health risk appraisal, their validity and generalizability have been tested only in a limited way. Previous attempts lacked an absolute standard of performance and looked only at the equations' ability to predict who would become ill (sensitivity), not the equally important ability to predict who would remain healthy (specificity). We compared six all-cause mortality prediction equations using receiver operating characteristic curves and accuracy curves, which overcome the limitations of earlier methods and provide a concise visual representation of the results. We used equations from five prospective studies conducted in the United States (Tecumseh at 8 and 12 years of follow-up, Framingham, Chicago Gas, Chicago Western Electric, and Albany), each of which included cholesterol, smoking, and blood pressure as independent variables, to predict 12-year mortality in Tecumseh males age 40-54 years. Previous studies suggested that these equations predict equally well. Our analysis found that, although all predict better than chance, Albany, Chicago Western Electric, and Tecumseh at 8 years underestimate mortality. Receiver operating characteristic and accuracy curves are a promising technique for assessment of prediction equations.

Cholesterol↗

PubMed1992

Patterns of low incidence of treated end-stage renal disease among the elderly.

We present US county-level maps of the 1983 to 1988 incidence of treated end-stage renal disease (ESRD) among white and nonwhite persons 65 years of age and older (N = 66,129). Recent statistical advances permit the investigation of geographical patterns of unusually low disease incidence. Our maps highlight those US counties which have been determined to have rates of ESRD treatment incidence that are low relative to those of all counties, revealing several interesting geographic patterns. For whites, low rates are found in the Northwest, the Midwest, and the South. Nonwhite rates are seen to be low primarily in the South and Alaska. Low treatment incidence could be due to a combination of (1) low true incidence, (2) lack of access to health care services, (3) insufficient diagnosis and referral, and (4) patients' reluctance to accept ESRD therapy, due to cultural or personal concerns. A state-level regression of elderly rates on those aged 40 to 64 years indicates the variation in treatment incidence among the elderly may be due to factors other than variation in true incidence, which the middle-aged rates reflect more closely. Residual analysis corroborates the visual impression of the maps of low ESRD treatment incidence in several southern states, where referral to dialysis may be as much as 40% lower than the national level. Further research on factors contributing to low treatment incidence, including competing risks, regional lags relative to the national trend to dialyze more elderly patients, and lack of access to health care resources, is indicated.

Aged↗

PubMed1992

Risk factors for mortality from lower respiratory infections in nursing home patients.

BACKGROUND: Little is known about the factors that predict whether nursing home residents with lower respiratory infection (LRI) will do well or poorly, although this information is critically important when making treatment decisions. METHODS: Using nursing home and hospital medical records, we performed a case-control study to identify risk factors for death from LRI among residents of a 110-bed, midwestern community nursing home. Three experienced geriatricians aided in the development of an operational definition of an LRI. In a 3 1/2-year period, we identified 26 cases in which the patients died from LRI and 66 control episodes in which the patients recovered from LRI. RESULTS: Compared with those who survived, those who died were 14 times more likely to be totally dependent with respect to activities of daily living (ADL) than the group of patients least ALD-dependent (odds ratio [OR] = 14; 95% confidence interval [95% CI] = 2.85 to 68.87). After adjusting for ADL, mortality was significantly decreased when a broad-spectrum oral antibiotic (trimethoprim-sulfamethoxazole, cefaclor, amoxicillin-clavulanate, or ciprofloxacin) was used as the initial therapy (OR = .14; 95% CI = .02 to .81). CONCLUSIONS: Better functional status and initial therapy with broad-spectrum oral antibiotics were strong predictors of surviving an LRI in this population of nursing home patients. The antibiotic effect may be a treatment effect or the consequence of underlying factors leading physicians to select particular antibiotics; however, it appears possible to identify low-risk persons who do not require the aggressive treatment and hospitalization that is often recommended for these patients. An approach to the treatment of nursing home LRI is suggested.

Activities of Daily Living↗

PubMed1991

Mastitis among lactating women: occurrence and risk factors.

Puerperal mastitis is a potentially serious illness among lactating women which traditionally has been thought to be associated with primiparity, stress, improper nursing technique, and incomplete emptying of the breast. However, none of these putative associations has been examined analytically in recent years. Further, the incidence of mastitis in the United States has not been estimated since 1975, although the prevalence of breastfeeding has increased dramatically since then. In this retrospective cohort study of 966 lactating women, the cumulative incidence of mastitis in the first seven weeks postpartum was 2.9%. This incidence was associated with professional, technical, or managerial occupation in both parents (rate ratio = 12.29; 95% CI: 1.62, 93.43) and with giving birth in the hospital delivery room, rather than the labor room (rate ratio = 4.05; 95% CI: 0.92, 17.83). Parity was not associated with risk of mastitis in this sample.

Adolescent↗