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Biomedical subjects

B Rosner

Publications and source records attributed to B Rosner.

At least 271 records · Page 15Linked to original sources
PubMed1984

A case-control study of risk indicators among women with premenopausal and early postmenopausal breast cancer.

Among 714 premenopausal and 130 postmenopausal breast cancer cases matched with 8440 controls for age in years and menopausal status, risk indicators for breast cancer were similar, although most associations were stronger in the premenopausal women. Compared with nulliparous women, the relative risk (RR) for those with first birth before age 25 years was 0.7 (95% confidence limits [CL] from 0.5 to 0.9) among premenopausal women, and 0.7 (0.4-1.4) for postmenopausal women. In the premenopausal cases, a history of breast cancer in a sister gave a RR of 3.0 (2.1-4.1) and in a mother 1.9 (1.4-2.5), whereas for the postmenopausal women the RRs were 1.4 (0.6-3.1) and 1.3 (0.6-2.6), respectively. Fibrocystic breast disease was also a significant predictor of subsequent breast cancer in the premenopausal and postmenopausal women. In relation to women having a single birth, premenopausal women with six or more births had a risk of breast cancer of 0.6 (0.4-1.0), which was present even after adjustment for age at first birth.

Age Factors↗
PubMed1984

Plasma renin substrate, renin activity, and aldosterone levels in a sample of oral contraceptive users from a community survey.

Fasting plasma renin substrate (PRS), plasma renin activity (PRA), plasma aldosterone (PA), and blood pressure (BP) levels were measured from 212 apparently healthy normotensive nonpregnant white women aged 21 to 39 years, selected on the basis of oral contraceptive (OC) use of nonuse in 1976 following a community survey in East Boston. The mean PRS level was 7118 ng/dl among OC users and 1935 ng/dl among nonusers (p less than 0.0001). In contrast, mean PRA was 2.9 ng of angiotensin 1 per milliliter per hour among users and 3.0 ng of angiotensin l/ml/hr among nonusers (p = NS); mean PA levels were 26.2 ng/dl and 25.4 ng/dl, respectively (p = NS). Mean systolic BPs were 113.8 mm Hg among current OC users and 111.2 mm Hg among nonusers (p = 0.078); diastolic BPs were 68.5 and 68.9, respectively (p = NS). These data indicate a greater than three-fold increase in PRS among current OC users compared to nonusers, with virtually identical PRA and PA levels. The data indicate that normotensive women using OCs maintain normal PRA and PA levels despite marked elevations in PRS.

Adult↗
PubMed1984

Is serum free estriol measurement essential in the management of hypertensive disorders during pregnancy?

A prospective study of antepartum fetal evaluation of 306 randomized hypertensive pregnancies was carried out. One hundred and fifty-four patients (group 1) were managed in accordance with a protocol (protocol A) which included non-stress test (NST), oxytocin challenge test (OCT), serum unconjugated (free) estriol measurements (E3), and ultrasound measurement of the fetal head-to-abdomen circumference ratio (H/A c.r.). A second group (group 2), composed of 152 patients, was managed using another protocol (protocol B) which included the NST, OCT and ultrasound measurement of the fetal head-to-abdomen circumference ratio (H/A). We found a good correlation between the serial normal tests and the outcome of pregnancies. We obtained good results in patients with abnormal NST-OCT and meconium-stained amniotic fluid and in patients with repeated abnormal NST-OCT with clear amniotic fluid due to active management by early deliveries ignoring fetal lung maturity. This management increased the rate of cesarean section and prematurity. There was a low correlation between patients with abnormal serum free estriol as the only antepartum pathological test and the appearance of intrapartum fetal distress, low birth weight and perinatal morbidity and mortality. The contribution of serum free estriol (E3) measurements in such patients was only of value in cases of intra-uterine fetal growth retardation, but its prediction rate was less than that of ultrasound measurement of head-to-abdomen circumference ratio. Our results indicate that hypertensive pregnancy management without serum free estriol measurement may be valuable and safe.

Estriol↗
PubMed1984

Tolerance and absence of rebound vasodilation following topical ocular decongestant usage.

Commercial preparations of two topical ophthalmic vasoconstrictors were evaluated for whitening ability, duration of action, tolerance, and rebound vasodilation in 11 normal volunteers. Both 0.02% naphazoline HCI and 0.05% tetrahydrozoline HCI significantly reduced baseline redness after a single use (Part I); however, naphazoline produced significantly more whitening than did tetrahydrozoline. Only naphazoline retained its whitening ability after ten days (Part II). The level of redness remained significantly below baseline for eight hours after a single use of either vasoconstrictor and for six hours after multiple use of naphazoline. The diminished effectiveness of tetrahydrozoline after the ten-day test period may encourage its overuse. Neither vasoconstrictor produced rebound vasodilation after discontinuation of use.

Drug Evaluation↗
PubMed1984

A case-control study of oral contraceptive use and breast cancer.

Among 989 cases of breast cancer and 9,890 controls selected from a cohort of married, female registered nurses aged 30-55 years, the relative risk (RR) of breast cancer for women who had ever used oral contraceptives (OC) compared with those who had never used them was 1.0, with 95% confidence limits 0.9-1.2. Among OC users, there was no consistent pattern of excess risk with increasing duration; in fact, the few women who had used OC longest (greater than 10 yr) had a slightly lower risk than never-users. Moreover, there was no association between OC use and breast cancer among women with a positive history of breast cancer in the mother or sister or with OC use before their first pregnancy. The only subgroup of women among whom any adverse effect was apparent was current OC users aged 50-55 years (two onsets expected vs. seven observed). This finding is consistent with earlier reports of an increased risk of breast cancer among older OC users; however, it is also likely to reflect, at least to some extent, the play of chance, since at ages 45-49 and in each younger age group fewer cases than expected were observed among current OC users.

Adult↗
PubMed1984

Nifedipine and conventional therapy for unstable angina pectoris: a randomized, double-blind comparison.

To characterize the potential of nifedipine in the therapy of unstable angina pectoris we implemented a blinded, randomly assigned, titrated schedule of conventional therapy (propranolol, if not contraindicated, and isosorbide dinitrate) or nifedipine for 14 days in 126 patients hospitalized in a coronary care unit for ischemic chest pain of less than 45 min duration. There were no significant differences between conventionally and nifedipine-treated patients with regard to (1) the time to relief of pain as judged by life table analysis, (2) the decrease in anginal attacks per 24 hr from day 0 to day 2 (-2.5 +/- 0.4 for conventional therapy vs; -2.8 +/- 0.3 for nifedipine), (3) the decrease in the number of nitroglycerin tablets consumed per 24 hr (-2.0 +/- 0.5 for conventional vs -2.1 +/- 0.4 for nifedipine therapy), (4) the percentage of patients requiring morphine on day 1 (13% for conventional vs 21% for nifedipine therapy), or (5) the percentage of patients who developed infarction (14% in both groups). Among the 27 patients who did not respond to initial conventional (n = 13) or nifedipine therapy (n = 14), five in each group became pain free when the opposite therapy (either nifedipine or conventional therapy) was added. In the subgroup of 67 patients who were receiving propranolol before randomization, addition of nifedipine was more effective in controlling pain than was an increase in conventional therapy (p = .026). In the subgroup of 59 patients not receiving prior propranolol, initiation of conventional therapy produced more rapid pain relief than initiation of nifedipine therapy alone (p less than .001), which tended to increase heart rate. Thus, for the study population as a whole therapy with nifedipine alone was equivalent to conventional therapy for unstable angina, although this overall equivalence may result from a combination of superiority of nifedipine therapy in patients previously receiving beta-blocker therapy and superiority of beta-blocker therapy in patients not previously receiving beta-blockers.

Angina Pectoris↗
PubMed1984

Nifedipine therapy for patients with threatened and acute myocardial infarction: a randomized, double-blind, placebo-controlled comparison.

Preliminary clinical and laboratory observations suggest that nifedipine might prevent progression of threatened myocardial infarction by reversing coronary spasm or might limit necrosis during the course of acute myocardial infarction. We screened 3143 patients with ischemic pain of greater than 45 min duration and randomly assigned 105 eligible patients with threatened myocardial infarction and 66 with acute myocardial infarction to receive nifedipine (20 mg orally every 4 hr for 14 days) or placebo plus standard care. Treatment was started 4.6 +/- 0.1 hr after the onset of pain. Infarct size index was calculated by the MB-creatine kinase (CK) method and expressed as CK-geq/m2 +/- SE. The incidence of progression to infarction among patients with threatened myocardial infarction was not significantly altered by nifedipine (36 of 48 [75%] for placebo-treated and 43 of 57 [75%] for nifedipine-treated patients). Furthermore, infarct size index was similar among placebo- and nifedipine-treated patients (16.9 +/- 1.5 MB-CK-geq/m2, n = 65, and 17.0 +/- 1.5 MB-CK-geq/m2, n = 68, respectively) with threatened myocardial infarction who exhibited infarction and for those with acute myocardial infarction. Among the 171 eligible patients randomly assigned to drug or placebo, 6 month mortality did not differ significantly (8.5% for placebo vs 10.1% for nifedipine, NS), but mortality in the 2 weeks after randomization was significantly higher for nifedipine-treated patients (0% for placebo compared with 7.9% for nifedipine, p = .018).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Postural changes in diastolic blood pressure and the risk of myocardial infarction: the Normative Aging Study.

To assess the relationship of postural changes in blood pressure to risk of myocardial infarction, 1359 men were followed for an average of 8.7 years. The men were participants in the Normative Aging Study, a longitudinal study of aging initiated in 1963 at the Veterans Administration Outpatient Clinic in Boston. It was found that the relationship of sitting blood pressure to the subsequent incidence of myocardial infarction was modified by a variable formed by subtracting supine from standing diastolic blood pressure (delta DBP). The effect of sitting diastolic blood pressure on risk of myocardial infarction was confined primarily to men with a delta DBP of 10 mm Hg or more. The effect of sitting systolic blood pressure on risk of myocardial infarction was apparent in all categories of delta DBP (less than 1, 1 to 9, greater than or equal to 10 mm Hg), but the gradient of risk became stronger with increasing levels of delta DBP. The modifying influence of delta DBP remained even when standard coronary risk factors were included in multivariate analyses. These findings suggest a relationship of vascular responsiveness to risk of subsequent myocardial infarction and may have clinical utility.

Adult↗
PubMed1984

Multivariate methods in ophthalmology with application to other paired-data situations.

Methods are presented for performing multiple regression analyses and multiple logistic regression analyses on ophthalmologic data with normally and binomially distributed outcome variables, while accounting for the intraclass correlation between eyes. These methods are extended to more general nested data structures where a variable number of subunits are available for each primary unit of analysis, as in familial data. These methods can also be applied to other types of paired data, as in matched studies with a variable matching ratio, where one has a continuous outcome variable and wishes to control for other confounding variables while maintaining the matching. Examples are given of these methods with a group of over 400 patients with retinitis pigmentosa, in which spherical refractive error and visual acuity are related to genetic type after the effects of age, sex and the presence of cataract, have been controlled.

Biometry↗
PubMed1983

Lack of association between contraceptive usage and congenital malformations in offspring.

Previous reports have linked the use of oral contraceptives and spermicides to the occurrence of malformations in offspring. With information from 12,440 women interviewed during the delivery hospitalization, we found no relationship between contraceptive method and the occurrence of malformations. Whereas any unnecessary drug should be avoided during pregnancy, prior contraceptive method seems to be unrelated to the risk of congenital malformations.

Abortion, Induced↗
PubMed1983

Longitudinal study of the effects of maternal smoking on pulmonary function in children.

We investigated the effects of maternal cigarette smoking on pulmonary function in a cohort of children and adolescents observed prospectively for seven years. A multivariate analysis revealed that after correction for previous forced expiratory volume in one second (FEV1), age, height, change in height, and cigarette smoking in the child, or adolescent, maternal cigarette smoking significantly lowered the expected average annual increase in FEV1 (P = 0.015). On the basis of this analysis, it is estimated that if two children have the same initial FEV1, age, height, increase in height, and personal cigarette-smoking history, but the mother of one has smoked throughout the child's life whereas the mother of the other has not, the difference in the change in FEV1 over time in the exposed child, as compared with that in the unexposed child, will be approximately 28, 51, and 101 ml after one, two, and five years, respectively, or a reduction of 10.7, 9.5, and 7.0 per cent, respectively, in the expected increase. These results suggest that passive exposure to maternal cigarette smoke may have important effects on the development of pulmonary function in children.

Adolescent↗
PubMed1983

The relationship of the baseline ECG to blood pressure change.

A total of 1,090 male participants (aged 23 to 80 years) of the Normative Aging Study who had baseline BP less than 140/90 mm Hg were observed prospectively for ten years. Blood pressures were taken at five- and ten-year follow-up examinations. Multiple linear regression analysis indicated that baseline levels of systolic pressure, age, R-wave amplitude (aVL), hematocrit, T-wave amplitude (V5), and S-wave amplitude (V4, V5, and V6) were statistically significant predictors of systolic pressure change. Baseline levels of diastolic pressure, R-wave amplitude (aVL), and hematocrit were statistically significant predictors of diastolic pressure change. Multiple logistic regression analysis showed that baseline levels of BP, S-wave amplitude (V1, V2, and V3), body mass index, R-wave amplitude (V4, V5, and V6), and T-wave amplitude (V5) were statistically significant predictors of subsequent hypertension. Whether the identified ECG amplitudes are an indicator of early increases in peripheral resistance or a function of neurohumoral factors, or both, is unknown.

Adult↗
PubMed1983

Prediagnostic serum selenium and risk of cancer.

Selenium levels in serum samples collected in 1973 from 111 subjects in whom cancer developed during the subsequent 5 years were compared with those in serum samples from 210 cancer-free subjects matched for age, race, sex, and smoking history. The mean selenium level of cases (0.129 +/- SEM 0.002 micrograms/ml) was significantly lower than that of controls (0.136 +/- 0.002 micrograms/ml). The risk of cancer for subjects in the lowest quintile of serum selenium was twice that of subjects in the highest. Multivariate adjustment for geographical area and serum levels of lipids, vitamins A and E, and carotene, did not alter this relation. The association between low selenium level and cancer was strongest for gastrointestinal and prostatic cancers. Serum levels of vitamins A and E compounded the effect of low selenium; relative risks for the lowest tertile of selenium were 2.4 and 3.9 in the lowest tertiles of vitamins E and A, respectively.

Adult↗
PubMed1983

The relationship between induced abortion and outcome of subsequent pregnancies.

We analyzed interview and record review data from 9,823 deliveries to evaluate the relationship between prior history of induced abortion and subsequent late pregnancy outcomes. Complications such as bleeding in the first and third trimesters, abnormal presentations and premature rupture of the membranes, abruptio placentae, fetal distress, low birth weight, short gestation, and major malformations occurred more often among women with a history of two or more induced abortions. A logistic regression analysis to control for multiple confounding factors showed that a history of one induced abortion was statistically significantly associated with first-trimester bleeding but with no other untoward pregnancy events, and a history of two or more induced abortions was statistically associated with first-trimester bleeding, abnormal presentations, and premature rupture of the membranes. While these relationships merit further research, the results of this study are largely reassuring. A history of one or more prior induced abortions does not appear to increase substantially the risk of adverse late outcomes of subsequent pregnancies.

Abortion, Induced↗
PubMed1983

Reduction of mortality associated with nosocomial urinary tract infection.

A randomised controlled trial was conducted to assess whether bladder catheters with preconnected sealed junctions were associated with a lower risk of urinary-tract infection than were catheters without such junctions, and to determine whether prevention of catheter-associated infection would be accompanied by a reduction of mortality. Among those not taking systemic antibiotics, patients assigned sealed junction catheters had fewer infections and deaths. Before they received antibiotics, the risk of infection among those assigned unsealed catheters was 2.7 times that of patients assigned sealed catheters (95% confidence interval=1.3-5 . 4, p=0 . 007). Among the 220 patients who received no antibiotics, 14% (15/108) of those assigned unsealed catheters and 4% (4/112) of those assigned sealed catheters died. Stratification by important risk factors for mortality yielded an adjusted risk ratio for death of 3.4 (95% CI=1.1-10.7, p=0.03). Among patients who received systemic antibiotic the use of sealed catheters did not affect infection rates (RR=0.9, 95% CI=0.5-1.5, p=0.68) or deaths (RR=1.2, 95% CI=0.6-2.2, p=0.62). These data indicate how the rates of infection and mortality can be reduced in hospital. Since the degree of reduction in mortality corresponded with the degree of reduction of infection, measures to prevent catheter-associated nosocomial urinary tract infection should be implemented.

Anti-Bacterial Agents↗
PubMed1983

Middle ear disease and the practice of pediatrics. Burden during the first five years of life.

To determine the burden on pediatricians imposed by disease of the middle ear, we analyzed data from 2,570 children followed up prospectively since birth. Disease of the middle ear accounted for a large proportion of all visits made during the first five years of life, rising from 22.7% during the first year to about 40% in years 4 and 5. About one visit in three made for illness of any kind resulted in the diagnosis of disease of the middle ear. Approximately three fourths of all visits to follow up any illness were made to follow up disease of the middle ear. Disease of the middle ear was diagnosed at between 5% and 10% of all well-baby visits. Children from private practice averaged fewer visits for all reasons than did children using a large neighborhood health center, but the proportions of visits accounted for by disease of the middle ear were similar in both settings.

Age Factors↗
PubMed1983

Epidemiologic study of abuse of analgesics containing phenacetin. Renal morbidity and mortality (1968-1979).

A study group of 623 working women 30 to 49 years old with objective evidence of intake of phenacetin-containing analgesics and a matched control group of 621 women without such intake in 1968 were assessed six times from 1969 to 1978 for laboratory evidence of urinary-tract disorders. The two groups did not differ in development of bacteriuria, hematuria, or proteinuria. However, a low specific gravity of urine (study group vs. control group, 23 vs. 7 per cent) and a raised level of serum creatinine (6.7 vs. 0.9 per cent) were significantly more frequent in the study group (P less than 0.001). Adjusted analyses of mortality over 11 years showed significant differences between the groups in overall mortality (study group vs. control group, 39 vs. 13 deaths; P less than 0.001), mortality due to urinary-tract disorders (P = 0.033), and cardiovascular diseases (P = 0.008). We conclude that heavy users of analgesic mixtures in the course of a decade have a higher incidence of both abnormal kidney function and kidney-related mortality than do casual users and nonusers, but the absolute incidences remain small even among heavy users.

Acetaminophen↗