Biomedical subjects
Publications and source records attributed to B Rosner.
The bacteria colonizing the surface of the skin of a group of frequent sunbathers and a group of infrequent sunbathers were surveyed. Frequent sunbathing does not greatly affect the total number of organisms on the skin, but does tend to increase the proportion of bacteria containing carotenoid pigments.
Fasting plasma triglyceride, plasma cholesterol and high-density lipoprotein (HDL) cholesterol levels were studied for 190 white women, ages 21--39 years, who were classified according to their oral contraceptive (OC) usage patterns at two community surveys, 3 years apart. The mean level of fasting triglyceride was higher among current OC users (95 mg/100 ml) than among nonusers (73 mg/100 ml) (p = 0.002). After adjustment for the possible confounding effects of age, weight, current cigarette smoking and fasting glucose level, current OC users still had a mean plasma triglyceride level 19 mg/100 ml higher than that of nonusers (p = 0.007). Current OC users also appeared to have somewhat higher levels of total cholesterol which were of borderline significance in crude and adjusted analyses. There was a nonsignificant inverse relationship of OC use with HDL cholesterol levels. Past use did not affect these results, indicating that the OC-induced lipid changes were reversible.
To assess both independent and synergistic effects of exposure to asbestos and cigarette smoking on the development of asbestosis, survey data from 4 groups of workers exposed to asbestos were analyzed with multivariate statistical models. Survey methods were standardized and included for the 383 subjects a respiratory symptoms questionnaire, occupational history, physical examination, pulmonary function testing, and a chest radiograph. Exposure to asbestos and cigarette smoking were assessed by questionnaire. Synergism between the 2 exposures was not present for previously identified manifestations of asbestosis including bilateral fine crackles, clubbing, dyspnea, radiographic abnormality, decreased forced vital capacity, and decreased single-breath diffusing capacity of the lung for CO. However, additive, independent effects of these 2 exposures were present for each of these parameters.
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The use of antimicrobial drugs was studied among 933 randomly selected infants and children who were hospitalized in 20 short-stay general hospitals in Pennsylvania. Twenty-two percent of pediatric patients received antimicrobial drugs: 5% of neonates and 57% of patients aged 12 to 18 months. Sixty-eight percent of the 265 antimicrobial courses administered to these children consisted of a penicillin or a penicillin analogue. Ampicillin was the single drug most frequently administered and was given in 32% of all courses. In contrast to the findings in older children, penicillin or penicillin analogues and aminoglycosides were the only antimicrobial drug groups administered to neonataes. Seventy-nine percent of courses were initiated for proved or suspected infections and 17% were initiated to prevent infections associated with surgical or nonsurgical invasive procedures. Cultures were associated with the initiation of 84% of courses among neonates and 39% of courses among children 6 to 9 years of age. This study provides the initial information, from data derived from randomly selected general hospitals, to permit a statement of norms of practice with respect to use of antimicrobial drugs in pediatric populations.
To investigate the efficacy of antibiotic irrigation in preventing catheter-associated urinarytract infection, we carried out a randomized controlled trial of a neomycin-polymyxin irrigant administered through closed urinary catheters. Eighteen of 98 (18 per cent) of the patients not given irrigation became infected, as compared with 14 of 89 (16 per cent) of those given irrigation, yielding a mean daily incidence of 5 per cent in each group. The distribution of organisms and their antibiotic sensitivities differed in the two groups, the organisms from the patients with irrigation being more resistant. Disconnections of the catheter junctions were associated with high rates of infection. The rate of disconnections of the junctions in the group given irrigation was almost twice that of the control group because of the presence of the extra junction on overall infection rate represents the result of two opposing phenomena: the increased entry of organisms and the suppression of a portion of them.
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There is a positive association between cigarette smoking and coronary heart-disease (C.H.D.). In non-fatal myocardial infarction a dose-response relation persists even after the effects of additional variables have been controlled for. The relation between cigarette consumption and deaths from C.H.D. was investigated in a matched-pair case/control study. The overall simple matched-pair risk ratio (R.R.) between current smokers and non-smokers was 1.9 (95% confidence limits 1.5-2.4). For smokers of fewer than 20 cigarettes per day, the R.R. was 1.2; at a level of 21-40 cigarettes per day, the R.R. was 2.3; and for smokers of 41+ cigarettes per day, the R.R. was 4.0. A similar relation was found after adjustment for additional variables. These results suggest that the heaviest smokers could halve their risk of death from C.H.D. by reducing their tobacco consumption to an intermediate level; and that benefit of a similar order would be experienced by smokers of 21-40 cigarettes per day who cut down to less than one pack (20 cigarettes) daily.
A study group of originally 623 employed women of Northwestern Switzerland who were aged 30 to 49 yr and showing objective evidence of intake of phenacetin-containing analgesics, and a control group of 621 comparable women showing no such intake, were examined in 1968 and followed-up five times from 1969 to 1975 for laboratory evidence of urorenal disorders. Mortality was higher in the study group, with 21 deaths, compared to the control group, with 5 deaths, and was higher than expected in a comparative population in Switzerland (P less than or equal to 0.05). In both study and control groups, morbidity was low. There was no difference between the study and control groups with respect to subsequent proteinuria and hematuria. The seven-year incidence of low urine specific gravity after overnight thirsting was higher in the study group than in the control group (2.9% vs. 1.0%), and the incidence of raised serum creatinine was also significantly higher in the study group (2.9% vs. 0%). However, when the study group was further subdivided into a subgroup showing evidence of high intake of phenacetin-containing analgesics and one showing low-intake, only the high-intake subgroup had an incidence of raised serum creatinine concentrations (5.3%), significantly higher than the control group (0%), whereas the low-intake subgroup had an incidence (0.4%) similar to the control group. Also the high-intake subgroup showed significantly higher rates of bacteriuria than the controls (P less than or equal to 0.004).
The familial aggregation of chronic bronchitis and obstructive airways disease was investigated in a propositus population of 430 persons aged 45-54 years and 1340 of their first (1 degree), second (2degrees) and third (3 degrees ) order relatives. All subjects were screened in their homes using a modified British MRC respiratory disease questionnaire and a portable spirometer. 1 degree relatives of propositi with either chronic bronchitis or obstructive airways disease demonstrated up to a two-fold excess prevalence of chronic bronchitis when compared to 1 degree relatives of non-affected propositi. This excess prevalence of chronic bronchitis was independent of sex, cigarette smoking patterns, respiratory illness history, residence in a common household, geographical distribution within the study community and the presence of alpha1-antitrypsin Pi variants. The prevalence of chronic bronchitis in 1 degree relatives of diseased propositi was also greater than in 2 degrees relatives of diseased propositi, in whom the prevalence approximated that of the general population.
Two methods of analysis of matched pair epidemiologic studies are presented. The within pair difference between study and comparison individuals is evaluated with respect to additional confounding variables while simultaneously maintaining the matching. The effects of additional confounding variables are quantiated by their association with the response variable (i.e. exposure in a case-control study or disease in a cohort study). For a binary response variable a multiple logistic function is used and a method to estimate the odds ratio is given. For a continous response variable multiple regression is used and a method to estimate an odds ratio function is derived.
Titers of mycoplasmacidal antibody to the human genital mycoplasmas Ureaplasma urealyticum and Mycoplasma hominis were determined using genital isolates from pregnant patients as antigens and comparing these isolates with the 11 prototypic reference strains for U. urealyticum and the seven reference strains for M. hominis. Virtually all titers that were detected with use of the patient's own isolates were detected by the 11 reference strains of U. urealyticum and by the seven reference strains of M. hominis. Serologic surveys of pregnant women who harbored either or both mycoplasmas in vaginal cultures indicated that antibody to M. hominis was found more commonly than antibody to U. urealyticum. It was demonstrated that significant postpartum rises in titers of antibody to M. hominis were correlated with the presence of these mycoplasmas in genital cultures. Postpartum rises in titer of antibody were particularly likely to occur in women with low titers of mycoplasmacidal antibody in serum at the time of delivery. Approximately 88% of the women who were colonized with M. hominis showed significant changes in titer of antibody to M. hominis throughout an apparently normal pregnancy; only 40% of the women who were colonized with U. urealyticum showed such changes in titers to U. urealyticum. Statistical analysis showed that mean log titers of antibody to both mycoplasmas at the first prenatal visit were significantly associated with the number of pregnancies experienced by these women.
A survey for bacteriuria was conducted in a community-wide, unselected population of women 16--69 years old. The overall prevalence of bacteriuria was 3.5%. The prevalence of bacteriuria increased with age with a linear trend, but with a significant nonlinear component as well. Bacteriuria was associated with parity after correction for the effects of age. Current symptoms of dysuria and a history of previous urinary tract infection were slightly but significantly more common in women with bacteriuria. The population described should serve as an adequate base for continuing studies of the possible consequences of bacteriuria.
Of 377 men attending clinics for the treatment of sexually transmitted disease, 104 had gonococcal urethritis, 72 had definite nongonococcal urethritis, 53 had possible nongonococcal urethritis, and 123 had no urethritis. A purulent urethral discharge was noted in 78% and 14% of patients with gonococcal urethritis and definite nongonococcal urethritis, respectively (P less than 0.001). In contrast, 4% and 64% of men with gonococcal urethritis and definite nongonococcal urethritis, respectively, had a clear urethral discharge (P less than 0.001). Black men with urethritis were more likely to have gonococcal infection, whereas white men were more likely to have nongonococcal urethritis. Homosexual and bisexual white men with urethritis were more likely to have gonorrhea, whereas heterosexual white men with urethritis were more likely to have nongonococcal urethritis. Heterosexual men were more likely than homosexual men to be colonized with Ureaplasma urealyticum. There were no differences in the rates of colonization with Mycoplasma hominis among heterosexual and homosexual men.
For a series of 568 married white men who died from coronary heart disease (CHD) and an equal number of matched controls, information was collected on a large number of variables, including daily alcohol consumption. The crude matched pair ratio estimate for any versus no daily drinking was 0.6 (95% confidence limits 0.4 to 0.7). After controlling for additional confounding variables the risk ratio for any versus no daily alcohol consumption was 0.6 (0.5--0.8). This preventive effect was restricted to light drinkers, defined as those who drank less than or equal to 59.2 ml (2 oz) of alcohol daily. These data provide strong evidence against a causal role of daily alcohol consumption in fatal CHD and are consistent with a small preventive effect of any versus no daily drinking which is attributable only to light but not heavy drinkers.
We have investigated prospectively the efficacy of two nonpharmacologic relaxation techniques in the therapy of anxiety. A simple, meditational relaxation technique (MT) that elicits the changes of decreased sympathetic nervous system activity was compared to a self-hypnosis technique (HT) in which relaxation, with or without altered perceptions, was suggested. 32 patients with anxiety neurosis were divided into 2 groups on the basis of their responsivity to hypnosis: moderate-high and low responsivity. The MT or HT was then randomly assigned separately to each member of the two responsivity groups. Thus, 4 treatment groups were studied: moderate-high responsivity MT; low responsivity MT; moderate-high responsivity HT; and low responsivity HT. The low responsivity HT group, by definition largely incapable of achieving the altered perceptions essential to hypnosis, was designed as the control group. Patients were instructed to practice the assigned technique daily for 8 weeks. Change in anxiety was determined by three types of evaluation: psychiatric assessment; physiologic testing; and self-assessment. There was essentially no difference between the two techniques in therapeutic efficacy according to these evaluations. Psychiatric assessment revealed overall improvement in 34% of the patients and the self-rating assessment indicated improvement in 63% of the population. Patients who had moderate-high hypnotic responsivity, independent of the technique used, significantly improved on psychiatric assessment (p = 0.05) and decreased average systolic blood pressure from 126.1 to 122.5 mm Hg over the 8-week period (p = 0.048). The responsivity scores at the higher end of the hypnotic responsivity spectrum were proportionately correlated to greater decreases in systolic blood pressure (p = 0.075) and to improvement by psychiatric assessment (p = 0.003). There was, however, no consistent relation between hypnotic responsivity and the other assessments made, such as diastolic blood pressure, oxygen consumption, heart rate and the self-rating questionnaires. The meditational and self-hypnosis techniques employed in this investigation are simple to use and effective in the therapy of anxiety.
Information was collected for a large number of coronary risk factors on a series of 568 married, white men, aged 30--70 years, who died from coronary heart disease. Information on the same risk factors was collected on an equal number of living controls matched on age, sex, marital status and neighborhood. For regular aspirin users (i.e. greater than or equal to 4 days per week) compared with non-users, the crude matched pair risk ratio estimate was 1.0 (95% confidence limits 0.9--1.1). Even after controlling for possible confounding effects of other variables using a paired multiple logistic regression analysis, there was no evidence of association. These data provide no evidence for a preventive role of regular aspirin intake in coronary deaths.
Previous studies in a population of 721 children aged 2--14 years demonstrated the familial aggregation of blood pressure in children, and a significant regression coefficient (b = 0.25) of follow-up on initial blood pressures over a four-year period. Urinary kallikrein concentration (UKal) also aggregated in families, was lower in black than in white children and was inversely related to blood pressure. Further studies in the same cohort have been conducted. These variables were again measured in 484 children in 129 families seven to eight years after the initial blood pressure and three to four years after the original UKal measurements were made. Familial aggregation again was found for blood pressure and urinary kallikrein. Blood pressure tracking was demonstrated by the finding that blood pressure scores at the third survey were related significantly to those at both previous surveys. Kallikrein concentrations in casual urines at Survey 3 were related to those obtained at Survey 2 (r = 0.499), and were again significantly lower in black than in white children (log = 3.84 +/- 0.8 vs 4.37 +/- 0.7; P less than 0.001). These were significant inverse relations between UKal/creatinine concentration and blood pressure in both white and black children. Thus, familial aggregation of blood pressure, blood pressure rank and concentration of kallikrein in casual urine specimes are relatively stable in children over an eight-year period of observation. This study demonstrates in a free living population of normal children, a stable relation between blood pressure and an enzyme which is involved in the production of potent vasodilator peptides and is related to hypertension in adults.