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Biomedical subjects

D Lieberman

Publications and source records attributed to D Lieberman.

At least 37 records · Page 2Linked to original sources
PubMed1999

Seasonal variation in hospital admissions for community-acquired pneumonia: a 5-year study.

OBJECTIVES: We conducted a retrospective analysis of computerized hospitalization and regional meteorological and geophysical data in a university hospital in southern Israel. The aim of the study was to determine and depict the seasonal variation in hospitalization for community-acquired pneumonia (CAP-H) and the factors affecting it, for all age groups combined and by age group, over a 5-year period. METHODS: All cases of CAP-H over the period from January 1, 1990 to December 31, 1994 were studied by season of the year and age group. The rates of CAP-H for the four seasons were compared by t-tests. Mathematical models based on quasi-Fourier generalized linear models were developed and used to evaluate potential variables and their relative contributions to CAP-H. RESULTS: A total of 4101 CAP-H were analysed in the study. Throughout the study period the prevalence of CAP-H was significantly higher in the winter and spring than in the summer and fall for all age groups combined and within each age group (P<0.00001). When CAP-H was compared between the winter and the spring, we found that in the 0-16 age group CAP-H was higher in the winter (P<.0.00001), in the 17-64 age group it was higher in the spring (P<0.002), and in the 65+ age group as well as for all age groups combined there were no significant differences between these two seasons. The most important factor explaining the variance in CAP-H in the 0-16 age group were direct and indirect effects of minimum daily temperature (31%), in the 17-64 age group direct and indirect effects of the difference between minimum and maximum daily temperatures (19%), and in the 65+ age group it was geophysical factors (13%). CONCLUSIONS: There is a significant seasonal variation in CAP-H with higher rates for all age groups in the winter and spring. The extent to which the prevalence of CAP-H is dominant in the winter and spring seasons differs among the age groups, as does the principal variable explaining these differences. The most important factor is the direct and indirect effects of meteorological variables in the 0-16 and 17-64 age groups, and a geophysical one among the more elderly patients.

Adolescent↗
PubMed1999

Atypical pathogens in community-acquired pneumonia.

The atypical pathogens are an important and significant cause of CAP. The clinical and radiologic manifestations of CAP caused by these pathogens are modulated by the immunologic and physiologic status of the host, and therefore are not pathogen-specific. The range of frequencies found in various studies for the atypical pathogens among the causes of CAP is broad. These frequencies are affected by very important factors that should be recognized. In a significant percentage of patients, an atypical pathogen can be identified together with an additional cause. The significance of multiple causes has not been clarified sufficiently. The principal diagnostic techniques in use today for the causative diagnosis of CAP are serologic tests. Different serologic methods have been used in various studies and diagnostic criteria are not standardized. In the future it is likely that diagnostic testing will be based on the PCR technique on serum samples. The effectiveness and importance of antimicrobial therapy in some patients with atypical pathogen CAP are unclear. The accepted therapy today for atypical pathogen CAP, which is based on erythromycin, will probably be changed in the near future in favor of the new generations of fluoroquinolone or the new macrolide preparations.

Adult↗
PubMed1999

Characterization of elderly patients in rehabilitation: stroke versus hip fracture.

PURPOSE: To compare the characteristics of elderly patients hospitalized for rehabilitation following stroke with those following hip fracture (HF). METHODS: A prospective study in a geriatrics department of a general university hospital in southern Israel. Five hundred and sixteen hospitalized elderly patients were included in the study, 221 following stroke and 295 following HF. The characteristics were compared by univariate and logistic regression analyses. RESULTS: The mean age (+/-SD) of the stroke patients was 71.7+/-7.8 years compared to 77.4+/-7.9 for HF (p < 0.000001). Fifty-three per cent of the stroke patients were women compared to 76% of the HF patients (p < 0.000001). Stroke patients had significantly lower levels of folic acid (p = 0.00002). HF patients had more hearing and visual impairments (p = 0.008 and p = 0.017, respectively), but these were related to age differences between the groups. The Folstein Minimental test result was significantly higher in the HF group (p = 0.002). There were no differences in the symptoms of depression score as measured by geriatric depression screening scale. The Functional Independent Measure scale showed a higher pre-event functional capacity among the stroke patients (p < 0.000001), but there was no difference in this scale on admission to rehabilitation or upon discharge. CONCLUSIONS: There is a difference in the nature of the stroke and HF events. When either event involves an elderly patient with a broad range of limitations and diseases, a new medical condition develops. In this condition the symptoms of depression and the functional state at admission and upon discharge are not significantly different between these groups of patients.

Activities of Daily Living↗
PubMed1999

Neurodevelopmental outcome in children with intrauterine growth retardation: a 3-year follow-up.

The study was designed to detect early clinical predictors of developmental outcome in children with intrauterine growth retardation. Eighty-five children with intrauterine growth retardation were followed up prospectively to 3 years of age, using biometric parameters, perinatal risk questionnaires, and neurodevelopmental evaluations. Forty-two children served as controls. A significant difference in neurodevelopmental score at 3 years of age was noted between the intrauterine growth retardation and control groups (P < .001). In the intrauterine growth retardation group, the clinical parameters that most significantly correlated with outcome were cephalization index (head circumference:birthweight ratio), neonatal risk score, and birthweight. The best predictor of 3-year outcome was the cephalization index (P < .01). The children with intrauterine growth retardation with neonatal complications had significantly lower IQ scores (P < .05) and a poorer neurodevelopmental outcome (P < .01) than those without complications. Children with intrauterine growth retardation are at higher risk for developmental disabilities than are controls, especially in the presence of neonatal complications and a high cephalization index.

Case-Control Studies↗
PubMed1999

Factors affecting the results of the clock drawing test in elderly patients hospitalized for physical rehabilitation.

The Clock Drawing Test (CDT) is a recognized and accepted instrument for the early diagnosis of dementia in the elderly. In a prospective study we evaluated the association between the results of this test and a broad range of clinical, functional and sociodemographic variables. The study was conducted on elderly patients hospitalized for rehabilitation following stroke or hip fracture (HF) in the geriatric ward of a university hospital in southern Israel. The administration of the CDT and its scoring system were adapted from Sunderland et al. and Wolfe-Klein et al. The study was conducted on all 425 elderly patients who were hospitalized during the study period and who were capable of completing the test. Stepwise multiple regression was used to evaluate the association between the results of the CDT and the other variables. The mean CDT score (+/- SD) for the entire study population was 7.8 +/- 2.5 and 145 patients (34%) had scores of 6 or below. Of the 41 variables that were tested, significant associations with the CDT were found for the following four variables only: the Folstein minimental test (beta = 0.447, p < 0.0001), the cognition value from the admission FIM (beta = 0.252, p < 0.0001), years of education (beta = 0.183, p = 0.0001), and the patient's age (beta = -0.075, p = 0.037). The total variance of the CDT explained by these four variables (Adjusted R2) was 0.554. We conclude that in the study population there was a significant proportion of patients with low CDT scores. This score, in this population, is influenced in particular by two other measures of cognitive function and by the formal level of education, together with a weaker effect of age.

Aged↗
PubMed1999

Legal issues in the reproductive health care of adolescents.

There is significant evidence that both physicians and adolescents are uninformed of adolescents' legal rights to confidential reproductive health care. When young people are aware of their right to confidentiality and assured that physicians will respect that right, they are more likely to seek care. Restricting adolescent reproductive health care places added stress on young women, delays treatment, and may even lead young women to resort to dangerous alternatives. The legal framework governing minors' ability to obtain confidential health services is key. This paper will identify recent threats to adolescent reproductive health care, analyze informed consent and confidentiality in the context of adolescent care, review minors' constitutional rights, and review the legal framework governing adolescent care in New York State as one example.

Adolescent↗
PubMed1999

Disease-specific outcomes assessment for gastroesophageal reflux disease.

Endoscopy is commonly performed to evaluate patients with symptoms of gastroesophageal reflux disease (GERD). This review focuses on outcomes related to endoscopy in GERD. There is clear evidence that patients with GERD who have dysphagia are likely to benefit from endoscopy. In the vast majority of patients without dysphagia, the benefits of endoscopy are less certain and require further study.

Endoscopy, Digestive System↗
PubMed1998

[Cyclic vomiting syndrome in children].

Cyclic vomiting syndrome in children is a manifestation of various etiologies, including gastroenterological and renal disorders, central and autonomic nervous system abnormalities, as well as metabolic and endocrine dysfunction. Frequently no organic cause is found. Personality profiles of children with cyclic vomiting reveal perfectionism, competitiveness, and aggressive behavior. Vomiting attacks have been induced by anxiety and excitement in patients with cyclic vomiting. We describe an 8-year-old girl with cyclic vomiting, frequently associated with occipital headaches, photophobia or dizziness. Psychiatric evaluation indicated a generalized anxiety disorder.

Anxiety Disorders↗
PubMed1998

Etiology of respiratory tract infection in adults in a general practice setting.

A prospective study was conducted over a 3-month winter period in three general practice clinics in an urban population in southern Israel to identify the etiological agents of respiratory tract infections (RTI) in adults. RTI was defined as an acute febrile illness with cough, coryza, sore throat or hoarseness. Serum samples were taken from all patients in both the acute and convalescent phases of their illness. Tests were conducted for detection of 17 microorganisms known to cause RTI, including serological tests for 16 known pathogens. An etiological diagnosis was established in 80 (66%) of the 122 patients who participated in the study. The distribution of the etiological agents was as follows: influenza B virus in 27 (22%) patients. Chlamydia pneumoniae in 22 (18%), Legionella spp. in 15 (12%), Mycoplasma pneumoniae in 13 (11%), influenza A virus in 11 (9%), Bordetella pertussis in 9 (7%), adenovirus in 4, Epstein Barr virus in 4, Haemophilus influenzae in 3, beta-hemolytic streptococci in 3, Streptococcus pneumoniae in 2, respiratory syncytial virus in 2, parainfluenza 1 virus in 2 and parainfluenza 2 virus in 1. No patients were found to be infected with Coxiella burnetii, Moraxella catarrhalis or parainfluenza 3 virus. More than one pathogen was identified in 27 (34%) patients in whom an etiological diagnosis was established. It is concluded that RTI is caused by a broad spectrum of etiological agents, a considerable number of patients having evidence of infection with more than one pathogen. The therapeutic significance of these findings should be elucidated in further studies.

Adult↗
PubMed1998

Colonoscopy as a mass screening tool.

There is strong evidence that population screening can reduce mortality from colorectal cancer. Screening tests such as faecal occult blood test and flexible sigmoidoscopy are used to identify patients with an increased risk of cancer who would benefit from a full colon examination. There is indirect evidence that colonoscopy may be effective as a mass screening tool. Potential benefits of colonoscopy include the ability to visualize the entire colon and to detect and remove polyps, which could prevent cancers, and identify cancers if present anywhere in the colon. Issues related to the implementation of a colonoscopy screening programme are discussed.

Colonoscopy↗
PubMed1998

How to screen for colon cancer.

The biology of colorectal cancer provides a unique opportunity for early detection and prevention. There is now evidence that screening of asymptomatic average-risk individuals over 50 years of age can reduce mortality resulting from colorectal cancer. New recommendations from the US Preventive Services Task Force endorse screening with fecal occult blood tests or sigmoidoscopy. The best method for population screening remains uncertain. The cost of screening is an important issue in the development of public policy. This review discusses the various screening options, examines the "downstream" effects of screening, and reviews the anticipated costs and effectiveness. Ultimately, the effectiveness of any screening program depends on patient compliance. Further research is needed to determine the best methods of enhancing patient adherence to a screening program.

Age Factors↗
PubMed1997

Pneumococcal community-acquired pneumonia in 148 hospitalized adult patients.

In a previous prospective study, Streptococcus pneumoniae was identified as the causative agent in 148 (42.8%) of 346 adult patients hospitalized over the course of one year with community-acquired pneumonia (CAP) in the Soroka Medical Center, Beer-Sheva, Israel. The present study characterizes those cases in which Streptococcus pneumoniae was the only pathogen and those in which additional etiological agents were identified. Pneumococcal CAP was diagnosed by standard blood cultures or positive serological tests by one of two laboratory methods. In 100 (67.6%) patients, at least one other etiological agent of CAP was identified in addition to Streptococcus pneumoniae. Compared with patients who were not infected by Streptococcus pneumoniae, patients with Streptococcus pneumoniae CAP were older and had a higher rate of comorbidity (39.5% vs. 29.8%). Streptococcus pneumoniae CAP had a more severe clinical course and a higher mortality rate, especially when Streptococcus pneumoniae was the only pathogen. Community-acquired pneumonia due to Streptococcus pneumoniae only was more similar in its clinical manifestations to classic typical pneumococcal pneumonia. When an additional etiological agent was identified, the clinical characteristics could not be distinguished from those of atypical pneumonia. It is concluded that Streptococcus pneumoniae remains the principal cause of CAP in this region. The frequency of additional etiological agents of CAP and the difficulty in differentiating clinically between cases due to Streptococcus pneumoniae only and those due to Streptococcus pneumoniae plus other organisms necessitates initial empirical treatment that covers Streptococcus pneumoniae as well as other causative agents of atypical pneumonia.

APACHE↗
PubMed1997

The epidemiology of community-acquired pneumonia among hospitalized adults.

OBJECTIVE: To identify and characterize the aetiological agents of community-acquired pneumonia (CAP) among hospitalized patients, as an aid in therapeutic decision-making. METHOD: A prospective 1 year study of all patients hospitalized with CAP in the Negev region of Israel. The aetiology was determined by blood and pleural fluid cultures, and specific serological testing for pathogenic agents. Eighty-nine percent of the patients underwent follow-up for a month after discharge. RESULTS: The study included 346 patients (53% males, mean age 49.3 +/- 19.5, range 17-94). A single aetiologic agent was identified in 146 patients (42.2%), multiple agents were found in 133 (38.4%), and no agent was identified in 67 (19.4%). Among the common pathogens were Pneumococcus sp. in 148 patients (42.8%). Mycoplasma pneumoniae (101, 29.2%), Chlamydia pneumoniae (62, 17.9%), Legionella sp. (56, 16.2%), viruses (35, 10.1%), Coxiella burnetti (20, 5.8%). Haemophilus influenzae (19, 5.5%), and other bacteria (21, 6.1%). Approximately 70% of the patients infected with M. pneumoniae and C. burnetti were younger than 45 years (P < 0.05). In contrast, about 50% of the patients with C. pneumoniae (TWAR) were over the age of 65 (P = 0.03). The presence of comorbidity was associated with a greater frequency of bacterial aetiologies (57% vs. 44%, P = 0.02), and fewer infections with M. pneumoniae (15% vs. 36%, P = 0.0004), or C. burnetii (2% vs. 8%, P = 0.02). Specific causative agents were associated with specific seasons: viruses between December and April (P = 0.03), and Legionella sp. from July to October (P = 0.003). In contrast, no seasonal variation was associated with pneumococcus, M. pneumoniae, or C. pneumoniae (TWAR). CONCLUSIONS: Patients are hospitalized with CAP throughout the year. Since the pathogen is usually unknown at hospitalization, epidemiological data is important for choosing medication. The findings of this study point to the importance of macrolides alone or in combination with cephalosporins, as the treatment of choice for patients in our region.

Adolescent↗
PubMed1997

Endoscopic screening for colorectal cancer.

There is strong evidence that colon screening of asymptomatic, average-risk subjects can reduce colorectal cancer mortality. Endoscopic screening with sigmoidoscopy can reduce mortality associated with left-sided cancers due to the discovery of early curable cancers and the detection removal of premalignant adenomas. Screening with colonoscopy is widely accepted for high-risk groups and would likely be effective for the screening of average-risk subjects.

Colonoscopy↗
PubMed1997

Community-acquired pneumonia in old age: a prospective study of 91 patients admitted from home.

OBJECTIVE: to characterize the background, aetiology, clinical course and outcome of community-acquired pneumonia (CAP) in elderly compared with younger patients. DESIGN: a 1 year prospective study. SETTING: a university hospital in southern Israel. PARTICIPANTS: ninety-one patients over 65 years who were hospitalized from their homes with CAP. These patients were compared with a reference group of 54 CAP patients, aged 55-64 years. MEASUREMENTS: an intensive work-up (primarily serological) to identify the aetiological causes of CAP. The age groups were compared in terms of variables related to CAP. RESULTS: the proportion with pneumococcal infection, the most common aetiology for CAP, increased from 29.6% in the 55-64-year group through 45.6% in the 65-74-year group; up to 57.8% in the 75+ group (P = 0.019). Chlamydia pneumoniae was identified as the aetiological agent in 26.4% of elderly patients. Mortality in patients > or = 75 years was 20% and was significantly higher than in the two younger age groups (P = 0.019). The leucocyte count was significantly higher among the elderly group (P = 0.013) and the serum urea concentration was higher in patients 75 years and older (P = 0.025). The proportion of patients treated with antibiotics before admission decreased with increasing age (P = 0.026). CONCLUSIONS: CAP has more serious clinical and abnormal laboratory features in the elderly than younger patients, particularly in those over 75. In independent elderly people, the pneumococcus is the most common causative agent for CAP but other agents, particularly C. pneumoniae, are common. Initial antibiotic treatment for these patients should therefore include a macrolide.

Aged↗
PubMed1997

Atypical pathogen pneumonia.

The term atypical pathogens has been applied in recent years to Chlamydia pneumoniae, Mycoplasma pneumoniae, and the various species of Legionella. The incidence of pneumonia caused by these pathogens has increased with the development of specific diagnostic techniques. Atypical pathogen community-acquired pneumonia demonstrates a broad spectrum of severity from a mild disease not requiring hospitalization to adult respiratory distress syndrome necessitating mechanical ventilation. The clinical, radiological, and laboratory manifestations of the disease are similar to those of community-acquired pneumonia caused by other pathogens, and reliable etiological differentiation cannot be based on these factors alone. The possibility of shortening treatment time, at least in some patients, by antibiotic therapy with the new macrolides has been added to standard therapeutic regimens with erythromycin, tetracyclines, or quinolones.

Chlamydia Infections↗