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Biomedical subjects

E Baum

Publications and source records attributed to E Baum.

At least 37 records · Page 2Linked to original sources
PubMed1998

Family practitioners' remuneration and patterns of care--does social class matter?

The objective of the study is to examine whether medical care patterns and/or outcomes for patients under a prepaid system differ from those under fee-for-service according to social class. An effect of this kind was suggested by the investigators reporting on the RAND Health Insurance Experiment (RAND HIE). We performed a cross-sectional study in family practice in Germany (fee-for-service) and the UK (predominantly capitation i.e. prospective payment). 778 attending patients aged 18 and above were included. Indicators of care, relating mainly to cardiovascular prevention, were collected by patient interview and questionnaire, doctor's questionnaire, analysis of records, and blood pressure (BP) measurement. Multiple linear and logistic regression models with these indicators as dependent variables were calculated to examine possible interactions between social class and system of payment. Social class as a main effect was related to diastolic BP, BP measurement frequency, and the number of non-pharmacological interventions to lower BP. The data on the process and the outcome of primary care from British and German family practice do not show any significant interaction between system of family practitioners' remuneration and patients' social class. We were unable to reproduce the effect postulated by the RAND HIE investigators.

Adolescent↗
PubMed1996

Family practitioners' intervention against smoking in Germany and the UK: does remuneration affect preventive activity?

The effect of different systems of remuneration on preventive activity of family practitioners (FPs) were studied. Interventions against smoking were compared in FPs' practices in Germany and the UK. Almost 800 consecutively attending patients were included in a cross-sectional survey. Smoking prevalence was remarkably similar among German and British practice attenders. Slightly more than 50% of smokers in both countries remembered an intervention against their smoking by their FP or related staff. Multiple logistic regression analysis also showed that there was no significant difference for remembered interventions between the two countries (adjusted OR 1.15 [95%-Cl 0.6, 2.2]). The structure of interventions employed was similar in both countries. Most British and German ex-smokers denied that their FP had made an important contribution to their giving up smoking. There is evidence that, under capitation, FPs concentrate their activities on patients who are more at risk. Overall, however, the economic structure does not seem to influence the core of preventive behaviour of FPs to any great extent. Smoking cessation efforts in Family Practice need to be improved in both countries.

Cross-Sectional Studies↗
PubMed1994

Treatment of overt isolated testicular relapse in children on therapy for acute lymphoblastic leukemia. A report from the Childrens Cancer Group.

BACKGROUND: Fifty-seven children with acute lymphoblastic leukemia (ALL) receiving therapy who experienced overt isolated testicular relapse while in bone marrow remission were entered into a study that featured an intensive retreatment regimen. METHODS: The objective was to determine whether a change in chemotherapy and local irradiation would prevent subsequent marrow relapse and increase the survival rate. The regimens used (modified Berlin-Frankfurt-Munster or modified New York) delivered acceptable therapy based on analyses of toxicity data. RESULTS: Overall survival at 5 years from the time of testicular relapse was 47%, with an event-free survival of 43%. Events have been documented in 28 of 55 evaluable children. Analysis of these patients revealed that 23 children had bone marrow relapse, 4 children had central nervous system relapse, and 1 child had testicular relapse. In addition, two patients were removed from the study for toxicity, one child for infection (mucormycosis), and five children had a bone marrow transplantation while in remission and became ineligible to continue in the study. Two children were removed at the request of their parents, and nine children were lost to follow-up. CONCLUSION: Because of their high risk of developing systemic relapse, boys with ALL who experience isolated overt testicular relapse during active therapy should be retreated with intensive treatment.

Adolescent↗
PubMed1994

Hypotension--does it make sense in family practice?

In general practice many diagnostic labels are used that are related to cultural background rather than a scientific basis. To estimate the use of diagnoses like 'hypotension' and depression, a cross-sectional survey in German and British GPs' surgeries was performed. Prevalence of related symptoms, sociodemographic and medical data were recorded as well as actual and previous blood pressure levels. In German general practice, where 'hypotension' is an established entity, 17% of all patients attending were reported as hypotensive either by their doctor or by themselves. The proportion was twice as high among women than among men. It was more common among the young. One-quarter of these patients were on medication to raise their blood pressure. Actual and previous blood pressure levels failed to explain the occurrence of symptoms like tiredness, dizziness, headache etc. Demographic characteristics of patients diagnosed as depressed were similar in both countries. Presumably for economic reasons there is a tendency for German GPs to use more diagnostic labels of any kind. It was concluded that diagnostic labels attached to vague but frequently presented symptoms vary considerably between countries. They often lack a physiologic rationale. Nevertheless they often support the tendency to somatize common problems.

Adolescent↗
PubMed1992

Determination of the maximum tolerated dose of idarubicin when used in a combination chemotherapy program of reinduction of childhood ALL at first marrow relapse and a preliminary assessment of toxicity compared to that of daunorubicin: a report from the Childrens Cancer Study Group.

An escalating-dose trial of idarubicin, used weekly for 3 doses in combination with vincristine, prednisone, and L-asparaginase (VPLI), to reinduce remission of childhood ALL at first bone marrow relapse was conducted by the Childrens Cancer Study Group (CCSG). The maximum tolerated dose (MTD) of idarubicin, used in the manner, was determined to be 12.5 mg/m2/dose. Twelve of 16 (75%) evaluable patients in first marrow relapse of ALL treated at a dose of 10 or 12.5 mg/m2 entered a second complete remission, compared to 41 of 69 evaluable patients (59%) treated in a comparable way with daunorubicin (30 mg/m2) (VPLD). Prolonged myelosuppression was observed in both groups, but the frequency of documented bacterial sepsis and the duration of required hospitalization were greater among patients treated with idarubicin. No additional toxicity, specifically attributable to idarubicin, was observed at these doses.

Adolescent↗
PubMed1992

13C NMR studies of glucose metabolism in human leukemic CEM-C7 and CEM-C1 cells.

Glucose metabolism of human leukemic cell lines CEM-C7 and CEM-C1 was investigated in vivo by 13C NMR using 13C-labeled glucose. Exact knowledge of glucose concentration, cell count, and cell viability of the cell suspensions made it possible to analyze glucose metabolism in detail. In both cell lines aerobic glycolysis accounts for virtually all glucose consumption. The use of D-[13C2]glucose provided a simple method to measure the glucose flux through the pentose phosphate pathway as 9% (CEM-C1) and 11% (CEM-C7) of glucose channeled into glycolysis. The dexamethasone-sensitive CEM-C7 cells consume glucose at a rate about 50% higher than the dexamethasone-resistant CEM-C1 cells. It is shown that this higher consumption correlates with a larger size of the CEM-C7 cells. Therefore in CEM cells the development of drug resistance does not seem to involve related changes in cell energetics.

Carbon Isotopes↗
PubMed1990

31P nuclear magnetic resonance studies of growth inhibition and dexamethasone resistance in human leukemic cells.

31P Nuclear magnetic resonance spectra of perchloric acid extracts from wild-type human leukemic CEM-C7 cells and the dexamethasone-resistant CEM-C1 mutant reveal significant differences in concentrations of phospholipid precursors and ATP+, which indicate metabolic differences between these two cell lines. At high cell concentrations the CEM-C7 cells are growth inhibited, which is reflected by low phospholipid precursor levels, indicative of low phospholipid turnover. The CEM-C1 mutant does not exhibit this growth inhibition and has constant phospholipid precursor levels over the same cell concentration range. Dexamethasone causes phospholipid precursor and ATP levels in CEM-C7 to drop after 48 h, but spectra obtained for CEM-C1 cells continue to show high cell viability up to 72 h.

Adenosine Triphosphate↗
PubMed1990

[Psychosocial effects of the onset of menopause and physical symptoms in early postmenopause].

57 women were studied who were GMP patients, whose spontaneous menopause had occurred 6 to 36 months ago and who did not take any sexual hormones. Purpose of the study was to determine psychosocial influences on the time of onset of the menopause and on climacteric complaints. It was found that the overall impairment by hot flushes and pain in the limbs during this phase of life was largely independent of the studied parameters. With regard to the time of onset of the menopause there was a trend to an linear relationship between the factor "social dependence" and the age at which menopause occurred, as well as a link between that age and period intervals 5 years before cessation of menstrual bleeding. An enhanced tendency to exhaustion representing a nonspecific menopause syndrome was found particularly often in women who were highly "socially dependent". There was no relationship between climacteric complaints on the one hand and, on the other hand, experiences of loss, social stress and relief factors, partnership relations, experiences of menarche, menstruation and menopause as well as basic feeling tone; however, a depressive tone, as defined by the Giessen test, was clearly predominant in the examined population. It is concluded from these results that flushes in the early postmenopausal phase are mostly a biological phenomenon, whereas vegetative concomitant complaints are markedly dependent on psychosocial factors that correspond to a typically "feminine" role enactment as postulated by social convention.

Adaptation, Psychological↗
PubMed1988

Chemotherapy-related toxicity in infants treated according to the Second National Wilms' Tumor Study.

Babies under 12 months of age have been included in the National Wilms' Tumor Study (NWTS) series of clinical trials. Undue chemotherapy-related toxicity was encountered early during the course of the second NWTS. The prescribed doses of actinomycin D (AMD), vincristine (VCR), and Adriamycin ([ADR] doxorubicin; Adria Laboratories, Columbus, OH) were therefore halved. The frequency of severe hematologic toxic episodes was reduced (30 of 64 or 47% for babies receiving full doses [FD], and six of 48 or 13% for those given reduced doses [RD]). Similar reductions in pulmonary and hepatic effects were noted, and treatment-related deaths were reduced from 6% to 0 for the FD and RD samples, respectively. These frequencies among RD babies were similar to those encountered in 530 older children administered FD. Reduction of dose did not compromise therapeutic effectiveness.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

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Journal Article↗
PubMed1987

A randomized study comparing high-dose methotrexate with moderate-dose methotrexate as components of adjuvant chemotherapy in childhood nonmetastatic osteosarcoma: a report from the Childrens Cancer Study Group.

Methotrexate (MTX) has demonstrated significant activity against relapsed and metastatic osteosarcoma. However, there is little published data to indicate the appropriate dose for MTX when given as a component of a multidrug regimen for the treatment of osteosarcoma. Therefore, the investigators at the Childrens Cancer Study Group undertook a randomized clinical trial that compared Adriamycin and vincristine given with either high-dose methotrexate or moderate-dose methotrexate as postoperation chemotherapy in the treatment of childhood osteosarcoma. We report here the results for 166 patients with completely resected nonmetastatic disease of an extremity. The two therapies demonstrated equivalent disease-free survival (DFS). Further, no therapy prejudices survival after relapse. Approximately 38% of patients remain disease free 4 years after diagnosis. Two relapses occurred in patients free of disease at least 36 months after initiation of treatment. Some factors found by other investigators to be prognostic of poorer DFS, namely, male sex, primary tumor in the humerus or femur, and larger primary tumors, demonstrated similar though not statistically significant trends. The presence of spontaneous necrosis in the tumor sample from the definitive surgery was associated with poor prognosis for DFS. We postulate that this feature represents rapidly growing tumors with increased potential for metastases.

Adolescent↗
PubMed1985

Second malignant neoplasms in children: an update from the Late Effects Study Group.

This paper presents an update from the Late Effects Study Group on 292 cases of second malignant neoplasms (SMN) occurring in individuals who were diagnosed with their first neoplasm in childhood. Data are presented regarding the types of first and second neoplasm, the therapy administered, and the predisposing factors. Of the 292 cases (308 SMN), the most common primary was retinoblastoma followed by Hodgkin's disease, soft-tissue sarcomas, and Wilms' tumor. This is not similar to the relative frequency of these cancers in children but rather reflects specific risk factors. Bone sarcomas were the most common SMN among the 208 SMN developing in previously irradiated sites while acute leukemia was the most common SMN unassociated with radiation. Known predisposing conditions to cancer were present in 73 cases; retinoblastoma was the most common of these, followed by neurofibromatosis. There were ten patients with three and three patients with four malignant neoplasms. In 14 patients, the cause of SMN was not suggested by known risk factors as these patients had negative family histories and received no radiation or chemotherapy. We note, therefore, that although most cases of SMN in survivors of childhood cancer can be attributed to radiation, genetic disease, chemotherapy, or combinations of these, unrecognized predisposition or chance may also play a role.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Treatment of patients with metastatic osteogenic sarcoma: a report from the Children's Cancer Study Group.

Fifty-three patients with metastatic osteogenic sarcoma were treated with vincristine, high-dose methotrexate with citrovorum factor rescue, and cisplatin. Metastases were surgically removed in most patients, either prior to chemotherapy or following initial response to therapy. Among 29 previously treated patients, responses to initial chemotherapy included two complete remissions, six partial remissions, and eight patients with stable disease. Twenty-three patients were disease-free, six for greater than 12 months. Toxicity was moderate, but usually reversible. There were two toxic deaths and one unexplained death 48 hours following a dose of cisplatin.

Adolescent↗