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Biomedical subjects

E R Brown

Publications and source records attributed to E R Brown.

At least 91 records · Page 5Linked to original sources
PubMed1988

Detection of abnormal cervical smears. A comparative study.

The inefficiency of the Ayres Spatula in detecting abnormality in cervical cytology has been demonstrated recently in a number of trials. In a randomized single-blind trial we have compared the Multispatula with the Ayres Spatula in a group of 158 women who previously had abnormal smears and had been referred to colposcopy clinics in the Lewisham and North Southwark Health Authority of London. The quality of the smears, as assessed by the presence or absence of endocervical cells, revealed that the Multispatula (87.3% pick-up) produced significantly better smears (p less than 0.005) compared with the Ayres Spatula (54.4% pick-up). In 149 smears collected with the Multispatula, atypia was confirmed. However, in only 129 smears taken with the Ayres Spatula were abnormal smears detected (p decreases less than 0.005). We concluded that the Multispatula produces a better quality smear which results in a decreased false negative rate in comparison with the Ayres Spatula.

Clinical Trials as Topic↗
PubMed1988

Maternal toxemia and neonatal germinal matrix hemorrhage in intubated infants less than 1751 g.

Two hundred seventy-two intubated infants who weighed less than 1751 g were enrolled in a clinical trial of phenobarbital prophylaxis of postnatal germinal matrix hemorrhage. The incidence of germinal matrix hemorrhage was 3.1% (one of 32) among infants born to women with toxemia, and 23% (55 of 240) among those born to women without toxemia. The apparent protective effect of toxemia could not be explained by intrauterine growth retardation, mode of delivery, or maternal receipt of any medication. Infants born to toxemic women were less likely than their peers to develop pneumothorax, become acidotic, and to require extensive respiratory assistance. This apparently protective effect of maternal toxemia was not seen in infants born to nontoxemic, hypertensive women. Thus, maternal toxemia, but not hypertension, might reduce the risk of germinal matrix hemorrhage by reducing the occurrence and/or severity of pulmonary and related problems that place infants at high risk of germinal matrix hemorrhage.

Cerebral Hemorrhage↗
PubMed1988

Arterial blood gas derangements associated with death and intracranial hemorrhage in premature babies.

We evaluated to what extent acidosis and alkalosis and their respiratory and metabolic components during the first 12 hours of life occurred prior to early neonatal death and postnatal intracranial hemorrhage among 206 low birth weight, intubated premature babies participating in a clinical trial of phenobarbital prophylaxis for intracranial hemorrhage. Time-weighted indices included the time each baby spent with abnormal values of pH, PaCO2 and HCO3-. Babies whose birth weight was less than 1 kg suffered adversities associated with prolonged pH less than 7.35. Heavier birth weight babies were at increased risk of adversity if their pH fell below 7.2. Babies who were not severely acidotic initially, but became so within hours, were at prominently increased risk of death and hemorrhage. Babies who had a mild increase of PaCO2 between 45 and 60 mmHg were less likely to develop germinal matrix hemorrhage than their peers who had more severe hypercapnia. A time-weighted measure of metabolic deficit correlated with death, but not with hemorrhage. Prolonged exposure to pH greater than 7.55 was associated with reduced risk of subependymal/intraventricular hemorrhage and death, especially in babies below 1 kg birth weight. We conclude that acidosis is an antecedent of intracranial hemorrhage in low birth weight premature babies, that duration of exposure might convey important risk information, and that birth weight is a correlate of vulnerability to some pH disturbances.

Acidosis↗
PubMed1988

Principles for a national health program: a framework for analysis and development.

Growing gaps in health insurance coverage have generated increased interest in enactment of major reforms. A framework for evaluating proposals embodying different approaches to a national health program is offered, highlighting seven dimensions: inclusiveness of coverage; comprehensiveness of benefits; financing methods; efficiency of resource utilization; extent of planning and market forces in resource allocation; accountability to beneficiaries; and political feasibility. Four health care reform bills in the Congress are shown either to emphasize political feasibility at the expense or universal coverage and comprehensive benefits, or to stress coverage, benefits, and system reform at the cost of such feasibility.

Financing, Organized↗
PubMed1988

Workplace smoking policies: attitudes of union members in a high-risk industry.

We surveyed members of a medium-size national union representing workers in high-risk industries to assess workers' support for union and company programs to help smokers break the habit and policies that restrict smoking. Two surveys were conducted that involved 690 respondents in 1984 and 593 respondents in 1985. Respondents overwhelmingly (82%) favored restrictions on smoking in the workplace but less than half agreed that companies or unions should be concerned about workers smoking off the job. For both smokers and nonsmokers, beliefs that cancer has specific causes and can be prevented strongly predict support for workplace smoking control policies. Exposure to company occupational health training also influenced smokers and nonsmokers to support selected smoking control policies. These and other findings led to the conclusion that: (1) educating workers about cancer may promote support for smoking control policies, and (2) smoking control policies are more acceptable in the context of a strong company health and safety program.

Attitude↗
PubMed1988

Bilirubin, intraventricular hemorrhage, and phenobarbital in very low birth weight babies.

The relationships among serum bilirubin concentration on days 5 and 7, birth weight, the presence of intraventricular hemorrhage, and the receipt of phenobarbital were examined in a group of 232 newborns weighing less than 1,751 g who were intubated, mechanically ventilated by 12 hours after birth, and whose parents had given permission for a randomized trial of phenobarbital prophylaxis of intraventricular hemorrhage. The ratio of serum bilirubin concentration to birth weight (the bilirubin divided by birth weight index [BBI]) was used to examine the impact of 25 variables on a clinical guideline for therapy of hyperbilirubinemia in newborn infants. A linear regression model was used; the most powerful covariate was a birth weight less than 1.0 kg. The only other variable that reduced the BBI was phenobarbital receipt. The presence of intraventricular hemorrhage and ecchymoses had a significant influence increasing the BBI.

Bilirubin↗
PubMed1987

Organization and evolution of the rat tyrosine hydroxylase gene.

This report describes the organization of the rat tyrosine hydroxylase (TH) gene and compares its structure with the human phenylalanine hydroxylase gene. Both genes are single copy and contain 13 exons separated by 12 introns. Remarkably, the positions of 10 out of 12 intron/exon boundaries are identical for the two genes. These results support the idea that these hydroxylase genes are members of a gene family which has a common evolutionary origin. We predict that this ancestral gene would have encoded exons similar to those of TH prior to evolutionary drift to other members of this gene family.

Amino Acid Sequence↗
PubMed1987

Respiratory complications in low-birth-weight infants who received phenobarbital.

We compared the ventilatory requirements of 127 infants who received phenobarbital for five days with those of 111 infants who received placebo. All infants were intubated, weighted less than 1750 g at birth, and survived the first ten days of life. Those infants who received phenobarbital did not require ventilatory assistance for more days than did placebo receivers. However, a pneumothorax or pulmonary interstitial emphysema was more likely to develop in infants who received phenobarbital than in infants who received placebo, even when adjustment was made for the presence of subependymal-intraventricular hemorrhage. We believe this is the first report of this relationship and recommend additional studies to test the hypothesis that phenobarbital contributes to the occurrence/recognition of pneumothorax or pulmonary interstitial emphysema in very-low-birth-weight infants if phenobarbital continues to be used routinely as prophylaxis or treatment.

Cerebral Hemorrhage↗
PubMed1987

The prophylactic clinical trial as a epidemiologic resource.

We encourage investigators to use data collected in a clinical trial of a prophylactic agent or procedure to study the epidemiology of the disease or event the prophylactic was meant to prevent. Making additional use of previously collected data is economically attractive. Problems can arise, however, if the sample is not representative of the universe of all people at risk of the disorder, the data set is not adequate to the task, or the prophylactic and/or its correlates influence the risk of the disorder. Investigators should consider modifying data collection procedures in future prophylactic trials so that they are suitable for an epidemiologic study. They and readers of their reports, however, are advised to be cautious in drawing inferences from epidemiologic studies extracted from prophylactic trials.

Clinical Trials as Topic↗
PubMed1986

Neonatal intracranial hemorrhage and phenobarbital.

We enrolled 280 intubated babies with birth weights of less than 1,751 g in a double-blind randomized prospective clinical trial to evaluate whether phenobarbital influences the likelihood of developing subependymal-intraventricular-intraparenchymal hemorrhage. Phenobarbital was associated with an increased risk of developing any subependymal-intraventricular-intraparenchymal hemorrhage and was not associated with a diminished risk of either severe hemorrhage or germinal matrix hemorrhage. This increased risk was apparent even after we considered the influence of phenobarbital levels, timing of phenobarbital administrations, institutional differences, quality of ultrasound scans, gestational age- and birth weight-specific effects, ascertainment bias, and other possible confounders of phenobarbital administration.

Cerebral Hemorrhage↗
PubMed1986

ICWU cancer control education and evaluation program: research design and needs assessment.

The International Chemical Workers Union is implementing a 3-year nationwide field experiment in cancer prevention education. The educational program includes three stages: generalized cancer control education, education tailored to each local union, and an interactive monitoring system designed to provide ongoing communication and reinforcement for desired cancer control behaviors among local unions and their members. These alternative educational approaches will be systematically evaluated using a randomized factorial study design involving more than 120 local unions. The need for such a program is demonstrated by the results of a needs assessment survey of 690 union members. Respondents expressed strong concern regarding possible carcinogen exposures at the work site, combined with generally low ratings of co-worker knowledge of and adherence to appropriate cancer control behaviors. Engineering controls and personal protective equipment were reported to be inadequate in many work sites.

Attitude to Health↗
PubMed1985

Interfering with taste aversion learning in rats: the role of associative interference.

Six experiments with rats investigated the conditions under which one flavor interferes with aversion conditioning to a second, familiar flavor. Conditioning to the familiar flavor was weakest when the interference flavor was contiguous to lithium-induced toxicosis, novel, more intense, and strongly associated with toxicosis. In addition, conditioning to the familiar flavor was weakened even if multiple conditioning trials were used. The repeated finding of an inverse relationship between strength of aversion to the target and interference flavors is interpreted as support for an associative competition hypothesis of the interference effect. The possible relevance of the interference effect to the attenuation of taste aversions in cancer patients is discussed.

Animals↗
PubMed1985

Competing for Medi-Cal business: why hospitals did, and did not, get contracts.

Although we cannot yet judge the broad consequences of Medi-Cal selective contracting, we can assess the outcome of the contracting process and the role that competition and other factors played in that process. In this study of the qualitative and quantitative characteristics of hospitals in Los Angeles County that bid for Medi-Cal contracts, we analyzed the factors that were important determinants of whether or not hospitals received contracts. We found that hospital dependence on Medi-Cal inpatient revenues was most strongly associated with winning a contract and the presence of a teaching program next most strongly related. We discuss the relative importance of hospital need for a contract and the Medi-Cal special negotiator's desire to include certain hospitals in the program, and conclude with a discussion of our study's implications for competition and regulation methods in Medicaid cost containment strategies.

California↗
PubMed1985

Problems in the cultivation of cervical bacteria.

Multiple variations in the types, species and prevalence of cervical bacteria are described in the literature. A review of the literature was undertaken to determine the effect of delay on the ability to identify bacteria. Experiments were initiated to elaborate on those observations. The rate of organism isolation was related to the delay in transport to the laboratory.

Adult↗
PubMed1985

Medi-Cal hospital contracting--did it achieve its legislative objectives?

The 1982 Medi-Cal reforms and reductions established selective contracting with hospitals for inpatient care of Medi-Cal beneficiaries. The legislation established a special negotiator and criteria to be used in selecting contract hospitals. We report the findings of a study that analyzed the characteristics of contract and noncontract hospitals in Los Angeles County to assess how well these criteria were reflected in the outcome of the contracting process. We examine issues of beneficiary access to general inpatient care and to specialized services, the efficiency of contract hospitals compared with noncontract ones and quality-related issues.

California↗