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Biomedical subjects

I B Tager

Publications and source records attributed to I B Tager.

At least 91 records · Page 5Linked to original sources
PubMed1985

Epidemiology of tuberculous infection in a chronic care population.

A prospective study of serial tuberculin skin testing was performed on 642 patients from the chronic care wards of a Veterans Administration Hospital. Five hundred eighty-eight patients without a documented history of tuberculosis or a positive tuberculin skin test received an initial 5 TU PPD, and results in 139 were positive (23.6%). Of those initially tuberculin negative, 398 received a second 5 TU PPD 2 to 4 wk later; 45 (11.3%) showed a booster effect. Of the initial 642 patients, 64 had documented negative tuberculin skin tests within the year preceding the survey. Eight (12.5%) of the 64 patients were positive at the initial survey. There were 213 patients with 2 negative tuberculin tests within the first 4 wk of the study who were followed for the year of the study, and 10 converted their tuberculin skin test for a converter rate of 4.7%. The decrease in the converter rate from 12.5 to 4.7% suggests that the initial converter rate was falsely elevated by the booster effect. The high rate of conversion during the year of the study (4.7%) suggests that there may have been inapparent spread of tuberculous infection among patients in this chronic care facility.

Adolescent↗
PubMed1984

Genetic and environmental determinants of level of pulmonary function.

Measurements of level of pulmonary function (one second forced expiratory volume (FEV1) and forced expiratory flow between the 25% and 75% volume points (FEF 25-75)) were obtained on members of 404 nuclear families living in East Boston, Massachusetts in 1974. These families were ascertained through a random sample of children aged 5-9 years. Measurements were obtained on family members on three separate occasions during a 5-year period. These data were subjected to the techniques of path analysis to study the relative contributions of heredity and environment to individual levels of pulmonary function. Genetic heritability was found to be consistent through time (41-47%) and was the same for parents and their children. Common familial environmental effects on level of pulmonary function explained 1-4% of the variability in children and 11-28% in adults. Furthermore, we were able to confirm prior epidemiologic analysis of these data which have demonstrated an effect of maternal smoking on the level of pulmonary function in their children.

Boston↗
PubMed1984

Airways responsiveness in a population sample of adults and children.

Nonspecific bronchial responsiveness was assessed with eucapneic hyperpnea to subfreezing air in a population-based sample of 134 adults and 213 children in East Boston, Massachusetts. Increased responsiveness was considered to be present if the decrease in forced expiratory volume in one second with cold air divided by the initial vital capacity was greater than 9%. Men and women had similar bronchial responsiveness, but children and young adults (24 yr of age and younger) were significantly more likely to be responders than were older subjects (p less than 0.001). Children with a doctor's diagnosis of asthma at any time in the past were twice as likely (42.9%) to be responders as were nonasthmatic children (19%) (p = 0.004). Ninety-two percent (11/12) of currently active asthmatics were responders. However, a large percentage of asymptomatic children had increased levels of bronchial responsiveness (18.9%). This cross-sectional study demonstrates the feasibility of measurement of nonspecific bronchial responsiveness in epidemiologic studies, and its relationship to age and wheeze symptoms in children.

Adult↗
PubMed1984

The relationship of airways responsiveness to cold air, cigarette smoking, and atopy to respiratory symptoms and pulmonary function in adults.

The response to eucapnic hyperventilation with subfreezing air was studied in a population based sample of 171 adults, all of whom also completed a respiratory questionnaire, spirometry, and skin testing. A positive response to the cold air challenge was defined as [initial FEV1-post-challenge FEV1)/initial FVC) X 100) greater than or equal to 9%. Cigarette smoking was with a positive cold air response: 12 of 128 current and ex-smokers (9.4%) versus 1 of 43 nonsmokers (2.3%) (p = 0.095). Among current and ex-smokers, a positive response to the cold air challenge was significantly associated with asthma (p = 0.046). Using a logistic regression model, both current smoking and response to cold air were significant predictors of the presence of "persistent wheeze" or asthma. A positive skin test to any of the 4 environmental antigens used (ragweed, housedust, trees, and grasses) was significantly associated with cigarette smoking (p = 0.018) and hay fever (p = 0.003 among current and ex-smokers) but not with wheezing or asthma. Though not statistically significant, cold air responders had a lower percentage of positive skin test reactivity than nonreactors. The findings of this cross-sectional analysis suggest that in adults, both airways responsiveness and cigarette smoking are important predictors of wheezing and asthma. Furthermore, the data suggest that airway hyperresponsiveness and atopy are independent traits. However, in adults, these traits are associated with cigarette smoking, a common environmental exposure.

Child↗
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

Benefit-cost analysis of antimicrobial prophylaxis in abdominal and vaginal hysterectomy.

We performed a benefit-cost analysis of antimicrobial prophylaxis for hysterectomy using data from a randomized, placebo-controlled clinical trial of the efficacy of three doses of cefazolin sodium. The excess cost per patient with either operative site or urinary tract infection, or febrile morbidity diagnosed during hospitalization, was +1,777 for vaginal and +716 for abdominal hysterectomy. In patients undergoing vaginal hysterectomy, prophylactic cefazolin reduced in-hospital infectious morbidity from 52% to 23% (preventive fraction, 56%), resulting in an average net benefit of +492 per patient. In abdominal hysterectomy, cefazolin decreased in-hospital morbidity from 43% to 25% (preventive fraction, 42%), resulting in an average net savings of +102 per patient. These benefits would be eroded by use of newer, more expensive cephalosporins unless they were considerably more effective than cefazolin. The benefits also would be diminished by inappropriate prolongation of the duration of prophylaxis.

Cefazolin↗
PubMed1983

An epidemiologic study of the risks associated with peripheral intravenous catheters.

As part of a standardized, multi-hospital prospective surveillance system for nosocomial infections in Rhode Island, an analysis was undertaken in March 1980-February 1982 to determine the interplay of factors that contribute to the risk of phlebitis in peripheral, non-steel, non-butterfly intravenous catheters. The authors studied 3094 patients with 5161 total episodes of peripheral intravenous catheters from day of admission until day of discharge. The overall rate of phlebitis was 2.3% (118 episodes), and the rate of intravenous catheter-associated bacteremia was 0.08% (1 definite episode, 3 possible episodes). Factors significantly associated with the occurrence of phlebitis were: underlying risk for any nosocomial infection, duration of the catheter episode, chronological order of the episode and an interaction between the latter two variables. Analysis of day-specific risk of phlebitis indicated that, for patients with low risk diagnoses, initial peripheral intravenous catheters might be left in place with relative safety for up to 96 hours. Over this time period, the day-specific risk for such patients ranged between 0.8% and 1.4%, exclusive of the first day. In all other circumstances, the current recommendation of 48-72 hours seems appropriate.

Adult↗
PubMed1983

The relationship between respiratory illness in childhood and chronic air-flow obstruction in adulthood.

This review evaluates the hypothesis that lower respiratory infection in childhood is a risk factor for chronic air-flow obstruction (CAO) in adulthood. Clinical CAO appears to result from a lengthy and initially asymptomatic loss of function that correlates with the development of peripheral airways abnormalities and emphysema. The relative functional silence of the small airways, the apparent vulnerability of the child's lung to injury, and the demonstration of functional abnormalities after several types of viral respiratory infection are consistent with the proposed role of lower respiratory infection. Relevant epidemiologic studies, however, have provided conflicting results, and many are flawed by recall bias. The observed association in children between lower respiratory infection and impaired ventilatory function may be noncausal and not a direct consequence of infection. A complete test of the hypothesis would require follow-up of study subjects from birth to adulthood with monitoring of respiratory infections and pulmonary function.

Adolescent↗
PubMed1983

The health effects of involuntary smoking.

Involuntary smoking is defined as the exposure of nonsmokers to tobacco combustion products in the indoor environment. Involuntary smokers are exposed to a quantitatively smaller and qualitatively different smoke exposure than active smokers. Quantitation of exposure is particularly difficult in both physiologic and epidemiologic studies. Acute physiologic studies have documented minimal physiologic changes in healthy subjects. However, individuals with heart or lung disease may be differentially affected. A relatively large body of data relates parental (particularly maternal) cigarette smoking to the occurrence of both acute respiratory illnesses and chronic respiratory symptoms in children. The effect seems to be greatest early in life and cannot be separated from in utero exposure. Data linking parental smoking to lower levels of pulmonary function are all cross-sectional and less conclusive. What is apparent is that the magnitude of the direct effect of passive smoke exposure is likely to be relatively small (from 1 to 5% reduction in maximally obtained lung function level in exposed children). Data on adults are insufficient to allow for a quantitative estimate. The important effects of passive smoke exposure in childhood are twofold. The slight reduction in pulmonary function level may predispose individuals to increased risks from environmental agents later in life. In addition, having a parent who smokes substantially increases the likelihood that a child will become a smoker. Finally, two studies have linked lung cancer in nonsmokers to exposure to spouses' cigarette smoke. Further research is needed to confirm these findings. Involuntary smoking may have important health effects, either direct or indirect, which deserve further study.

Adolescent↗
PubMed1982

Risk factors for infection at the operative site after abdominal or vaginal hysterectomy.

We studied risk factors for postoperative infections at the operative site after hysterectomies. Data were collected prospectively on all women undergoing vaginal hysterectomies (323 patients) or abdominal hysterectomies (1125 patients) at the Boston Hospital for Women between February 1976 and April 1978. Logistic-regression analysis indicated that factors significantly associated (P less than 0.05) with a higher risk of infection at the operative site were increased duration of operation, lack of antibiotic prophylaxis, younger age, being a clinic patient, and an abdominal approach. After these variables were accounted for, the variables of obesity, preoperative functional and anatomical diagnoses, postoperative anatomical and pathological diagnoses, estimated blood loss, menopausal status, and operation by a specific surgeon did not add predictive power. An increasing duration of operation was associated with a decreasing effect of antibiotic prophylaxis, the preventive fraction of which diminished from 80 per cent at one hour to an unmeasurable effect at 3.3 hours.

Adult↗
PubMed1980

Randomised clinical trial of perioperative cefazolin in preventing infection after hysterectomy.

To determine the efficacy of perioperative cefazolin in preventing pelvic and wound infections after elective non-radical hysterectomy, a randomised, placebo-controlled, double-blind clinical trial was done. Among 86 patients undergoing vaginal hysterectomy, those who received three perioperative 1 g doses of cefazolin (44) had significantly fewer pelvic infections (21% vs. 2%); less standard febrile morbidity (31% vs. 14%); shorter length of stay (LOS); and fewer courses of antibiotics postoperatively. There was no reduction in rate of urinary-tract infection (UTI) (21% vs. 23%). Among 429 women having abdominal hysterectomy, the 206 who received cefazolin had significantly lower rates of wound and pelvic infections (21% vs. 14%), UTI (21% vs. 9%), and febrile morbidity (20% vs. 14%). They also had shorter LOS and received fewer courses of antibiotics postoperatively. Use of perioperative cefazolin was not accompanied by more side-effects. Three doses of perioperative cefazolin seem to be safe, efficacious, and cost-effective in preventing infection after vaginal or abdominal hysterectomy.

Adult↗
PubMed1980

Bactericidal antibody and susceptibility to otitis media caused by nontypable strains of Haemophilus influenzae.

We have developed a bactericidal antibody assay to determine the role of circulating antibody to nontypable strains of Haemophilus influenzae in children with otitis media. Antibody infecting strain was present in the acute sera of 2/20 children with otitis media caused by H. influenzae NT; 15/18 of these patients had covalescent specimens with titers greater than or equal to 1:2 (X2 = 13.0, P < 0.001). The acute sera of 95 children with otitis media caused by various organisms were screened for bactericidal activity against a randomly selected H. influenzae NT stain. Antibody was present in 0/28 acute sera of patients whose infection was caused by H. influenzae NT and in 18/67 (26.9% of those whose middleear exudates were sterile or contained other bacterial species (X2 = 9.95, P < 0.01). A bactericidal antibody response generally follows infection of the middlw ear with H. influenzae NT. The absence of antibody to a single strain in the sera of some children appears to be associated with susceptibility to this infection.

Antibodies, Bacterial↗
PubMed1980

Persistent wheeze. Its relation to respiratory illness, cigarette smoking, and level of pulmonary function in a population sample of children.

In a study of early-life risk factors for the development of adult obstructive airway disease, respiratory symptoms, disease and smoking histories, and spirometry were obtained for 650 children 5 to 9 yr of age and their families in East Boston, Massachusetts. Persistent wheezing was the most frequently reported chronic symptom, occurring in 9.2% (60/650) of the population. Children with persistent wheezing were more likely to report cough and phlegm (p < 0.001), a history of asthma (p < 0.001), hay fever (p < 0.02), or past hospitalization with a respiratory illness (p < 0.001) than their asymptomatic peers. Prospective evaluation of a subsample of the 650 children confirmed a greater occurrence of acute lower respiratory illness in those children with persistent wheeze. Parental cigarette smoking was linearly related to the occurrence of persistent wheezing (p = 0.012) and lower degrees of mean normalized forced expiratory flow during the middle half of the forced vital capacity (FEF-Z score). A multiple linear regression identified the mother's current smoking status and current persistent wheeze as significant predictors of the children's mean FEF-Z score. Other variables, such as the father's smoking, children's personal smoking, a doctor's diagnosis of asthma, and a past history of lower respiratory illness were not significant predictors of the FEF-Z score.

Child↗
PubMed1980

Serum antibody response to Bacteroides fragilis in women with abscesses following hysterectomy.

To determine the role of Bacteroides fragilis in the development of infectious complications following hysterectomy, serum antibody to the capsular polysaccharide was measured with a radioactive antigen-binding assay in 53 women before and several days after surgery. Patients with postoperative abscess formation had a significantly greater mean increase in antibody concentration (4.91 micrograms/ml) than those without complications (0.62 micrograms/ml), those with wound infection (1.90 micrograms/ml), those with pelvic cellulitis (0.63 micrograms/ml), and those with febrile morbidity (0.95 micrograms/ml). There were no significant differences among the latter 4 groups. The authors conclude that B fragilis may play an important role in abscess formation following hysterectomy, but is infrequently involved in other infectious complications of this procedure.

Abscess↗
PubMed1979

Effect of parental cigarette smoking on the pulmonary function of children.

The authors have investigated the effects of parental smoking patterns on the pulmonary function of children in East Boston, Massachusetts. A crude inverse dose-response relationship was observed between the level of FEF25--75% predicted of children who never smoked and the number of smoking parents in the household. Compared to children with two non-smoking parents, the level of FEF25--75% predicted was 0.156 and 0.355 standard deviation units lower for children with one and two currently smoking parents, respectively. An additional decline in level of FEF25--75% predicted was observed for children who themselves had smoked. Smoking children with two smoking parents had an average FEF25--75% predicted level which was 0.355 standard deviation units lower than non-smoking children with two smoking parents. These data not only confirm that cigarette smoking by young children and teenagers has direct measurable effects on their pulmonary function, but also show that cigarette smoking by parents has a measurable effect on the pulmonary function of their children which is independent of any direct use of cigarettes by the children.

Child↗