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Biomedical subjects

J A Epstein

Publications and source records attributed to J A Epstein.

162 records · Page 9Linked to original sources
PubMedDate not supplied

Alcohol and marijuana use among rural youth: interaction of social and intrapersonal influences.

Epidemiological research indicates that the prevalence rate of drug use among adolescents has risen steadily during this decade, and although alcohol use has stabilized it is still highly prevalent. Psychosocial etiological models have typically examined main effects of risk and protective factors. This study examined moderating effects of intrapersonal skills on social (peer and parental) risks associated with alcohol and marijuana use among eighth-grade rural adolescents, an understudied population. Results indicated that the relationships of peer and parental attitudes, and peer usage to alcohol and marijuana use, are moderated by adolescents' decision-making and self-reinforcement skills. Social risk factors were strongly associated with increased alcohol and marijuana use among adolescents with poor intrapersonal skills. However, good decision-making and self-reinforcement skills diminished the influence of social risk factors on substance use. Results are discussed in terms of implications for psychosocial models of alcohol and drug use, and for designing effective school-based universal prevention interventions.

Adaptation, Psychological↗
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Preventing illicit drug use in adolescents: long-term follow-up data from a randomized control trial of a school population.

National survey data indicate that illicit drug use has steadily increased among American adolescents since 1992. This upward trend underscores the need for identifying effective prevention approaches capable of reducing the use of both licit and illicit drugs. The present study examined long-term follow-up data from a large-scale randomized prevention trial to determine the extent to which participation in a cognitive-behavioral skills-training prevention program led to less illicit drug use than for untreated controls. Data were collected by mail from 447 individuals who were contacted after the end of the 12th grade, 6.5 years after the initial pretest. Results indicated that students who received the prevention program (Life Skills Training) during junior high school reported less use of illicit drugs than controls. These results also support the hypothesis that illicit drug use can be prevented by targeting the use of gateway drugs such as tobacco and alcohol.

Adolescent↗
PubMedDate not supplied

Total myelography in the evaluation of lumbar discs. With the presentation of three cases of thoracic neoplasms simulating nerve root lesions.

It has been our practice to perform total myelography in all cases of lumbar disc disease including the various syndromes of spinal stenosis, because experience has indicated that myelographic abnormalities in the cervical and thoracic areas could have clinical importance despite the presence of gross changes in the lumbar region. Failure to establish a definite diagnosis by restricted lumbar myelography makes it mandatory to evaluate all levels of the spinal axis. Recently, 3 patients with thoracic spinal cord tumors presented with primary signs and symptoms of lumbar spine disorders. Evidence of spinal cord disease was minimal and could be readily overlooked. Total myelography disclosed varying degrees of lumbar spinal pathology, but also showed evidence of lesions in the thoracic region. One proved to be an intramedullary astrocytoma of the spinal cord, and two were schwannomas. The symptoms of low-back pain and lumbar radiculopathy improved after excision of the schwannomas and following x-ray therapy and chemotherapy in the patient with the intramedullary neoplasm.

Adult↗
PubMedDate not supplied

Symptomatic lumbar scoliosis with degenerative changes in the elderly.

Lumbar scoliosis with degenerative changes in the elderly presents with spondylosis, variable apophyseal joint arthrosis, laminar hypertrophy, and marginal osteophytos most prominent within the scoliotic apex. Resultant lumbar stenosis, alone or with ventral spurs and herniated discs as isolated or associated lesions, can produce disabling low-back and lower extremity pain, weakness, and neurogenic claudication relievable by appropriate decompressive surgery. Myelography is essential as a preoperative measure. Whether such scoliosis is superimposed on adolescent thoracolumbar scoliosis or arises anew in later life remains an open question.

Adult↗
PubMedDate not supplied

Traumatic myelopathy in patients with cervical spinal stenosis without fracture or dislocation: methods of diagnosis, management, and prognosis.

The New York University Spinal Cord Trauma Center recently completed an evaluation of 200 patients seen over a period of four years, from 1974 to 1978. A unique group of 23 patients with cervical spinal stenosis and myelopathy without fracture or dislocation was isolated. The presence of a narrow canal significantly influenced morbidity and prognosis. Based on a review of plain roentgenograms and myelograms, there were seven patients with an average age of 41 who had absolute low levels of narrowing of the spinal canal without evidence of degenerative changes. The remaining 16 patients, averaging 61 years of age, had superimposed spondylosis. In both groups, patients with the lowest anteroposterior diameters of the spinal canal had the most severe myelopathy after trauma. Patients with absolute stenosis were more susceptible to traumatic myelopathy than were those with relative stenosis. Varying the dose of steroids to maximal levels had no effect on prognosis. Patients showing improvement during the initial 48 hours had the greatest degree of eventual recovery.

Adult↗
PubMedDate not supplied

Traumatic myelopathy in a seventeen-year-old child with cervical spinal stenosis (without fracture or dislocation) and a C2-C3 Klippel-Feil fusion. A case report.

A 17-year-old white male patient sustained a cervical hyperextension injury while body surfing. Plain cervical radiographs, tomography, and CAT scan showed neither fracture nor subluxation, but congenital narrowing of the spinal canal and fusion of C2-C3 (Klippel-Feil). Clinically, he had a central cord syndrome, characterized by a motor dominant myelopathy. The conservative management of this patient with a central cord injury in the presence of spinal stenosis and a Klippel-Feil syndrome resulted in almost full recovery although he was quadriplegic initially. This constellation of findings rarely has been reported in adolescence.

Adolescent↗
PubMedDate not supplied

Lumbar intervertebral disk herniation in teenage children: recognition and management of associated anomalies.

Herniated disks in children and adolescents can be extremely disabling and difficult to diagnose because of the paucity of neurologic abnormalities and the consequent suspicions of hysteria. The Laségue sign is often the only consistent positive finding, and when persisting without remission, justifies early diagnostic studies such as CT scanning, and electromyography. Myelography may be avoided if these studies are definitively diagnostic. The almost uniformly good results that follow diskectomy do not justify prolonged conservative care. Management is facilitated by awareness of often unrecognized structural abnormalities found in these patients. These include spinal stenosis, lateral recess narrowing, and transitional vertebra. Spinal fusion, while rarely indicated, should be considered where motion segment instability contributes to persistent backache. The management of 25 patients is recorded. Twenty-one of these presented with an anomaly worthy of record requiring modifications in surgical technique to provide proper decompression and lasting relief of symptoms.

Adolescent↗
PubMedDate not supplied

The relationship between language spoken and smoking among Hispanic-Latino youth in New York City.

This study was designed to examine the relationship between language spoken and smoking (at least once a month) among New York City Hispanic-Latino adolescents, using a large sample of specific Hispanic-Latino subgroups (Puerto Rican, Dominican, Colombian, and Ecuadorian youth) and controlling for social and environmental factors. The sample included 3,129 Hispanic-Latino students in 47 New York City public and parochial schools. Of the total sample, 43 percent were Puerto Rican, 20 percent Dominican, 7 percent Colombian, and 7 percent Ecuadorian. The students completed questionnaires that were designed to assess social and environmental influences on their smoking and determine what languages they spoke (English and Spanish) with parents and friends. Self-reported smoking data were collected by means of the bogus pipeline to enhance the veracity of self-reports. In the logistic regression model, including background, social influence, and language use variables, 101 students were smokers. Logistic regression analysis indicated that being bicultural (speaking both English and Spanish) at home and with friends appeared to increase the odds of currently smoking. Separate logistic regression analyses for girls and boys revealed that being bicultural at home increased the odds of currently smoking for boys but not girls. Results are discussed in terms of their implications for prevention.

Acculturation↗