Search PubMed⌕ Search

Biomedical subjects

J A Jacobs

Publications and source records attributed to J A Jacobs.

At least 55 records · Page 3Linked to original sources
PubMed1994

Change in self-definition from specialist to generalist in a national sample of physicians.

OBJECTIVE: Current proposals to reform the health care system call for a physician work force composed of at least 50% generalists. Achieving this objective will likely require that some physicians who are currently specialists become generalists. We sought to determine the extent of such change before any concerted reform efforts and the types of physicians most amenable to such change. DESIGN: Retrospective cohort study. PARTICIPANTS: 335,438 physicians in active practice. MEASUREMENTS: Rates of change between 1982 and 1986 in self-defined specialties, analyzed with demographic methods and logistic regression. RESULTS: In 1982, our participants comprised 134,647 (40.1%) generalists and 200,791 (59.9%) specialists. Over the 4-year period of the study, 8319 (6.2%) of the generalists became specialists and 4322 (2.2%) of the specialists became generalists. Although physicians younger than 40 years of age were more likely than those older than 40 years of age to switch into generalist disciplines, specialist physicians between the ages of 40 and 69 years (who accounted for 62.0% of the physician work force) made most of the moves into generalist fields (58.4%). After adjustment for other factors, the physicians most likely to switch into generalist disciplines were women, subspecialty internists, emergency medicine physicians, subspecialty pediatricians, and pathologists. In 1986, the 130,650 physicians (38.9%) in this cohort who considered themselves generalists were supplemented by another 49,226 (14.7%) who considered themselves to have a secondary interest in generalist practice. Physicians with such a secondary interest in 1982 constituted 65% of the new generalists in 1986. CONCLUSIONS: Our findings support three principal conclusions. First, change from specialist to generalist disciplines is not uncommon, even for physicians older than 40 years of age. Second, many physicians already consider a generalist discipline to be a secondary emphasis of their practices. And third, efforts to retrain specialists to be generalists might effectively target those physicians predisposed to become generalists.

Adult↗
PubMed1994

Combined abdominal and vaginal approach for bladder neck closure and permanent suprapubic tube: urinary diversion in the neurologically impaired woman.

Chronic indwelling Foley catheter placement in the neurologically impaired patient can lead to pressure necrosis of the urethra with incontinence. We report on 2 series of patients who underwent bladder neck closure and insertion of a suprapubic catheter for this problem. Our initial group includes 4 patients who underwent 5 transvaginal procedures, of which 2 (40%) were successful. Subsequently, we modified our approach, and used a combined abdominal and transvaginal repair, which was successful in 10 consecutive patients with a followup of 6 to 40 months (mean 15.6).

Abdomen↗
PubMed1994

Bacteremia involving the "Streptococcus milleri" group: analysis of 19 cases.

During a 3-year study period, 19 patients at the University Hospital of Maastricht developed bloodstream infections with species of the "Streptococcus milleri" group, for an incidence of 0.33 per 1,000 admissions. The patients' median age was 48 years; the male-to-female ratio was 2.8. Eleven patients (57.9%) had underlying diseases, among which malignancy was predominant. Local trauma to the mucosal barrier was an important risk factor. An associated site of infection was found most frequently in the abdominal and thoracic cavities (nine and five cases, respectively). Bacteremia was polymicrobial in four of 19 episodes. The 20 infecting S. milleri strains were identified to the species level; Streptococcus anginosus was the most prevalent (16 strains). Eight strains carried Lancefield group C. The isolates were sensitive to most antibiotics. Abscess formation was documented in nine cases (47.3%); repeated drainage procedures were required in half of these episodes. Mortality was high (five of 19 patients, or 26.3%).

Adolescent↗
PubMed1994

Agglutination of "Streptococcus milleri" by lectins.

The agglutination of 218 clinical isolates and three ATCC type strains of "Streptococcus milleri" was tested with 25 different lectins from plants and fungi. An agglutination reaction with one or more lectins was observed with 42 isolates when the cells were untreated. After trypsinisation of the bacteria, 109 strains yielded a positive reaction and after boiling the bacterial cells at pH2, 218 isolates were agglutinated. As an overall result of our experiments with untreated, trypsinised and boiled cells, 17, 37 and 45 different agglutination patterns, respectively, were obtained. The lectins from Datura stramonium, Robinia pseudoacacia and Dolichos biflorus agglutinated isolates belonging only to Lancefield group C, being non-reactive with other isolates. These lectins were also found to be specific for "large colony type" streptococci of group C. The use of lectin agglutination in epidemiological and ecological studies of "S. milleri" is discussed.

Agglutination↗
PubMed1994

Intervertebral infection caused by Streptococcus milleri. A case report.

Intervertebral infection caused by Streptococcus milleri is described in a 45-year-old man. Initially, a tuberculous infection was suspected; this diagnosis resulted in a considerable delay in correct diagnosis and treatment. The patient recovered well with combined medical-surgical treatment. Streptococcus milleri, a common inhabitant of the gastrointestinal tract, comprises a variety of strains implicated in deep-seated purulent infections. Although reports of this are rare, S. milleri can be the offending organism in intervertebral disk infections.

Anti-Bacterial Agents↗
PubMed1993

[Pneumococci].

Explore the source record for details and available documents.

Chloramphenicol Resistance↗
PubMed1993

Infection due to a contaminated thoracic drainage system.

Infection and colonization of the pleural space in three patients was traced to contaminated thoracic drain equipment. The organisms implicated were Bacillus cereus, Staphylococcus aureus and various non-fermenting Gram-negative bacteria. A careful examination of cleaning and decontamination procedures revealed delay in replacing the drainage bottle jar to be the main factor responsible for the contamination of the drainage unit and the pleural space. Recent technical adaptation of the drainage apparatus had removed the need for daily changing of this jar. These findings confirm that thoracic drainage systems may be a potential source of contamination for the patient. We emphasize that technical improvements to existing operating apparatus should necessitate the adaptation of recommendations governing their use in accordance with approved hospital hygiene standards.

Aged↗
PubMed1993

The agglutination of beta-haemolytic streptococci by lectins.

The ability of 25 lectins, isolated from different plants and fungi, to agglutinate 95 clinical isolates of beta-haemolytic streptococci was examined. Cell suspensions were untreated, trypsin-treated or boiled at pH 2.0. None of the 95 untreated cell suspensions gave a visible reaction with any of the lectins. When the cells were trypsinised, 42 strains were agglutinated with one or more lectin and after boiling at pH 2, all the strains were agglutinated. After treatment with trypsin, 20 different agglutination patterns were observed, and after boiling, 19 patterns, four of which were similar. A correlation was found between Lancefield group C and some of these patterns. Some lectins reacted specifically with group C streptococci; DBA and WFA, both specific for D-GalNAc, DSA, a GlcNAc-specific lectin, and RPA, which showed a complex specificity, reacted only with group C strains. Furthermore, the lectin of Maackia amurensis reacted with 50% of group B streptococci only. Agglutination assays with lectins were reproducible, easy to perform, relatively inexpensive and, therefore, applicable to studies of cell-wall structure and epidemiology of beta-haemolytic streptococci.

Agglutination↗
PubMed1989

Effects of multiple roles on women's health--evidence from a national longitudinal study.

This study analyzes longitudinal data for a national sample of older middle-aged women in order to assess the health effects of three roles--labor force participant, spouse and parent. Women who held more roles had better health trends. The effect of each specific role varied, depending on race and the other roles a woman held. For example, our evidence indicates that labor force participation had beneficial effects on health for white women who were not married and for black women who had children at home, but not for other women. The findings of this study do not support the hypothesis that involvement in multiple roles contributes to role overload and role conflict with consequent harmful effects on women's health. Rather, it appears that involvement in multiple roles generally contributed to better health, due to the beneficial effects of labor force participation and marriage for some women.

Adult↗
PubMed1988

Effects of labor force participation on women's health: new evidence from a longitudinal study.

Effects of labor force participation on women's health are evaluated in analyses of longitudinal data for a national sample of older middle-aged women. Our findings indicate that labor force participation had beneficial effects on health for unmarried women and for married black women, but, on the average, labor force participation had no significant effect on health for married white women. Analyses by occupational category suggest that labor force participation had beneficial effects on health for some blue collar married women, but, on the average, labor force participation had harmful effects on health for white collar married women. Our findings, taken together with previous evidence, suggest that employment may increase social support, and job-related social support may have particularly beneficial effects on health for unmarried women and for married women whose husbands are not emotionally supportive confidants. Additional results from this study showed no significant difference in the health effects of part-time and full-time employment.

Adult↗
PubMed1988

Pooling of sera for human immunodeficiency virus (HIV) testing: an economical method for use in developing countries.

To determine whether donated blood samples in African countries could be pooled, then tested for the presence of human immunodeficiency virus (HIV) antibodies with a single test without loss of accuracy, a single test on five pooled samples was used, followed by individual testing of positive pools. This resulted in no loss of either sensitivity or specificity. Pooling 10 samples resulted in a loss of sensitivity for low antibody titre specimens. Pooling reduced the costs of screening by 70% and time needed for analysis. It is concluded that pooling of five samples for HIV screening may result in a substantial reduction in costs; in countries where the prevalence of HIV is higher than the 2-3% found in Zimbabwean donors, however, savings may not be as great.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Nocturnal penile tumescence and penile responses in the waking state in diabetic and nondiabetic sexual dysfunctionals.

This study compared diabetics with sexual dysfunction, nondiabetics with sexual dysfunction, and a group of controls on nocturnal penile tumescence (NPT) during three nights in a sleep laboratory, and penile response to erotic stimulation in the waking state on one of the nights. Both diabetic and nondiabetic dysfunctionals showed less erectile response to erotic films and tape than controls but did not differ from each other. In contrast, the diabetic dysfunctionals showed significantly weaker NPT response than both the nondiabetic dysfunctionals and the controls, and 58% of them (contrasted with 23% of nondiabetic dysfunctionals and 0% of controls) would be classified as organic using minimal NPT (less than 11.5 mm maximal increase in penile circumference during any nocturnal erection) as the sole criterion. There was a significant relationship between NPT and waking erections in response to erotic stimuli, especially in the diabetic dysfunctionals and the controls.

Adult↗