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Biomedical subjects

J D Klein

Publications and source records attributed to J D Klein.

At least 91 records · Page 5Linked to original sources
PubMed1995

Training pediatric residents to prevent tobacco use.

OBJECTIVE: To assess the effectiveness and acceptability of incorporating the National Cancer Institute (NCI) Guide to Preventing Tobacco Use During Childhood and Adolescence into pediatric training. DESIGN: Preintervention and postintervention self-reported surveys for residents receiving training and postintervention baseline surveys for those residents not receiving training. Measures include: (1) a self-reported knowledge, attitude, and behavior survey of residents; and (2) physician behavior reports from parent exit interviews. SETTING: A hospital-based pediatric residency program and continuity clinic. SUBJECTS: Pediatric residents and parents of pediatric patients seen for well child examinations. INTERVENTIONS: Structured NCI smoking cessation curriculum modified for delivery during scheduled teaching activities. RESULTS: The NCI training was acceptable and perceived as important by residents. Many did not recall receiving the materials or training. Trained residents who remembered the intervention improved their smoking cessation counseling effectiveness. Most patients' parents think it appropriate for physicians to ask; however, most reported not having been asked about smoking or environmental smoke exposure. CONCLUSIONS: For residents to learn effective prevention counseling strategies, systematic, reinforced preventive educational curricula must become an institutionalized part of residency training.

Adolescent↗
PubMed1994

The angiotensin II AT1 receptor is tyrosine and serine phosphorylated and can serve as a substrate for the src family of tyrosine kinases.

Angiotensin II AT1 receptor signal transduction has recently been shown to function through the phospholipase C isozyme, PLC-gamma. Since PLC-gamma is known to interact with phosphotyrosine containing proteins through SH2 domains, we examined the phosphorylation state of the AT1 receptor. Immunoprecipitation of the [32P] labeled AT1 receptor from rat aortic smooth muscle cells followed by alkali hydrolysis demonstrated the presence of tyrosine phosphorylation. Phosphoamino acid analysis of the excised bands demonstrated the presence of phosphoserine and phosphotyrosine residues. A fusion protein comprising the intracellular tail of the AT1 receptor was used to screen for candidate kinases, and the src kinase family displayed high activity. In summary, this study shows that the AT1 receptor is serine and tyrosine phosphorylated in vivo and suggests that a soluble kinase related to the src family may be responsible for the tyrosine phosphorylation.

Angiotensin II↗
PubMed1994

Osteochondroma formation after a Salter II fracture.

Osteochondromas are one of the most commonly observed benign bone tumors. Although there have been a number of experimental studies carried out to determine the origin of osteochondromas, their etiology remains a controversial issue. A well-documented case is presented in which a displaced Salter-Harris type II physeal fracture preceded the development of an osteochondroma.

Child↗
PubMed1994

Atypical cat-scratch disease: diagnosis by a serologic test for Rochalimaea species.

Three patients with atypical manifestations of cat-scratch disease (CSD) had the diagnosis supported by a newly available serologic assay for antibodies to Rochalimaea henselae. Previously, CSD has been a diagnosis of exclusion because no confirmatory test was readily available. Atypical or severe cases of CSD have often required detailed (and expensive) clinical and laboratory investigation. The use of Rochalimaea-specific serologic tests may help avoid extensive diagnostic testing or invasive procedures in such cases.

Adolescent↗
PubMed1994

The geography of AIDS: patterns of urban and rural migration.

We sought to describe the migration patterns of patients infected with the human immunodeficiency virus (HIV) who seek health services in North Carolina. Of 390 consecutive adult patients with HIV seen at one tertiary care medical center in the southeastern United States in the summer of 1990, 340 (87%) were approached, and 325 (83%) completed surveys. Thirty-seven percent of respondents thought they had been infected and 20% were told they were infected with HIV while living outside of North Carolina. One in five patients thought they had been infected while living in a rural county and more than half now live in rural communities (population of < 50,000). Sixty percent of patients had moved to North Carolina since 1980; 61% of these were North Carolina natives. Injecting drug users were more likely than those with other modes of exposure to HIV to have been diagnosed with HIV infection out of state (34% vs 18%). Patients' reasons for moving to North Carolina included social support (88%), health reasons (54%), and better work/educational opportunities (52%). We found that most patients with HIV who seek health care services in North Carolina live in rural areas with their families, and a substantial proportion migrated in after they were diagnosed out of state. Characterizing these migration patterns is crucial for predicting the diffusion of HIV to rural areas; designing AIDS prevention strategies, education, and health service needs; and assessing federal HIV care funding policies.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Physician beliefs, attitudes, and approaches toward Lyme disease in an endemic area.

To assess the beliefs and practice habits regarding Lyme disease among practitioners, questionnaires were sent to physicians in a seven-county Lyme-endemic region. One hundred twenty-four evaluable responses were returned from 53 family physicians, 39 pediatricians, 27 internists, and five subspecialists who diagnosed three to four cases of Lyme disease per year, on average. The majority presented with erythema migrans (EM) or other early symptoms, although arthritis was the presenting sign in 16%. The enzyme-linked immunosorbent assay (ELISA) was the most frequently ordered diagnostic test, but 45% of respondents did not specify which test when ordering Lyme serology. The majority would use amoxicillin or doxycycline to treat EM in children or adults, respectively. Nearly all would use ceftriaxone for meningitis, and half would use it to treat Lyme arthritis or Bell's palsy. Physicians differed markedly in the duration of therapy they would prescribe. Eighty-three percent would treat a patient for possible Lyme disease with antibiotics (many intravenously), even in the absence of EM or positive serology. Thirty-five percent of practitioners prescribed antibiotics for deer-tick bites. Our survey documents significant variation in approaches to Lyme disease among primary-care physicians and suggests the need for well-designed clinical trials, continuing basic research, and physician education.

Adult↗
PubMed1994

Pediatric practice in a summer sleep-away camp.

Clinical practice was surveyed over a 4-week period at a sleep-away camp for children ages 9 to 16 years. The facility is located in the Pocono Mountains in Pennsylvania and has an enrollment of 694 campers and 266 adult staff members. There was a total of 895 visits to the infirmary; however, 190 children were evaluated on more than one occasion. Younger children and girls were more likely to seek medical help. The most common presenting complaints involved physical injuries related to sports activities, followed by a wide range of upper respiratory difficulties, such as sore throat, conjunctivitis, and stuffed nose. Tick bites were not observed in any campers. Significant psychosocial problems were not encountered among any children. Only one child had to be sent home from camp for specific treatment; this was a 14-year-old girl who suffered a lacerated nerve of the third finger on her right hand that required surgical correction. These data indicate that, aside from an increase in minor sports-related injuries, the health problems of children in camp are not significantly different in type or severity from those they experience at home. Furthermore, children attending camp can be relied upon to accurately report their complaints and receive appropriate medical attention.

Adolescent↗
PubMed1994

Cognitive effects of Lyme disease in children.

OBJECTIVE: To measure possible cognitive sequelae of Lyme disease (LD) within a pediatric population. DESIGN: Prospective, blinded, controlled study of cognitive skills in children who had been treated for LD. SETTING: A children's hospital in an area endemic for LD. PATIENTS: Forty-one children with strictly defined LD were compared with 14 control children who had subacute rheumatological diseases, and with 23 healthy sibling controls. OUTCOME MEASURES: Neuropsychologic measures were administered to each child to assess the following cognitive areas: IQ information processing speed, fine-motor dexterity, novel-problem solving and executive functioning, short-term and intermediate memory, and the ability to acquire new learning. Predisease and postdisease academic achievement test scores were also gathered. Impressions from parents concerning the disease's subsequent impact were also obtained. RESULTS: No differences between LD and control groups were found for any of the numerous neuropsychologic measures. Analyses also failed to show differences between LD patients grouped with respect to the presence or absence of known neurologic involvement, disease stage, duration of symptoms before therapy, or type of antibiotic treatment. No predisease versus post-disease difference in academic performance was found. No perceived long-term deterioration in cognitive, social, or personality areas was reported by parents. CONCLUSION: Children appropriately treated for LD have an excellent prognosis for unimpaired cognitive functioning.

Achievement↗
PubMed1993

Regulation by cell volume of Na(+)-K(+)-2Cl- cotransport in vascular endothelial cells: role of protein phosphorylation.

Na(+)-K(+)-2Cl- cotransport in aortic endothelial cells is activated by cell shrinkage, inhibited by cell swelling, and is responsible for recovery of cell volume. The role of protein phosphorylation in the regulation of cotransport was examined with two inhibitors of protein phosphatases, okadaic acid and calyculin, and a protein kinase inhibitor, K252a. Both phosphatase inhibitors stimulated cotransport in isotonic medium, with calyculin, a more potent inhibitor of protein phosphatase I, being 50-fold more potent. Neither agent stimulated cotransport in hypertonic medium. Stimulation by calyculin was immediate and was complete by 5 min, with no change in cell Na + K content, indicating that the stimulation of cotransport was not secondary to cell shrinkage. The time required for calyculin to activate cotransport was longer in swollen cells than in normal cells, indicating that the phosphorylation step is affected by cell volume. Activation of cotransport when cells in isotonic medium were placed in hypertonic medium was more rapid than the inactivation of cotransport when cells in hypertonic medium were placed in isotonic medium, which is consistent with a shrinkage-activated kinase rather than a shrinkage-inhibited phosphatase. K252a, a nonspecific protein kinase inhibitor, reduced cotransport in both isotonic and hypertonic media. The rate of inactivation was the same in either medium, indicating that dephosphorylation is not regulated by cell volume. These results demonstrate that Na(+)-K(+)-2Cl- cotransport is activated by protein phosphorylation and is inactivated by a Type I protein phosphatase. The regulation of cotransport by volume is due to changes in the rate of phosphorylation rather than dephosphorylation, suggesting the existence of a volume-sensitive protein kinase. Both the kinase and the phosphatase are constitutively active, perhaps to allow for rapid changes in cotransport activity.

Animals↗
PubMed1993

School-based clinic use and school performance.

School-based health clinics (SBCs) have been promoted as an innovative approach to providing adolescent health care. The present study examined the effect of a SBC on academic success. We studied the effect of clinic registration and use on students' absence, suspension, withdrawal, and graduation or promotion rates in an alternative high school for students who were not able to succeed in traditional educational programs. On average, these 322 high-risk students attended school only 56% of the time; 24% were suspended; and only 26% graduated or were promoted. The 189 (59%) students who were registered to use the clinic and the 159 (49%) who actually used the clinic were as likely to be absent or to be suspended as non-registered students. However, students who used the clinic were significantly more likely to stay in school, and to graduate or be promoted than students who were not registered for the clinic. This relationship was strongest for black males; those who used the clinic were nearly three times [odds ratio = 0.35; 95% confidence interval (CI) = (0.16-0.78)] more likely to stay in school than those who did not use the clinic. In multiple linear regression models predicting school performance, only clinic use and percent of enrolled days absent were significantly associated with graduation/promotion, and these two variables predicted 23% of the variance in promotion status.

Absenteeism↗
PubMed1993

Adolescent health services in North Carolina's local health departments.

The purpose of this study was to assess availability of clinical health services and special adolescent health programs for those aged 10-19 years administered by local health departments in North Carolina, and to evaluate factors that were associated with the existence of specialized adolescent programs, comprehensive services, and school services. We used self-report surveys mailed to 100 county health directors. All counties responded. One in five (21%) North Carolina youth received one or more health department service in 1990. Thirty-four health departments have programs or services specifically designed for adolescents; 7 health departments provide comprehensive services. The majority of health departments (85%) provide services in public schools, most often health education or counseling. Counties with more adolescents and with higher per capita income were more likely to have adolescent programs and more likely to provide comprehensive clinics. Health departments with school services served proportionally twice as many of their county's adolescents as those without school services. We concluded that few local health departments in North Carolina provide comprehensive health services to their youth. Community-wide participation and state support are needed to improve public sector access to comprehensive health care for adolescents in North Carolina and in other states with decentralized, county-controlled public health systems.

Adolescent↗
PubMed1993

Inhibition of the scarlet fever exanthem in concurrent varicella and group A streptococcus infection.

An atypical scarlet fever exanthem was noted in a 5-year-old child with varicella complicated by secondary group A beta-hemolytic streptococcus pneumonia and empyema. The rash consisted of symmetrical, concentric, circular exanthem-free zones surrounding individual varicella vesicles. The possible role of virus-induced interferon in locally modifying the effect of streptococcal pyrogenic exotoxin is explored.

Chickenpox↗
PubMed1993

Recurring ventriculitis due to Citrobacter diversus: clinical and bacteriologic analysis.

Neonatal meningitis due to Citrobacter diversus is usually accompanied by the development of brain abscesses and tends to have high rates of morbidity and mortality. We report a case of a newborn with C. diversus meningitis and brain abscesses who relapsed after initial antibiotic therapy and from whom C. diversus was recovered from cerebrospinal fluid 4 years later during a neurosurgical procedure. Genetic differences in the early and late isolates were discovered, and explanations for this phenomenon are suggested. Possible mechanisms for prolonged persistence in the central nervous system are explored. This unusual case and the analysis of the organisms illustrate the unique features of C. diversus as a pathogen and underscore the need for developing optimal therapeutic strategies.

Cerebrospinal Fluid↗
PubMed1993

Serum cefazolin levels during spinal fusion: effect of blood loss and duration of surgery.

Perioperative cefazolin prophylaxis is commonly employed in posterior spinal fusion (PSF) procedures, which are often lengthy and involve significant blood loss. In this study, serum levels of prophylactically administered cefazolin were measured serially during spinal fusion procedures, and the possible relationship of antibiotic concentrations to blood loss and fluid therapy were examined. Serum antibiotic levels, measured at 30-min intervals, declined with a half-life of 90 min, similar to the previously reported experience with normal adult volunteers. There was no relationship between serum half-life and blood loss or fluid replacement. An explanation for these findings is offered, along with recommendations for dosing.

Adolescent↗
PubMed1993

Adolescents and access to health care.

The developmental characteristics and health behaviors of adolescents make the availability of certain services--including reproductive health services, diagnosis and treatment of sexually transmitted disease, mental health and substance abuse counseling and treatment--critically important. Furthermore, to serve adolescents appropriately, services must be available in a wide range of health care settings, including community-based adolescent health, family planning and public health clinics, school-based and school-linked health clinics, physicians' offices, HMOs, and hospitals. National, authoritative content standards (for example, the American Medical Association's Guidelines for Adolescent Preventive Services (GAPS), a multispecialty, interdisciplinary guideline for a package of clinical preventive services for adolescents may increase the possibility that insurers will cover adolescent preventive services, and that these services will become part of health professionals' curricula and thus part of routine practice. However, additional and specific guidelines mandating specific services that must be available to adolescents in clinical settings (whether in schools or in communities) are also needed. Although local government, parents, providers, and schools must assume responsibility for ensuring that health services are available and accessible to adolescents, federal and state financing mandates are also needed to assist communities and providers in achieving these goals. The limitations in what even comprehensive programs currently are able to provide, and the dismally low rates of preventive service delivery to adolescents, suggests that adolescents require multiple points of access to comprehensive, coordinated services, and that preventive health interventions must be actively and increasingly integrated across health care, school, and community settings. Unless access issues are dealt with in a rational, coordinated fashion, America's adolescents will not have access to appropriate health services. Current efforts to minimize current health care expenditures through managed care programs inevitably conflict with efforts to deliver comprehensive preventive services to all adolescents. Use of multiple sites may not represent inadequate access to care. However, as managed care reimbursement continues to expand, school-based clinics and free-standing adolescent health programs increasingly report decreases in reimbursement without a change in demand for services. The Office of Technology Assessment study called for explicit funding and expansion of services for America's youth; since then, a federal Office of Adolescent Health has been authorized, and, by the time this reaches print, should have received appropriations and been staffed. Dryfoos has called for expansion to nearly 5000 comprehensive programs in the coming years. 76 Additionally, The Robert Wood Johnson Foundation has just announced a $23.2 million state-community partnership grant program to increase availability of school-based health services for children and youth with unmet health needs.77 As health care reform efforts move forward,both careful definition of the services adolescents need and adequate financing for these services are essential to ensure access to care for all adolescents.

Adolescent↗