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Biomedical subjects

J Feldman

Publications and source records attributed to J Feldman.

At least 91 records · Page 5Linked to original sources
PubMed1997

Benefit of two-step PPD testing of new employees at a New York City hospital.

BACKGROUND: Recent concern about nosocomial transmission of tuberculosis has led hospitals to scrutinize employee tuberculin conversion rates. The Centers for Disease Control and Prevention recommends two-step testing of new employees to limit the booster phenomenon. The cost of such a program and its subsequent yield have not recently been examined. METHODS: Employee health records were retrospectively reviewed of persons hired from 1993 and 1994 at St. Clare's Hospital in New York City, all of whom received two-step testing at time of initial employment. RESULTS: Of 262 new employees, 107 (41%) had positive tuberculin results on initial testing. The results of 15 (9.7%) of the remaining 155 patients became positive on two-step testing administered 1 week later. Persons with a positive second test result were significantly more likely to be male or foreign born or to have received previous bacille Calmette-Guérin vaccination. Identification of these 15 persons and exclusion of them from probable subsequent conversion prevented an almost 50% increase in the annual conversion rate at our hospital, from 3.2% to 4.7%. CONCLUSION: Two-step tuberculin testing is an essential means of identifying persons with a baseline positive tuberculin test result, thus allowing accurate reporting of subsequent employee tuberculin conversions.

Adult↗
PubMed1997

Association of serum albumin and mortality risk.

Reduced levels of serum albumin concentration, a routine blood test, within the "normal" range have been reported to be associated with mortality risk. The literature is reviewed, with a focus on cohort studies meeting specified criteria, and findings are summarized. In studies of many populations, comprising healthy subjects and patients with acute or chronic illness, serum albumin concentration is inversely related to mortality risk in a graded manner over its entire range; the estimated increase in the odds of death ranges from 24% to 56% for each 2.5 g/l decrement in serum albumin concentration. The association predicts overall and cause-specific mortality including cardiovascular mortality. It is likely that albumin concentration is a highly sensitive indicator of preclinical disease and disease severity. A direct protective effect of the albumin molecule is suggested by the persistence of the association after adjustment for other known risk factors and preexisting illness, and after exclusion of early mortality. Although biologically plausible, there is no direct evidence for this hypothesis. Serum albumin concentration is an independent predictor of mortality risk and could be useful in the quantification of risk in a broad range of clinical and research settings.

Adult↗
PubMed1997

Sexual risk behaviour among subgroups of heterosexual HIV infected patients in an urban setting.

OBJECTIVE: To determine the frequency of characteristics associated with unprotected heterosexual intercourse in HIV infected adults in an urban area. DESIGN: Retrospective comparison of sexual risk transmission behaviour between HIV infected men and women from a drug treatment site and between women from the drug site and HIV infected women from an urban medical centre. METHODS: HIV infected women and men were asked questions on sexual behaviour for a 1 year period before enrollment. The outcome variable was heterosexual risk behaviour (HRB) defined as having vaginal sex at least once in the previous year and not always using condoms. RESULTS: 73% of the drug clinic females, 72% of the drug clinic males, and 42% of the medical centre female engaged in HRB. Using logistic regression analysis, women and men in drug treatment engaged in similar rates of HRB; however, women in drug treatment were four times (95% CI = 2.0-8.3) more likely to engage in HRB risk behaviour than women from the medical centre. CONCLUSION: The data suggest that a surprisingly large portion of HIV infected patients under treatment engaged in HRB, especially former drug users. Without specifically targeted interventions, the heterosexual spread of HIV in urban areas will continue to be a serious problem.

Adult↗
PubMed1997

Risk of tuberculin conversion according to occupation among health care workers at a New York City hospital.

Concern about the risk to health care workers of occupationally acquired tuberculosis has resulted in extensive and frequently revised guidelines from the Centers for Disease Control and Prevention (CDC). Most recent studies, however, have determined that community, rather than occupational, exposure is the more significant risk for tuberculin conversion. To assess the relative contribution of community versus occupational risk, we reviewed the health records of 1,303 persons employed from 1991 to 1994 at St. Clare's Hospital in New York City, a hospital with a high tuberculosis case-rate. Demographic information included age, gender, postal zone of residence, country of birth, and BCG vaccination status, while occupations were placed into one of five groups. In multivariate analysis, occupation was significantly associated with risk of tuberculin conversion, while postal zone of residence was not. The group that included housekeeping, laundry, and security personnel and the physician-nurse group had the highest conversion rates. After implementation of CDC guidelines, there was a significant improvement in the employee tuberculin conversion rate. At our hospital, occupation was strongly associated with risk of tuberculin conversion.

Female↗
PubMed1997

An association between the heat-humidity index and preterm labor and delivery: a preliminary analysis.

OBJECTIVES: The goal of this study was to determine whether a relationship exists between heat-humidity indexes and rates of preterm labor and preterm delivery. METHODS: Preterm labor and delivery rates were compared during the 2 summer and 2 winter weeks with the highest and lowest heat-humidity indexes for each season. RESULTS: The rate of preterm labor increased consistently from 1.23% to 3.00% as the heat-humidity index rose. When preterm births were examined, the trend was similar but not statistically significant. CONCLUSIONS: Given the public health import of preterm labor and the frequency with which pregnant women may be exposed to extremes of heat, studies designed to confirm or refuse our preliminary observations are warranted.

Delivery, Obstetric↗
PubMed1997

Antiretroviral therapy for HIV infection. Heartening successes mixed with continuing challenges.

Probably nothing in the field of medicine has changed as rapidly over the last decade as antiretroviral (ARV) therapy for HIV infection. New insights into pathogenesis, new tests for measuring virus levels in plasma, and availability of powerful new drugs have combined to transform the care of persons with HIV infection into a field infused with real hope. However, ARV therapy remains complex, expensive, and not universally effective or available. This article focuses on a general approach to the use of ARV agents.

Anti-HIV Agents↗
PubMed1996

Menstrual function in human immunodeficiency virus-infected women without acquired immunodeficiency syndrome.

To assess whether HIV infection is associated with menstrual abnormalities in HIV-infected women without AIDS, we evaluated 248 premenopausal HIV-infected women without AIDS and 82 HIV-negative women. Detailed medical, drug use, and menstrual histories (using menstrual calendars) were obtained. Complete physical and pelvic examinations and CD4 counts were performed. HIV-infected women were more likely to experience intervals > 6 weeks without menstrual bleeding [8 vs. 0%, odds ratio (OR) = 10.8, 95% confidence interval (CI) 1.8-1,000) and amenorrhea > 3 months (5 vs. 0%, OR = 7.1, 95% CI 1.1-1,000) (after adjustment for drug use, age, and race). Premenstrual breast swelling (p = 0.01), tenderness (p = 0.01), and dysmenorrhea (p = 0.04) were less common in HIV-infected women. There were no differences in intermenstrual bleeding or irregular menstrual cycles. Among HIV-infected women, only a past history of substance abuse was significantly associated with menstrual irregularities in a logistic regression model adjusting for age, current and past drug use, alcohol use, cigarette smoking, CD4 count, and category B conditions [1993 Centers for Disease Control (CDC) classification system]. The increase in amenorrhea (> 3 months) and in menstrual cycle intervals > 6 weeks and the lower rates of premenstrual breast symptoms in HIV-positive women suggest the possibility of disturbances in menstrual function that do not appear to be attributable to clinically apparent secondary complications of HIV. Changes in menstrual function were also significantly associated with a past history of, but not current, substance abuse, suggesting the possibility that socioeconomic factors rather than biologic effects of drugs may be responsible.

Adult↗
PubMed1996

MK-801 and memantine inhibit a centrally induced increase in myocardial oxygen demand in rabbits.

Electrical stimulation of the paraventricular nucleus of the hypothalamus in the anaesthetized rabbit induces an increase in indexes of myocardial oxygen demand. This increase in myocardial oxygen demand is due to the activation of sympathetic pathways which include glutamatergic relays. In this model, systemic injection of dizolcipine (MK-801) and memantine inhibited these responses. Because these drugs have only one pharmacological property in common i.e. blockade of the NMDA receptor channel complex, these results fit with our previous results concerning the possible involvement of NMDA receptors in the central control of sympathetic activation. Memantine appears to be an interesting prototype for centrally acting cardioprotective drugs devoid of serious side effects.

Animals↗
PubMed1996

A national outbreak of Salmonella enteritidis infections from ice cream. The Investigation Team.

BACKGROUND: In September 1994, the Minnesota Department of Health detected an increase in the number of reports of Salmonella enteritidis infections. After a case-control study implicated a nationally distributed brand of ice cream (Schwan's) in the outbreak, the product was recalled and further epidemiologic and microbiologic investigations were conducted. METHODS: We defined an outbreak-associated case of S. enteritidis infection as one in which S. enteritidis was cultured from a person who became ill in September or October 1994. We established national surveillance and surveyed customers of the implicated manufacturer. The steps involved in the manufacture of ice cream associated with cases of S. enteritidis infection were compared with those of products not known to be associated with infection matched for the date of manufacture. Cultures for bacteria were obtained from ice cream samples, the ice cream plant, and tanker trailers that had transported the ice cream base (premix) to the plant. RESULTS: We estimate that S. enteritidis gastroenteritis developed in 224,000 persons in the United States after they ate Schwan's ice cream. The attack rate for consumers was 6.6 percent. Ice cream associated with infection contained a higher percentage of premix that had been transported by tanker that had carried nonpasteurized eggs immediately before (P = 0.02). S. enteritidis was isolated from 8 of 226 ice cream products (3 percent), but not from environmental samples obtained from the ice cream plant (n = 157) or tanker trailers (n = 204). CONCLUSIONS: This nationwide outbreak of salmonellosis was most likely the result of contamination of pasteurized ice cream premix during transport in tanker trailers that had previously carried nonpasteurized liquid eggs containing S. enteritidis. To prevent further outbreaks, food products not destined for repasteurization should be transported in dedicated containers.

Adolescent↗
PubMed1996

The intensity of hemodialysis and the response to erythropoietin in patients with end-stage renal disease.

BACKGROUND: Anemia (characterized by a hematocrit of 30 percent or lower) persists in 40 to 60 percent of patients treated for end-stage renal disease with maintenance hemodialysis, despite concomitant erythropoietin (epoetin) therapy. We tested the hypothesis that inadequate dialysis is a key reason for the insufficient response to erythropoietin in patients with end-stage renal disease who are receiving hemodialysis. METHODS: We prospectively studied 135 randomly selected patients undergoing hemodialysis who had been receiving intravenous erythropoietin for at least four months. The adequacy of dialysis was assessed by measuring the percent reduction in the blood urea nitrogen concentration and the serum albumin concentration. The hematocrit was measured weekly for four weeks, transferrin saturation was measured, and coexisting illnesses were documented. To determine the effect of an increased level of dialysis on the hematocrit, the thrice-weekly schedule of dialysis was increased to raise the mean urea-reduction value from 60.7 to 72 percent for six weeks in 20 consecutive patients whose base-line urea-reduction value was less than 65 percent. The change in the hematocrit in these patients was compared with that observed in the next 20 patients who had an equivalent base-line urea-reduction value but whose level of dialysis was not altered. RESULTS: The mean hematocrit of the entire group was 29.2 +/- 4 percent, and the mean thrice-weekly dose of erythropoietin was 59 +/- 29 U per kilogram of body weight. The mean serum albumin concentration was 3.8 +/- 0.4 g per deciliter, the mean urea-reduction value was 62 +/- 4.8 percent, and the mean transferrin saturation was 20 +/- 9 percent. Multiple regression analysis revealed direct correlations between the hematocrit and the serum albumin concentration (P = 0.009) and between the hematocrit and the urea-reduction value (P = 0.012) after adjustment for other factors. A logistic-regression analysis indicated that an 11 percent increase in the urea-reduction value doubled the odds that a patient would have a hematocrit above 30 percent. After six weeks of increased intensity of dialysis in 20 patients with base-line urea-reduction values of less than 65 percent, the mean (+/- SE) hematocrit rose from 28.4 +/- 0.78 percent to 32.3 +/- 0.71 percent (P = 0.002); there was no significant change in a control group of 20 patients with equivalent base-line urea-reduction values in whom the dialysis level was not altered (28.2 +/- 0.84 percent to 26.3 +/- 0.85 percent; P = 0.175). CONCLUSIONS: In patients with end-stage renal disease, inadequate hemodialysis is associated with a suboptimal response to erythropoietin therapy. Increasing the intensity of dialysis in patients with anemia who are receiving inadequate dialysis results in a significant increase in the hematocrit.

Aged↗
PubMed1996

Inhibition of centrally induced ventricular arrhythmias by rilmenidine and idazoxan in rabbits.

In a model of ventricular arrhythmias of central origin, we investigated the effects of rilmenidine, an oxazoline with antihypertensive properties, and idazoxan, an imidazoline that is an antagonist of the hypotensive effects of rilmenidine. Bicuculline, a GABAA receptor antagonist, was administered intracisternally (i.c.) to produce arrhythmias in pentobarbitone anaesthetised rabbits; 10 micrograms/kg bicuculline i.c. induced polymorphic ventricular ectopic beats and ventricular tachycardia while blood pressure increased by about 50-60% and sinusal heart rate decreased by about 20%. Rilmenidine, either administered intravenously (0.01, 0.1, 1 mg/kg i.v.) or i.c. (3, 10, 30 micrograms/kg) dose-dependently prevented the occurrence of bicuculline-induced arrhythmias while, because of a lower base-line, the blood pressure values reached were less as compared to controls. Idazoxan administered i.v. (3, 10 mg/kg) had a similar action. Idazoxan i.c. (15 micrograms/kg) had no significant antiarrhythmic effect but antagonized in part the haemodynamic and antiarrhythmic effects of rilmenidine (1 mg/kg i.v.; 30 micrograms/kg i.c.). It is suggested that the antiarrhythmic effects observed with rilmenidine are mainly mediated by blunting the bicuculline-induced increase in the sympathetic nervous output to the heart and the vascular beds. These effects of rilmenidine are likely to originate both from the central and peripheral nervous system. The antiarrhythmic effects of idazoxan i.v. might be related to a blocking action on alpha 2-adrenoceptors at the level of the coronary arteries and other vascular beds.

Adrenergic alpha-Antagonists↗
PubMed1996

Health-related quality of life of HIV-infected women: evidence for the reliability, validity and responsiveness of the Medical Outcomes Study Short-Form 20.

The purpose of this study was to assess the reliability, validity and responsiveness of a health-related quality of life (HRQOL) instrument, the Medical Outcomes Short-Form 20-Item General Health Survey (MOS SF-20), in a sample of women with the human immunodeficiency virus (HIV). Longitudinal data were collected on 202 HIV-infected women without AIDS who were receiving care at Kings County Hospital or SUNY Health Sciences Center, Brooklyn, New York. Internal consistency results showed acceptable reliability for the four multi-item MOS scales (role function, physical function, general health perceptions and mental health). Symptomatic patients and patients with lower Karnofsky Performance Status (KPS) ratings reported lower HRQOL than those who were asymptomatic or who had higher KPS scores. Patients who were older, unemployed or who had a history of injection drug use (IDU) also reported lower HRQOL than those who were younger, employed or who had no drug use history. Adjusted mean scores on the MOS role and physical functioning scales proved sensitive to differences in clinical status over time. The MOS SF-20 is a reliable and valid instrument of HRQOL for women with HIV infection. Its sensitivity to differences in clinical status over time suggest that it may be useful as an HRQOL indicator for HIV/AIDS clinical trials.

Adult↗
PubMed1996

Pigmented basal cell carcinoma in Hispanics.

BACKGROUND: Pigmented basal cell carcinoma (PBCC) may occasionally be misdiagnosed as melanoma. In the Hispanic population, PBCC is common. OBJECTIVE: We attempted to determine the prevalence of PBCC in a Hispanic population. METHODS: A randomized, blinded, retrospective study was designed to assess histologic slides for the presence of microscopic pigment. Basal cell carcinoma (BCCs) from 30 patients with a Hispanic surname were compared histologically with BCCs from 30 patients with a northern European surname. In the prospective phase of the study, 15 Hispanic and 44 non-Hispanic patients with clinically suspected BCC or PBCC completed a questionnaire about their ethnic background and skin type to determine whether PBCC is more common in Hispanics. RESULTS: Pigment was identified twice as frequently in BCCs from patients with a Hispanic surname than in BCCs from patients with a northern European surname. In the prospective clinical study, 66% of clinically diagnosed PBCCs were found in Hispanic patients, whereas only 11% of nonpigmented BCCs came from Hispanic patients (p < 0.01). CONCLUSION: In patients with a BCC, PBCCs are more common in Hispanics than non-Hispanics. This may reflect an increased incidence of PBCCs in the Hispanic population.

Basal Cell Carcinoma↗
PubMed1996

Regularity vs genericity in the perception of collinearity.

The perception of collinearity is investigated, with the focus on the minimal case of three dots. As suggested previously, from the standpoint of probabilistic inference, the observer must classify each dot triplet as having arisen either from a one-dimensional curvilinear process or from a two-dimensional patch. The normative distributions of triplets arising from these two classes are unavailable to the observer, and are in fact somewhat counterintuitive. Hence in order to classify triplets, the observer invents distributions for each of the two opposed types, 'regular' (collinear) triplets and 'generic' (ie not regular) triplets. The collinear prototype is centered at 0 degree (ie perfectly straight), whereas the generic prototype, contrary to the normative statistics, is centered at 120 degrees away from straight-apparently because this is the point most distant in triplet space from straight and thus creates the maximum possible contrast between the two prototypes. By default, these two processes are assumed to be equiprobable in the environment. An experiment designed to investigate how subjects' judgments are affected by conspicuous environmental deviations from this assumption is reported. The results suggest that observers react by elevating or depressing the expected probability of the generic prototype relative to the regular one, leaving the prototype structure otherwise intact.

Adult↗
PubMed1996

Factors associated with cytomegalovirus infection among human immunodeficiency virus type 1-seronegative and -seropositive women from an urban minority community.

Cytomegalovirus (CMV) seroprevalence and genital tract shedding in human immunodeficiency virus (HIV)-seronegative and HIV-seropositive women from an urban minority community were investigated. CMV seropositivity was high in both groups: 181 (95.2%) of 190 HIV-negative and 158 (90.3%) of 175 HIV-positive subjects. Cervicovaginal shedding was detected in 8 (4.4%) CMV-positive HIV-negative subjects and 31 (19.6%) HIV-positive subjects (odds ratio [OR], 5.28; P < .001). Multiple logistic regression analysis revealed that CMV shedding was independently associated with younger age (OR = 0.90; P < .001) and concurrent Chlamydia trachomatis or Neisseria gonorrhoeae infection (OR = 3.60; P = .08). However, shedding was observed over a broad age range in HIV-positive subjects, with 54.8% of shedders being > or = 30 years old. Among HIV-positive subjects, CMV shedding was also associated with decreased CD4 cell counts (P = .04) and, compared with HIV-negative subjects, was significantly higher (P < .001) among subjects with CD4 cell counts < 500 x 10(6)/L (26.5% in subjects with counts < or = 200 and 22.1% in subjects with counts of 201-499 x 10(6)/L).

AIDS-Related Opportunistic Infections↗
PubMed1996

Enhancing treatment adherence with a specialized emergency room program for adolescent suicide attempters.

OBJECTIVE: The evaluation of outpatient treatment adherence among 140 Latina adolescent suicide attempters and their families. METHOD: Sequentially, 75 attempters received standard emergency room care and 65 attempters received a specialized emergency room program including (1) training workshops for emergency room staff, (2) a videotape aimed at modifying families' treatment expectations, and (3) an on-call family therapist. RESULTS: Attempters receiving the specialized program were more likely to attend one treatment session (95.4% versus 82.7%) and were somewhat more likely to attend more sessions (5.7 versus 4.7) than those receiving standard emergency room care; however, their mothers were less likely to complete treatment. In addition, participants receiving the specialized program reported reduced psychiatric symptoms, and mothers reported more positive attitudes toward treatment and perceptions of family interactions. CONCLUSIONS: Adherence was significantly improved by receiving the specialized care program in the emergency room. Adherence was also associated with increased suicidal ideation, more cohesive family relations, and lower self-esteem at baseline.

Adolescent↗