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Biomedical subjects

J Horan

Publications and source records attributed to J Horan.

15 recordsLinked to original sources
PubMed2000

National study of the impact of managed care on osteopathic physicians.

The study reported here was designed to provide insight into the impact managed care has had on osteopathic physicians' ability to practice medicine, as well as data to substantiate the prevalence of the specific problems encountered by the 40,000 osteopathic physicians in the United States. New data on the extent to which osteopathic physicians use osteopathic manipulative treatment was also obtained, as a review of the literature revealed only two previous surveys on the use of osteopathic manipulative treatment. The American Osteopathic Association hired an independent research company to conduct the survey.

Humans↗
PubMed1998

A viral gastroenteritis outbreak associated with person-to-person spread among hospital staff.

OBJECTIVE: To identify the etiologic agent and risk factors associated with a hospital ward outbreak of gastroenteritis. SETTING: A regional referral hospital in upstate South Carolina. METHODS: We reviewed patient charts, surveyed staff, and tested stool from acutely ill persons. A case was defined as diarrhea and vomiting in a staff member or patient from January 5 to 13, 1996. RESULTS: The initial case occurred on January 5 in a staff nurse who subsequently was hospitalized on the ward and visited by many staff colleagues. The staff were at a significantly greater risk for gastroenteritis than were patients (28/89 [31%] vs 10/91 [11%]; relative risk [RR], 2.9; 95% confidence interval [CI95], 1.5-5.5). All 10 case-patients had been exposed to case-nurses (assigned nurses who were primary caretakers), and eight had documented exposure to case-nurses 1 to 2 days before their illness. Patients exposed to case-nurses had a significantly increased risk of illness (8/57 [14%] vs 0/32; RR, >4.5; CI95, undefined). Neither staff nor patients had significantly increased risk from food, water, ice, or exposure to case-patients. Electron microscopy identified small round-structured viruses (SRSVs) in nine of nine stool samples. CONCLUSION: This nosocomial outbreak of gastroenteritis was likely caused by SRSVs introduced by a staff member and spread via person-to-person transmission from and among staff. The potential for spread of SRSV-associated gastroenteritis from and among staff should be considered in developing strategies to prevent similar outbreaks in hospital settings.

Adult↗
PubMed1996

Evidence that interleukin-1, but not interleukin-6, affects costochondral chondrocyte proliferation, differentiation, and matrix synthesis through an autocrine pathway.

Although the effects of interleukin-1 (IL-1) and interleukin-6 (IL-6) on articular cartilage chondrocytes have been reported, little is known concerning the effects of these cytokines on growth plate chondrocytes. In this study, we examined the effect of IL-1 alpha, IL-1 beta, and IL-6 on growth plate chondrocyte proliferation, differentiation, and matrix production as a function of cell maturation and examined the ability of these cells to produce IL-1 alpha and IL-1 beta. Confluent fourth passage cultures of rat costochondral resting zone and growth zone chondrocytes were treated with 0-100 ng/ml of IL-1 alpha, IL-1 beta, or IL-6 for 24 h and then assayed for [3H]-thymidine incorporation, alkaline phosphatase specific activity, [35S]-sulfate incorporation, and percent collagen production. Neutralizing polyclonal antibodies were used to confirm the specificity of response to each cytokine. Treatment of resting zone cells with IL-1 alpha produced a significant, dose-dependent decrease in [3H]-thymidine incorporation, while similarly treated growth zone cells were unaffected by treatment with this cytokine. IL-1 alpha also stimulated alkaline phosphatase specific activity and inhibited [35S]-sulfate incorporation by resting zone chondrocytes, but had no affect on growth zone chondrocytes. When collagen production was examined, it was observed that IL-1 alpha had a stimulatory affect on growth zone cells but no affect on resting zone cells. When the effect of IL-1 beta was examined, it was observed that this cytokine inhibited [3H]-thymidine incorporation by resting zone cells and stimulated isotope incorporation in growth zone cells. IL-1 beta also stimulated alkaline phosphatase specific activity and inhibited [35S]-sulfate incorporation by resting zone chondrocytes but had no affect on growth zone chondrocytes. In contrast to IL-1 alpha, IL-1 beta stimulated collagen production by resting zone cells but not growth zone cells. IL-6 had no affect on any of the parameters measured in either cell type. When cytokine production was measured, it was found that IL-1 alpha was produced by both cell types, while IL-1 beta was produced only by resting zone cells. Resting zone cells secreted both IL-1 alpha and IL-1 beta into the media, but 75% of the total cytokine produced by these cells was retained in the cell layer. In contrast, growth zone cells did not secrete measurable IL-1 alpha into the media. These results suggest that IL-1 alpha and IL-1 beta target resting zone cells, inducing them to differentiate and acquire a phenotype characteristic of the more mature growth zone cells. Moreover, resting zone chondrocytes produce both IL-1 alpha and IL-1 beta, suggesting the possibility of an autocrine effect of these cytokines on the cells.

Animals↗
PubMed1995

Typhoid fever in the park: epidemiology of an outbreak at a cultural interface.

The number of reported outbreaks of typhoid fever in the United States has recently increased. Only six were reported from 1980-1989, but seven outbreaks were reported in 1990. In August 1990, health officials in Montgomery County, Maryland, were notified of two cases of typhoid fever among persons who had attended both a family picnic attended by 60 persons and a Latin Food Festival attended by 100,000 people. We obtained interviews, blood and stool cultures, and Vi serologies from attendees at and food handlers for the picnic. We defined cases as culture-confirmed or probable. Of the 60 picnic attendees, 24 (40%) had cases, of which 16 were culture confirmed. Those who ate potato salad were at increased risk of disease (17/32 vs. 6/28, relative risk [RR] = 2.5, 95% confidence interval [CI] 1.1-5.4). Picnic attendees who also attended the Latin Food Festival were not at significantly greater risk of disease than those who did not, (11/22 vs. 13/38, RR = 1.5, CI = 0.8-2.7) and we found no evidence of disease among other festival attendees. The potato salad was prepared with intensive handling and without adequate temperature control by a recent immigrant from El Salvador who was asymptomatic, did not attend the picnic, had Salmonella typhi (S. typhi) in her stool, and had elevated Vi antibodies, strongly suggestive of the carrier state. Outbreaks of typhoid fever are a threat for cosmopolitan communities. While currently available control measures are unlikely to prevent all outbreaks, thorough investigation can identify previously unrecognized carriers.

Adolescent↗
PubMed1994

Using CD4 counts to evaluate the stages and epidemiology of HIV infection in South Carolina public clinic patients.

OBJECTIVES: CD4 lymphocyte counts decrease with the duration of human immunodeficiency virus (HIV) infection. We used CD4 counts collected for clinical reasons to evaluate the stage of HIV infection and the epidemiology of recent HIV infections among attendees of South Carolina's public health clinics. METHODS: We measured the CD4 T-lymphocyte counts of persons newly diagnosed with HIV infection April 1989 through June 1990 at South Carolina public health clinics who returned for follow-up. RESULTS: Of 812 newly diagnosed HIV-infected health department patients, 420 (52%) had their CD4 lymphocyte counts measured. Of these 420, 51 (12%) had CD4 counts of < 200, the level below which prophylaxis for pneumocystis pneumonia prolongs survival, and 193 (46%) had CD4 counts of < 500, the level below which zidovudine may prolong disease-free survival. The highest CD4 counts (> or = 900), which are associated with more recent HIV infection, were more common in females. CONCLUSIONS: In South Carolina, almost half of newly reported HIV-infected persons who agreed to CD4 testing at the health department might benefit from immediate drug therapy. Within this population, women may be an emerging risk group that requires specifically directed HIV prevention efforts.

Adolescent↗
PubMed1994

A nosocomial outbreak of Mycobacterium tuberculosis.

BACKGROUND: The national incidence of tuberculosis (TB) is increasing, and hospitals are a site of transmission. We investigated a nosocomial outbreak of TB at a 160-bed community hospital in South Carolina that highlights the central role that primary care physicians must play to control this epidemic. METHODS: We reviewed medical records to identify potential source cases. We retrospectively evaluated exposures to suspected source patients and the subsequent tuberculin reactivity of the 38 hospital employees who had a previous negative tuberculin skin test and were assigned to the ward where the outbreak began. We also evaluated the out-of-hospital contacts of TB cases. RESULTS: A review of medical records identified one patient who had died of prostate cancer and chronic cavitary pneumonia but was never in isolation nor evaluated for TB. Ward employees who worked while this patient was hospitalized had an increased risk for skin-test conversion (43% [12 of 28] vs 0% [0 of 9]; relative risk undefined; P = .02). Among employees who worked with this patient, skin-test converters worked more shifts with (median, 10.5 vs 7), dispensed more medication to (median 7 doses vs 1), and wrote more notes on (median 18 vs 5) the index patient than did nonconverters. Five of 12 of the patient's close out-of-hospital contacts had newly recognized positive tuberculin skin tests. Among 20 casual contacts, there were no new skin-test conversions. CONCLUSIONS: A high index of suspicion, prompt isolation and diagnostic testing of potentially infectious hospitalized patients, and a thorough investigation of contacts of patients with TB are needed to prevent TB transmission.

Aged↗
PubMed1993

A large outbreak of gastroenteritis caused by diarrheal toxin-producing Bacillus cereus.

An outbreak of diarrhea occurred after a university field day. Of 643 attendees who returned mailed questionnaires, 139 (22%) reported illness. Persons who ate barbecued pork, which was unrefrigerated for 18 h after cooking, were five times more likely to become ill than those who did not eat pork (26% vs. 5%; relative risk, 5.4; 95% confidence interval, 1.4-20.9). A leftover pork sample grew a Bacillus cereus isolate, > 10(5) cfu/g, that produced diarrheal toxin. Thirty-four percent of ill persons noted onset of illness outside the 6- to 24-h incubation period traditionally ascribed to B. cereus-mediated diarrhea, and an unusually high percentage (23%) noted fever. B. cereus may cause a wider spectrum of disease than previously described.

Bacillus cereus↗
PubMed1992

Treatment of congenital and acquired hemophilia patients by extracorporeal removal of antibodies to coagulation factors: a review of US clinical studies 1987-1990. Hemophilia Study Group.

This paper reviews the use of extracorporeal immunoadsorption with immobilized Staphylococcal Protein A in attempts to lower the inhibitor titer in 22 patients with either congenital hemophilia or with acquired inhibitors. Eighty-five immunoadsorption procedures were performed at 13 locations in the United States between June, 1987 and February, 1990. In general, immunoadsorption was shown to efficiently remove IgG and, in eight congenital hemophilia patients, it also produced a clinically significant lowering of inhibitors allowing effective conventional factor replacement therapy. Three of thirteen congenital hemophilia patients treated received factor concentrate prior to immunoadsorption and were anamnestic at the time of treatment. Although they experienced substantial lowering of their inhibitor titers, it was not sufficient to allow effective factor replacement. The effectiveness of immunoadsorption therapy in the 9 patients with acquired inhibitors was more difficult to evaluate due to the wide variety of concomitant medications which were employed, although in several patients serious bleeding episodes were substantially improved (or halted) following immunoadsorption. Side effects associated with immunoadsorption were slight. These findings suggest that immunoadsorption can be a significant benefit to patients with inhibitors, particularly if it is instituted prior to factor administration.

Adolescent↗
PubMed1992

Risk factors associated with severe measles in Puerto Rico.

From January to April, 1990, 695 measles cases were reported to the Puerto Rico Health Department; there were 12 measles-associated deaths (case fatality ratio, 17/1000), more than in any year since 1967. We conducted a case-control study of risk factors for severe measles. We identified 16 children (ages 5 to 34 months) with severe measles and selected children with nonsevere measles as controls (39 hospitalized and 38 nonhospitalized). Controls were frequency matched to severe measles cases by region of residence. One case and two controls had been vaccinated. An underlying illness was present in 50% of cases and 16% of nonhospitalized controls (Mantel-Haenszel weighted odds ratio 5.3; 95% confidence interval 1.4, 20.2). In a multivariate analysis cases were significantly more likely than hospitalized controls to be from families with an annual income of < $5000 (odds ratio (OR), 26.9), to have a mother without a high school degree (OR 11.1), to be anemic (hemoglobin < 10 g/dl) (OR 15.9) and have an underlying illness (OR 18.3). During measles outbreaks preventing severe illness requires aggressive control measures and strategies to increase vaccine coverage of children with underlying illnesses and of low socioeconomic status.

Child, Preschool↗
PubMed1978

Obituary.

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Amino Acid Sequence↗