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Biomedical subjects

J Hutchinson

Publications and source records attributed to J Hutchinson.

18 recordsLinked to original sources

AIDS and racism in America.

Institutionalized racism affects general health care as well as acquired immunodeficiency syndrome (AIDS) health intervention and services in minority communities. The overrepresentation of minorities in various disease categories, including AIDS, is partially related to racism. The national response to the AIDS epidemic in minority communities has been slow, showing an insensitivity to ethnic diversity in prevention efforts and AIDS health services.

Acquired Immunodeficiency Syndrome

Azathioprine combined with prednisone in the treatment of idiopathic pulmonary fibrosis: a prospective double-blind, randomized, placebo-controlled clinical trial.

Twenty-seven newly diagnosed patients with idiopathic pulmonary fibrosis (IPF) who were previously untreated for IPF were enrolled in a prospective, double-blind, randomized, placebo-controlled study to compare the therapeutic effect of combined prednisone/azathioprine (n = 14) with prednisone plus placebo (n = 13). Prednisone was started at 1.5 mg/kg/day (not to exceed 100 mg/day) for the first 2 wk followed by a biweekly taper to a maintenance dose of 20 mg/day. Azathioprine was administered at a daily dose of 3 mg/kg (not to exceed 200 mg/day). The patients tolerated the use of azathioprine well with few associated side effects. Changes in lung function at 1 yr, as measured by resting alveolar-arterial oxygen difference P[A-a]O2, FVC, and single breath diffusing capacity for carbon monoxide (DLCOSB), were all somewhat better in the azathioprine/prednisone group compared with the prednisone alone group, although none of these comparisons were statistically significant. Six of 14 (43%) patients randomized to prednisone plus azathioprine died during the 9-yr follow-up period, compared with 10 of 13 (77%) patients randomized to prednisone plus placebo. A Cox model survival analysis shows a nonsignificant but potentially large survival advantage for azathioprine/prednisone (hazard ratio 0.48, with 95% confidence interval increasing from 0.17 to 1.38). When adjusted for age, the survival advantage of azathioprine/prednisone becomes marginally significant (hazard ratio 0.26, with 95% confidence interval increasing from 0.08 to 0.88; p = 0.02 by large sample approximation, p = 0.05 by randomization test). We conclude that combined prednisone and azathioprine is a safe and possibly effective regimen for the treatment of IPF.(ABSTRACT TRUNCATED AT 250 WORDS)

Azathioprine

Evaluation of click-evoked oto-acoustic emissions in the newborn.

Click-evoked oto-acoustic emissions and auditory brainstem responses (ABR) have been recorded in 723 babies taken largely from a neonatal intensive care unit to evaluate the use of oto-acoustic emissions as a method of screening for hearing impairment. Twenty-nine infants failed to pass the initial ABR test and repeat ABR tests carried out up to the age of 3 months. The 'sensitivity' and 'specificity' of the oto-acoustic emission test for the ABR test results up to 3 months of age in surviving infants were 93% and 84% respectively. It is proposed that click-evoked oto-acoustic emissions be considered as the initial method to screen for hearing impairment, test failures being followed up by ABR.

Acoustic Stimulation

Click evoked otoacoustic emissions in neonatal screening.

Seven hundred and twenty-three neonates under intensive care have been tested by evoked otoacoustic emissions (EOAE) and the auditory brain stem response (ABR) to investigate the use of EOAE as a test for hearing impairment. Three hundred and thirty-one have had follow-up tests to the age of at least 2 years. The EOAE test has been found to be practical and quick to perform. The proportion of NICU infants producing a recordable EOAE is 80%, and the sensitivity and selectivity to the ABR result in the period up to 3 months post due date is 93 and 84%, respectively. These figures are high enough and the reduction in time compared to ABR is sufficient for the EOAE to be considered as the primary screen. The follow-up data show mixed results with both false positives and false negatives present. The incidence of severe hearing impairment is close to that expected from retrospective studies at 2 in 331 (1 bilateral, 1 unilateral). Firm conclusions on the sensitivity of EOAE to long-term hearing impairment await the results from larger numbers of infants and further follow up data.

Audiometry, Evoked Response

Click evoked otoacoustic emissions compared with brain stem electric response.

The hearing of 346 babies taken largely from a neonatal intensive care unit has been tested by otoacoustic emissions and brain stem electric response audiometry. A total of 336 (97%) of the babies have been followed up by hearing tests from the age of 8 months. The otoacoustic emission test has been found to be practical with a mean test time of 12.1 minutes compared with 21.0 minutes for brain stem electric response. An otoacoustic emission was recorded bilaterally in 274 (79%) babies. Twenty of the 21 surviving infants who failed brain stem electric response in the neonatal period did not produce an emission. It is concluded that the otoacoustic emission test would make a good first screen to be followed by the brain stem electric response if no otoacoustic emission was present. There is poor agreement between the test results in the neonatal period and those of the follow up period, however, indicating the need for continuous monitoring of those babies failed by brain stem electric response.

Acoustic Stimulation

How to insert a Minitrach.

Minitracheotomy is a technique of cricothyroid cannulation to allow efficient tracheobronchial toilet and the application of other techniques for respiratory support. Indications and contraindications for the procedure are reviewed. Two methods of insertion are described with their potential difficulties. Possible complications and their treatment are considered.

Hemorrhage

Crack.

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Blood-Brain Barrier

Beliefs about high blood pressure prevention in a survey of blacks and Hispanics.

Beliefs about the potential for high blood pressure prevention were assessed during a telephone survey of cardiovascular risk factor awareness among black and Hispanic adults in Chicago, Illinois. A high proportion of those interviewed-82% of blacks and 69% of Hispanics--thought a person could do something to prevent getting high blood pressure and either selected one or more of several possible preventive measures listed by the interviewer or volunteered other measures. Awareness of two widely cited prevention possibilities that may be particularly important for black and Hispanic populations--lowering salt intake and maintaining ideal weight--was low. Fewer than half of the respondents in this survey (44% of blacks and 26% of Hispanics) thought that lowering salt intake would help prevent high blood pressure. An even smaller number (10% of blacks and 20% of Hispanics) thought that maintaining ideal weight would help prevent high blood pressure. Moreover, other measures that are unrelated to high blood pressure or for which a relation to high blood pressure is not well established were selected frequently. These findings were contrary to our expectations, because black and Hispanic populations have been targeted by the National High Blood Pressure Education campaign and because high levels of awareness in other areas of cardiovascular disease risk were observed in this sample. These data suggest that awareness of potential strategies for high blood pressure prevention among black and Hispanic communities needs to be addressed specifically in related educational campaigns.

Adult