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J Kline

Publications and source records attributed to J Kline.

At least 37 records · Page 2Linked to original sources
PubMed1999

Cocaine and tobacco use and the risk of spontaneous abortion.

BACKGROUND: Cigarette smoking and cocaine use may be risk factors for spontaneous abortion, but data supporting such a link are limited. METHODS: We studied the associations between cocaine and tobacco use and spontaneous abortion among pregnant adolescents and women (age range, 14 to 40 years) who sought care at an inner-city emergency department. A total of 400 adolescents and women had spontaneous abortions either at study entry or during follow-up (which lasted until 22 weeks' gestation), and 570 adolescents and women remained pregnant past 22 weeks' gestation. Cocaine use was measured at base line by self-reports and analysis of urine and hair samples. Cigarette smoking was measured by self-reports and urine analysis. RESULTS: The adolescents and women in both groups were predominantly black and of lower socioeconomic status. Among those who had spontaneous abortions, 28.9 percent used cocaine on the basis of hair analysis and 34.6 percent smoked on the basis of a urine cotinine assay, as compared with 20.5 percent and 21.8 percent, respectively, of the adolescents and women who did not have spontaneous abortions. The presence of cocaine in hair samples was independently associated with an increase in the occurrence of spontaneous abortion (odds ratio, 1.4; 95 percent confidence interval, 1.0 to 2.1) after adjustment for demographic and drug-use variables. However, the use of cocaine as measured by self-reports and by urine analysis was not. The presence of cotinine in urine was also independently associated with an increased risk of spontaneous abortion (odds ratio, 1.8; 95 percent confidence interval, 1.3 to 2.6). Twenty-four percent of the risk of spontaneous abortion could be related to cocaine or tobacco use. CONCLUSIONS: Cocaine and tobacco use were common in our study population and were associated with a significant risk of spontaneous abortion.

Abortion, Spontaneous↗
PubMed1999

Darryl, a cartoon-based measure of cardinal posttraumatic stress symptoms in school-age children.

OBJECTIVES: This report examines the reliability and validity of Darryl, a cartoon-based measure of the cardinal symptoms of posttraumatic stress disorder (PTSD). METHODS: We measured exposure to community violence through the reports of children and their parents and then administered Darryl to a sample of 110 children aged 7 to 9 residing in urban neighborhoods with high crime rates. RESULTS: Darryl's reliability is excellent overall and is acceptable for the reexperiencing, avoidance, and arousal subscales, considered separately. Child reports of exposure to community violence were significantly associated with child reports of PTSD symptoms. CONCLUSIONS: Darryl possesses acceptable psychometric properties in a sample of children with frequent exposure to community violence.

Arousal↗
PubMed1999

Exercise and spontaneous abortion of known karyotype.

We examined whether exercise during pregnancy is associated with chromosomally normal spontaneous abortion. We hypothesized that associations would be confined to chromosomally normal losses since only these can be influenced appreciably by experiences during pregnancy. The study population comprises women with chromosomally normal (N = 173) and aberrant (N = 173) losses. Women who exercised during pregnancy had a lower risk of a chromosomally normal spontaneous abortion (OR 0.6; 95% CI 0.3-0.9). Other types of physical activity had little effect.

Abortion, Spontaneous↗
PubMed1998

Hyperproduction of erythropoietin in nonanemic lead-exposed children.

Lead (Pb) poisoning has numerous effects on the erythropoietic system, but the precise mechanism whereby high dose exposure causes anemia is not entirely clear. We previously reported that Pb exposure is associated with depressed serum erythropoietin (EPO) in pregnant women residing in a Pb mining town and in a nonexposed town in Kosovo, Yugoslavia. In a prospective study, we tested the hypothesis that blood Pb concentration (BPb) may be associated with depressed EPO in children. BPb, hemoglobin (Hgb), and serum EPO were measured at ages 4.5, 6.5, and 9.5 years in 211, 178, and 234 children, respectively. At 4.5 years of age, mean BPbs were 38.9 and 9.0 microg/dl in the exposed and nonexposed towns, respectively; BPbs gradually declined to 28.2 and 6.5 microg/dl, respectively, by age 9.5 years. No differences were found in Hgb at any age. At age 4. 5 years, a positive association between BPb and EPO (beta = 0.21; p = 0.0001), controlled for Hgb, was found. The magnitude of this association declined to 0.11 at age 6.5 years (p = 0.0103) and 0.03 at age 9.5 years (p = 0.39). These results were confirmed using repeated measures analyses. We concluded that in Pb-exposed children, the maintenance of normal Hgb requires hyperproduction of EPO. With advancing age (and continuing exposure), this compensatory mechanism appears to be failing, suggesting a gradual loss of renal endocrine function due to Pb exposure.

Age Factors↗
PubMed1997

Anionic- and lipophilic-mediated surface binding inhibitors of human leukocyte elastase.

We report the synthesis of a series of diphenylmethane-based oligomers containing anionic and lipophilic functionalities that are potent inhibitors of human leukocyte elastase (HLE). The enzyme inhibition is regulated by the size of the oligomer, as well as, the number of charges. Lipophilicity is an important element in determining potency and specificity against other basic enzymes. Compounds whose scaffolds contain three phenoxyacetic acid groups and three alkyl ethers are competitive and specific inhibitors of HLE with Ki = 20 nM. The mechanism of action of this class of compounds is believed to involve multidendate interactions with the surface of HLE near the active site which prevents substrate access to the catalytic site.

Benzhydryl Compounds↗
PubMed1997

Major depressive disorder in the 6 months after miscarriage.

OBJECTIVE: To test a priori hypotheses that miscarrying women are at increased risk for a first or recurrent episode of major depressive disorder in the 6 months following loss and that this increased risk is greater for childless women, women with prior reproductive loss, and women aged 35 years or older; and to evaluate whether risk varies by time of gestation or by attitude toward the pregnancy. DESIGN: Cohort study. SETTING: The miscarriage cohort consisted of women attending a medical center for a spontaneous abortion (n=229); the comparison group was a population-based cohort of women drawn from the community (n=230). PARTICIPANTS: Miscarriage was defined as the involuntary termination of a nonviable intrauterine pregnancy before 28 completed weeks of gestation. Half of all participants were between 25 and 34 years of age; 40% were white and 35% Hispanic; 55% had more than a high school education. Participants constituted 60% of miscarrying women and 72% of community women who completed the first phase of this cohort study. MAIN OUTCOME MEASURE: Major depressive disorder was measured using the Diagnostic Interview Schedule. RESULTS: Risk for an episode of major depressive disorder among miscarrying women in the 6 months following loss was compared with the 6-month risk among community women who had not been pregnant in the preceding year. Among miscarrying women, 10.9% experienced an episode of major depressive disorder, compared with 4.3% of community women. The overall relative risk (RR) for an episode of major depressive disorder for miscarrying women was 2.5 (95% confidence interval [CI], 1.2-5.1) and was substantially higher for childless women (RR, 5.0; 95% CI, 1.7-14.4) than for women with children (RR, 1.3; 95% CI, 0.5-3.5) (P<.06). Among miscarrying women, 72% of cases of major depressive disorder began within the first month after loss; only 20% of community cases started during the comparable period. Among miscarrying women with a history of major depressive disorder, 54% experienced a recurrence. However, RR did not vary significantly by history of prior reproductive loss or by maternal age, nor did risk vary by time of gestation or attitude toward the pregnancy. CONCLUSIONS: Physicians should monitor miscarrying women in the first weeks after reproductive loss, particularly women who are childless or who have a history of major depressive disorder. Where appropriate, supportive counseling or psychopharmacologic treatment should be considered.

Abortion, Spontaneous↗
PubMed1997

Early menopause in women with Down's syndrome.

We used the AAMR's Adaptive Behavior Scale to ascertain current menstrual status in a population-based sample of 157 women with Down's syndrome (DS) and 187 women with other intellectual disability, all 40 years of age or older. The age-adjusted likelihood of menopause was twice as high in women with DS syndrome as in women with other intellectual disability (OR = 2.3; 95% CI = 1.1-4.9). Treated thyroid conditions did not influence menstrual status and did not modify the relationship between DS and menstrual status. These findings support the hypothesis that women with DS experience menopause at an earlier age and that this may be associated with accelerated aging.

Adult↗
PubMed1997

Cocaine use during pregnancy: sensitive detection by hair assay.

OBJECTIVES: This paper compares the sensitivity of two tests of cocaine use, interview and urine test, with that of a radioimmunoassay of hair. METHODS: Interviews and hair samples were provided by 397 obstetric patients in one New York City hospital; urine samples were obtained in 377. Of these patients, 241 were receiving prenatal care (were registered) and 156 delivered without prenatal care (were unregistered). The 241 registered patients were derived from 400, comprising all reporting use of cocaine ever ("ever-users"), all reporting use by the father but not themselves ("lifestylers"), and a sample of women who were neither ever-users nor lifestylers. The 156 unregistered patients were derived from 352 women interviewed at delivery, unselected for reported use. RESULTS: Thirty-two percent reported ever using cocaine, 45% of these within 6 months before interview. Urine tests were positive in 20%, hair tests in 59%. The estimated sensitivity of the hair test (92%) was 3.1 times higher than that of the urine test (95% confidence interval [CI] = 2.5, 3.8) and 4 times higher than that of reported use in the past 6 months (95% CI = 3.2, 5.0). CONCLUSIONS: Self-report and urine tests alone miss most of cocaine users during pregnancy. Hair tests greatly improve detection and thus can enhance evaluations of the effects of prenatal cocaine use on fetal and child development.

Cocaine↗
PubMed1996

Association of stressful life events with chromosomally normal spontaneous abortion.

Spontaneous abortion is the most common adverse reproductive outcome. Despite evidence that negative life events increase risk for a number of medical disorders, their role in pregnancy disruption has not been investigated. The present study tested an a priori hypothesis that recent negative life events increase the odds of spontaneous abortion of a chromosomally normal conceptus. Between 1984 and 1986, 192 women aged 18-42 years who visited a medical center after spontaneous abortion were interviewed about positive and negative events that had occurred in the 4-5 months preceding the loss. Subsequently, women with chromosomally normal (n = 111) and chromosomally abnormal (n = 81) losses were identified on the basis of tissue culture after interview. The women with chromosomally abnormal loss provided an estimate of the expected frequency of life events against which to compare the event frequencies of women with chromosomally normal loss. Analyses were adjusted for duration of the recall period, payment status, maternal age, education, and ethnicity. Seventy percent of the women with chromosomally normal losses reported having had one or more negative life events in the months preceding loss, compared with 52% of the women with chromosomally abnormal losses (adjusted odds ratio = 2.6, 95% confidence interval (CI) 1.3-5.2). For private patients (n = 69), the adjusted odds ratio was 4.2 (95% CI 1.3-13.4); for public patients (n = 123), it was 1.9 (95% CI 0.8-4.8). The associations held for postconception events alone and were absent for positive events. Results were unaltered by adjustment for smoking, caffeine intake, and alcohol consumption. With recall bias precluded by the study design, the strength, timing, and specificity of these associations suggest that recent negative life events play a role in chromosomally normal spontaneous abortion. Efforts to replicate these results and to elucidate underlying biologic mechanisms are required.

Abortion, Spontaneous↗
PubMed1996

The effects of extracellular ions on beta-blocker cardiotoxicity.

The mechanism of beta-blocker induced cardiotoxicity is poorly understood. One possible explanation is that beta-blockers induce ion dyshomeostasis, resulting in cardiac hyperpolarization. The intent of this study was to determine if modifying extracellular ions would reverse cardiotoxicity from two beta-blockers: propranolol (PROP) and atenolol (ATEN). Two treatments were studied: low extracellular K+ and high extracellular Na+. Isolated rat hearts were perfused on a Langendorff apparatus with Krebs-Henseleit- Bicarbonate buffer (KHB) solution. Toxicity (Tox) was induced by perfusing hearts for 30 min with KHB + PROP [5 microgram/ml] or KHB + ATEN [2.5 mg/ml]. Subsequently, hearts were perfused with KHB containing either PROP or ATEN, but modified by lowering K+ [2.3 mM] or raising Na+ [160 mM] for a 30-min treatment (Tx) period. Hearts were paced near the end of treatment. Cardiodynamics were monitored via a balloon-tipped catheter in the left ventricle. The first derivative of LV pressure (dP/dt) with respect to time served as our index of myocardial performance. Tx groups were as follows: (1) KHB only, (2) PROP only, (3) PROP + K, (4) PROP + Na, (5) ATEN only, (6) ATEN 4 K, and (7) ATEN + Na. PROP induced negative chronotropic effects and rendered the hearts refractory to pacing. ATEN demonstrated similar chronotropic toxicity plus decreased myocardial contractility. Tx with low extracellular K+ and high extracellular Na+ increased HR and restored the ability to pace, thereby reversing toxicity. These data suggest that beta-blocker toxicity is mediated via hyperpolarization.

Adrenergic beta-Antagonists↗
PubMed1996

Age and the ovarian follicle pool assessed with transvaginal ultrasonography.

OBJECTIVE: We tested whether transvaginal ultrasonography could detect the age-related decrease in follicle counts that has been observed in autopsy studies. STUDY DESIGN: Thirty-one healthy volunteers in three age groups (22 to 25, 30 to 33, and 39 to 42 years) underwent ultrasonography in the follicular and luteal phases of the menstrual cycle. At the conclusion of the study the 124 ovarian scans were randomly ordered and antral follicles > or = 2 mm were counted by an evaluator unaware of age. Ordinary least-squares linear regression was used to estimate the associations of age with the total antral follicle count and with ln (1 + follicle count). RESULTS: The numbers of antral follicles > or = 2 mm decreased by about 60% between 22 and 42 years. Age-related decreases were similar for both phases of the cycle and held for both smaller (2 to 3.5 mm) and larger (>3.5 mm) follicles. CONCLUSION: We hypothesize that ultrasonographically derived counts of follicles provide a measure of reproductive age that may help to predict age-related phenomena.

Adult↗
PubMed1996

Meaning and development in the interpersonal treatment of severe psychopathology.

As a result of increasing empirical evidence for biological etiologies and economic pressures for rapid symptom relief, treatments for patients with severe psychopathology have become more directive, behavioral, and biomedical. Since a more comprehensive understanding of severe mental disorders is gained through both empirical causal explantation and the discovery of meaning (Carpenter, 1987), clinicians are currently under a greater challenge to help patients cultivate more phenomenologically meaningful change experiences. An interpersonal treatment approach based upon narrative, intersubjective, developmental, and relational principles of understanding severe psychopathology that is complementary to behavioral and biomedical intervention is presented. Four universal maturational processes (interpersonal self, boundary formation, symbolization, response differentiation) are then described and used to illustrate how life-story repair, adjustment, and elaboration can create more meaningful treatment experiences.

Combined Modality Therapy↗
PubMed1995

Cigarette smoking and spontaneous abortion of known karyotype. Precise data but uncertain inferences.

Data from the first phase (1974-1979) of this New York City case-control study showed that 1) cigarette smoking during pregnancy was associated positively with chromosomally normal spontaneous abortion and 2) both past and current smoking were associated inversely with trisomic loss in women under age 30 years and positively in older women. The authors used data from two subsequent study phases (1979-1982 and 1982-1986) to test the stability of these associations over time and the homogeneity between payment groups (private vs. public). Spontaneous abortions (cases) were classified as chromosomally normal (n = 1,388), trisomic (n = 557), or other chromosomally aberrant (n = 409). Controls (n = 4,165) were women who had registered for prenatal care before 22 weeks' gestation and delivered at 28 weeks or later. For chromosomally normal loss, later data gave modest support to prior observations. In the total sample, current smoking (defined as smoking during the month of the last menstrual period) of 14 or more cigarettes per day was increased among chromosomally normal cases in comparison with controls (adjusted odds ratio (OR) = 1.3, 95% confidence interval (CI) 1.1-1.7) and in comparison with other aberrant cases (adjusted OR = 1.2, 95% CI 0.8-1.8). Stronger associations in public patients than in private patients (adjusted odds ratios of 1.4-1.5 versus 0.8-0.9, respectively) might indicate either a mediating effect of social disadvantage or a chance fluctuation. For trisomic loss, later data did not support prior observations. Associations between trisomy and past or current smoking did not vary significantly with age in either payment group; assuming no effect modification of age, adjusted odds ratios for smoking in relation to trisomy were 0.9-1.0.

Abortion, Spontaneous↗
PubMed1995

Heroin use during methadone maintenance treatment: the importance of methadone dose and cocaine use.

OBJECTIVES: The purpose of this study was to examine factors associated with heroin use during methadone maintenance treatment. METHODS: Logistic regression statistical models were used to examine data obtained in a cross-sectional sample of 652 methadone patients. RESULTS: Heroin use during the 3 months prior to interview was shown to be greatest among (1) patients maintained on methadone dosages of less than 70 mg/day (adjusted odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.3, 3.4) and (2) patients who used cocaine during treatment (adjusted OR = 5.9, 95% CI = 3.8, 9.1). These results were independent of treatment duration, treatment compliance, alcohol use, and socioeconomic factors. Cocaine users were more likely than nonusers of cocaine to use heroin at all methadone dosage levels. CONCLUSIONS: This study confirms and extends past research showing high-dose methadone maintenance to be important to heroin abstinence. Further investigation of the independent association between heroin use and cocaine use is needed.

Adult↗
PubMed1994

Previous use of oral contraceptives and spontaneous abortion.

This analysis tests the hypothesis that women who conceive within 3 months after stopping oral contraceptives ("the pill") have an intrinsically lower risk of chromosomally normal loss. About 30% of women show evidence of endocrine dysfunction, including anovulation, for 1-3 months after stopping the pill. In women who recover rapidly, and therefore are at risk of pregnancy, a common endocrinologic factor may account for both the quick return to normal functioning and improved intrauterine survival of the chromosomally normal conceptus. The hypothesis was tested in women with chromosomally normal (N = 334) and chromosomally aberrant (N = 239) spontaneous abortions. Women were classified according to the number of months between last pill use and last menstrual period. The adjusted odds ratios relating conception in months 0 and 1 after stopping the pill to chromosomally normal (vs chromosomally aberrant) loss were each 0.4, with upper 95% confidence limits of 1.0 and 0.9, respectively. The odds ratios for conception at longer intervals after stopping were 1.1 [95% confidence interval (CI) = 0.4-3.1], 0.7 (95% CI = 0.3-1.2), and 0.9 (95% CI = 0.5-1.5) for 2, 3-11, and > or = 12 months, respectively. Rates of spontaneous abortion in previous pregnancies were lowest in women who conceived quickly after stopping the pill. Further support for an endocrinologic explanation requires direct measures of endocrine functioning in the post-pill period among women with varying reproductive histories.

Abortion, Spontaneous↗