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Biomedical subjects

J Kline

Publications and source records attributed to J Kline.

At least 55 records · Page 3Linked to original sources
PubMed1994

Physicians' attitudes toward a new gynecological examination gown.

Gynecologists' attitudes toward an examination gown found in previous studies to reduce patients' distress during examination were investigated. Twenty-six gynecologists in four cities volunteered to use the new examination gown and complete a questionnaire evaluating the gown for adequacy of design and perceived patient comfort. Participants rated the gown positively overall. Favorability ratings were highly correlated with ratings of the structural adequacy of the gown for performing the breast, back, and pelvic exams. Favorability was also highly correlated with physicians' perceptions of the patients' comfort with the gown. The new gynecological examination gown is well accepted by gynecologists. It appears that gynecologists are open to changes in examination procedures that do not interfere with the exam and increase patient comfort. This new gown offers a strategy for decreasing patient distress during examination, which may reduce delay in seeking examinations.

Attitude of Health Personnel↗
PubMed1994

Beta-blocker and calcium channel blocker toxicity.

Toxicity from beta-blocker and calcium channel blocker drugs is a challenging medical emergency with steadily increasing incidence. Clinical manifestations of intoxication with these drugs are presented in light of known pharmacologic and pharmacokinetic properties, as well as the physiology of the beta-adrenoreceptor and calcium channel. Review of clinical and basic science literature provides the basis for specific management guidelines for beta-blocker and calcium channel blocker toxicity.

Adrenergic beta-Antagonists↗
PubMed1993

Cigarette smoking and trisomy 21 at amniocentesis.

Several studies raise the possibility that smoking during pregnancy is associated with a slightly decreased odds of trisomy 21 at birth. If it is, associations may reflect decreased incidence at conception, increased intrauterine loss (at one or several times in gestation), or both. Women (n = 13,729) undergoing prenatal diagnosis completed a questionnaire before learning karyotype results. For each women with a trisomy, up to 4 controls with chromosomally normal pregnancies, matched for age and hospital, were selected. Analyses drew on the 89 trisomy 21-control matched m-tuples in which diagnosis was by amniocentesis at 14-26 weeks. We compared the odds of smoking at last menstrual period and in the past in cases and controls. The odds of current smoking versus never smoking were decreased [adjusted odds ratio = 0.8, 95% confidence interval (CI) 0.4-1.6] and the odds of exsmoking increased (adjusted odds ratio = 1.4, 95% CI 0.9-2.4) in trisomy 21 cases. The association with current smoking was essentially unchanged when the unexposed reference group was defined as exsmokers and women who never smoked (adjusted odds ratio = 0.7, 95% CI 0.4-1.4). These results for current smoking agree well with a summary estimate based on combined studies of births. One interpretation is that at amniocentesis, as has been reported for births, current smoking is associated with a slightly decreased odds of trisomy 21. If associations at amniocentesis and birth are of equal magnitude, the explanation that observations at birth reflect increased loss in the second half of pregnancy with current smoking is unlikely to be correct.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Enhancement in vitro of the low interferon-gamma production of leukocytes from human newborn infants.

Interferon-gamma (IFN-gamma), a lymphokine produced by lymphocytes with the help of monocytes, is essential for host resistance to intracellular pathogens. Leukocytes from normal term newborn infants cannot produce IFN-gamma in vitro in response to stimulation by antigen or mitogens in vitro or in vivo. We investigated the production of IFN-gamma in vitro using endotoxin from Salmonella typhimurium as a stimulus. In contrast to those from adults, mononuclear cells derived from the cord blood of newborn infants did not produce IFN-gamma in response to this endotoxin. We investigated the contribution of the functional immaturity of cord blood monocytes to this relative inability to produce IFN-gamma. Aging of the monocytes for 2 weeks in vitro or treatment of freshly isolated cord blood monocytes with conditioned medium (from cultures of mononuclear cells from healthy adults) greatly enhanced IFN-gamma production stimulated by endotoxin. Furthermore, recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF), macrophage colony-stimulating factor (M-CSF), or IFN-gamma was able to substitute in part for the conditioned medium from adult cells. Thus correction of the functional immaturity of monocytes derived from newborn infants can result in enhanced production of IFN-gamma in vitro.

Adult↗
PubMed1993

Treatment of late-life schizophrenia with neuroleptics.

There is a death of literature on the effects of neuroleptics in older schizophrenia patients. In this article, we review the available literature and present findings from our own studies. Neuroleptics are effective in the treatment of late-life schizophrenia, although older patients generally need lower dosages than younger subjects. Neuroleptics, however, carry a relatively high risk of side effects such as tardive dyskinesia (TD) in middle-aged and elderly patients. By the end of 1 year of a prospective longitudinal study of neuroleptic treatment, we found a 26 percent cumulative incidence of TD among schizophrenia patients over age 45. If neuroleptics are withdrawn, there is a significant risk of a schizophrenic relapse; however, that risk is no greater in older patients than in younger ones. We offer clinical recommendations for the use of neuroleptics in the treatment of late-life schizophrenia.

Aged↗
PubMed1993

Modulation of the QT interval: effects of graded exercise and reflex cardiovascular stimulation.

During exercise, as heart rate (HR) increases, the QT interval of the electrocardiogram shortens. The mechanism(s) involved in this QT shortening has not been clearly defined. To distinguish the influence of increased circulating catecholamines from myocardial efferent stimulation, the relationship between HR and QT interval was investigated during exercise and cardiovascular reflex stimulation in cardiac transplant patients and normal control subjects. Because of cardiac denervation, increases in HR in these patients are solely due to circulating catecholamines and thus allow isolation of their effect on the QT interval. Twenty-one cardiac transplant patients were studied and compared with 16 normal control subjects. The QT-HR relationship was determined according to an exponential model during treadmill exercise in both groups [QT = 0.12 + 0.492e(-0.008.HR) and QT = 0.12 + 0.459e(-0.007.HR) in normal subjects and transplant patients, respectively] and was statistically similar between groups, suggesting similar QT interval shortening in both groups. During cold pressor and Valsalva maneuvers, HR increased significantly in normal subjects only, whereas QT interval changed minimally in both groups. These results suggest that during exercise the QT interval is influenced predominantly by increases in circulating catecholamines rather than by neurally mediated reflex autonomic changes.

Adult↗
PubMed1993

Analysis of factors determining the selection of repeated cesarean section or trial of labor in patients with histories of prior cesarean delivery.

We investigated the motivation behind procedures in 241 patients with prior cesarean births; 120 had elective repeat cesarean sections and 121 had vaginal birth after cesarean section (VBAC). Patients were of similar age, gravity and parity, but significantly more patients in the repeat cesarean group had their initial surgery because of failure to progress in labor; significantly more patients in the VBAC group had their initial cesarean section because of fetal distress. The main factors behind the decision to attempt VBAC were patient's desire (81.0%), patient's desire and physician's advice (12.4%) and physician's advice (6.6%). The main factors behind the decision to have repeat cesarean sections were medical or obstetric indication (45.8%), patient's desire (31.6%), patient's desire and physician's advice (9.1%) and physician's advice (13.3%). We conclude that it will be difficult to substantially decrease the present rate of repeat cesarean births, and that preventive efforts should be directed toward decreasing the incidence of primary cesarean deliveries.

Adult↗
PubMed1992

Depressive symptoms in women in the six months after miscarriage.

This study, the first systematic investigation of the psychiatric impact of miscarriage, tests whether miscarriage markedly increases depressive symptoms in the 6 months after loss. We interviewed 382 miscarrying women entering the study at 2 weeks, 6 weeks, or 6 months after loss and, for comparison, 283 pregnant women and 318 community women not recently pregnant. Among women interviewed 2 weeks after miscarriage the proportion highly symptomatic on the Center for Epidemiologic Studies-Depression scale was 3.4 times that of pregnant women (95% confidence limits 2.0 and 5.0) and 4.3 times that of community women (95% confidence limits 3.0 and 5.8). Among women first interviewed 6 weeks and 6 months after miscarriage the proportion highly symptomatic was three times that of the community women. Women reinterviewed at 6 weeks and 6 months did not have elevated symptom levels, a result attributed to the unintended therapeutic and test effects of study interviews. Interviews were fully structured, readily administered by telephone by nonmedical personnel. The possibility that such interviews afford miscarrying women substantial psychologic benefits merits future investigation.

Abortion, Spontaneous↗
PubMed1992

Trisomy and age at menopause: predicted associations given a link with rate of oocyte atresia.

The association of trisomy with advancing maternal chronological age suggests that some aspect of physiological aging is accelerated in women with trisomic pregnancies. This paper develops a quantitative theoretical model based on the hypothesis that trisomy risk is primarily a function of the size of the oocyte pool and, in particular, that risk is increased in women with accelerated rates of oocyte atresia and hence smaller pools at given chronological ages. Since the rate of oocyte atresia is a determinant of age at menopause, this hypothesis leads to the prediction that women who have had trisomic pregnancies reach menopause earlier than women who have not. We used data relating chronological age to oocyte number, trisomy and menopause to deduce the distribution of oocyte atresia rates in all women and in women with trisomic pregnancies. Given certain simplifying assumptions, we predict that associations between trisomy and age at menopause will vary with a woman's age at the time of trisomy such that trisomies at 34-43 years will be associated with a 1-3.4 year earlier onset of menopause, while trisomies at younger or older ages will have no or little association with age at menopause. This model, while vulnerable to the uncertainties that attend its assumptions, provides a testable prediction that permits separation of one aspect of physiological age from chronological age.

Aging↗
PubMed1992

Reducing distress associated with pelvic examinations: a stimulus control intervention.

The effect of a new pelvic examination gown on patients' experienced discomfort during pelvic examination was tested. It was hypothesized that a better designed gown would reduce reported distress. Subjects were 87 patients at a private gynecology clinic. Age ranged from 17 to 72. Informed consent was obtained and patients were randomly assigned to either the experimental gown or the standard drape condition. Following examination, subjects completed questionnaires assessing demographic characteristics, state and trait anxiety, desired changes in pelvic examination procedures, and reactions to the examination. The attending nurse recorded heart rate and blood pressure. Results supported the hypotheses. Experimental subjects rated the gown as more comfortable than control subjects rated the drape. Experimental subjects desired fewer changes in exam procedures than control subjects, indicating that the gown provided them with an overall more comfortable experience.

Adolescent↗
PubMed1992

Reducing distress associated with pelvic examinations: a replication.

A previous study of the effect of a new examination gown on patients' experienced discomfort during pelvic examination demonstrated that the gown was effective. This study replicated the previous study with a younger group of subjects. It was hypothesized that the new gown would reduce reported distress. Subjects were 147 patients at a university student health center. Age ranged from 18 to 31. Informed consent was obtained and patients were randomly assigned to either the experimental gown or the standard drape condition. Following examination, subjects completed questionnaires assessing demographic characteristics, state and trait anxiety, desired changes in pelvic examination procedures, and reactions to the examination. The attending nurse recorded blood pressure. Results supported the hypotheses. Experimental subjects rated the gown as more comfortable than control subjects rated the drape. Results indicate that this simple stimulus control intervention reduces one source of distress associated with pelvic examinations.

Adolescent↗
PubMed1992

Determinants of depressive symptoms in the early weeks after miscarriage.

OBJECTIVES: We tested whether and under what conditions miscarriage increases depressive symptoms in the early weeks following loss. METHODS: We interviewed 232 women within 4 weeks of miscarriage and 283 pregnant women and 318 community women who had not recently been pregnant. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression (CES-D) Scale. RESULTS: Among women who had miscarried, the proportion who were highly symptomatic on the CES-D was 3.4 times that of pregnant women and 4.3 times that of community women. Among childless women, the proportion of women who had miscarried who were highly symptomatic was 5.7 times that of pregnant women and 11.0 times that of community women. Women who had miscarried were equally depressed regardless of length of gestation; among pregnant women, depressive symptoms declined with length of gestation. Among women who had miscarried, symptom levels did not vary with attitude toward the pregnancy; among pregnant women, depressive symptoms were elevated in those with unwanted pregnancies. Prior reproductive loss and advanced maternal age (35+ years) were not associated with symptom levels in any cohort. CONCLUSIONS: Depressive symptoms are markedly increased in the early weeks following miscarriage. This effect is substantially modified by number of living children, length of gestation at loss, and attitude toward pregnancy.

Abortion, Spontaneous↗
PubMed1991

Pre-pregnant body size and spontaneous abortion of known karyotype.

We examined the relation of pre-pregnancy body size to chromosomally normal and chromosomally aberrant spontaneous abortion. Data derive from a hospital based case-control study of spontaneous abortion in the public and private facilities of three New York City hospitals. Chromosomally normal (n = 1265) and chromosomally aberrant (n = 872) spontaneous abortions (cases) were compared with 3795 women attending prenatal care before 22 weeks of gestation and delivering at 28 weeks or later (controls). Data on height and pre-pregnant weight were obtained by interview and Body Mass Index (BMI, weight/height squared) was computed. Associations were consistent across payment strata with disparate sociodemographic characteristics. BMI was similar in chromosomally normal cases and controls (pooled adjusted mean difference = 0.21 kg/m squared, 95% CI -0.06, 0.48) and reduced in chromosomally aberrant cases compared with controls (pooled adjusted mean difference = -0.29 kg/m squared, 95% CI -0.58, 0.00). These associations are unlikely to be due to reporting bias. However, they were of small magnitude and the association with chromosomally aberrant loss did not differ from that with chromosomally normal loss, nor was it specific to one, or even two, types of aberration. We therefore infer that, in relatively well nourished populations, low pre-pregnant body size does not increase the risk of either chromosomally normal or chromosomally aberrant spontaneous abortion.

Abortion, Spontaneous↗
PubMed1991

Caffeine and spontaneous abortion of known karyotype.

We tested associations of caffeine from beverages with spontaneous abortions of known karyotype. Spontaneous abortions (cases) were classified as chromosomally normal (n = 510) or chromosomally aberrant (n = 389) and, within the latter category, by type of aberration (237 trisomies, 54 monosomies X, 49 triploidies, 49 others). Controls registered for prenatal care before 22 weeks gestation and delivered at 28 weeks or later (n = 1,423). Caffeine intake in the perifertilization period did not differ among case groups and controls. For the highest category, 225+ mg/day, odds ratios (OR), adjusted for payment group and maternal age, were 1.0 for chromosomally normal cases, 0.9 for trisomies, 1.6 for monosomies X, and 0.8 for triploidies. Caffeine intake during pregnancy was tested for associations with chromosomally normal loss using the chromosomally aberrant cases to provide a robust comparison group. Although the proportion of subjects with intake of 225+ mg/day of caffeine intake in the perifertilization period does not influence the risk of chromosomally normal loss or trisomy. For monosomy X and triploidy, no strong associations were observed, but numbers were insufficient to rule out moderate effects. For caffeine intake during pregnancy, we found little evidence to support an influence on chromosomally normal loss.

Abortion, Spontaneous↗