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Biomedical subjects

J Malone

Publications and source records attributed to J Malone.

At least 55 records · Page 3Linked to original sources
PubMed1992

Adverse outcome in pregnancy following amniotic fluid isolation of Ureaplasma urealyticum.

Infections in pregnancy with Ureaplasma urealyticum have been associated with a wide range of adverse outcomes, such as early abortion, stillbirth, prematurity, and neonatal morbidity and mortality. Causality has been difficult to demonstrate secondary to the high prevalence of asymptomatic lower genital tract (LGT) colonization and culture data from inaccessible or potentially contaminated sites. Between 1985 and 1989, 2461 second-trimester genetic amniocenteses were evaluated at the cytogenetics section of the Children's Hospital Medical Center of Akron. All were cultured for the genital mycoplasmas: Mycoplasma hominis and Ureaplasma urealyticum. A total of nine patients were positive, all for Ureaplasma urealyticum, with one patient excluded because of subsequent therapeutic abortion. In addition, complete follow-up data, such as indication for amniocentesis, serum alpha-fetoprotein levels, gestational age at parturition, and outcome of pregnancy, were available on 86 Ureaplasma-negative (U-) patients during an approximate 2-year span within the time-frame of the study. This was in part due to physician response to a questionnaire sent after amniocentesis. Of the eight positive cultures, 100 per cent were associated with an adverse outcome, defined as fetal loss or premature delivery. This was significant compared with the U- group (p less than 0.001) with a more than eight times greater risk of adverse outcome. Six (75 per cent) resulted in spontaneous miscarriage within 4 weeks of amniocentesis and at less than 21 weeks' gestation. Two (25 per cent) delivered prematurely, with one (12.5 per cent) neonatal death at 24+ weeks. Histological examination of all eight placentae and the seven fetuses revealed a 100 per cent incidence of chorioamnionitis and pneumonia, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Spontaneous↗
PubMed1992

High frequency eye tremor: reliability of measurement.

Recent reports suggest that high frequency eye tremor or ocular microtremor (OMT) may be a useful indicator of brainstem function. The method of record analysis, and in particular the amount of record subjected to such analysis, has varied widely. We have recorded OMT from 10 normal subjects. Using these records we have performed 42 distinct replication reliability studies. We suggest seven parameters of OMT (including overall frequency of tremor) which may be of value in comparing abnormal with normal records. For each parameter we have determined the optimal duration of the record to analyse and the reliability of such analysis. Our results suggest that at least 5 s of OMT should be analysed to yield an acceptable estimate of all seven parameters.

Adult↗
PubMed1991

The fast flush test: evaluation in radial artery catheter-manometer systems.

The 'fast flush test' is commonly used to determine the dynamic response of catheter-manometer systems in vivo. We compared the fast flush test with an established bench top test in vitro. The results of the two tests were compared in fifteen underdamped radical artery catheter-manometer systems. There were significant differences between the results, (P less than 0.001 for both resonant frequency and damping factor), and the variance of estimates within measurement systems was significantly greater in the case of the fast flush test (P less than 0.05 and P less than 0.005 for resonant frequency and damping factor respectively). Nevertheless, the differences between the tests were small by comparison with the errors associated with either test; in addition there was a significant linear correlation between the results of the two tests (r = 0.91, P less than 0.001 and r = 0.85, P less than 0.001 for resonant frequency and damping factor respectively). In the in vitro situation, therefore, the fast flush test provides a crude estimate of the dynamic parameters of underdamped catheter-manometer systems.

Arteries↗
PubMed1991

Targeting long-term care for the frail elderly: models from the Social/HMO demonstration.

This study examined the effect of differing eligibility rules for receipt of long-term care services in the four sites of the Social/HMO National Demonstration Program. Data from the first year of Social/HMO enrollment were used to model the probability of receiving a comprehensive assessment of need for long-term care benefits. Sites using state criteria for Medicaid reimbursement of a nursing home stay were more likely to give assessments to elders with functional impairment problems, whereas those using broader eligibility criteria gave assessments to enrollees with a wider range of characteristics. The results indicate that decisions about eligibility for care have important access and cost implications for consumers, payers, and providers.

Activities of Daily Living↗
PubMed1991

Adding long-term care to Medicare: The Social HMO Experience.

The rancor accompanying the repeal of most of the 1988 Medicare Catastrophic Act reflects both the national need to improve health and long-term care benefits for the elderly and the political obstacles to finding new sources of financing for such benefits. Neither the need nor the obstacles will go away, but policymakers are now likely to look for lower-cost, efficient, and privately funded alternatives. The authors have developed and tested one such approach: the Social Health Maintenance Organization (SHMO). Operating since 1985, the SHMO model integrates community-based, long-term care services into the managed, prepaid HMO design. The four test sites are adding long-term care to Medicare at no extra cost to the government and only modest premiums for the 17,000 current members. Although the benefits offer limited protection for long-term nursing home care, they do cover long-term care in community settings, where people tend to prefer to stay. Also, integration of the acute and long-term care systems improves the ability to respond to the medical needs of frail members, who also have high acute-care use. The SHMO's model of front-end, community-oriented, long-term care benefits integrated with Medicare appears to be a practical, affordable, and clinically appropriate way to address the rising concern with the lack of coverage and services for long-term care.

Aged↗
PubMed1990

A prospective study of the development of diabetes in relatives of patients with insulin-dependent diabetes.

BACKGROUND: The presence of cytoplasmic islet-cell autoantibodies has been recognized as a risk factor for the development of diabetes mellitus in relatives of patients with insulin-dependent diabetes mellitus (IDDM), but the magnitude of the risk is unknown, as is the influence of other factors, such as age, sex, and race. METHODS: From 1979 through 1989, we studied 4015 initially nondiabetic relatives of 1590 probands with IDDM to determine the risk of IDDM according to the presence and titer of autoantibodies, as well as other factors. RESULTS: Of the 4015 nondiabetic relatives, 125 (3.1 percent) had islet-cell antibodies in their initial serum samples, and 40 contracted IDDM. Islet-cell antibodies were most frequent (4.3 percent) in relatives who were under 20 years of age (P = 0.001) and in those (4.8 percent) from families with more than one affected member (a multiplex pedigree) (P = 0.003). Independent risk factors for the development of diabetes in the relatives included age of less than 10 years at the time of the initial study (P = 0.001), membership in a multiplex pedigree (P = 0.02), and a positive test for islet-cell antibodies in the initial serum sample (P = 0.0001). Twenty-seven of the relatives in whom diabetes developed (67.5 percent) had positive tests for islet-cell antibodies before the diagnosis of IDDM, giving a relative risk of IDDM of 68 (95 percent confidence interval, 34 to 134) for antibody-positive relatives. Islet-cell-antibody titers of 20 Juvenile Diabetes Foundation units or higher were associated with an increasing risk of diabetes. CONCLUSIONS: Nondiabetic relatives of probands with IDDM who are in the first two decades of life, are members of multiplex pedigrees, and have increased titers of islet-cell antibodies are the most likely to contract IDDM themselves.

Adolescent↗
PubMed1990

Multiparametric analysis of peripheral blood in the normal pediatric population by flow cytometry.

Lymphocyte subset analysis was performed on 114 healthy children and 84 healthy adults. Samples were prepared by a whole blood lysis technique and analyzed by flow cytometry. The percentage and total number of CD3+, CD4+, CD8+, and CD19+ lymphocytes were calculated for each of six age groups. A direct correlation with age was seen in the percentages of CD3+, CD4+, and CD8+ lymphocytes. The absolute number and percentage of total lymphocytes, the percentage and absolute number of CD19+ lymphocytes, and the absolute number of CD3+ lymphocytes decreased with age. No significant correlation with age was observed for white blood cells, the absolute number of CD4+ and CD8+ lymphocytes, and the CD4+/CD8+ ratio.

Adolescent↗
PubMed1990

Results of treatment in locally advanced carcinoma of the endometrium.

The impact of treatment on survival was analyzed in 106 patients with carcinoma of the endometrium stage II (n = 61) and stage III (n = 45). There was no significant difference in survival in patients with stage II who were treated with radiation therapy alone or with combination of surgery and radiation therapy. Their five-year actuarial survival was 74.5% and 71.3% respectively (p = greater than 0.05). However, combined treatment was associated with significantly superior survival in patients with stage III disease where the survival was 57.3% versus 17.5% in patients who received irradiation alone (p = 0.01). Diagnosis of stage III disease based upon clinical (CS III) or pathological (PS III) findings was responsible for this difference in survival. Patients with CS III whose tumor could not be resected because of its extent carried poorer prognosis. Patients with stage II had excellent tumor control in pelvis as compared to patients with stage III. Treatment-related complications were minimal. Overall survival of patients with stage III was poor (33.8%) due to a high rate of pelvic and/or extrapelvic recurrences.

Adenocarcinoma↗
PubMed1990

Financial performance in the social health maintenance organization, 1985-88.

Since early 1985, four social health maintenance organizations have delivered integrated health and long-term care services to Medicare beneficiaries under congressionally mandated waivers that included shared public-program risk for losses. Three of four sites had substantial losses in the first 3 years, primarily because of slow enrollment and resultant high marketing and administrative costs. After assuming full risk, two of the three showed surpluses in 1988. Service and management costs for expanded long-term care were similar across sites and were affordable within the framework of Medicare and Medicaid reimbursement and private premiums.

Accounts Payable and Receivable↗
PubMed1990

Adherence-health status relationships in childhood diabetes.

Used 24-hr recall interviews to assess adherence in a sample of seventy-eight 6- to 19-year-olds with insulin-dependent diabetes mellitus over a 3-month period. Thirteen adherence measures were quantified and grouped into six adherence factors (Injection, Exercise, Diet Type, Testing/Eating Frequency, Calories Consumed, and Concentrated Sweets). Prevailing glucose levels over a 2- to 3-month interval were indexed by glycosylated hemoglobin A1c (HA1c) and glycosylated serum protein (GSP) assays. Fasting triglycerides (TRIG) and total cholesterol (CHOL) assays were used to estimate lipid metabolism. Adolescents were generally less adherent than their young counterparts. Using hierarchical multiple-regression techniques, HA1c and GSP were not reliably predicted by most of the adherence factors; only Calories Consumed showed any predictive power. No significant regression equations emerged for CHOL. In contrast, TRIG was significantly associated with five of the six adherence factors; in all cases, adherence interacted with the patients' metabolic status (as defined by HA1c) at study entry, suggesting that adherence had different effects for youngsters in good versus poor diabetes control.

Adolescent↗
PubMed1989

Radiation therapy in stage II carcinoma of the endometrium.

A retrospective analysis of 61 patients with Stage II carcinoma of the endometrium was carried out. Our results suggest that when given carefully and adequately, radiation therapy alone is as effective as a combination of surgery and irradiation and is well tolerated. Five-year actuarial survival was 74.5% in patients treated with radiation therapy alone (16 patients) as compared to those patients who received either preoperative radiation (35 patients) or postoperation radiation (ten patients) where the survival was 70.8% and 78.3%, respectively (P greater than or equal to 0.05). Tumor was controlled in the pelvis in 93.4% of patients. Complications of treatment were seen in 8.2%. With the exception of one patient with bowel obstruction requiring surgery, the rest of the complications were minor. From these results, it appears that a planned radiotherapy is a good alternative to combination of surgery and irradiation.

Combined Modality Therapy↗
PubMed1989

Prevalence and stability of physical aggression between spouses: a longitudinal analysis.

Community couples (N = 272) were assessed in a longitudinal study of early marriage. More women than men reported physically aggressing against their partners at premarriage (44% vs. 31%) and 18 months (36% vs. 27%). At 30 months, men and women did not report significantly different rates of aggression (32% vs. 25%). However, using either the self-report or the partner's report, the prevalence of aggression was higher for women than men at each assessment period. Modal forms of physical aggression for both men and women were pushing, shoving, and slapping. Conditional probability analyses indicated that the likelihood of physically aggressing at 30 months given that one had engaged in such aggression before marriage and at 18 months after marriage was .72 for women and .59 for men. Furthermore, 25-30% of the recipients of physical aggression at all three assessment periods were seriously maritally discordant at 30 months.

Adult↗
PubMed1989

Psychological and physiological responses to acute laboratory stressors in insulin-dependent diabetes mellitus adolescents and nondiabetic controls.

Thirty 11- to 18-year old adolescents with insulin-dependent diabetes mellitus (IDDM) of at least 1-year duration and 15 nondiabetic controls were subjected to three laboratory stressors: a venipuncture and two public-speaking tasks. Half of the IDDM participants were in good metabolic control prior to the inception of the experiment and half were in poor control. The IDDM adolescents in poor control and the nondiabetics were matched to the well-controlled IDDM group on the basis of age, sex, and race. The two IDDM groups were also matched on disease duration. Self-report, behavioral, and physiological measures of anxiety or arousal were monitored during the stress.

Adolescent↗
PubMed1989

Concepts for the rehabilitation of the long-term mentally ill in the community.

Grounded theory research of a unique supervised independent living program, Community Bound, generated six empirical concepts: Survival skills, cooperation, hanging out, checking up, backing, and supplementing. These concepts, which combined aspects of activities of daily living and social skills training, need to be further developed; their utility may serve to link clinical practice, the nursing process, and the needs of long-term mentally ill individuals in the community. Forty-three clients and six staff were studied using participant observation and semistructured interviews. A 5-year adjusted recidivism rate of 8.14% serves to provoke critical examination of the underlying processes.

Activities of Daily Living↗
PubMed1989

Stage III carcinoma of the endometrium. Results of treatment.

The impact of treatment on survival was analysed in 45 patients with stage III carcinoma of the endometrium. Our results indicate that patients treated with a combination of surgery and radiation therapy did significantly better than those treated with radiation alone. The five-years survival was 57.3% and 17.5%, respectively (p = 0.01). Patients with clinical stage III (CS III) whose tumor could not be resected surgically did poorly than patients with pathological stage III (PS III). This difference, however, was not statistically significant (p = greater than 0.05). Treatment related complications were minimal. Overall survival of patients of 33.8% was directly attributable to increased pelvic and/or extra pelvic recurrences.

Adult↗