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Biomedical subjects

J R Hebel

Publications and source records attributed to J R Hebel.

At least 91 records · Page 5Linked to original sources
PubMed1990

The use of urethral, condom, and suprapubic catheters in aged nursing home patients.

In this study of 4,259 aged patients in 53 randomly selected nursing homes in Maryland, we found that 10% of women and 15% of men used a urine collection device. Among bedfast patients, 47% of women and 58% of men and, among patients with decubitus ulcers, 37% of women and 33% of men were using a urine collection device. The indwelling urethral catheter was the most commonly used device. Indeed, for women, few other options were available: 93% of women used this device. In women, multiple logistic regression analysis indicated that presence of a decubitus ulcer and occupation of a long-term care bed were the attributes most strongly associated with the use of the urethral catheter. Of men with urine collection devices, 43% were using the urethral catheter; poor mobility status was the characteristic most strongly associated with its use. Long-term urethral catheterization has been well studied and is associated with universal bacteriuria and with a number of complications. Options need to be further explored, particularly external urine collection devices for women. Furthermore, because urethral catheterization may be used as a management technique for decubitus ulcers, prevention of the latter may diminish the use of urethral catheters and their subsequent complications.

Activities of Daily Living↗
PubMed1989

Carcinoma of the esophagus: a comparison of the results of transhiatal versus transthoracic resection.

The cases of 78 patients with primary esophageal carcinoma treated from 1977 to mid-1987 were retrospectively analyzed. Fifty-two of the patients underwent transthoracic esophagogastrectomy (TTE) and 26, transhiatal esophagectomy (THE). The two groups were statistically similar in preoperative characteristics except that more of the THE group had received chemotherapy; this group had relatively more tumors of the upper esophagus; and 20 (77%) of the THE group, compared with 50 (96%) of the TTE group, had tumors in stages III and IV. The incidence of major postoperative complications did not differ significantly between the two groups. There were five (19%) anastomotic leaks in the THE group, but only one led to a prolongation of hospital stay by more than 14 days, whereas all three (6%) of the leaks in the TTE group caused hospital stay to be prolonged several weeks. Overall morbidity was high: 75% (39/52) for the TTE patients and 85% (22/26) for the THE patients (p greater than 0.10). Hospital mortality was 6% (3/52) in the TTE group and 8% (2/26) in the THE patients (p greater than 0.10). There was no significant difference in actuarial survival either between the two groups as a whole or between those patients in each group who had stage III or IV tumors. We conclude that THE, among the types of patients for whom we used the procedure, provides long-term survival comparable with that provided by TTE without causing a significant increase in hospital mortality or morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1989

The reliability of self-reports of smoking and alcohol consumption by pregnant women.

The reliability of self-reports of prepregnancy smoking and drinking habits was assessed in over 700 pregnant smokers who participated in a randomized clinical trial of smoking cessation intervention. The participants provided self-reports of their prepregnancy smoking and drinking habits prior to the 18th week (test) and again in the eighth month of gestation (retest). About half the subjects gave identical reports of prepregnancy smoking habits at test and retest. Among those who changed their estimates, the changes were usually small. The reliability of reports of prepregnancy alcohol intake was also high. The reliability of reports by the treatment group - which experienced an anti-smoking intervention and extensive contact with study personnel - was very similar to that of the control group.

Adult↗
PubMed1989

Acute pulmonary response in healthy, nonsmoking adults to inhalation of formaldehyde and carbon.

Formaldehyde (HCHO) is a common chemical found in occupational and residential environments and has been suggested as a cause of asthmalike symptoms in some individuals. Clinical and animal studies suggest that HCHO adsorbed on respirable particles may elicit a greater pulmonary physiologic and inflammatory effect than gaseous HCHO alone. The purpose of this study was to determine if respirable carbon particles have a synergistic effect on the acute symptomatic and pulmonary physiologic response to HCHO inhalation. We randomly exposed 24 normal, nonsmoking, methacholine-nonreactive subjects to 2 h each of clean air, 3 ppm formaldehyde, 0.5 mg/m3 respirable activated carbon aerosol, and the combination of 3 ppm formaldehyde plus activated carbon aerosol. The subjects engaged in intermittent heavy bicycle exercise (VE = 57 l/min) for 15 min each half hour. Measures of response included symptom questionnaires, spirometry, body plethysmography, and postexposure serial peak flows. Formaldehyde exposure was associated with significant increases in reported eye irritation, nasal irritation, throat irritation, headache, chest discomfort, and odor. We observed synergistic increases in cough, but not in other irritant respiratory tract symptoms, with inhalation of formaldehyde and carbon. Small (less than 5%) synergistic decreases in FVC and FEV3 were also seen. We observed no HCHO effect on FEV1; however, we did observe small (less than 10%) significant decreases in FEF25-75% and SGaw which may be indicative of increased airway tone. Overall, our results demonstrated synergism, but the effect is small and its clinical significance is uncertain.

Administration, Inhalation↗
PubMed1989

Effect of nitrogen dioxide exposure on susceptibility to influenza A virus infection in healthy adults.

The effect of NO2 exposure and human susceptibility to respiratory virus infection was investigated in a placebo-controlled, randomized, double-blind trial conducted in an environmentally controlled research chamber over 3 yr. Healthy, nonsmoking, young adult volunteers who were seronegative to influenza A/Korea/82 (H3N2) virus were randomly assigned to breathe either filtered clean air (control group) or NO2 for 2 h/day for 3 consecutive days. The NO2 concentrations were 2 ppm (Year 1), 3 ppm (Year 2), and 1 or 2 ppm (Year 3). Live, attenuated cold-adapted (ca) influenza A/Korea/82 reassortant virus was administered intranasally to all subjects immediately after the second exposure. Only one of the 152 volunteers had any symptoms; this person had a low grade fever. Pulmonary function measurements and nonspecific airway reactivity to methacholine were unchanged after NO2 exposure, virus infection, or both. Infection was determined by virus recovery, a fourfold or greater increase in serum or nasal wash influenza-specific antibody titers, or both. The infection rates of the groups were 12/21 (2 ppm NO2) versus 15/23 (clean air) in Year 1, 17/22 (3 ppm NO2) versus 15/21 (clean air) in Year 2, and 20/22 (2 ppm) and 20/22 (1 ppm) versus 15/21 (clean air) in Year 3. Each group exposed to 1 or 2 ppm NO2 in the last year became infected more often (91%) than did the control group (71%), but the differences were not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Survival experience of aged hip fracture patients.

Hip fracture has long been considered a major threat to survival in aged populations. This report describes the survival experience of 814 aged, community dwelling hip fracture patients treated in seven Baltimore hospitals between 1984 and 1986: 4.3 per cent died during hospitalization; 8.2, 12.6, and 17.4 per cent died within three, six, and 12 months after fracture, respectively. The mortality rate for the entire population approaches expected mortality approximately six months post-fracture, but varies by age and sex. The most important factors predicting mortality are presence of serious concomitant illness and marked delirium (in the absence of dementia) at the time of hospital admission. The authors suggest that medical factors that may contribute to patient disorientation be investigated and treated, when possible, in an effort to improve the survival status of hip fracture patients.

Age Factors↗
PubMed1989

The prevalence of urethral catheterization in Maryland nursing homes.

Urinary incontinence is common in the increasing numbers of aged people and is often the precipitating factor for nursing home admission. Recalcitrant incontinence may be managed by urethral catheters. In this study of a random stratified sample of Maryland nursing homes (4259 patients), we found that the daily prevalence of urethral catheter use in Maryland nursing homes was 7.5%. More than 80% of urethral catheter users were women. Among men, we found equal prevalences of urethral and condom catheter use. Previous studies have demonstrated long-term use of urethral catheters to be associated with almost universal bacteriuria of a polymicrobial and dynamic nature. Combining these data suggests that long-term catheter-associated bacteriuria is the most common infection in American health care facilities.

Aged↗
PubMed1988

The probability that long-term mean diastolic blood pressure is extreme: tables for black individuals.

With use of a large data base and a statistical model for diagnosis developed earlier, we have constructed the among-individual conditional distribution of the long-term mean diastolic blood pressure, md, of an individual, given the means of several measurements of systolic and diastolic blood pressure on the individual. Using this conditional distribution we provide tables and a simple algorithm for computation of the conditional probability that md for an individual exceeds a specified value (for example, 90 mmHg), given the measured values of systolic and diastolic pressure.

Adult↗
PubMed1988

Dose-response of birth weight to various measures of maternal smoking during pregnancy.

Thus far little is known about the dose-response relationship between birth weight and the amount of maternal smoking during pregnancy. The purpose of this report is to describe the effects of smoking intensity, duration, and timing on birth weight with the use of three measures of exposure: self-reported daily consumption, self-reported cumulative consumption, and salivary thiocyanate. Data were obtained on 867 single live-born infants and their mothers who participated in a randomized anti-smoking intervention trial. Smoking was measured for the women at about 15 weeks gestation and again during the eighth month. Although all indicators of dose, as derived from early or late pregnancy smoking measures, were significantly associated with birth weight, whether or not the mother had quit smoking by the time of the 8th month follow-up was almost as predictive as any dose variable. For women who quit smoking before 30 weeks gestation, neither the duration nor the amount of smoking earlier in pregnancy was an important determinant of birth weight.

Adolescent↗
PubMed1988

Patient-proxy response comparability on measures of patient health and functional status.

The present study evaluates the response comparability between 361 elderly hip fracture patients admitted from the community to seven Baltimore area hospitals between 1984 and 1986 and interviewer selected proxies on items pertaining to patients' pre-fracture health and functional status. Agreement across items ranges from very poor to good and varies with respect to the health or functional area assessed. Proxies tend to overestimate patient disability relative to the patients themselves, especially with regard to capacity to perform instrumental activities of daily living. Although proxies who report the greatest contact with patients respond most comparably to the patients, when they do disagree, proxies with the greatest patient contact tend to overestimate patient disability. The authors suggest that attention to item construction and phrasing may improve response comparability.

Activities of Daily Living↗
PubMed1988

The association of Chlamydia trachomatis, Neisseria gonorrhoeae, and group B streptococci with preterm rupture of the membranes and pregnancy outcome.

There is conflicting evidence regarding a possible causal role for Chlamydia trachomatis in the development of preterm premature rupture of the membranes. We investigated the relative prevalence of endocervical infection with C. trachomatis and group B streptococci in patients with preterm premature rupture of membranes compared with a control group taken from the same obstetric population. C. trachomatis was isolated from 23/52 (44%) patients with preterm premature rupture of membranes versus 13/84 (15%) women in the control group (p less than 0.001). This association was independent of infection with group B streptococci or Neisseria gonorrhoeae. Group B streptococci were isolated from 16% of the patients with preterm premature rupture of membranes versus 4% of the control population (p less than 0.05). The risk of preterm premature rupture of membranes associated with group B streptococcal infection was independent of infection with C. trachomatis and N. gonorrhoeae. Endocervical infection with C. trachomatis did not significantly affect early maternal complication rates after delivery.

Adult↗
PubMed1988

Health and living arrangements among older women: does living alone increase the risk of illness?

This study compares the physical, mental, and functional health of aged women living alone to those living with a husband and to those living with others, and considers whether living arrangements lead to health problems or if health problems influence the choice of living arrangements. Data were collected in 1984 during the first wave of a prospective study of 807 women 65 years or older living in an area consisting of 20 contiguous census tracts in Baltimore, MD. Multivariate analyses demonstrate no particular disadvantage associated with living alone for this group of elderly women. After controlling for age and socioeconomic status, analyses indicate that it is those living with persons other than their husbands who are most impaired. In addition, poor health does not appear to result from living arrangement; rather, those who are sickest choose to live with others because of health problems.

Activities of Daily Living↗
PubMed1987

Risk-factor changes in wives with husbands at high risk of coronary heart disease (CHD): the spin-off effect.

This study of 220 wives of participants from four of the 22 clinics in the Multiple Risk Factor Intervention Trial (MRFIT) addresses the question of whether spouses of men exposed to a continuous coronary heart disease (CHD) risk-factor intervention program (SI group) make changes in their own risk status compared to wives of men who did not receive the intervention program (UC group). Total serum cholesterol and low-density lipoprotein (LDL) cholesterol were significantly lower for the SI wives. These differences were found for both hypertensive and normotensive wives, although the magnitudes were much greater for the hypertensive wives. There were also significant differences between the two groups of wives in the food-record rating and in dietary-knowledge scores, indicating that the probable mechanism for the beneficial effect of the intervention with respect to cholesterol levels was the change in the family diet. Although not statistically significant, differences indicating a lower risk for SI wives were found for diastolic blood pressure. There was also a greater mean reduction in cigarettes per day for SI wives who smoked.

Attitude to Health↗
PubMed1987

Hamster tracheal organ culture in serum-free media: a quantitative comparison of in vitro epithelial morphology with that of in vivo controls.

The epithelial morphology of the hamster trachea in serum-free organ culture was compared with that of age-matched in vivo control tissues by collecting and statistically analyzing several quantifiable parameters. By this technique it was possible to detect both subtle and dramatic epithelial alterations. Midtracheal tissues from 6-wk-old male Syrian golden hamsters were used as the explants. Explants were placed on Gelfoam sponges and cultured for 1,2, and 3 wk in CMRL 1066 alone and in CMRL 1066 to which seven factors were added: insulin and transferrin (5 micrograms/ml); hydrocortisone (5 X 10(-7) M); epidermal growth factor (5 ng/ml); bovine pituitary extract (0.5%); and phosphoethanolamine and ethanolamine (5 X 10(-5) M). The following data were collected and statistically analyzed for each tracheal ring: number of epithelial cells; proportion and number of each cell type; basement membrane length; linear density of epithelial cells; epithelial height; and mitotic index. Compared to controls, ciliated cells decreased by 52% during washes in Leibovitz (L15) medium and tissue manipulation performed before culture and this loss persisted after culture for 1 wk. Explants cultured without the factors showed marked changes after 2 and 3 wk including epithelial thickening and folding, which was associated with increased linear density. Many cells in these specimens could not be categorized by type (22% were unidentifiable after 3 wk). Epithelial migration onto the outside of the explant was inhibited. In contrast, explants cultured with the factors maintained a morphology similar to controls at 2 and 3 wk and epithelial migration onto the outside of the explant was supported. This study shows that explants in CMRL 1066 with the seven factors provide a useful biological model for the in vitro study of mucociliary respiratory epithelium.

Animals↗
PubMed1987

Predicting performance on the Mini-Mental State Examination. Use of age- and education-specific equations.

Inclusion of a mental status examination in research and clinical screening instruments lengthens the protocol, thereby adding to the difficulty of using instruments addressing all relevant issues under study without taxing participants. The purpose of the present study was to evaluate the possibility of substituting a subset of items from the widely used Mini-Mental State Examination (MMSE) for the entire examination in order to reduce the time needed to screen for cognitive status. Study data came from a health study of 783 community-dwelling, white females, 65 years of age and over, selected randomly from a 20-census-tract area of northeast Baltimore. Results indicate that seven MMSE items can be used to reliably predict total MMSE scores. Because of an age X education interaction in the prediction of total MMSE scores, four age X education-specific predictive equations were developed. These four equations are most useful for predicting continuous MMSE scores rather than for categorizing individuals according to impaired versus unimpaired status. A short form of the MMSE and four age X education-specific scoring equations are presented and their potential utility discussed.

Age Factors↗
PubMed1987

Alcohol consumption among pregnant smokers: effects of a smoking cessation intervention program.

This study describes patterns of alcohol consumption among pregnant women who participated in a randomized clinical trial of smoking cessation intervention. Data on alcohol habits were obtained prospectively prior to the 18th week of gestation and during the 8th month of pregnancy. Average alcohol intake for both groups was reduced primarily prior to registration for prenatal care. The smoking cessation intervention reduced smoking during pregnancy but had no effect on alcohol intake.

Alcohol Drinking↗