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Biomedical subjects

K Damus

Publications and source records attributed to K Damus.

31 records · Page 2Linked to original sources
PubMed1982

Protective role of human milk against sudden death from infant botulism.

We examined the possibility that human milk and formula milk might differentially affect the severity of the infant botulism because they differ in immunologic composition and in influence on the normal intestinal microflora against which Clostridium botulinum must compete. A beneficial effect of human milk was suggested by the different feeding experiences of the moderate, hospitalized patients and the sudden death cases. Of patients hospitalized in California, 66% (33/50) were still being nursed at onset of illness, a percentage significantly greater than that of matched controls (P less than 0.01). In contrast, all ten California cases of sudden infant death attributable to C. botulinum infection were being fed iron-supplemented formula milk at death) unlike their controls, P less than 0.02) and had received no human milk within ten weeks of death. A beneficial effect of human milk was also observed in differences in mean age at onset; hospitalized breast-fed patients were almost twice as old (13.8 +/- 6.7 weeks) as were hospitalized formula-fed patients (7.6 +/- 2.9 weeks) (P less than 0.01). Human milk (or possibly other factors associated with breast-feeding) appeared to have moderated the severity at onset of infant botulism, allowing time for hospital admission, whereas for some infants with this illness, formula milk (or possibly other factors associated with formula feeding) was linked to sudden unexpected death.

Botulism↗
PubMed1979

Honey and other environmental risk factors for infant botulism.

Infant botulism results from the in vivo production of toxin by Clostridium botulinum after it has colonized the infant's gut. Epidemiologic and laboratory investigations of this recently recognized disease were undertaken to identify risk factors and routes by which C. botulinum spores might reach susceptible infants. Clostridium botulinum organisms, but no preformed toxin, were identified in six different honey specimens fed to three California patients with infant botulism, as well as from 10% (9/90) of honey specimens studied. By food exposure history, honey was significantly associated with type B infant botulism (P = 0.005). In California, 29.2% (12/41) of hospitalized patients had been fed honey prior to onset of constipation; worldwide, honey exposure occurred in 34.7% (28/75) of hospitalized cases. Of all food items tested, only honey contained C. botulinum organisms. On household vacuum cleaner dust specimens and five soil specimens (three from case homes, two from control homes) contained Clostridium botulinum. The known ubiquitous distribution of C. botulinum implies that exposure to its spores is universal and that host factors contribute importantly to the pathogenesis of infant botulism. However, honey is now an identified and avoidable source of C. botulinum spores, and it therefore should not be fed to infants.

Botulism↗
PubMed1978

Intestinal infection and toxin production by Clostridium botulinum as one cause of sudden infant death syndrome.

The spontaneous production of botulinum toxin in the infant gut by ingested Clostridium botulinum organisms is the underlying cause of infant botulism, recognised as an infectious disease only in late 1976. Because of the recognition of the pathophysiology of this disease and because the known potency and action of botulinum toxin can lead to rapid respiratory arrest, it appeared possible that the in-vivo production of botulinum toxin could cause the sudden death of some infants. To test this hypothesis, serum, selected tissues, and bowel contents from 280 dead infants were examined for the presence of C. botulinum toxin and/or organsisms. We found C. botulinum organisms in 10 infants, all of whom died suddenly and unexpectedly. 9 of these deaths were classified by the forensic pathologist as sudden infant death syndrome (S.I.D.S. or crib death). In 2 of these 10 sudden deaths both C. botulinum organisms and botulinum toxin were identified, and from the spleen of 1, C. botulinum organisms were isolated. Faecal specimens from 160 age-matched healthy infants who served as controls in studies of inpatient infant botulism cases were negative for both C. botulinum organisms and toxin, except for one specimen that contained only C. botulinum type A organisms. The 9 S.I.D.S. cases with evidence of C. botulinum infection comprised 4.3% of the 211 S.I.D.S. cases examined over 12 months. These findings suggest that intestinal production of botulinum toxin by C. botulinum is one cause of S.I.D.S. The strikingly similar age-distribution of 62 inpatient infant botulism cases and the 211 S.I.D.S. cases is also consistent with this concept. The possibility that in-vivo production of botulinum toxin may account for a larger proportion of S.I.D.S. cases is discussed.

Botulinum Toxins↗
PubMed1977

"Pap" testing and hysterectomy prevalence: a survey of communities with high and low cervical cancer rates.

There is an inverse relation between cervical cancer rates and income in Los Angeles County communities, and there is a positive association between level of Papanicolaou (Pap) testing and income. Ethnic differences in cervical cancer rates and Pap testing are dependent on income. The relatively high rate of cervical cancer and low level of systematic screening in low income communities suggest that a community trial to assess the value of cytologic screening in reducing cervical cancer rates is feasible. Information on hysterectomy prevalence by type of procedure supports the idea that the long-observed decline in cervical cancer rates is in part attributable to a concomitant decrease in the ratio of subtotal to total hysterectomy.

Adult↗
PubMed1977

Papanicolaou testing and hysterectomy prevalence in low-income communities: a survey in Los Angeles County.

A survey of the prevalence of Papanicolaou (Pap) testing and of hysterectomy and a feasibility study were conducted in low-income communities with high rates of cervical cancer, identified by an analysis of mortality and case rates. Although about 90% of the women reported having had a Pap regular testing. For example, in the 5 years preceding the study (1971--75), about a quarter of the women had been tested only once and about a third not at all. No evidence of a secular change in hysterectomy prevalence in these communities was found.

Adult↗
PubMedDate not supplied

What do pregnant women know about preventing preterm birth?

Approximately 75% of all perinatal mortality is attributable to preterm birth and its sequelae; therefore, the prevention of preterm birth is a major public health priority. In an effort to determine what pregnant women need to be taught about this subject, 211 pregnant women in an inner-city clinic were given a questionnaire to ascertain their basic knowledge about the subject. Among the results were that almost one-half of the women surveyed did not know how many weeks constituted a normal pregnancy and one-third did not know that neonates born preterm could have health problems. The importance of teaching these and other basic facts (which nurses might think are already known by pregnant women) is a notable finding of this research. If perinatal nurses are to effectively teach pregnant women about the prevention of preterm birth, they must target the appropriate facts and build their patients' knowledge base.

Adolescent↗
PubMedDate not supplied

What pregnant women want to know: a comparison of client and provider perceptions.

OBJECTIVE: To compare client and health-care provider perceptions concerning health topics. DESIGN: A survey conducted at the first prenatal visit asked women to indicate levels of interest in 38 topics. Providers answered the same survey, indicating perceptions of clients' interests. SETTING: A prenatal clinic and a private office, both in an inner city area. PARTICIPANTS: Two groups of prenatal clients (n = 135 private care and n = 250 public care) and their health-care providers (n = 32 nurses and physicians). RESULTS: Significant differences were found (p < .01 for four topics, p < .05 for six topics) between the clients' interests and the providers' perceptions. Women in private and public care differed significantly (p < .01) in their levels of interest. Interest was significantly affected by parity, but not maternal education. CONCLUSIONS: Nurses and other health professionals should be aware of the range of topics in which clients express interest. This study suggests that site of care and parity should be considered when developing prenatal health education.

Adolescent↗
PubMedDate not supplied

Can precolposcopy education increase knowledge and decrease anxiety?

OBJECTIVE: To investigate the impact of an educational intervention on knowledge and anxiety level of women scheduled for colposcopy after an abnormal Papanicolaou (Pap) test. DESIGN: Experimental, randomized controlled study. SETTING: An inner-city medical school. PARTICIPANTS: The final sample consisted of 58 women in the intervention group and 55 women in the control group. Exclusion criteria included any previous colposcopy. INTERVENTIONS: The women in the intervention group received in the mail, approximately 1 week before their appointment, a one-page handout about colposcopy. The control group received no mailed handout. After arriving for the visit, women were asked to participate in the study and then were interviewed. MAIN OUTCOME MEASURES: Knowledge of reason for visit and knowledge of colposcopy as measured by content analysis of interview; and anxiety as measured by the Spielberger State/Trait Anxiety Inventory. RESULTS: Women in the intervention group demonstrated significantly more knowledge about the reason for their visit and about colposcopy than did the other women. No significant difference in mean anxiety score was found between the groups. CONCLUSIONS: The intervention increased knowledge about colposcopy for this population. Because patient education is an essential nursing function, these results are encouraging. This intervention can be replicated by nurses in other settings. Further research is necessary to understand how nurses can best help women alleviate anxiety before colposcopy.

Adaptation, Psychological↗
PubMedDate not supplied

The relationship between passive smoking and child health: methodologic criteria applied to prior studies.

Most studies investigating the relationship between passive smoking and child health have found a significant effect on respiratory illness and lung function. The wide range of findings is based on diverse types of studies which use multiple criteria for respiratory illness, smoke exposure, and outcome variables. The aim of this review is to examine these studies in an attempt to focus attention on methodological criteria which relate to the strength of the association and likelihood of a causal relationship between passive smoking and child health. We examined 30 studies and judged their strength by examining (1) data collection, (2) surveillance bias, (3) definition of amount of smoking, (4) definition of illness, (5) detection bias, (6) outcome variables, and (7) control for confounding variables. Poor scores were noted in the use of "blinded" data collectors (37 percent of possible score), use of multiple specific outcome variables (51 percent), and definition of the quantity of smoking (56 percent). Good scores were noted in the detection of illnesses (98 percent), recall by study subjects of symptoms of illness (71 percent), control for confounding variables (81 percent), and definition of illnesses (86 percent). The range of scores for the studies was from 44 percent to 89 percent (of the total possible score). While a few well-designed studies demonstrate a significant effect of passive smoking on child health, most studies had significant design problems that prevent reliance on their conclusions. Thus, many questions remain, and future studies should consider important methodological standards to determine more accurately the effect of passive smoking on child health.

Child↗
PubMedDate not supplied

The effect of using "race of child" instead of "race of mother" on the black-white gap in infant mortality due to birth defects.

OBJECTIVE: For at least 20 years, birth defects have been the leading cause of infant mortality in the United States. Some studies have reported higher rates for black infants than white infants of mortality due to birth defects, while other studies have reported no black-white differences. The authors analyzed the effect on these rates of a change in the way the National Center for Health Statistics (NCHS) tabulates "race" for newborns. METHODS: The authors calculated infant mortality rates due to birth defects for 1980-1993 using two standard methods of assigning newborns to "racial" categories: a "race of child" algorithm and the "race of mother" approach currently used by NCHS. RESULTS: From 1980 through 1993, birth defect-specific infant mortality rates (BD-IMRs) were significantly higher for black infants than white infants 12 of the 14 years by "race of mother" and only 5 of 14 years by "race of child." Calculation of BD-IMRs by "race of mother" reduced the rate for white infants and increased the rate for black infants in each of the 14 years. The choice of method for assigning newborns to "racial" categories had a progressively greater effect over time on the black-white gap in BD-IMRs. CONCLUSIONS: Calculations of trends in "race"-specific BD-IMRs by may vary substantially by whether "race of mother" or "race of child" is used. Identifying the method of tabulation is imperative for appropriate comparisons and interpretations.

Adult↗