Research in developing countries.
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Biomedical subjects
Publications and source records attributed to K Warren.
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The impact of occupational stressful life events on psychological distress and blood pressure was examined among employees of a major New York City brokerage firm undergoing massive layoffs. One hundred thirty-nine employees of the firm, who had participated in a blood pressure screening in 1986, were rescreened during the period of layoffs within their company in 1989. About two-thirds of the 139 employees reported being "somewhat" or "very" anxious or upset in 1989 during the period of layoffs, and psychological distress was significantly elevated among those employees reporting possible or definite layoff or job change and/or difficulty in obtaining a comparable job. However, we found no increase in overall blood pressure level, and no effect of anticipation of job loss on 1989 blood pressure when controlling for 1986 blood pressure level, age, body mass index, work hours, and other demographic variables. On the other hand, employment in a department sold to another employer on the day of screening, as well as employment in a clerical job title, were both associated with significant increases in diastolic blood pressure of about 5 mm Hg.
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"Job strain" (defined as high psychological demands and low decision latitude on the job) has been previously reported to be associated with increased risk of hypertension and increased left ventricular mass index (LVMI) in a case-control study of healthy employed men, aged 30-60 years, without evidence of coronary heart disease. We hypothesized that job strain would be associated with increased ambulatory blood pressure (AmBP). A total of 264 men at eight work sites wore an AmBP monitor for 24 hours on a working day. In an analysis of covariance model, job strain was associated with an increase in systolic AmBP of 6.8 mm Hg (p = 0.002) and diastolic AmBP of 2.8 mm Hg at work (p = 0.03) after adjusting for age, race, body mass index, Type A behavior, alcohol behavior, smoking, work site, 24-hour urine sodium, education, and physical demand level of the job. Alcohol use also had a significant effect on AmBP. However, among subjects not in high-strain jobs, alcohol had no apparent effect on AmBP at work. Instead, alcohol use and job strain interacted such that workers in high-strain jobs who drank regularly had significantly higher systolic AmBP at work (p = 0.007). Among the other risk factors, only age, body mass index, and smoking had significant effects on AmBP. Job strain also had significant effects on AmBP at home and during sleep as well as on LVMI.(ABSTRACT TRUNCATED AT 250 WORDS)
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This report presents a case requiring a combination of restorative dentistry and orthodontic treatment in a mature adult patient. Occlusal splint and periodontal therapies were used initially. Orthodontic treatment combined the use of the occlusal splint and fixed appliance in the maxillary arch. Sectional fixed appliances were used in the mandibular arch. The final restorations were fixed--movable bridges in the mandibular arch and a removable tooth and mucosally borne prosthesis in the maxilla. Retention of the orthodontic result was provided by the fixed prostheses in the lower arch and the continued wear of a full coverage maxillary occlusal splint at night served to prevent relapse of the upper teeth.
This report summarizes current knowledge about pica practices during pregnancy through a systematic review of the literature for the period 1950 through 1990. Pica behavior was considered in terms of its prevalence, risk factors, clinical profile, and effect on pregnancy outcome. Data on pica practices by pregnant women are limited and inconclusive but reveal several interesting relationships. The prevalence of pica among pregnant women in high-risk groups declined between the 1950s and the 1970s but now remains steady, affecting about one fifth of high-risk women. Women at high risk of pica are more likely to be black, to live in rural areas, and to have a positive childhood and family history of pica. The clinical picture of the disorder during pregnancy is not well described. The evidence suggests that pica during pregnancy results in anemia, but it is not definitive. Pica also has been associated with maternal and perinatal mortality. We conclude that the behavior is more prevalent than commonly believed, shows no sign of further decline, and may have serious effects, particularly anemia, on mother and infant. Dietetic practitioners who counsel pregnant women should ask questions about pica when they conduct nutrition assessments of their clients.
This paper describes the clinical and laboratory stages necessary to ensure the occlusal precision of fixed restorations. The important diagnostic stages, including elimination of mandibular dysfunction, the occlusal analysis and waxing of diagnostic casts, and the diagnostic use of provisional restorations, are outlined. The importance of having the clinician control all stages of laboratory work, including die trimming, mounting working casts on an articulator, the determination of both anterior and posterior tooth form, and the final occlusal adjustment of the restorations, is emphasized.
This descriptive study compares the inflammatory, coagulant, and hemodynamic responses of the baboon to a 2-hr infusion of lethal and sublethal concentrations of Escherichia coli (40 and 4.0 billion organisms per kilogram, respectively). The response to lethal E. coli challenge occurred in three stages: an inflammatory stage marked by a fall in white blood cell count (0-2 hr), a coagulant stage marked by a fall in fibrinogen concentration (2-6 hr), and a hypoxic cell injury stage marked by a rise in SGPT/BUN and by a gradual cardiovascular collapse, and death (6-24 hr). The inflammatory, or first stage coincided with the appearance in plasma of tumor necrosis factor (TNF) and interleukin-1 beta (IL-1 beta), which peaked at 120 and 240-300 min, respectively; a slow but continuous appearance and rise of interleukin-6 (IL-6); and the appearance of endotoxin reaching a maximum at 120 min. This contrasted markedly with the response to sublethal E. coli, in which only one of the three stages was observed (inflammatory) and only minor amounts of the cytokines or endotoxin appeared in the plasma. This study describes the cytokine and endotoxin profiles and the bacteremia in the primate under experimental conditions. It shows for the first time the extreme qualitative differences in their response to lethal and sublethal concentrations of E. coli. It raises the possibility that lethality is associated with an override of the tissue threshold for processing these mediators, as marked by their appearance in plasma in response to lethal E. coli infusion.
To determine whether "job strain" (defined as high psychological demands and low decision latitude on the job) is associated with increased workplace diastolic blood pressure and the left ventricular mass index, we conducted a case-control study at seven urban work sites of 215 employed men aged 30 to 60 years without evidence of coronary heart disease. After comprehensive blood pressure screening of male employees (N = 2556) at the work site, 87 cases of hypertension and a random sample of 128 controls were studied. In a multiple logistic regression model, job strain was significantly related to hypertension, with an estimated odds ratio of 3.1, after adjusting for age, race, body-mass index, type A behavior, alcohol intake, smoking, work site, 24-hour urine sodium excretion, education, and physical demand level of the job. Controlling for the above variables in subjects aged 30 to 40 years with job strain, we found that the echocardiographically determined left ventricular mass index was, on average, 10.8 g/m2 greater than in subjects without job strain. We conclude that job strain may be a risk factor for both hypertension and structural changes of the heart in working men.
The prevalence of hypertension defined according to National Health and Nutrition Examination Survey II (NHANES II) criteria (140/90 mmHg and/or taking antihypertensive medication) was analyzed cross-sectionally at seven worksites in New York City (n = 4274; 2616 men and 1648 women), in order to assess whether exposure to different work environments and occupations contributes to blood pressure variation. The prevalence of hypertension across worksites was 26% among men and 12% among women. Blood pressure was significantly different across worksites even after controlling for known risk factors using analysis of covariance. Of the variation in systolic pressure, 34% was predicted significantly by eight variables; after adjusting for upper-arm circumference, age and body mass index, higher pressures were associated with worksite differences (9.0 mmHg), being male (7.2 mmHg), lacking a high-school education (4.3 mmHg), having a clerical occupation (2.9 mmHg) and being unmarried (1.8 mmHg). Similar results for diastolic pressure suggest that researchers should consider worksite and job characteristics as important predictors of blood pressure differences in working populations.
An investigation was carried out to measure the completeness of cure of samples of a composite resin, light cured for 40s and 60s through porcelain discs of varying thickness. Once cured, each specimen was subjected to Vickers microhardness testing to assess the completeness of cure. Composite resin specimens cured without an intervening porcelain disc were used to establish a baseline. The results showed that increasing the thickness of the porcelain disc produced a statistically significant decrease in microhardness of the composite resin. Increasing the cure time from 40s to 60s produced a significant increase in microhardness. The increase in microhardness with increased cure time was more pronounced when the discs of thickness 1 mm and 2 mm were used, and when there was no overlying porcelain disc.
A 60 item questionnaire was completed by a self-selected sample of nurses working with elderly patients. The questionnaire was divided into three sections; to collect personal data, to assess the nurses' attitude to mouthcare and their level of training in this subject, and to assess the level of dental knowledge. This paper identifies the disadvantages of using a self selected as opposed to a random sample. Analysis of the completed questionnaires revealed a fairly high level of basic training in dental and mouthcare matters. There was however, a paucity of specific dental knowledge e.g. there was some confusion over the aetiology and prevention of dental caries and also as to the difference between gingivitis and periodontitis. In addition, few nurses seemed to be aware of the effects systemic disease and drugs may have on the oral tissues. In spite of this most respondents achieved more than 50 per cent correct answers. A number of recommendations to improve nurses' dental knowledge is given at the end of the article.
Many older patients present requiring a multi-disciplinary approach to treatment aimed at restoring their dentition to health, satisfactory function, and appearance. The restorative dentist with specialist knowledge of periodontics, and fixed and removable prosthodontics is well qualified to provide a treatment plan to achieve these goals. The basic principles of formulating a treatment plan are discussed and a case presented which required a combination of occlusal therapy, periodontics, orthodontics and fixed and removable prosthodontics.
Patients who are physically disabled often face immense problems coping with the simple tasks of everyday life. These problems are particularly acute in those patients who have lost the use of their hands or have only restricted hand use. Their ability to work, study or to participate in leisure activities may be severely impaired. This article describes how the dentist may be able to mitigate the effects of restricted hand use by constructing a variety of tools and gadgets designed to help some of these patients lead a more normal life and reduce their reliance on others.
We have evaluated a new non-chromatographic commercial radioimmunoassay kit for serum, plasma, and urine aldosterone levels which employs 125 iodine as the tracer. Within-run and run-to-run precision data show coefficients of variation of 3 to 6% and 8 to 16%, respectively. Recovery of aldosterone added to serum and urine at several levels range from 92 to 109%. Antibody specificity was tested with six structurally related steroids at grossly elevated concentrations and no crossreactivity was observed. Serum or plasma can be used interchangeably in the assay, and normal levels correspond to generally accepted values.
It is extremely difficut to determine if it really makes a difference to provide a medical journal to medical students. Does it alter their reading habits? Does it indeed form the basis for learning? In 1976 84% of the third year class and in 1972 69% (n=97), personally subscribed to a Journal designated. In the fourth year class, 75% (n=149) subscribed in 1976 and 58% (n=82) in 1972. The conclusion is that the New England Journal of Medicine Project can be viewed as an endeavour which meets the need of students.
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