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Biomedical subjects

M A Armstrong

Publications and source records attributed to M A Armstrong.

At least 55 records · Page 3Linked to original sources
PubMed1996

An investigation of the effects of heparin, low molecular weight heparin, protamine, and fentanyl on the balance of pro- and anti-inflammatory cytokines in in-vitro monocyte cultures.

We report a study conducted to determine if drugs given peri-operatively during cardiac surgery could themselves modulate the balance of pro- and anti-inflammatory cytokines. We determined the cytokine response of 10 separate in vitro monocyte cultures to the administration of drugs at concentrations used during cardiac 'surgery:fentanyl (25 ng.ml-1), heparin 2.5 i.u.ml-1, heparin with an equal concentration of protamine, and enoxaparin 2.5 i.u.ml-1. Fentanyl, heparin and low molecular weight heparin (enoxaparin) led to increased tumour necrosis factor alpha but this did not reach statistical significance. Tumour necrosis factor soluble receptor 1 and 2 was not elevated. Interleukin-1 beta was increased by heparin (p < 0.05), whereas interleukin-1 receptor antagonist was increased by fentanyl (p < 0.05). Protamine blocked the heparin-induced increase in tumour necrosis factor alpha and interleukin-1 beta. These data raise the possibility that endogenous and exogenously administered opioids may be partly contributing to the interleukin-1 receptor antagonist response seen during major surgery.

Analgesics, Opioid↗
PubMed1996

Cardiovascular risk factors among Asian Americans.

MANY ASIANS HAVE RECENTLY IMMIGRATED to the United States, but there have been few studies of cardiovascular risk factors in these groups. Researchers analyzed data from 13,031 people who described themselves as Chinese, Filipino, Japanese, and other Asians, and used regression analyses controlled for age, alcohol use, education, and marital status. Adjusted mean body mass index and smoking prevalence were lowest in Chinese men and women. Adjusted total cholesterol levels were highest in Japanese men and women. Hypertension prevalence was highest in Filipino men and women. Comparisons of Asians born outside the United States with those U.S.-born showed 1) no major cholesterol differences; 2) higher body mass index in U.S.-born men, but not in women of most races; 3) more hypertension only in U.S.-born Chinese men; and 4) a lower smoking prevalence in U.S.-born men but generally higher smoking prevalence in U.S.-born women. These data show important ethnic differences in cardiovascular risk factors among Asian Americans and have implications for targeting public health efforts.

Adult↗
PubMed1995

More than the sum of their parts: Martha Rogers and Hildegard Peplau.

Nursing practice is guided by a variety of theoretical models. Therefore, nursing theories are commonly selected by service institutions to focus practice. Both Rogers and Peplau made major contributions to the theory and practice of nursing, and both are appropriate models for the discipline of psychiatric and mental health nursing. This article explores the grand theory of Martha Rogers in conjunction with the use of the middle-range theory of Hildegard Peplau. Points of resonance, theoretical fit, and differences between theories are discussed. Appropriateness to practice of both theories are identified and the need for both perspectives is articulated.

Models, Nursing↗
PubMed1995

Cytokine balance and immunosuppressive changes at cardiac surgery: contrasting response between patients and isolated CPB circuits.

In vitro work suggests that IL-10 plays a pivotal role in controlling the balance of pro- and anti-inflammatory cytokines and monocyte HLA-DR expression. In 20 patients undergoing cardiac surgery, we investigated elaboration of interleukin 10 (IL-10) and its relationship to pro- and anti-inflammatory cytokines and leucocyte expression of HLA-DR and adhesion molecules. There were small increases in pro-inflammatory cytokines (IL-1, IL-8 and tumour necrosis factor (TNF) after induction, returning to baseline on induction of cardiopulmonary bypass (CPB). After CPB another transient increase in IL-8 occurred (P < 0.05). The anti-inflammatory response began with elevated IL-10 during CPB (P < 0.001), which peaked early in recovery (P < 0.001), by which time IL-1 receptor antagonist (IL-1ra) and the TNF soluble receptors (TNFsr) had also increased (P < 0.01). The next day IL-10 and IL-1ra were decreasing but TNFsr continued to increase. Induction of anaesthesia caused HLA-DR downregulation. The IL-10 peak was associated with further monocyte HLA-DR downregulation (P < 0.001) and return towards baseline of granulocyte adhesion molecule expression which transiently increased during CPB (P < 0.001). To determine which aspects of the immune response arose from the interaction of blood with the CPB apparatus, the above variables were studied within an isolated CPB circuit and the influence of fentanyl on the magnitude of any such changes determined. Five healthy volunteers donated two, 250-ml samples of blood to which was added either fentanyl 175 micrograms with heparin 1050 u. or heparin alone 1050 u. These were used to prime two identical isolated CPB circuits and circulation was conducted under identical conditions for 90 min. Of the pro-inflammatory cytokines, only IL-8 was elevated at 90 min CPB (P < 0.05). There was no increase in anti-inflammatory cytokines and TNFsr decreased (P < 0.001). Granulocyte adhesion molecules were increased during CPB. In the fentanyl group, the CD11b increase was greater and preceded CPB. The reduction in lymphocyte HLA-DR expression, observed throughout the study period (P < 0.01), was greater with fentanyl (P < 0.05). Monocyte HLA-DR expression increased (P < 0.05), but to a lesser extent with fentanyl (P > 0.05). In contrast with the in vivo response where there was a phased anti-inflammatory response beginning with IL-10, in the isolated CPB model no anti-inflammatory cytokine response occurred.

Adult↗
PubMed1995

Score for neonatal acute physiology: validation in three Kaiser Permanente neonatal intensive care units.

BACKGROUND: Measurement of the severity of illness is a research area of growing importance in neonatal intensive care. Most severity of illness scales have been developed in tertiary care settings. Their applicability in community neonatal intensive care units has not been tested. OBJECTIVES: Our goal was to assess the operational characteristics of the score for neonatal acute physiology (SNAP): the relationship to birth weight, the length of total hospital stay, and in-hospital mortality. METHODS: We assigned SNAP scores prospectively to all inborn admissions at three community neonatal intensive care units during an 11-month period. Data on other neonatal predictors (eg, birth weight and the presence of congenital heart disease) were also collected. We measured in-hospital mortality, the experience of interhospital transport to a higher level of care, and total hospital stay. RESULTS: We found that the SNAP's relationship to birth weight was similar to previous reports. The SNAP's perinatal extension is a reliable predictor of newborn in-hospital mortality, with an area under the receiver operator characteristic curve of 0.95. The SNAP is also a good predictor of total hospital length of stay, whether by itself (by which it can explain 31% of the total stay) or in combination with other variables. Its predictive ability is better among infants of low birth weight (<2500 g) than among those of normal birth weight (> or = 2500 g). The SNAP's predictive power was most limited among infants admitted to rule out sepsis. The predictive ability of a model containing birth weight, the SNAP, and transport status was not improved by the inclusion of two major diagnostic categories, the presence of congenital heart disease or complex illness. CONCLUSION: Although it has definite limitations among infants who weight 2500 g or more, the SNAP is a potent tool for outcomes research. Modification of some of its parameters could result in a multifunctional scale suitable for use with all birth weights.

Birth Weight↗
PubMed1994

Alcohol consumption, smoking, and other risk factors and prostate cancer in a large health plan cohort in California (United States).

Alcohol consumption and cigarette smoking have been suggested as possible causes of prostate cancer. We therefore examined this relation in a cohort of 43,432 men who were members of a prepaid health plan in northern California (United States) and who had received a health examination in the period from 1979 through 1985. Detailed information on demographic variables, alcohol consumption, smoking habits, medical complaints and conditions, occupation, and surgery (including vasectomy) was assessed. Symptoms of prostatism and a history of sexually transmitted diseases were abstracted from the medical records of all prostate cancer patients and of a matched subsample of randomly selected control-subjects. Alcohol consumption was associated with no elevated prostate cancer risk for the 238 men in our study in whom prostate cancer developed, but smoking one or more packs of cigarettes per day was associated with an adjusted relative risk (RR) of 1.9 (95 percent confidence interval [CI] = 1.2-3.1). Prostate cancer risk for Black men was 2.2 (CI = 1.6-3.1) when compared with that for White men, and education level was associated positively in an increasing trend (P < 0.020) up to an RR of 1.4 (CI = 0.9-2.1) among men with postgraduate education. Symptoms of prostate hypertrophy were not associated with elevated risk of prostate cancer if they occurred two or more years before the diagnosis. The finding that smoking increased the risk of prostate cancer confirms the observations of others but needs cautious interpretation because we were unable to adjust for the potential confounding effect of dietary and hormonal factors.

Adenocarcinoma↗
PubMed1994

Early discontinuation of antibiotic treatment in newborns admitted to rule out sepsis: a decision rule.

We developed a decision rule to define a group of newborns eligible for discontinuation of antibiotic treatment 24 hours after initiation. The decision rule is based on two clinical assessments, three demographic variables, four maternal risk factors and six laboratory studies. The rule was created by retrospective analysis of all admissions to rule out sepsis at 10 Kaiser Permanente Northern California Region nurseries during a 2-month period in 1990. Of the 214 study subjects, 11 (5%) had a positive bacterial or viral culture result. No deaths occurred, but three babies who had negative culture results experienced late deterioration (after 24 hours in the special care nursery). After 24 hours of antibiotic treatment, 133 (67%) of the 199 babies who had negative culture results were asymptomatic, 36 (18%) had clear signs of illness and 30 (15%) had questionable signs of illness. The rule correctly identified all babies with positive culture results as well as all persistently symptomatic babies with negative culture results. The rule also identified 57 low-risk babies eligible for only 24 hours of antibiotic treatment. We tested the rule on a second data set. The rule identified 19 of 20 newborns with positive culture results in this independent group. The 20th baby was not identified because a required test (complete blood count at 12 to 24 hours of age) was not done. Under controlled clinical conditions, this baby could have returned to the nursery to complete antibiotic treatment. We concluded that early discontinuation of antibiotic treatment in selected newborns is safe and could lead to a 1 to 2% decrease in special care nursery days in our 10 hospitals.

Anti-Bacterial Agents↗
PubMed1994

The risk of hospitalization for ischemic heart disease among Asian Americans in northern California.

To supplement sparse data about ischemic heart disease in Asian Americans, hospitalization risk was prospectively examined in a group of Asian Americans living in Northern California. Analyses used Cox models with ischemic heart disease risk traits as covariables. With Whites as the referent category, relative risks by ethnic group were as follows: Chinese, 0.6 (P = .001); Japanese, 1.0 (P = .97); Filipinos, 1.0 (P = .95); South Asians, 3.7 (P < .001); other Asian Americans, 0.8 (P = .55). Thus, unexplained differences in ischemic heart disease risk exist among Asian-American ethnic groups, with Chinese Americans at lowest risk and persons of South Asian origin at highest risk.

Adult↗
PubMed1994

Changes in measurements of body fat distribution accompanying weight change.

The waist-to-hip circumference ratio (WHR), as an indicator of body fat distribution is related to several clinical diseases. Whether one can reduce this ratio with weight loss is still unconfirmed and may differ between sexes. The degree to which WHR changes with weight gain is also unclear. Changes in waist and hip circumferences and WHR accompanying changes in weight over 5 years were examined in 3,753 black and white men and women initially ages 18-30. Those who gained weight increased their WHR and in most cases those whose weight remained stable increased their WHR. Those who gained the most weight had the greatest increases in WHR. Men had greater increases in WHR per kg weight gain than women. In general, weight loss was accompanied by a decrease in the WHR. However, in those whose initial WHR was below the median, weight loss was associated with an increase in WHR. Smokers and black males also had increases in WHR with weight losses up to 4.9 kg.

Adipose Tissue↗
PubMed1993

Inconsistent associations of caffeine-containing beverages with blood pressure and with lipoproteins. The CARDIA Study. Coronary Artery Risk Development in Young Adults.

The authors examined associations of caffeine and caffeinated beverage intakes with blood pressure and with lipoproteins in 5,115 black and white men and women aged 18-30 years during 1985-1986. Caffeine and beverage intakes were not consistently associated with blood pressure in analyses controlling for race, sex, Keys score, sucrose intake, physical activity, oral contraceptive use, body mass index, alcohol use, age, and smoking. Associations of caffeine and beverage intakes with cholesterol, triglycerides, high-density lipoprotein cholesterol, and high-density lipoprotein2 cholesterol were also inconsistent. There is little or no association of caffeine with lipoproteins or with blood pressure in this cohort of healthy young adults.

Adolescent↗
PubMed1993

Long-term risk of hysterectomy among 80,007 sterilized and comparison women at Kaiser Permanente, 1971-1987.

To study the long-term risk of hysterectomy after tubal sterilization, the authors analyzed historical hospital discharge data on 39,502 parous women sterilized during 1971-1984 and 40,505 comparison women matched on age, race, parity, and interval since last birth. Sterilized women were significantly more likely than were comparison women to undergo hysterectomy (relative risk (RR) = 1.35, 95% confidence interval (CI) 1.26-1.44), especially for diagnoses of menstrual dysfunction and pelvic pain (RR = 1.88, 95% CI 1.65-2.13). Higher relative risks were not associated with greater tissue-destructive methods of tubal occlusion. Relative risks were highest for women who were young on the reference date (RR = 2.45, 95% CI 1.79-3.36 for women aged 20-24 years), but declined steadily as age increased (RR = 0.96, 95% CI 0.72-1.28 for women aged 40-49 years). In all age groups, relative risks were significantly above 1.00 after 7 years of follow-up. Reasons for elevated risks may be related to a greater willingness of sterilized women to forgo their uteruses. The emergence of greater risk in all age groups, however, prevents the authors from ruling out a possible latent biologic effect of tubal sterilization.

Adult↗
PubMed1993

Coffee, tea, and mortality.

Except for conflicting evidence about coffee and risk of coronary disease, coffee and tea are not linked to major causes of death. Because of widespread use of both beverages and limitations of prior studies, concern persists. Using Cox models (ten covariates) we studied relations in 128,934 persons to 4501 subsequent deaths. Except for slightly increased risk from acute myocardial infarction among heavier (> or = 4 cups/d) coffee users (relative risk versus nondrinkers = 1.4, 95% confidence interval = 1.0 to 1.9, P = 0.07), there was no increased risk of mortality for all deaths (relative risk per cup of coffee per day = 0.99, 95% confidence interval = 0.97 to 1.01; relative risk per cup of tea per day = 0.98, 95% confidence interval = 0.96 to 1.00) or major causes in adjusted analyses. Coffee was related to lower risk of liver cirrhosis death (relative risk per cup of coffee per day = 0.77, 95% confidence interval = 0.67 to 0.89). Use of both beverages was related to a lower risk of suicide, progressively lower at higher coffee intake (relative risk per cup of coffee per day = 0.87, 95% confidence interval = 0.77 to 0.98). We conclude that coffee and tea have no overall relation to mortality risk. If coffee increases coronary risk, this is balanced by an unexplained lower risk of other conditions, notably cirrhosis and suicide.

Adult↗
PubMed1993

Enhancing staff nurses' interpersonal skills: theory to practice.

Nurses working with psychiatric-mental health patients require a repertoire of skills to assess patient behavior and needs, design creative interventions, and evaluate care. The work of interpersonal psychiatric nursing exists within the therapeutic relationship between nurse and patient. A coordinated series of classes and clinical supervision sessions that present an approach to psychiatric nursing care using three major themes of Peplau's model: learning acquisition, language competencies, and anxiety reduction are described. Clinical supervision was strongly encouraged for participants and one clinical supervisor decided to model supervisory sessions using elements of Peplau's theory. Utilizing selected aspects of Peplau's interventional techniques during clinical supervision and reflecting on the experience provided an opportunity to validate and integrate new knowledge and skills. Nurses who sought supervision thus had the advantage of experimental learning through participation in clinical supervision.

Clinical Competence↗
PubMed1993

Alcohol use, other traits, and risk of unnatural death: a prospective study.

This study prospectively explores relations of usual alcohol intake in a Northern California population of 128,934 persons to risk of subsequent unnatural death. Of 385 such deaths during the 8-year study period, 88 were due to motor vehicle accidents (MVAs), 106 to suicide, 52 to homicide, and 139 to miscellaneous other unnatural causes. Comparisons of ex-drinkers and 5 levels of current drinkers to lifelong abstainers were studied by Cox proportional hazards models with 9 covariates. In adjusted analyses, persons reporting intake of 6 or more drinks daily were at greatly increased risk of death from suicide (6 times) and homicide (7 times), and at moderately increased risk of death from MVAs (2 times). Lighter and ex-drinkers were not at significantly increased risk for all unnatural deaths or any of its subsets. Among persons reporting 6 or more drinks/day, women and persons below 50 years of age were at especially high risk, but Blacks and Whites were at similar risk. Persons who usually drank liquor or wine were at greater risk for MVAs than those who usually drank beer; beverage choice was unrelated to the other causes of death. Among other covariates, men and not married persons were at higher risk and college graduates at lower risk, for each cause of death. The only major racial difference was a lower risk of suicide for Blacks (versus Whites). These data provide considerable detail about usual alcohol use and risk of unnatural death. They point to special need for preventive efforts among younger persons and women, with particular attention to suicide and homicide.

Accidents↗
PubMed1993

Association between alcoholic and caffeinated beverages and premenstrual syndrome.

We examined the association between alcohol and caffeine consumption and premenstrual syndrome (PMS). One hundred two women with PMS matched by age and race to an equal number of women without PMS were compared for differences in intake of alcoholic and caffeinated beverages, with differences determined using Student's t-tests and conditional logistic regression for matched pairs. Information on alcohol and caffeinated beverage consumption was obtained from three 24-hour dietary recall interviews conducted during the postmenstrual period and from three conducted during the premenstrual period. Results showed that no significant difference was observed in total caffeine intake or in the individual caffeinated beverages consumed during either the post-menstrual or the premenstrual period. For alcohol consumption, however, women with PMS drank 1.41 (95% confidence interval; range, 0.34-2.47) more servings per week during the postmenstrual period. Based on post-menstrual consumption, women in the heaviest drinking category (> or = 10 drinks per week) were significantly more likely to have moderate to severe PMS (P < .005) than nondrinkers. This same significant relation, but to a lesser degree, was observed based on premenstrual consumption. We conclude that because PMS is more strongly associated with alcohol consumed in the symptom-free, postmenstrual period, drinking is unlikely to be simply a response to PMS symptoms as others have previously suggested.

Alcohol Drinking↗