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Biomedical subjects

M C Mahoney

Publications and source records attributed to M C Mahoney.

At least 19 recordsLinked to original sources
PubMed2005

Childhood leukaemia in Belarus, Russia, and Ukraine following the Chernobyl power station accident: results from an international collaborative population-based case-control study.

BACKGROUND: There is little evidence regarding the risk of leukaemia in children following exposure to radionuclides from the Chernobyl Nuclear Power Plant explosion on April 26, 1986. METHODS: This population-based case-control study investigated whether acute leukaemia is increased among children who were in utero or <6 years of age at the time of the Chernobyl accident. Confirmed cases of leukaemia diagnosed from April 26, 1986 through December 31, 2000 in contaminated regions of Belarus, Russia, and Ukraine were included. Two controls were matched to each case on sex, birth year, and residence. Accumulated absorbed radiation dose to the bone marrow was estimated for each subject. RESULTS: Median estimated radiation doses of participants were <10 mGy. A significant increase in leukaemia risk with increasing radiation dose to the bone marrow was found. This association was most evident in Ukraine, apparent (but not statistically significant) in Belarus, and not found in Russia. CONCLUSION: Taken at face value, these findings suggest that prolonged exposure to very low radiation doses may increase leukaemia risk as much as or even more than acute exposure. However the large and statistically significant dose-response might be accounted for, at least in part, by an overestimate of risk in Ukraine. Therefore, we conclude this study provides no convincing evidence of an increased risk of childhood leukaemia as a result of exposure to Chernobyl radiation, since it is unclear whether the results are due to a true radiation-related excess, a sampling-derived bias in Ukraine, or some combination thereof. However, the lack of significant dose-responses in Belarus and Russia also cannot convincingly rule out the possibility of an increase in leukaemia risk at low dose levels.

Age Distribution↗
PubMed2002

Manipulation of colonic bacteria and volatile fatty acid production by dietary high amylose maize (amylomaize) starch granules.

AIMS: To study the effects of amylomaize starch and modified (carboxymethylated and acetylated) amylomaize starches on the composition of colonic bacteria and the production of volatile fatty acids, in mice. METHODS AND RESULTS: Balb/c mice were fed with experimental diets containing various amount of amylomaize and modified amylomaize starches. Colonic bacterial populations and short-chain fatty acids were monitored. Results showed that the increases in indigenous bifidobacteria were detected in mice fed all starches tested; however, the highest numbers were observed in the group fed with 40% unmodified amylomaize starch. The starch type influenced the populations of indigenous Lactobacillus, Bacteroides and coliforms. High Lactobacillus numbers were achieved in the colon of mice fed with high concentration of amylomaize starch. Acetylated amylomaize starch significantly reduced the population of coliforms. In addition, orally dosed amylomaize utilizing bifidobacteria reached their highest levels when fed together with amylomaize or carboxymethylated amylomaize starch and in both cases butyrate levels were markedly increased. CONCLUSIONS: These results indicate that different amylomaize starches could generate desirable variation in gut microflora and that particular starches may be used to selectively modify gut function. SIGNIFICANCE AND IMPACT OF STUDY: Amylomaize starch appeared to enhance the desirable composition of colonic bacteria in mice, and suggested it possessed the potential prebiotic properties. Therefore, resistant starch and its chemical derivatives may exert beneficial impacts to the human colon.

Amylose↗
PubMed2001

Introducing evidence based medicine to the journal club, using a structured pre and post test: a cohort study.

BACKGROUND: Journal Club at a University-based residency program was restructured to introduce, reinforce and evaluate residents understanding of the concepts of Evidence Based Medicine. METHODS: Over the course of a year structured pre and post-tests were developed for use during each Journal Club. Questions were derived from the articles being reviewed. Performance with the key concepts of Evidence Based Medicine was assessed. Study subjects were 35 PGY2 and PGY3 residents in a University based Family Practice Program. RESULTS: Performance on the pre-test demonstrated a significant improvement from a median of 54.5 % to 78.9 % over the course of the year (F 89.17, p <.001). The post-test results also exhibited a significant increase from 63.6 % to 81.6% (F 85.84, p <.001). CONCLUSIONS: Following organizational revision, the introduction of a pre-test/post-test instrument supported achievement of the learning objectives with a better understanding and utilization of the concepts of Evidence Based Medicine.

Cohort Studies↗
PubMed2000

Parental occupational exposures and risk of neuroblastoma: a case-control study (United States).

BACKGROUND: A case-control study was conducted with 183 histologically confirmed neuroblastoma cases aged 0-14 years diagnosed among residents of New York State, excluding New York City, between 1976 and 1987. Three hundred seventy-two controls were selected from the New York State live birth certificate registry and were matched to cases on year of birth. METHODS: Parental occupational exposures at the time of each child's birth were obtained from maternal telephone interviews, successfully completed for 85% of cases and 87% of controls. RESULTS: Odds ratios were significantly elevated for maternal occupation in the service (OR = 2.0, 95% CI = 1.0 4.1) and retail (OR = 2.0, 95% CI = 1.1-3.7) industries and paternal occupation in materials handling (OR = 3.8, 95% CI = 1.1-14.6). Odds ratios were also significantly elevated for maternal report of occupational exposure to acetone (OR = 3.1, 95% CI = 1.7-5.6), insecticides (OR = 2.3, 95% CI = 1.4-3.7), lead (OR = 4.7, 95% CI = 1.3-18.2) and petroleum (OR = 3.0, 95% CI = 1.5-6.1) and paternal exposure to creosote (OR = 2.1, 95% CI = 1.1-4.3), dioxin (OR = 6.9, 95% CI = 1.3-68.4), lead (OR = 2.4, 95% CI = 1.2-4.8), and petroleum (OR = 1.8, 95% CI = 1.1-2.8). CONCLUSIONS: Due to the uncertainty of the biologic plausibility of these associations and the possibility of alternative explanations, these results should be interpreted cautiously.

Acetone↗
PubMed2000

Clinical predictors of dysphagia and aspiration risk: outcome measures in acute stroke patients.

OBJECTIVE: To use an established dysphagia clinical screening system to evaluate outcomes in acute stroke patients. DESIGN: Case-control study. SETTING: Tertiary care center. PARTICIPANTS: Acute stroke patients (n = 56) consecutively referred to a speech pathology service. MAIN OUTCOME MEASURES: Outcomes (ie, pneumonia, dietary status at discharge) in patients who were referred for a videofluoroscopic swallow study (VSS) based on results of a previously validated clinical screening system were compared with outcomes in patients who were not referred for VSS based on the clinical evaluation. RESULTS: Thirty-eight of 56 patients (68%) presented with 2 or more clinical predictors of moderate to severe dysphagia and were further evaluated with VSS, whereas 18 patients (32%) had fewer than 2 clinical features and were not evaluated radiographically. Based on patient outcomes and VSS results, identification of at least 2 clinical predictors significantly distinguished patients with moderate to severe dysphagia from patients with mild dysphagia or normal swallowing. None of the patients in either group developed pneumonia while following recommendations of the clinical or dynamic swallowing evaluation, and 93% of the patients returned to a regular diet. CONCLUSIONS: These data demonstrate that clinical use of this screening system can objectively identify acute stroke patients who warrant further diagnostic studies and can safely determine which patients need no further deglutitive evaluation.

Case-Control Studies↗
PubMed2000

Predictors of anticipated breastfeeding in an urban, low-income setting.

BACKGROUND: Although the proportion of women who breastfeed is known to vary by demographic group, breastfeeding practices have not been sufficiently studied among urban, lower income African American populations seen in family medicine centers. METHODS: A cross-sectional design was used to examine demographic, clinical, and attitudinal factors that affect anticipated infant feeding practices reported by postpartum women from a low-income, urban family practice setting. Data was analyzed using chi-square, odds ratios (OR), and multiple logistic regression techniques. RESULTS: Among 66 respondents, only 3 subjects (4.5%) indicated that they planned to breastfeed exclusively, while an additional 11 subjects (16.7%) reported plans to use a combination of bottle-feeding and breastfeeding. Based on univariate analyses, women with less than 12 years of education were less likely to report anticipated breastfeeding. Otherwise, breastfeeding plans were not associated with subject demographic features or with reproductive characteristics. Respondents planning to bottle-feed noted that breastfeeding was too complicated. Logistic regression demonstrated an inverse relationship between level of maternal education and anticipated breastfeeding (OR=0.13, 95% confidence interval [CI], 0.05-0.35), and a direct association for encouragement from the baby's father or the woman's mother to breastfeed and anticipated breastfeeding (OR=12.4; 95% CI, 4.92-31.4). CONCLUSIONS: This study reports unique data regarding anticipated infant feeding practices among patients from an urban, low-income community served by a family medicine center. Findings from this study will be used to develop a family-centered educational intervention involving the mothers, grandmothers, and partners of pregnant patients to promote the benefits of breastfeeding in this community.

Adolescent↗
PubMed2000

Hypothyroidism and diabetes mellitus in an American Indian population.

BACKGROUND: The clinical relationship between diabetes and hypothyroidism is becoming more widely recognized. Although American Indians are disproportionately afflicted with diabetes, the occurrence of hypothyroidism within this group has not been previously reported. METHODS: We present data from a retrospective chart review of health clinic data from a rural isolated northeastern tribe. A total of 156 cases of diabetes and 25 cases of hypothyroidism were identified among 892 eligible individuals living in the service area. RESULTS: Both conditions exhibited strong sex differences. The prevalences of diabetes (21%) and hypothyroidism (5%) among women were higher than those observed among men (13% and 0.2%, respectively). The overall prevalence of hypothyroidism among women with diabetes (8.8%) varied by age ranging from 5% among women younger than 60 years to 21% among women aged 60 years and older. CONCLUSIONS: Our findings support the need for further investigation of the association between diabetes and hypothyroidism in American Indian populations with high prevalence rates of diabetes. This association may be of particular interest to family physicians and other clinicians caring for American Indian populations.

Diabetes Complications↗
PubMed2000

Evaluation of a youth tobacco education program: student, teacher, and presenter perspectives.

Few published studies have explored the impact of smoking prevention programs among elementary-school children. This study describes a qualitative, cross-sectional evaluation of the Tar Wars tobacco prevention program among 5th-grade students (n = 888), along with impressions from classroom teachers and program presenters. Results from this evaluation reveal that all constituencies involved with the Tar Wars program--5th-grade students, classroom teachers, and program presenters--indicated high satisfaction with this youth tobacco education program. Students enjoyed the program and indicated understanding of key themes, classroom teachers stated that the program was worthwhile in presenting unique information, and presenters were enthusiastic about the ease of presentation and opportunities for future presentations.

Child↗
PubMed1999

The health status of American Indians and Alaska Natives: 2. Lessons for cancer educators.

Malignant disease is largely unrecognized as a leading cause of death among American Indians and Alaska Natives (AI/ANs). Published studies of cancer incidence, cancer mortality, and cancer survival are highlighted to present an overview on the epidemiology of cancer among Native peoples. Cancer incidence and mortality have demonstrated steady increases among AI/ANs during a relatively limited time frame, as well as unique patterns of site-specific cancers. Cancer-survival data reveal that Native peoples have the poorest survival of any racial group for all cancer sites combined and for eight of the ten leading sites. Opportunities to educate health care providers, through continuing medical education programs and focused conferences for postdoctoral and current medical trainees, can be used to enhance cultural sensitivity and to examine ethnic differences in cancer patterns. Enhancement of recognition of the unique cancer patterns among AI/AN populations may lead to improved identification of at-risk individuals and more effective cancer screening programs within Native communities.

Cause of Death↗
PubMed1999

A clozapine overdose with markedly elevated serum levels.

Clozapine (Clozaril) is an atypical antipsychotic agent used to treat schizophrenia refractory to other pharmacological agents. This report describes an accidental clozapine overdose. The half-life of clozapine in this patient was determined from two blood levels, one obtained on admission and the second 10.5 hours later. The calculated half-life of 8.11 hours is consistent with published levels for single doses and suggests an apparent stability in clozapine elimination half-life in the face of overdose. The maximum clozapine blood level attained was probably among the highest nonfatal levels reported. The patient recovered fully following hospital admission for monitoring and supportive care. This case report illustrates the usefulness of following the time course of the changes in blood level at selected time intervals, as well as the importance of entertaining a diagnosis of drug overdose in patients presenting with acute mental status changes.

Adult↗
PubMed1999

An investigation of hypomagnesemia among ambulatory urban African Americans.

BACKGROUND: Magnesium represents the fourth most abundant cation in the body and plays an integral role in intracellular metabolism. Although magnesium deficiency states have been associated with a variety of medical conditions, the prevalence of hypomagnesemia has not been well studied, particularly in ambulatory settings. METHODS: We performed a period prevalence study using 120 patients seen for routine medical care at an urban family medicine center. Chart reviews were completed for these subjects. We used univariate and multivariate analyses to correlate magnesium levels with demographic and clinical factors. RESULTS: There was a 20% overall prevalence of hypomagnesemia among this predominantly female, African American population. The prevalence of hypomagnesemia was greatest among patients with a history of alcoholism (odds ratio [OR] = 6.00; 95% confidence interval [CI], 1.41-26.1) and among those having 1 or more of the following medical conditions: diabetes, hyperlipidemia, hypertension, renal disease, and asthma (OR = 4.69; 95% CI, 1.37-17.65). CONCLUSIONS: The prevalence of hypomagnesemia among patients from this urban minority community exceeds that reported in previous studies of the general population. This may be reflective of greater comorbidity, diminished nutritional status, or poorer overall health among patients from this community. The association between hyperlipidemia and magnesium deficiency warrants further investigation.

Adult↗
PubMed1998

Health status of American Indians/Alaska Natives: general patterns of mortality.

BACKGROUND AND OBJECTIVES: Investigations of American Indian and Alaska Native (AI/AN) populations suggest patterns of mortality that differ from the general population. Mortality data reveal excess overall mortality among AI/ANs, as well as excesses for specific causes of death, including accidents, diabetes, liver disease, pneumonia/influenza, suicide, homicide, and tuberculosis. A relative deficit of deaths has been noted for heart disease, cancer, and HIV infections. It is important that physicians demonstrate cultural competence so they may provide quality medical care for the populations they serve. Activities such as provider education, risk assessment, and emphasis on preventive services are offered to facilitate integration into teaching curricula. Knowledge of distinctive mortality patterns among AI/ANs will help clinicians recognize the unique needs of these patients.

Accidents↗