Covenants not to compete in Wisconsin: a general overview.
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Contract Services↗
Biomedical subjects
M Cohen
Publications and source records attributed to M Cohen.
Child survivors of the Holocaust: symptoms and coping after fifty years.
Holocaust survivors who were children during WW II have now reached the age of 52 to 67. Until about 10 years ago their voices were barely heard in society. Their successful adaptation to life may have contributed to this invisibility. However, reaching this stage of life, which is associated with the need to review life and with the crises of retirement and renewed losses, has activated the survivors to deal with their childhood. The impossibility of avoiding traumatic memories and an urge to deal with them have also contributed to the societal process of the survivors organizing and speaking out. Very little is known about this group with regard to their mental health status and the way they cope with their childhood memories. The present controlled double-blind study uses a randomized nonclinical sample and focuses on the level of psychosocial and post-traumatic symptoms, on achievement motivation, and on the way child survivors perceive the surrounding world. The results indicate a slightly higher level of psychosocial symptoms in the child survivors group (CS) than in the control group, a high level of post-traumatic symptomatology, and achievement motivation based mainly on the fear of failure. Surprisingly, the child survivors group shows a pattern of more positive views of the world than does the control group. This can be understood as a greater need to compensate for the lack of security suffered in childhood by creating a meaningful world in a chaotic reality.
Adaptation, Psychological↗
Hosts of the immature stages of the rhinoceros tick, Dermacentor rhinocerinus (Acari, Ixodidae).
The collection of the immature stages of Dermacentor rhinocerinus from host animals is described for the first time. These are the bushveld gerbil (Tatera leucogaster, from which larvae and nymphs were collected, the red veld rat (Aethomys crysophilus), from which a larva was collected, and the Natal multimammate rat (Mastomys natalensis), from which a nymph was collected. The rodents were examined in a nature reserve in which there are white rhinoceroses (Ceratotherium simum).
Animals↗
A safety double play.
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Accidents, Occupational↗
Physicians certified in family medicine. What are they doing 8 to 10 years later?
OBJECTIVE: To determine field of medicine and location of a cohort of physicians certified in family medicine between 1989 and 1991 and residing in Ontario in 1993 and to gather information on the scope of practice of family physicians in the cohort in 1999. DESIGN: Responses to a mailed questionnaire sent in 1999 were compared with responses to a 1993 survey of this group. SETTING AND PARTICIPANTS: All family physicians in Ontario in 1993 who received certification in 1989, 1990, or 1991 after completing a family medicine residency. Seven of 557 respondents to the 1993 survey were ineligible; 293 physicians (53%) responded to the 1999 survey. MAIN OUTCOME MEASURES: Field, location, and scope of practice. RESULTS: About 91% of the cohort were still practising family medicine, although 11% of these had restricted their practices to certain areas within family medicine. Physicians migrated from Ontario (6%) in nearly equal numbers to other provinces and other countries, predominantly the United States. More family physicians offered counseling, shared antenatal care, and newborn care in 1999 than in 1993. Those with restricted family practices provided fewer types of services and were less likely to provide antenatal or intrapartum care or to provide in-hospital services. CONCLUSION: Receiving certification in family medicine does not guarantee that physicians will remain in family practice 8 to 10 years later. Loss from general family medicine to restricted practices within family medicine and specialization was greater than loss from migration.
Family Practice↗
Professional activity. How is family physicians' work time changing?
OBJECTIVE: To examine hours worked professionally, work preferences, and changes in both of these and their correlates. DESIGN: Repeated surveys done in 1993 and 1999. SETTING: Ontario family practices. PARTICIPANTS: Cohort of physicians certified in family medicine between 1989 and 1991 after family medicine residency who were surveyed in 1993 when they resided in Ontario. MAIN OUTCOME MEASURES: Self-reported hours spent weekly on professional activities, desired hours of professional work, and balance between work and other activities. RESULTS: Fifty-three percent (293) of 553 physicians responded to the 1999 survey; 91% had remained family physicians; 85% of these had participated in the 1993 survey. The difference between the hours that family physicians preferred to work professionally and their actual hours of work had increased since 1993. Childless physicians, women physicians with preschool children, and women physicians married to other physicians worked fewer hours professionally than other physicians in 1999. Female physicians and physicians without children worked closer to their preferred hours than other physicians. Reporting a preference to work fewer hours professionally in 1993 was linked with a reduction in professional activities by 1999. CONCLUSION: Greater attention should be paid in physician resource planning to the family life cycle of female physicians. Lifestyle changes could lead to a reduction in professional activity among these physicians.
Analysis of Variance↗
Dressing for safety success.
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Cost-Benefit Analysis↗
Cost-effectiveness of two types of dysphagia care in head and neck cancer: a preliminary report.
We conducted a prospective, preliminary study to compare the cost-effectiveness of two different instrument-based techniques for diagnosing and managing dysphagia in 30 consecutive hospitalized patients with head and neck cancer. The two techniques are videofluoroscopy via modified barium swallow (MBS) and videoendoscopy via flexible endoscopic evaluation of swallowing with sensory testing (FEESST). Medicare was the primary insurer of all patients. Fifteen of these patients had their dysphagia diagnosed and managed by MBS and the other 15 by FEESST. Cost-effectiveness was assessed by determining the average Medicare reimbursement for each procedure. We found that the mean reimbursements were $451.01 (+/- $50.55) for MBS and $321.23 (+/- $3.01) for FEESST. The mean reimbursement for FEESST was significantly lower than that for MBS (p < 0.0001; Mann-Whitney U test). We conclude that FEESST appears to be more cost-effective than MBS for the inpatient management of dysphagia in patients with head and neck cancer.
Aged↗
Health care system reform. Ontario family physicians' reactions.
OBJECTIVE: To determine the effect on a cohort of family physicians of health care system reforms in Ontario and the relationship of reforms to their career satisfaction. DESIGN: Follow-up survey in 1999 of a cohort initially studied in 1993, posing many of the original questions along with some new ones. Four focus groups of other Ontario family physicians. SETTING: Family practices in Ontario. PARTICIPANTS: All family physicians who had received certification after completing a family medicine residency between 1989 and 1991 and were practising in Ontario in 1993. This report addresses only those members of the cohort who continued to practise family medicine in Ontario (N = 236). Four focus groups with a total of 27 family physicians. MAIN OUTCOME MEASURES: Reaction to health care system reforms. Perceived effect of reforms on practice. Current perception of quality of health care system and level of career satisfaction and changes in these variables since 1993. RESULTS: Response rate was 53% of original cohort. Only three of 13 selected health reforms were believed to have had a favourable effect. Physicians reported lower levels of satisfaction with their careers. Overall quality of the health care system was perceived by both respondents and focus group members to have declined. Several difficulties affected practice and personal life. CONCLUSION: Family physicians viewed the effect of health care reforms negatively and were significantly less satisfied with their careers than they were in 1993. Better consultation with stakeholders before implementation of reforms is needed to ensure that these stakeholders understand the likely effects of these reforms.
Adult↗
Uterine arterial embolization for the management of leiomyomas.
BACKGROUND: Leiomyoma is the common benign tumor of the female genital tract. The traditional treatment is hysterectomy, myomectomy or medical therapy by hormonal manipulation. Uterine arterial embolization, a recognized treatment for acute pelvic hemorrhage, has recently been applied to the management of non-acute uterine hemorrhage due to leiomyoma. OBJECTIVES: To describe our experience with uterine arterial embolization for the management of uterine fibroid. METHODS: Uterine arterial embolization was performed in nine patients with leiomyomas in whom medical therapy failed and who sought to avoid surgery. RESULTS: Follow-up ultrasound examination after 2 months revealed an average reduction in fibroid volume of 38%. There were no early or long-term complications. CONCLUSIONS: Uterine arterial embolization appears to be effective and safe in the management of symptomatic leiomyomas. It is a promising alternative to myomectomy or hysterectomy and warrants further investigation in this setting.
Adult↗
Pre-operative intra-aortic balloon counterpulsation in stable patients with left main coronary disease.
OBJECTIVE: To determine whether prophylactic, pre-operative, intra-aortic balloon counterpulsation (IABC) improves clinical outcome in stable patients with severe left main coronary artery disease. METHODS: A post-hoc analysis of 457 prospectively tracked, non-randomized patients undergoing coronary artery bypass graft surgery (CABG) for left main stenoses 50% and multivessel coronary disease, but without any hemodynamic compromise or ongoing angina, was conducted. Patients with heart failure, shock, ongoing ischemia or previous CABG were excluded. In 287 patients, pre-operative IABC was not used (Group 1), while IABC was initiated in 170 patients for "prophylaxis" (Group 2). RESULTS: Groups 1 and 2 were similar in age (67 +/- 10 years versus 67 +/- 11 years, respectively), sex (72% male versus 71% male, respectively), and body mass index (28 +/- 5.5 versus 27 +/- 5.1, respectively). However, more Group 1 patients had peripheral vascular disease (PVD) (25% versus 11%), but more Group 2 patients had diabetes (37% versus 29%), and a lower left ventricular ejection fraction. The unadjusted 30-day mortality was significantly higher in Group 1 [16 (5.6%) versus 2 (1.2%); p = 0.02]. Cardiopulmonary bypass time and post-operative length of stay did not differ between the two groups. After adjusting for PVD in the multivariate analysis, the p-value for the no IABP versus IABP comparison in the presence of PVD was 0.10, even though 0/18 patients with PVD and IABC died. CONCLUSION: While unadjusted mortality appears lower with prophylactic IABC, confounding variables such as PVD mandate a larger, randomized clinical trial in order to establish the role of IABC in stable patients with left main disease.
Age Factors↗
[Fistula of the fourth branchial pouch: apropos of a case treated by endoscopic cauterization].
Fistula of the fourth branchial pouch is a rare congenital cervical malformation. It typically affects child and occurs in the left side of the neck. Surgical removal of the entire fistulous tract through an external cervical approach is the treatment traditionally performed. We report a case of a right 4th branchial pouch in an adult managed through an endoscopic approach. Endoscopic cauterization of 4th branchial pouch may be considered as an attractive alternative procedure for the management of this congenital anomaly.
Adult↗
Calming the plaque to delay intervention for 24 hours in acute coronary syndromes.
One approach to management of patients with acute coronary syndromes involves use of pharmacologic therapy to passivate plaque for at least 24 hours before interventional procedures are undertaken. This approach is supported by the view that whatever subsequent treatment the patient receives will less likely be complicated. An important factor in revolutionizing treatment for acute coronary syndromes in recent years has been the introduction of potent new antithrombotic and antiplatelet pharmacologic therapies such as low-molecular-weight heparins and glycoprotein IIb/IIIa inhibitors. Incorporation of these newer agents into clinical practice, along with a better understanding of the pathophysiology underlying acute coronary syndromes, has contributed greatly to improved outcomes in these patients. Although the optimal methods for integrating the newer therapies remains to be determined, thus far, they have been shown to lower the risk of acute complications, as well as improve long-term results.
Angina, Unstable↗
The chaperone protein BiP binds to a mutant prion protein and mediates its degradation by the proteasome.
Familial prion diseases are thought to result from a change in structure of the mutant prion protein (PrP), which takes a pathogenic conformation. We have examined the role of molecular chaperones in the folding of normal and mutant PrP Q217R (PrP(217)) in transfected neuroblastoma cells. In a previous report we showed that, although most of the PrP(217) forms escape the endoplasmic reticulum quality control system and aggregate in post-Golgi compartments, a significant proportion of PrP(217) retains the C-terminal glycosylphosphatidyl inositol signal peptide (PrP32), and does not exit the endoplasmic reticulum (Singh, N., Zanusso, G., Chen, S. G., Fujioka, H., Richardson, S., Gambetti, P., and Petersen, R. B. (1997) J. Biol. Chem. 272, 28461-28470). We have now studied the folding and turnover of PrP32 to understand the mechanism by which abnormal PrP forms cause cellular toxicity in our cell culture model and in the human brain carrying the Gerstmann-Sträussler-Scheinker disease Q217R mutation. In this report, we show that PrP32 remains associated with the chaperone BiP for an abnormally prolonged period of time and is degraded by the proteasomal pathway. This study is the first demonstration that BiP is chaperoning the folding of PrP and plays a role in maintaining the quality control in the PrP maturation pathway. Our data provide new insight into the diverse pathways of mutant PrP metabolism and neurotoxicity.
Amino Acid Substitution↗
Selection by indication of potent antiretroviral therapy use in a large cohort of women infected with human immunodeficiency virus.
To characterize selection factors related to therapy initiation, the authors investigated the extent to which key markers of human immunodeficiency virus (HIV) disease severity were associated with initiation of potent antiretroviral therapy (ART). Logistic regression was used to determine the effects of CD4+ cell count and HIV RNA level on potent ART initiation during 6-month periods among 2,059 HIV-infected US women enrolled in the Women's Interagency HIV Study. Low CD4+ counts and high HIV RNA levels were significantly (p < 0.05) associated with initiation of potent ART. During all periods between April 1996 and March 1998, CD4+ counts were more strongly associated with potent ART initiation than HIV RNA levels were; however, during the last period, both were associated (odds ratio per 100 CD4+-count decrease = 1.17, p < 0.01; odds ratio per 1 log10 increase in HIV RNA level = 1.48, p < 0.05). For a CD4+ count of 500 cells/ml and an HIV RNA level of 5,000 copies/ml, the probability of potent ART initiation increased from 0.5% to 16.8% between October 1995-March 1996 and October 1997-March 1998, suggesting earlier initiation of potent ART. Given the documented occurrence of confounding by indication, prospectively collected, time-dependent data on markers of disease progression and therapy use should be considered when making population-level comparisons before and after introduction of potent ART.
Adult↗
Sex differences in management and outcome after acute myocardial infarction in the 1990s: A prospective observational community-based study. Israeli Thrombolytic Survey Group.
BACKGROUND: Previous studies have suggested that women with acute myocardial infarction (AMI) are less aggressively managed than are men. The aim of this study was to assess sex differences in medical and invasive coronary procedures (angiography, PTCA, and CABG) in AMI patients admitted to cardiac care units (CCUs) in Israel in the mid 1990s and their association with early and 1-year prognosis. METHODS AND RESULTS: We studied 2867 consecutive AMI patients (2125 men, 74%) hospitalized in all 25 CCUs in Israel from 3 prospective nationwide surveys conducted in 1992, 1994, and 1996. Women were, on average, older than men (69 versus 61 years, P:<0.0001) and had a higher prevalence of hypertension, diabetes, Killip class >/=II on admission, and in-hospital complications. Women received aspirin and beta-blockers less often than did men, but these differences were not significant after age adjustment. The unadjusted rates of thrombolysis, angiography, and PTCA/CABG use were lower in women than in men but not after covariate adjustment: 42% versus 48% (adjusted odds ratio [OR] 0.92, 95% CI 0.77 to 1.11), 23% versus 31% (OR 0.88, 95% CI 0.70 to 1.09), and 15% versus 19% (OR 0.93, 95% CI 0.72 to 1.19), respectively. The 30-day mortality was higher in women than in men (17.6% versus 9.6%, respectively; OR 1.39, 95% CI 1.06 to 1.82), but the 30-day to 1-year mortality rate was not (9.1% versus 5.6%, respectively; hazard ratio 1.18, 95% CI 0.84 to 1.66). CONCLUSIONS: This prospective nationwide observational community-based study of consecutive AMI patients hospitalized in the CCUs in the mid 1990s indicates that women fare significantly worse than do men at 30 days but not thereafter at 1-year. The difference in 30-day outcome was not influenced by the use of different therapeutic modalities, including thrombolysis and invasive coronary procedures, but was rather due to the older age and greater comorbidity of women; these findings seem also to explain the less frequent use of invasive procedures in women.
Age Distribution↗
Earlobes are less convenient than fingerpricks for blood glucose testing.
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Blood Glucose Self-Monitoring↗
Low molecular weight heparin decreases rebound ischemia in unstable angina or non-Q-wave myocardial infarction: the Canadian ESSENCE ST segment monitoring substudy.
OBJECTIVES: The goal of this study was to determine whether enoxaparin was more effective than heparin in reducing recurrent ischemic episodes. BACKGROUND: Continuous ST segment monitoring is a simple tool for assessment of ischemia and identifies patients with a worse prognosis. Little is known about the impact of low molecular weight heparin on ST segment shift. METHODS: Patients were randomized to receive enoxaparin or heparin (mean 3.4 days). Three-lead ST segment monitoring was performed for the first 48 h (n = 220) and an additional 48 h (n = 174) after intravenous study drug discontinuation (mean 1.9 days later). RESULTS: During initial monitoring, ischemia rates were similar among the heparin and enoxaparin groups (27.2% vs. 22.6%, p = 0.44); however, the time to first ischemic episode was earlier among heparin-treated patients (11 +/- 11 vs. 25 +/- 18 min, p = 0.001). After drug discontinuation, ischemic episodes occurred more frequently (44.6% vs. 25.6%, p = 0.009), and the total ischemic duration was greater among heparin patients (18 +/- 39 vs. 5 +/- 12 min/24 h, p = 0.005). Recurrent ischemia occurred more frequently after discontinuation in the heparin (46% vs. 31%, p = 0.043), but not the enoxaparin, group (18.4% vs. 25%, p = 0.33). Regardless of treatment, patients with ischemia were more likely to die or experience (re)infarction at one year (18.4% vs. 8.3%, p = 0.023). CONCLUSIONS: ST segment shift occurs frequently in unstable angina/non-Q-wave myocardial infarction despite antithrombotic therapy and is associated with worse one-year prognosis. Enoxaparin is a more effective antithrombotic treatment than unfractionated heparin and leads to greater prevention of rebound ischemia.
Aged↗