Biomedical subjects

M Goldberg

Publications and source records attributed to M Goldberg.

At least 91 records · Page 5Linked to original sources

PubMed2000

Computer modeling of population exposure to a carcinogen: the example of asbestos and mesothelioma mortality in France.

The multistage theory of carcinogenesis allows models to be constructed that provide the individual probability of a diagnosed tumor at a given age as a function of the person's past exposure to carcinogenic agents (exposure level versus age), the time since exposure, and age. When exposure to a carcinogenic agent and its impact in terms of morbidity and mortality are modeled on the scale of the general population, individual exposures must often be estimated. If appropriate data do not already exist, this difficult task necessitates expensive and difficult investigations. We propose here a method that allows this global exposure to be modeled without needing to know the individual exposures. The method is used and illustrated in the context of modeling the asbestos exposure of the French male population and calculating its mortality rate from mesothelioma (a type of cancer for which asbestos is the only carcinogen and for which a risk function based on the multistage theory of carcinogenesis exists). This method assumes that the exposure functions (how exposure levels vary with age) for all individuals are the same, with the exception of one parameter. That is, it utilizes a hypothesis that we called the hypothesis of the Standard Exposure Window (SEW). We used two methods to calculate the probability of death from mesothelioma in a representative sample of the French male population for whom individual histories of asbestos exposure are known: we applied the risk function to all the individuals, and we applied the SEW hypothesis. The number of deaths obtained by the two methods are very close and fit the observed mortality data satisfactorily.

Aged↗

PubMed2000

Review: nuclear lamins--structural proteins with fundamental functions.

The nuclear lamina is located between the inner nuclear membrane and the peripheral chromatin. It is composed of both peripheral and integral membrane proteins, including lamins and lamina-associated proteins. Lamins can interact with one another, with lamina-associated proteins, with nuclear scaffold proteins, and with chromatin. Likewise, most of the lamina-associated proteins are likely to interact directly with chromatin. The nuclear lamina is required for proper cell cycle regulation, chromatin organization, DNA replication, cell differentiation, and apoptosis. Mutations in proteins of the nuclear lamina can disrupt these activities and cause genetic diseases. The structure and assembly of the nuclear lamina proteins and their roles in chromatin organization and cell cycle regulation were recently reviewed. In this review, we discuss the roles of the nuclear lamina in DNA replication and apoptosis and analyze how mutations in nuclear lamina proteins might cause genetic diseases.

Animals↗

PubMed2000

Enamel biomineralization defects result from alterations to amelogenin self-assembly.

Enamel formation is a powerful model for the study of biomineralization. A key feature common to all biomineralizing systems is their dependency upon the biosynthesis of an extracellular organic matrix that is competent to direct the formation of the subsequent mineral phase. The major organic component of forming mouse enamel is the 180-amino-acid amelogenin protein (M180), whose ability to undergo self-assembly is believed to contribute to biomineralization of vertebrate enamel. Two recently defined domains (A and B) within amelogenin appear essential for this self-assembly. The significance of these two domains has been demonstrated previously by the yeast two-hybrid system, atomic force microscopy, and dynamic light scattering. Transgenic animals were used to test the hypothesis that the self-assembly domains identified with in vitro model systems also operate in vivo. Transgenic animals bearing either a domain-A-deleted or domain-B-deleted amelogenin transgene expressed the altered amelogenin exclusively in ameloblasts. This altered amelogenin participates in the formation an organic enamel extracellular matrix and, in turn, this matrix is defective in its ability to direct enamel mineralization. At the nanoscale level, the forming matrix adjacent to the secretory face of the ameloblast shows alteration in the size of the amelogenin nanospheres for either transgenic animal line. At the mesoscale level of enamel structural hierarchy, 6-week-old enamel exhibits defects in enamel rod organization due to perturbed organization of the precursor organic matrix. These studies reflect the critical dependency of amelogenin self-assembly in forming a competent enamel organic matrix and that alterations to the matrix are reflected as defects in the structural organization of enamel.

Amelogenesis↗

PubMed2000

Bone sialoprotein-induced reparative dentinogenesis in the pulp of rat's molar.

Bone sialoprotein (BSP), an osteogenic protein (OP), mixed with a carrier, was implanted in the pulp of rat first upper molars (OP group). Cavities were prepared with dental burs and pulp perforation was carried out by pressure with the tip of a steel probe. After 8, 14, and 30 days, the rats were killed and the pulps of the OP group were compared with (1) a sham group (S group), (2) a group where the carrier was implanted alone (C group), and (3) capping with calcium hydroxide (Ca group). After 8 days, a few inflammatory cells were seen, mostly located at the pulp surface near the perforation. In the Ca group, a dentin bridge started to form, in contrast to the other groups. After 15 days, globular structures were seen in the pulps of the S and C groups. A reparative osteodentin bridge isolated the pulp from the cavity in the Ca group. Variable reactions were seen in the OP group, with some evidence of cell and matrix alignments or plugs of osteodentin in continuity with an inner layer of reparative dentin. After 30 days, irregular osteodentin formation was observed in the pulps of the S and C groups, with a tendency for globular structures to merge, but with interglobular spaces filled by pulp remnants. In the Ca group, osteodentin was observed in the mesial part of the pulp chamber. In the BSP-implanted group, the osteogenic protein stimulated the formation of a homogeneous dentin-like deposit occupying most of the mesial part of the pulp. Apparently, BSP stimulates the differentiation of cells which secrete an organized extracellular matrix more efficiently than any other capping material used so far. Altogether, the results reported here support that bone sialoprotein displays novel bioactive properties and is capable of stimulating in 1 month's time the development of a thick reparative dentinal tissue in the pulp, occluding the perforation and filling the mesial third of the pulp chamber.

Animals↗

PubMed2000

Phase II trial of induction high-dose chemotherapy followed by surgical resection and radiation therapy for patients with marginally resectable non-small cell carcinoma of the lung.

The combination of carboplatin and paclitaxel is an active regimen in non-small cell lung cancer (NSCLC). Historically, patients with stage III disease have manifested higher response rates than patients with metastatic disease, and patients achieving a pathologic complete response to induction chemoradiation therapy prior to surgery have shown better long-term outcome. Based upon our pilot data using high-dose carboplatin and paclitaxel, we designed a phase II trial in patients with marginally resectable stage IIIA NSCLC. Ten patients, with bulky nodal stage IIIA disease, initially received etoposide (2 g/m2) and granulocyte colony-stimulating factor (G-CSF) to mobilize peripheral blood stem cells (PBSC). Two cycles, 28 days apart, of carboplatin (AUC 12 in seven patients; AUC 16 in three patients) and paclitaxel (250 mg/m2) were administered with filgrastim (5 microg/kg) and PBSC support. After re-evaluation, patients underwent a thoracotomy followed by radiotherapy (44-60 Gy) if deemed resectable, or radiotherapy alone (60 Gy) if not resectable. The median age was 58.5 years (48-66) with a median ECOG performance status of 0 (0-1). Histology was adenocarcinoma in seven patients; the remainder had either squamous cell, large cell or bronchoalveolar carcinoma. Based on CT radiography, the overall response rate was 40%. Eight of ten patients underwent resection with four right pneumonectomies, three right upper lobectomies and one wedge resection of the right upper lobe. Six patients had a complete resection. Of eight patients resected, four were downstaged by induction therapy, three remained unchanged and one was found to have more extensive disease. The remaining two patients developed metastatic disease while receiving chemotherapy. The median dose of postoperative radiotherapy was 54 Gy (35-66 Gy). Actual median follow-up for all patients was 89 weeks (25 to 136+). The actuarial median overall survival was 124 weeks (25 to 136+) and time to progression was 57 weeks (17 to 136+). The median dose of carboplatin delivered expressed as mg/m2 was 779 (615-1540). Neutropenic fever occurred in two patients during the initial mobilization cycle only. The median number of units of RBC and/or platelets transfused was 0 (0-2 and 0-6, respectively). There were no significant non-hematologic toxicities. High-dose induction chemotherapy with stem cell rescue is feasible and safe with an acceptable response rate. Thoracotomy, including pneumonectomy and postoperative radiotherapy, were well tolerated by patients after undergoing high-dose induction chemotherapy with no apparent increase in peri-operative morbidity. The pathologic complete response rate was low--one out of ten patients. These results indicate that dose escalation of induction chemotherapy does not improve response rates even in this highly selected patient population. Accordingly, the complexity and potential toxicity of high-dose chemotherapy, as delivered in this trial as neoadjuvant treatment of non-small cell lung cancer, is not warranted.

Adenocarcinoma↗

PubMed2000

In vivo study of the pulp reaction to Fuji IX, a glass ionomer cement.

OBJECTIVE: Our aims were to investigate the pulp biocompatibility of Fuji IX, a glass ionomer cement (GIC) used as a restorative material in cavities prepared in rat's upper molars, and to assess the value of this in vivo model for testing dental biomaterials. METHOD: Half-moon class V-like cavities were drilled on the mesial aspect of 26 rat upper first molars. Half of the experimental rats whose molars were restored with the GIC were killed after 8days and the second half after 30days. They were compared with two control groups, also submitted to cavity preparation, but with cavities left unfilled. Again, half of the control rats were killed at 8 days and the second half after 30days. Following intracardiac perfusion with the fixative solution, the specimens were processed to histologic procedures. RESULTS: After 8 days, in both groups a few inflammatory cells were observed. The odontoblastic layer was disrupted and dilated blood vessels were seen in the pulp area related to the cut tubules. The experimental group displayed a moderate inflammatory reaction whereas only a slight reaction was detected in the control group. In few teeth, bacteria were visualized in dentine tubules beneath the GIC restoration. Such colonies were not observed in unfilled molars.After 30days, in both groups, the pulp tissue recovered and displayed a normal appearance. Disruptions of the odontoblast layer were not visible anymore. Bacteria penetration into dentine tubules was reduced compared with the 8-day situation. A thick layer of reparative osteodentine was formed. However no difference in thickness was detected between the experimental and control groups, supporting that the formation of reparative dentine is not impaired. Irregular mineralizations including calcospherites were induced by the GIC. CONCLUSIONS: This study demonstrates that, despite small alterations in the mineralization processes, the GIC Fuji IX has a good biocompatibility and does not induce any harmful effect on pulp cells.

Animals↗

PubMed2000

A review of radiation proctitis in the treatment of prostate cancer.

Pelvic radiation is a common therapy for the treatment of prostate cancer. A complication of this therapy, radiation proctitis, may be limited to the direct posttreatment period or it may appear as serious complications that occur months to years after therapy has been completed. Mucosal damage, present with both acute and chronic radiation proctitis, produces a variety of symptoms including mucoid diarrhea, pain upon defecation, serious rectal bleeding, stenosis, and fistula formation. The treatment of radiation proctitis is symptom related, and the goals of therapy include the prevention or correction of mucosal changes and eradication of rectal bleeding. This article will review the pathophysiology of radiation proctitis and its treatment.

Humans↗

PubMed2000

Three-year surveillance study of nosocomial bacterial resistance in Argentina. The Antimicrobial Committee; and the National Surveillance Program (SIR) Participants Group.

INTRODUCTION: A national surveillance program (SIR) was introduced in 1996 in Argentina by the Antimicrobial Committee of the Argentinean Society for Microbiology to assess bacterial resistance. The present study reports the rates of nosocomial bacterial resistance found by this program. METHODS: A 2-month point-prevalence study was conducted twice yearly (i.e., April-May and October-November) from 1996 to 1998, by 27 Argentinean centers. Susceptibility testing was carried out by the disk diffusion method following the National Committee for Clinical Laboratory Standards guidelines. RESULTS: In all, 6343 isolates recovered from 5603 inpatients (> or =48-hr hospitalization) were included. Methicillin resistance was 58% and 56% in Staphylococcus aureus and coagulase-negative staphylococci (CNS), respectively. Although no vancomycin resistance was found in staphylococci, 2% and 8% of the S. aureus and CNS strains, respectively, proved resistant to teicoplanin. No ampicillin resistance was displayed by Enterococcus faecalis. High-level gentamicin and streptomycin resistance in enterococci were 33% and 37%, respectively. Acquired glycopeptide resistance in enterococci emerged in 1997 (2%). Imipenem resistance in Acinetobacter spp and Pseudomonas aeruginosa was 9% and 21%, respectively. Among Enterobacteriaceae, 1% and 5% of the Klebsiella pneumoniae and Enterobacter cloacae isolates, respectively, proved resistant to imipenem. Ceftazidime and cefepime resistance was found in 63% and 33% of the E. cloacae strains. Resistance to extended-spectrum cephalosporins was shown by 48%, 26%, and 8% of the K. pneumoniae, Proteus mirabilis, and Escherichia coli isolates, respectively. CONCLUSIONS: The alarming rates of resistance found in this study provide compelling evidence of the need for more rational use of antimicrobial agents in Argentina.

Anti-Bacterial Agents↗

PubMed2000

Validity of self-reported weight and height in the French GAZEL cohort.

OBJECTIVE: To examine the validity of self-reported weight and height and the resulting body mass index (BMI), and to explore the associations between demographic, socioeconomic, and health-related factors on the one hand and bias in self-reported weight and height on the other, in order to determine the groups most likely to exhibit bias. DESIGN: Prospective cohort study. SUBJECTS: 7350 middle-aged subjects, 5445 men and 1905 women, from the GAZEL cohort, who have been followed up since 1989 and work at the French national company Electricité De France-Gaz De France (EDF-GDF) in various occupations. MEASUREMENTS: Self-reported weight and height were based on information from yearly mailed questionnaires, and measured weight and height, used here as true values, were provided by occupational physicians from 1994 to 1997. Sex, age, marital status, education, occupation, history of ischemic heart disease, and treatment for cardiovascular risk factors were obtained from the mailed questionnaires or from data provided by the Company's personnel and medical departments. RESULTS: Strong correlations were found between measured and self-reported values, but self-reported weight and height displayed significant systematic errors. Weight was significantly underestimated for men (0.54 kg) and for women (0.85 kg), and height overestimated for men (0.38 cm) and women (0.40 cm). These biases led to significant underestimations of BMI (0.29 and 0.44 kg/m2 for men and women respectively). Consequently, the prevalence of overweight, defined as BMI > 26.9 kg/m2 for women and BMI > 27.2 kg/m2 for men, was also underestimated, by 13% for men and 17% for women. The five factors associated with bias in self-reported weight and height were: overweight status, end-digit preference, age, educational level and occupation. CONCLUSION: These findings suggest that self-reported weight and height should be treated with caution, because of biases leading to misclassification for overweight and obesity, especially in certain segments of the population.

Adult↗

PubMed2000

Schistosoma mansoni gene GP22 encodes the tegumental antigen sm25: (1) antibodies to a predicted B-cell epitope of Sm25 cross-react with other candidate vaccine worm antigens; (2) characterization of a recombinant product containing tandem-repeats of this peptide as a vaccine.

Monospecific antibodies against two putative epitopes of schistosome protein encoded by gene GP22 (182 codons, no introns) were used to probe worm extracts fractionated by lentil-lectin affinity chromatography or by electrophoresis. Anti-peptide-alpha (codons 70-84) exclusively identifies the N-glycanase-sensitive, 25 kDa tegumental glycoprotein Sm25 in the lectin-bound fraction of detergent-solubilized adult worm extract S3. In contrast, antipeptide-delta (codons 151-162) does not react with Sm25 but cross-reacts with other schistosome proteins, including candidate vaccine antigens paramyosin (Sm97) and glutathione-S-transferases (Sm26, Sm28, Sj26). Recombinant protein r4 x 47, constructed to express multiple copies of codon sequence 117-163 (containing delta), reacts with anti-delta and is uniquely recognized by protective Fischer twice-infected (F-2x) rat antiserum. Immunization with r4 x 47 induces antibodies with cross reactivities similar to anti-delta, but which also recognize Sm25. Despite these cross-reactivities with protective antigens, rodents vaccinated with r4 x 47 were not protected against cercarial infection. On the basis of these data, two hypotheses are proposed: (1) antigenic epitopes other than delta are present within the r4 x 47 sequence which induce antibodies reactive with Sm25 and/or (2) peptide-delta assumes alternative antigenic conformations, dependent upon the context of neighbouring sequences, some of which mimic epitopes of proteins encoded by other schistosome genes. These mimotopes are not targets of protective antibodies.

Amino Acid Sequence↗

PubMed2000

Variations in neutrophil count in preterm infants with respiratory distress syndrome who subsequently developed chronic lung disease.

Neutrophil counts were studied in 62 preterm infants receiving mechanical ventilation for neonatal respiratory distress syndrome (NRDS). Exploratory analysis indicated that the severity of NRDS, as demonstrated by fractional inspired oxygen (FiO2), mean airway pressure (MAP), arterial-alveolar PO2 ratio (a/APO2) and oxygenation index (OI), was correlated with percentage change of neutrophil counts during the first 5 days of life. Further analysis demonstrated that infants with NRDS who subsequently developed chronic lung disease (CLD) (n = 21) had statistically significant differences in variation of neutrophil counts when compared with the remainder (n = 41) without CLD (-35.0% +/- 4.3 vs. -16.9% +/- 5.8, p < 0.02). It is concluded that significant variations in neutrophil counts during the first 5 days of life may be found in infants with NRDS who subsequently develop CLD and that these changes may have predictive value regarding the development of CLD.

Chronic Disease↗

PubMed2000

Intrauterine growth retardation and brainstem auditory-evoked response in preterm infants.

Intrauterine growth retardation is frequently associated with intrauterine undernutrition, and can deleteriously affect brain function. Twenty-eight premature small for gestational age infants were compared with 28 premature appropriate for gestational age infants to determine whether intrauterine growth retardation was associated with abnormalities in the auditory pathway in the early neonatal period. The auditory pathway was studied between 4-18 wk of life by analysis of brainstem auditory-evoked potentials elicited by a 10/s 75 decibel above normal adult hearing level (dB nHL) click stimulus presented at the infants' ears. Peak latencies of components I, III and V, and interpeak latencies I-III, III-V and I-V, yielded no statistically significant differences between groups. The present study indicates that intrauterine growth-retarded premature infants may not have abnormalities of brainstem auditory-evoked response in the early neonatal period.

Age Factors↗

PubMed2000

An assessment of lead controls for torch cutting and rivet removal on steel structures.

The use of engineering and work practice controls to protect workers from lead-containing dusts and fumes generated during rehabilitation of steel structures is mandated by the Occupational Safety and Health Administration (OSHA) Lead in Construction Standard (1993). Because the implementation and assessment of controls can be problematic in the rugged and dynamic construction environment, industrial hygienists should understand the effectiveness and limitations of controls adopted. The present investigation assesses the efficacy of two controls to reduce lead exposure: paint removal prior to oxy-acetylene torch cutting of steel, and encapsulation of rivets prior to their removal. A task-based exposure assessment approach was used to evaluate these tasks at three sites. Exposures at one site without controls were compared to exposures at sites with controls. Comparison of the results via an analysis of variance (0.05 significance level) indicates that, for torch cutting, exposures at the control site were not significantly different from those at an uncontrolled site (p = 0.14). The results for rivet busting show no significant differences in exposures at the control site compared to the uncontrolled site (p = 0.08). Results are also presented from two control sites where work was done in enclosed spaces. Two main difficulties in applying the controls are explored: technical and managerial. Technical problems during torch cutting included the penetration of paint into the steel profile and the configuration of the structures. For rivet busting, working within an enclosure was an important factor. Management problems arose both from a lack of coordination among different contractors, and from a failure to provide day-to-day guidance and assessment of the control. Important components of a program to implement controls are preplanning and coordination of control implementation, frequent testing of control efficacy, and a method for timely intervention to correct deficiencies.

Dust↗

PubMed2000

The use of a task-based exposure assessment model (T-BEAM) for assessment of metal fume exposures during welding and thermal cutting.

Elevated disease rates have been documented among construction workers for cancer, pneumonoconiosis, asbestosis, and silicosis. However, methodologies for exposure assessment in construction are not well described in the U.S. literature. Working through a cooperative agreement with the National Institute for Occupational Safety and Health (NIOSH), the Center to Protect Workers' Rights--a research arm of the Building and Construction Trades Department, AFL-CIO--has developed and used a "Task-Based Exposure Assessment Model (T-BEAM)" for construction. The characteristic elements of T-BEAM are: (1) an emphasis on the identification, implementation, and evaluation of engineering and work practice controls; and (2) use of experienced, specially trained construction workers (construction safety and health specialists) in the exposure assessment process. A task-based approach was used because tasks, or specialized skills, form the single greatest thread of continuity in the dynamic environment of construction. Workers in the construction industry come from several crafts and are typically employed by a large number of contractors throughout their career. Project types (e.g., residential or industrial rehabilitation) are also highly variable and present unique health risks. Finally, because construction involves building, renovating, or dismantling physical surroundings, the work site is constantly changing. Between 1995 and 1996, T-BEAM was applied to the collection of approximately 200 personal exposure measurements associated with "hot work tasks"--welding and thermal cutting. Data were collected with the assistance of specially trained, journeyman ironworkers, pipe fitters, and boilermakers on nine construction sites located throughout the United States. Portable local exhaust ventilation was provided to participating contractors with the intent of measuring its impact on exposure. Results indicate that data collected in a standardized, systematic fashion from multiple work sites can be used to characterize exposures among sampled trades. Comparison of results to American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit values (TLVs) demonstrate a significant health hazard among sampled trades posed by welding and thermal cutting fume, manganese, nickel, and chromium VI. Direct estimates of the probability of exceeding the ACGIH TLV for respirable particulate suggests that boilermakers (100%) and ironworkers (71%) are at greatest risk. Other task variables evaluated with respect to exposure include task, whether work was performed indoors or outdoors, intermittency of work, and use of ventilation. Use of local or mechanical ventilation reduced mean exposures to fumes significantly.

Adult↗

PubMed2000

Surgical salvage therapy: abdominoperineal resection for recurrent anal carcinoma, metastasectomy of recurrent colorectal cancer, and esophagectomy after combined chemoradiation.

This review highlights the advances in the salvage surgical therapies for recurrent disease after definitive therapy of anal carcinoma, colorectal cancer, including liver metastasectomy, and esophageal carcinoma treated primarily with chemoradiation. New diagnostic modalities, advances in neoadjuvant therapies for unresectable liver metastases, and, in addition, the importance of adjuvant hepatic arterial chemotherapy after curative liver resections are reviewed. Although chemoradiation is not the standard of care for esophageal cancer, salvage esophagectomy after such treatment is discussed. Definitive chemoradiation for squamous cell carcinoma of the anus has altered the role of surgical intervention to a salvage option instead of primary treatment. Although this is not yet the case for esophageal carcinoma, recent improved chemoradiation regimens have been reported by the French and Japanese, who use surgery for nonresponders. For recurrent colorectal carcinoma, including liver-only metastases, patients can be rendered disease free after surgical extirpation with evidence of improved survival. Appropriate surveillance in these patients may identify subsets of patients with disease amenable to resection.

Abdomen↗

PubMed2000

Gamma resonance absorption. New approach in human body composition studies.

The main stream of body elemental analysis is based on the delayed, prompt, and inelastic neutron interactions with the main elements found in the human body, and subsequent analysis of the measured delayed or prompt gamma ray spectra. This methodology traditionally was, and still is, applied for whole body analysis and requires relatively high radiation doses. A new method, based on gamma nuclear resonance absorption (GNRA), is being established at Brookhaven National Laboratory as part of its body composition program. The method is element specific with a high tomographic spatial-resolution capability, at a small fraction of the radiation dose used in the current system. The new system, with its components and capabilities, is described below.

Adult↗

PubMed2000

Early postnatal dexamethasone treatment and increased incidence of cerebral palsy.

OBJECTIVE: To study the long term neurodevelopmental outcome of children who participated in a randomised, double blind, placebo controlled study of early postnatal dexamethasone treatment for prevention of chronic lung disease. METHODS: The original study compared a three day course of dexamethasone (n = 132) with a saline placebo (n = 116) administered from before 12 hours of age in preterm infants, who were ventilated for respiratory distress syndrome and had received surfactant treatment. Dexamethasone treatment was associated with an increased incidence of hypertension, hyperglycaemia, and gastrointestinal haemorrhage and no reduction in either the incidence or severity of chronic lung disease or mortality. A total of 195 infants survived to discharge and five died later. Follow up data were obtained on 159 of 190 survivors at a mean (SD) age of 53 (18) months. RESULTS: No differences were found between the groups in terms of perinatal or neonatal course, antenatal steroid administration, severity of initial disease, or major neonatal morbidity. Dexamethasone treated children had a significantly higher incidence of cerebral palsy than those receiving placebo (39/80 (49%) v. 12/79 (15%) respectively; odds ratio (OR) 4.62, 95% confidence interval (95% CI) 2.38 to 8.98). The most common form of cerebral palsy was spastic diplegia (incidence 22/80 (28%) v. 5/79 (6%) in dexamethasone and placebo treated infants respectively; OR 4.45, 95% CI 1.95 to 10.15). Developmental delay was significantly more common in the dexamethasone treated group (44/80 (55%)) than in the placebo treated group (23/79 (29%); OR 2. 87, 95% CI 1.53 to 5.38). Dexamethasone treated infants had more periventricular leucomalacia and less intraventricular haemorrhage in the neonatal period than those in the placebo group, although these differences were not statistically significant. Eleven children with cerebral palsy had normal ultrasound scans in the neonatal period; all 11 had received dexamethasone. Logistic regression analysis showed both periventricular leucomalacia and drug assignment to dexamethasone to be highly significant predictors of abnormal neurological outcome. CONCLUSIONS: A three day course of dexamethasone administered shortly after birth in preterm infants with respiratory distress syndrome is associated with a significantly increased incidence of cerebral palsy and developmental delay.

Anti-Inflammatory Agents↗

PubMed2000

Smoking cessation at the workplace. Results of a randomised controlled intervention study. Worksite physicians from the AIREL group.

OBJECTIVES: To compare the effects of a worksite intervention by the occupational physician offering simple advice of smoking cessation with a more active strategy of advice including a "quit date" and extra support. POPULATION: Employees of an electrical and gas company seen at the annual visit by their occupational physicians. CRITERIA END POINTS: Smoking point prevalence defined as the percentage of smokers who were non-smokers at one year. Secondary criteria were the percentage of smokers who stopped smoking for more than six months and the difference in prevalence of smoking in both groups. METHODS: Randomised controlled trial. The unit of randomisation was the work site physician and a random sample of the employees of whom he or she was in charge. The length of the follow up was one year. Each of 30 work site physicians included in the study 100 to 150 employees. RESULTS: Among 504 subjects classified as smokers at baseline receiving simple advice (group A) and 591 the more active programme (group B), 68 (13.5%) in group A and 109 (18. 4%) were non-smokers one year later (p=0.03; p=0.01 taking the occupational physician as the statistical unit and using a non-parametric test). Twenty three subjects (4.6%) in group A and 36 (6.1%) in group B (p=0.26) declared abstinence of six months or more. Among non-smokers at baseline, 3.4% in both groups were smokers after one year follow up. The prevalence of smokers did not differ significantly at baseline (32.9% and 32.4%, p=0.75). After the intervention the prevalence of smoking was 30.8% in group A and 28. 7% in group B (p=0.19). An increase of the mean symptoms score for depression in those who quit was observed during this period. CONCLUSIONS: A simple cessation intervention strategy during a mandatory annual examination, targeting a population of smokers independently of their motivation to stop smoking or their health status, showed a 36% relative increase of the proportion of smokers who quit smoking as compared with what can be achieved through simple advice.

Adult↗