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Biomedical subjects

M Schiff

Publications and source records attributed to M Schiff.

At least 37 records · Page 2Linked to original sources
PubMed1997

Motor vehicle crashes and maternal mortality in New Mexico: the significance of seat belt use.

In recent years, as deaths from medical complications during pregnancy have declined, injuries-specifically those sustained in motor vehicle crashes-represent a growing proportion of all pregnancy-associated deaths. To investigate pregnancy-associated deaths in motor vehicle crashes in New Mexico, we scrutinized the database of the New Mexico Office of the Medical Investigator for all deaths during pregnancy and up to 6 weeks postpartum from 1986 through 1995. A total of 97 deaths were identified, 47 of which were injury-related. Motor vehicle crashes accounted for 33 (approximately 70%) of the injury-related deaths. We analyzed the data on motor vehicle crashes for decedent's age and ethnicity, fetal gestational age, time of crash, rural vs urban location of crash, seat belt use, and drug and alcohol use. Compared with non-Hispanic white women, proportionately higher numbers of Hispanic and American Indian pregnant women were killed in motor vehicle crashes. In searching for modifiable risk factors, we noted that 45% of the crashes involved alcohol and that the majority of pregnant women killed (77%) were not wearing seat belts at the time of the crash. We conclude that education about seat belt use during pregnancy (as well as the dangers of alcohol use and riding with intoxicated drivers while pregnant) is a promising strategy to reduce motor vehicle fatalities.

Accidents, Traffic↗
PubMed1996

The length of active labor in normal pregnancies.

OBJECTIVE: To measure the length of active labor (first and second stages) in a low-risk population of non-Hispanic white, Hispanic, and American Indian women, and to identify any differences among these ethnic populations. METHODS: Descriptive statistics are presented for 1473 low-risk women at term who delivered at the University of New Mexico Hospital. Data examined by ethnicity included demographics, intrapartum care and complications, and duration of the active-phase first stage (4 cm to complete cervical dilatation) and second stage (complete cervical dilatation to delivery) of labor. RESULTS: Compared with Friedman's criteria, 20% of these low-risk women had a prolonged active phase of the first stage, and 4% had a prolonged second stage, without excess maternal or infant morbidity. The mean length of active-phase, first-stage labor was 7.7 hours for nulliparas and 5.7 hours for multiparas (statistical limits 19.4 and 13.7 hours, respectively), with no differences according to ethnic group. The mean length of second stage was 53 minutes for nulliparas and 17 minutes for multiparas (statistical limits 147 and 57 minutes, respectively). American Indian nulliparas had significantly shorter second stages than non-Hispanic white women (P < .05). CONCLUSION: Active labor in healthy women lasted longer than is widely appreciated. Upward revision of clinical expectations for the length of active labor is warranted.

Adult↗
PubMed1996

Effects of food and antacid on the pharmacokinetics of single doses of mycophenolate mofetil in rheumatoid arthritis patients.

1. Mycophenolate mofetil (MMF) is a prodrug of mycophenolic acid (MPA) and is being developed for the prevention of rejection following solid organ transplantation. This crossover study investigated the effect of food and antacid (Maalox TC) on the plasma pharmacokinetics of MPA and its inactive glucuronide metabolite MPAG after giving single 2 g MMF doses orally to rheumatoid arthritis patients. 2. With food, the AUC of MPA in plasma was equivalent to that following an overnight fast. MPA tmax was slightly delayed and Cmax was lowered about 25%, consistent with delay in gastric emptying in the fed state. MPAG Cmax and AUC were higher in the fed relative to the fasting state, suggesting more complex processes involving changes in glucuronidation may also be occurring with food. 3. With antacid, AUC of MPA was lowered about 15% compared with fasting and Cmax was decreased 37%. Plasma MPAG parameters were similarly reduced. These parallel changes in MPA and MPAG are consistent with reduced absorption. 4. The changes in MPA with both food and antacid are small in comparison with the interpatient variability and are not likely to have clinically major effects; the changes in MPAG are of mechanistic interest.

Administration, Oral↗
PubMed1996

Trends in motor vehicle traffic fatalities among Hispanics, non-Hispanic whites and American Indians in New Mexico, 1958-1990.

OBJECTIVE: New Mexico has had the highest motor vehicle fatality rate in the nation for many years. Our objective was to examine ethnic differences and trends in motor vehicle fatality rates. DESIGN: Using death certificate data from the New Mexico Bureau of Vital Records and Health Statistics, we compiled age-adjusted motor vehicle-related mortality rates from 1958-1990 among the three major ethnic groups in New Mexico--Hispanics, white non-Hispanics and American Indians. RESULTS: Over the 33-year study period, American Indians of both sexes had two to three times higher mortality rates than white non-Hispanics. Hispanic males also had higher motor vehicle death rates than white non-Hispanic males. During the 1970s fatality rates peaked, with age-adjusted death rates of 233/100,000 for American Indian males, 74.7 for Hispanic males and 49.3 for white non-Hispanics for the period 1973-1977. Evaluation of successive 5-year birth cohorts showed highest mortality rates for ages 15-29 years for each ethnic group and both sexes, and a dramatic decline in most ethnic, sex and age-specific rates during the last eight years of the study period. CONCLUSION: Although the recent trends indicate favorable changes in motor vehicle fatality rates, our data highlight the need for ethnic and age-specific interventions to further reduce rates of motor vehicle-related mortality in this state.

Accidents, Traffic↗
PubMed1996

Early versus late prenatal care in New Mexico: barriers and motivators.

BACKGROUND: Adequate prenatal care is important for ensuring a good outcome for pregnant women and their children, and its initiation in the first trimester is a major component. We investigated barriers and motivators for women receiving early versus late prenatal care. METHODS: A self-administered questionnaire was distributed to 205 women who began prenatal care at the University of New Mexico Hospital Obstetrics Clinic in Albuquerque, New Mexico. The questionnaire assessed demographic information, insurance status, feelings about the pregnancy, health behaviors, and barriers and motivators to initiating prenatal care. The participants were Hispanic (41%) and non-Hispanic white (46%), low-income women with Medicaid (42%) or no health insurance (41%). They were divided into early (1st trimester 67%) and late (after 1st trimester 33%) care groups. RESULTS: Ethnicity, education, income, and age did not predict initiation of prenatal care. Late initiators cited financial problems (26%), not being aware of the pregnancy (15%), and dislike of going to doctors (14%) as reasons for the delay in seeking prenatal care. Over two-thirds of the pregnancies were unplanned, but 82 percent of the women felt positive about the pregnancy. CONCLUSIONS: Our study documents the continuing need for public health efforts to encourage women to seek early prenatal care. Specific attention should be directed toward women's perceived reasons for not initiating early care.

Adolescent↗
PubMed1996

Patient outcomes after spinal reconstructive surgery in patients > or = 40 years of age.

This study provides outcome data on the quality of life in 84 patients 40 years of age or older who had spinal reconstructive surgery. A 30-min questionnaire covering the patients' pre- and postoperative functional status, expectations for surgery, medication use, quality of life, and overall satisfaction was administered via telephone by a trained interviewer. Clinical data were obtained from chart and radiographic review. The majority of the patients had back or leg pain as their indication for surgery. Diagnoses included kyphosis, scoliosis, spinal stenosis, spondylolisthesis, and failed surgery. Overall satisfaction with functional status and surgical outcome was 81%, and there was significant improvement in most functional measures. This study suggests that improved qualify of life for the majority of appropriately selected spinal reconstruction patients is achievable in this mature population.

Adult↗
PubMed1996

Ovarian cancer incidence and mortality in American Indian, Hispanic, and non-Hispanic white women in New Mexico.

Although ethnic and racial differences in ovarian cancer incidence and mortality have been reported worldwide, few published data have addressed the epidemiology of ovarian cancer among U.S. American Indians and Hispanics. We reviewed ovarian cancer incidence and survival data from New Mexico's population-based cancer registry collected from 1969 to 1992, and examined state vital records data for ovarian cancer deaths collected from 1958 to 1992, focusing on ethnic differences in occurrence and outcomes of ovarian malignancies. Non-Hispanic white women had age-adjusted incidence rates that were slightly higher (13.3/100,000) than rates for American Indians (11.4) and Hispanics (10.7) over the 24-year period. Ovarian cancer mortality rates were also higher for non-Hispanic whites than for minority women. Neither incidence rates nor mortality rates for ovarian cancer improved over the span of the study period. In addition, the stage at diagnosis did not shift substantially over time for any of the ethnic groups studied, nor did the distribution of various histopathological types shift proportionately. Only slight improvement was observed in 5-year survival over the time period of the study, with greater gains among younger (50 years old or less) versus older women. Ethnic differences in ovarian cancer incidence and mortality were apparent in our population-based data. However, our analysis indicated no reduction in ovarian cancer incidence or mortality in our state over the past quarter century and only slight improvement in 5-year survival.

Adenocarcinoma↗
PubMed1995

P-element repressor autoregulation involves germ-line transcriptional repression and reduction of third intron splicing.

P cytotype is a regulatory state, characteristic of Drosophila P-strain females, in which P-element transposition is repressed. P cytotype is established maternally in the germ line but is also dependent on the presence of P elements in the zygote. One aspect of P cytotype involves transcriptional repression of the P-element promoter. Here, we show that transcriptional repression by P cytotype in the female germ line occurs by a general promoter-independent mechanism with heterologous promoters carried in P-element vectors. P-cytotype transcriptional repression results in low levels of pre-mRNA and a reduction in splicing of the P-element third intron (IVS3)-containing mRNA, thus causing an increase in the proportion of 66-kD repressor mRNA. Increased retention of IVS3 in P cytotype would result in an autoregulatory loop of 66-kD repressor production. This combination of germ-line transcriptional repression and splicing control provides a mechanism to maintain repression during the maternal inheritance of P cytotype. These findings suggest that transcriptional repression may play an additional role in the regulation of gene expression, namely allowing alteration of pre-mRNA splicing patterns.

Animals↗
PubMed1995

Prostate-specific antigen obtained under optimal conditions determines extracapsular adenocarcinoma of the prostate.

OBJECTIVE: To assess the relationship of prostate-specific antigen (PSA) obtained under optimal conditions with the presence or absence of organ-confined prostate cancer following radical prostatectomy. PATIENTS AND METHODS: The medical records of 300 consecutive patients who underwent radical retropubic prostatectomy were retrospectively reviewed. Ninety-three patients were excluded who had a pre-operative PSA level potentially altered by various factors (prostate infection, manipulation or instrumentation). RESULTS: A pre-operative PSA value < 4 ng/mL accurately predicted pathologically confined disease in 42 of 51 patients (82%) which contrasted with extracapsular disease in 74 of 84 patients (88%) who had a PSA value > 10 ng/mL. One of the 53 patients with a PSA > 15 ng/mL had organ-confined disease at surgery. CONCLUSION: These data demonstrate that optimal serum PSA values correlate well with pathological stage.

Adenocarcinoma↗
PubMed1994

A 12-year experience with enterovesical fistulas.

OBJECTIVES: To review our experience with enterovesical fistulas in order to determine the most accurate diagnostic studies and most effective method of treatment. METHODS: A retrospective record review of 76 patients who were diagnosed and treated for enterovesical fistulas over a 12-year period was performed. Data collection focused on presenting symptoms, urinary disease process, diagnostic studies, and methods of management. RESULTS: Diverticular disease was the primary etiologic factor in the majority of patients (59%), with colonic malignancy, granulomatous bowel disease, and radiation therapy accounting for the majority of the remainder. Cystoscopy (60%) and cystography (44%) were the most sensitive diagnostic studies. There was no statistical difference in the complication rate between groups treated with single or multistage repair. CONCLUSIONS: One-stage repair of enterovesical fistulas can be safely performed when the cause is diverticular or granulomatous bowel disease. Staged repairs may be more judicious in patients with large intervening pelvic abscesses or those in whom advanced malignancy or radiation changes are present.

Adult↗
PubMed1993

Measuring satisfaction with organizations. Predictions from information accessibility.

The study explored the process through which customers assess their satisfaction with service organizations. Our theoretical analysis suggests that when a general satisfaction question appears after questions about specific domains were asked (SG order), the earlier questions increase the accessibility of both positive and negative information. In contrast, when a general satisfaction question appears prior to any other question (GS order), negative information is more accessible than positive information. On the basis of these differences in accessibility we predicted (1) greater asymmetry in the impact of positive and negative information on the general satisfaction response in the GS order, (2) higher correspondence between domain-specific satisfaction and general satisfaction in the SG order, and (3) higher levels of general satisfaction in the SG order. These predictions were supported in analyses of customers' responses in a national survey of satisfaction with the Israel Telecommunication Corporation (Bezeq).

Consumer Behavior↗
PubMed1993

Pneumocystis carinii pleural effusion. Pathogenesis and pleural fluid analysis.

We present three new cases of Pneumocystis carinii in pleural effusions of patients with AIDS, bringing the total number of reported cases to six. In our patients, diagnosis was made by visualization of Pneumocystis in pleural fluid stained with Gomori methenamine silver. LDH was greater than 400, and pleural fluid to serum LDH ratio was greater than 1.0 in all cases at time of presentation. All six reported patients have been associated with aerosolized pentamidine, and five of the six had documented underlying Pneumocystis pneumonia. The sixth patient, which we report, presented with primary pleural infection with Pneumocystis. Although we could not document underlying pneumonia, we suspect it was present. Pneumocystis pleural disease appears to be an anatomic extension of smoldering subpleural Pneumocystis pneumonia, and prognosis is not worse than with pneumonia alone.

AIDS-Related Opportunistic Infections↗
PubMed1992

Juvenile nasopharyngeal angiofibroma contain an angiogenic growth factor: basic FGF.

The presence of an angiogenic protein basic fibroblast growth factor (FGF) was established in juvenile nasopharyngeal angiofibroma (JNF). Extracts of these tumors have the capacity to stimulate endothelial cell proliferation. This activity is indistinguishable from basic FGF. The biological activity contained in the extracts binds to heparin-Sepharose columns and is eluted with a characteristic 2 mol sodium chloride. The exact fraction of the biological activity corresponds to the location where an immunoreactive basic FGF can be detected by radioimmunoassay. These same fractions contain an 18,000-d molecule which is identified by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting with an antibody to basic FGF. Indeed, immunohistochemical studies localize the growth factor to the endothelium of JNF. Although these findings do not establish that basic FGF mediates the development of this angiofibroma, they do support the possibility that the pathogenesis of JNF is associated with the presence of angiogenic factors like basic FGF. If this is the case, a comprehensive study of the etiology of JNF may lead to a better understanding of how locally produced growth factors mediate proliferative disease and how its modification might lead to better treatment on a biological basis.

Adolescent↗
PubMed1990

Vaginal ultrasonographic assessment of cervical length changes during normal pregnancy.

We measured the cervical length of 166 normal, gravid patients between 8 and 37 weeks' gestation by vaginal ultrasonography. Patients were assigned to one of five groups according to gestational age at the time of the measurements. Cervical length was longest (48 mm) in group 3 (20 to 25 weeks) and significantly longer than that of groups 1 (8 to 13 weeks), 2 (14 to 19 weeks), and 5 (32 to 37 weeks). The use of vaginal ultrasonography to assess cervical length eliminates some technical problems encountered with abdominal ultrasonography. Nomogram of cervical length throughout pregnancy was established. This may aid in early diagnosis and management of preterm labor and cervical incompetence.

Cervix Uteri↗
PubMed1989

Self-esteem in abused chemically dependent adolescents.

In a random sample of 500 admissions to a residential treatment center for chemically dependent adolescents. 150 cases of physical and sexual abuse had been identified. These adolescents were matched for age, race, and socioeconomic status, with two comparison groups: a group of nonabused chemically dependent adolescents and a group of nonabused, nonchemically dependent adolescents. Self-esteem was measured, utilizing the Tennessee Self-Concept Scale (TSCS), which was administered to all subjects. The abused, chemically dependent adolescents were found to demonstrate significantly lower self-esteem on all subscales when analyzed against these two comparison groups. There were negligible differences within the abused group when the TSCS scores were analyzed according to type of abuse. Aggressive/physically abused adolescents scored higher on the Physical Self subscale and the incest group scored significantly lower on the Identity subscales. These results suggest that abuse is equally devastating, regardless of the type of abuse, e.g., physical, sexual, incest, and has a long-lasting impact on self-esteem.

Adolescent↗