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Biomedical subjects

N H Miller

Publications and source records attributed to N H Miller.

At least 37 records · Page 2Linked to original sources
PubMed1996

Genetic analysis of structural elastic fiber and collagen genes in familial adolescent idiopathic scoliosis.

Adolescent idiopathic scoliosis is a genetic disorder of unknown etiology. Scoliosis is a clinical feature of inherited connective-tissue disorders including Marfan syndrome. Mutations within the gene of FBN1 (fibrillin 15), a component of the extracellular matrix, are now linked to Marfan syndrome and similar clinical phenotypes. This study investigated the potential association of structural genes encoding for extracellular matrix components of FBN1, elastin, and one of the polypeptides of type-I collagen (COL1A2) with familial adolescent idiopathic scoliosis. Eleven pedigrees, including 96 individuals, were identified in which adolescent idiopathic scoliosis segregated in an apparent autosomal dominant pattern. Fifty-two individuals were determined to be affected with scoliosis. Genomic DNA was analyzed by genetic linkage utilizing four intragenic markers for the structural genes of FBN1, elastin, and COL1A2. Collectively, our results exclude the structural genes of FBN1, elastin, and COL1A2 as candidate genes within these families. However, when viewed individually, specific markers cannot be excluded within all of the families. This information complements previously reported data that fibrillin production and matrix incorporation from scoliotic fibroblasts in vitro are normal in more than 80% of patients studied.

Adolescent↗
PubMed1996

Home-based cardiac rehabilitation and lifestyle modification: the MULTIFIT model.

Managed care has changed the way health care is delivered in the United States. Simultaneously, major changes in the management of patients with coronary heart disease has led to dramatic shifts in cardiac rehabilitation. Exercise training, education, and counseling to modify coronary risk factors has clearly been shown to benefit patients with coronary disease. Moreover, intensive risk factor modification has been shown to prevent progression of coronary atherosclerosis and to lower morbidity and mortality. Newer delivery models of rehabilitation are needed to improve health outcomes in a cost-effective way. A nursing case management model (MULTIFIT), illustrates one such innovative delivery model that meets the needs of a managed care plan for comprehensive cardiovascular risk reduction and surveillance of patients.

California↗
PubMed1996

A nurse-managed smoking cessation program for hospitalized smokers.

OBJECTIVES: This study evaluated a nurse-managed smoking cessation program for smokers hospitalized for a variety of conditions. METHODS: Hospitalized patients who smoked prior to hospitalization and who were motivated to quit (n = 660) were randomized to intervention or usual-care groups and followed for the next year. The intervention included a meeting with the nurse-case manager; the use of a videotape, workbook, relaxation audiotape, and nicotine replacement therapy; and nurse-initiated phone contacts after discharge. RESULTS: The 12-month confirmed cessation rates were 21% and 31% for, respectively, the usual-care and intervention groups (odds ratio = 1.7; 95% confidence interval = 1.1, 2.3). CONCLUSIONS: A nurse-managed smoking cessation intervention can significantly increase cessation rates for hospitalized patients.

Adult↗
PubMed1996

Breastfeeding practices among resident physicians.

OBJECTIVE: To determine how employment as a resident physician (resident) affects breastfeeding practices and experiences. DESIGN: Cross-sectional questionnaire survey. SETTING: US resident physicians in the second half of their postgraduate year three (PGY3). PARTICIPANTS: 1500 questionnaires were mailed at random to female 1990 graduates of American medical schools. After eliminating unusable surveys, an adjusted response rate of 45% produced 450 surveys; 60 delivered a child during residency. INTERVENTIONS: None. MEASUREMENT/MAIN RESULTS: Forty-eight (80%) of 60 residents who delivered initiated breastfeeding, and continued for the duration of their maternity leave (mean, 7 weeks). With a return to residency half (24) of those who had initiated breastfeeding discontinued breastfeeding. The breastfeeding rate dropped to 15% (9/60) at 6 months. Residency work schedule was the most common reason (80%) for discontinuing breastfeeding. Of the 24 residents who continued breastfeeding while working, 83% pumped breast milk during their work shifts; 79% felt there was insufficient time during work, and 42% reported no appropriate place at work to express milk. Only 54% who continued felt supported by their attending physicians for their efforts to breastfeed; 67% felt colleagues were supportive. CONCLUSIONS: The breastfeeding initiation rate for resident mothers was in compliance with the Healthy People 2000 guidelines, but the rate at infant age 6 months fell well below the goal of 50%. Modifiable factors in residents' work sites include both physical and emotional accommodations to encourage resident mothers to breastfeed.

Adult↗
PubMed1995

The contraceptive use of Depo-Provera in U.S. adolescents.

UNLABELLED: Little is known about the use of depot medroxyprogesterone acetate (Depo-Provera, DMPA) in U.S. adolescents before the FDA approved its usage for contraception in 1992. PURPOSE: To determine the experience with DMPA use in adolescents for contraception in the United States. METHODS: A questionnaire survey was sent to U.S. physicians identified as adolescent health care providers. RESULT: DMPA had been prescribed by 41% of surveyed physicians who prescribe contraception for adolescents. Eighty-five percent of patients continued use beyond nine months and 40% continued beyond 21 months. Sixty-seven percent of physician/respondents reported using DMPA in mentally retarded patients. CONCLUSIONS: Many providers used DMPA for contraception in adolescents prior to its FDA approval for contraception. DMPA has a high rate of continuation of use as a contraception in adolescents.

Adolescent↗
PubMed1995

Physical activity: one approach to the primary prevention of hypertension.

1. Despite the merits of physical activity reducing the risk of hypertension and showing other health benefits, Americans continue to be relatively sedentary. 2. Low to high intensity physical activities result in a reduction in both systolic and diastolic blood pressure in middle aged to older adults. Individuals can obtain benefits by engaging in aerobic exercise, a wide variety of leisure time activities, short bouts of exercise, and even isometric work. 3. Behavioral techniques of contracting, self monitoring, and relapse prevention training offer important methods to help clients adopt and maintain physical activity.

Behavior Therapy↗
PubMed1994

A case-management system for coronary risk factor modification after acute myocardial infarction.

OBJECTIVE: To evaluate the efficacy of a physician-directed, nurse-managed, home-based case-management system for coronary risk factor modification. DESIGN: Randomized clinical trial in which patients received a special intervention (n = 293) or usual medical care (n = 292) during the first year after acute myocardial infarction. SETTING: 5 Kaiser Permanente Medical Centers in the San Francisco Bay area. PATIENTS: 585 men and women aged 70 years or younger who were hospitalized for acute myocardial infarction. INTERVENTION: In the hospital, specially trained nurses initiated interventions for smoking cessation, exercise training, and diet-drug therapy for hyperlipidemia. Intervention after discharge was implemented primarily by telephone and mail contact with patients in their homes. All medically eligible patients received exercise training; all smokers received the smoking cessation intervention; and all patients received dietary counseling and, if needed, lipid-lowering drug therapy. OUTCOME: Smoking prevalence and plasma low-density lipoprotein cholesterol (LDL) concentrations were measured 2 months after infarction, and functional capacity was measured 6 months after infarction. RESULTS: In the special intervention and usual care groups, the cotinine-confirmed smoking cessation rates were 70% and 53% (P = 0.03), plasma LDL cholesterol levels were 2.77 +/- 0.69 mmol/L and 3.41 +/- 0.90 mmol/L (107 +/- 30 mg/dL and 132 +/- 30 mg/dL) (P = 0.001), and functional capacities were 9.3 +/- 2.4 METS and 8.4 +/- 2.5 METS (P = 0.001), respectively. CONCLUSION: In a large health maintenance organization, a case-management system was considerably more effective than usual medical care for modification of coronary risk factors after myocardial infarction.

Adult↗
PubMed1994

Managing drug therapy: new insights into the National Cholesterol Education Program guidelines.

1. The National Cholesterol Education Program ATP II Report clearly defines those individuals most likely to benefit from drug therapy for treatment of cholesterol. 2. Knowing the choice of drugs, method of action, administration hints, and side effects of these agents is important for occupational health nurses. 3. The nurse's role in providing education, defining techniques to enhance compliance to medications, and reinforcing change in lifestyle behaviors is key to the client's success in maintaining life long therapy for cholesterol management.

Anticholesteremic Agents↗
PubMed1990

Studies on the metabolism of apolipoprotein B in hypertriglyceridemic subjects using simultaneous administration of tritiated leucine and radioiodinated very low density lipoprotein.

To study the metabolic pathways of apolipoprotein B (apoB), a series of studies were carried out in which both radioiodinated very low density lipoproteins (VLDL) and tritiated leucine were simultaneously injected into three hypertriglyceridemic subjects. The appearance and disappearance of tritium activity in VLDL apoB, intermediate density lipoprotein (IDL) apoB, and low density lipoprotein (LDL) apoB were followed as was the disappearance of iodine activity from VLDL and the appearance and disappearance of iodine activity in IDL apoB and LDL apoB. It was found that a delipidation chain could describe the kinetics of both endogenously and exogenously labeled VLDL. A slow component of VLDL was necessary to fit the VLDL 131I-labeled apoB data and was consistent with the observed VLDL [3H]apoB kinetics. In addition, the estimated rate of conversion of VLDL apoB to LDL exceeded that which appeared to pass through the measured IDL pools, suggesting that a fraction of the IDL was not directly observed. It was also found that a higher percentage of VLDL 131I-labeled apoB was converted to LDL apoB than was VLDL [3H]apoB. To evaluate possible causes of this apparent anomaly, simultaneous examination of all kinetic data was performed. This exercise resulted in the resolution of removal pathways from multiple compartments in the VLDL delipidation chain and the conversion of slowly metabolized VLDL to IDL and LDL. The wide spectrum of this loss pathway indicates that previous estimates of VLDL apoB production rate using the radioiodinated methodology probably represent lower bounds for the true physiologic variable. It is important to note that these direct losses were apparent only when the combination of endogenous and exogenous labeling was used.

Apolipoproteins B↗
PubMed1989

Pregnancies among physicians. A historical cohort study.

Sixty-seven pregnancies in practicing physicians were compared with 201 pregnancies in nonphysicians in a historical cohort study. All subjects were cared for and delivered by the same obstetricians. Physician and nonphysician pregnancies of similar socioeconomic status were matched for age, race and parity. After statistically controlling for alcohol and tobacco use and adequacy of prenatal care, physicians had a 1.86 (1.00, 3.46) relative risk of an adverse pregnancy outcome. Physicians were at a 4.0 (1.58, 10.1) and 2.33 (0.93, 5.8) times higher risk for preterm labor and delivery than were nonphysicians. Pregnancies in physicians were found to be similar to those in nonphysicians in the use of obstetric technology except for an increased number of ultrasound examinations among physicians. These results suggest that physicians are at increased risk for an adverse pregnancy outcome and should be considered and treated as a high-risk obstetric group.

Adult↗
PubMed1988

Pregnancy complications of physicians.

Studies indicate an increased risk of adverse late pregnancy events, such as preterm labor and preterm delivery, for practicing physicians. These adverse pregnancy outcomes also occur among pregnant women who work long hours with high levels of psychological stress, a mechanism most likely related to catecholamine and posturally mediated alterations in uterine blood flow. Further evaluation and research into the epidemiology of physicians' pregnancies are needed because of the increasing number of women physicians in their childbearing years.

Female↗
PubMed1987

Structural studies of apolipoprotein B: physical properties of the protein in guanidine hydrochloride.

Apolipoprotein B was isolated from human plasma low-density-lipoprotein without precipitation by diethyl ether/ethanol extraction of the protein in 6 M guanidine hydrochloride. The physical properties of this protein, which contained a residuum of approximately 7% phospholipid, were examined in 6 M guanidine solution under reducing conditions. The circular dichroism spectrum was indistinguishable from that of a random coil protein. Sedimentation equilibrium analyses of apolipoprotein B by the meniscus depletion method of Yphantis (1984, Biochemistry 3, 297-317) were complicated by heterogeneity and nonideality despite the low concentrations employed. 63 analyses of the weight average (Mw) and z average (Mz) molecular weight were made on the apolipoprotein B from 12 subjects. The Mw observed was a function of initial concentration, rotor speed, and a heterogeneity index (Mz/Mw). Multiple linear regression of apolipoprotein B molecular mass against these parameters suggested that an Mw of 540,000 +/- 110,000 would be observed under apparently ideal and homogeneous conditions. The sedimentation coefficient and intrinsic viscosity of the reduced protein at 25 degrees C in 6 M guanidine were 2.13 S and 116 ml/g, respectively; these values predict molecular weights of 640,000 and 250,000, respectively, if apolipoprotein B was fully denatured into a random coil. Lack of agreement between these estimates and with the sedimentation equilibrium analysis can best be explained by compactness of structure and incomplete denaturation to a random coil state. Furthermore, an irreversible temperature dependence of apolipoprotein B reduced viscosity indicated that residual structure remained in solutions of 6 M guanidine hydrochloride/20 mM dithiothreitol. Taken together, the physical data demonstrate that apolipoprotein is a single polypeptide of approximately 540 kDa, whose structure resists denaturation under conditions where most proteins exist as random coils.

Apolipoproteins B↗
PubMed1987

Systematic dyskinesia examination of profoundly mentally retarded persons: cooperation and assessment.

Performance of 344 institutionalized mentally retarded adults was measured to assess the applicability of the Dyskinesia Identification System Condensed User Scale. A larger proportion of profoundly retarded persons cooperated with Dyskinesia Identification examination procedures than has previously been found. Performance deficits were observed on activation tasks (APA, 1979) that precede assessment of lingual abnormal involuntary movements. Intelligence quotients, neuroleptic dosage, gender, and ambulatory and visual impairments were associated with performance of activation tasks. Results suggest the difficulty of implementing standardized tardive dyskinesia assessments and that client behavior problems may threaten the valid assessment of this disorder among institutionalized profoundly retarded persons.

Adolescent↗
PubMed1986

Effects of low- and high-intensity home-based exercise training on functional capacity in healthy middle-aged men.

The effects of 12 weeks of home-based exercise training on peak oxygen consumption (VO2 max) in healthy sedentary middle-aged men, mean age 49 +/- 6 years, were evaluated. Twenty-one men trained at low intensity, 23 trained at high intensity and 20 were control subjects. Individually prescribed low- and high-intensity training was performed 5 times per week within a range of 42 to 60% and 63 to 81% of baseline VO2 max, corresponding to average heart rates of 102 to 122 and 128 to 148 beats/min, respectively. Caloric expenditure per training session approximated 350 kcal in both groups; adherence was at least 90% in both groups. VO2 max increased 8% in patients who trained at low intensity, 17% in those who trained at high intensity (both p less than 0.001), and not at all in control subjects. Low-intensity exercise training at home significantly augments functional capacity in healthy sedentary middle-aged men.

Adult↗
PubMed1985

Exercise testing to enhance wives' confidence in their husbands' cardiac capability soon after clinically uncomplicated acute myocardial infarction.

The effects of wives' involvement in their husbands' performance of treadmill exercise testing 3 weeks after clinically uncomplicated acute myocardial infarction was compared in 10 wives who did not observe the test, 10 who observed the test, and 10 who observed and participated in the test themselves. In a counseling session after the treadmill test, couples were fully informed about the patient's capacity to perform various physical activities. Wives' final ratings of confidence (perceived efficacy) in their husbands' physical and cardiac capability were significantly (p less than 0.05) higher in those who also performed the test than in the other 2 groups. Only wives who walked on the treadmill increased their ratings of their husbands' physical and cardiac efficacy to a level equivalent to those of their husbands. Spouses' and patients' perceptions of patients' cardiac capability after treadmill testing and counseling at 3 weeks were significantly correlated with peak treadmill heart rate and workload at 11 and 26 weeks. Efficacy ratings at 3 weeks were slightly better than peak 3-week treadmill heart rate and workload as predictors of treadmill performance at 11 and 26 weeks. Participation in treadmill testing early after acute myocardial infarction is an effective means for reassuring spouses about the capacity of their partners to resume their customary physical activities with safety.

Adult↗
PubMed1985

The determination of specific radioactivity of proteins eluted intact from polyacrylamide gels, utilizing a fluorescamine assay.

The methodology described permits the measurement of the specific radioactivity of diverse proteins resolvable by separatory techniques using cylindrical polyacrylamide gels. Following separation, the proteins are electroeluted; eluted protein is quantitated in the microgram range using a fluorescamine assay, while the major portion of the recovered sample is used for radioactivity measurement. These procedures have been adapted for use in tracer studies of protein metabolism. Their utility in kinetic investigations is demonstrated with data on the time course of changing specific radioactivities of human plasma albumin and apolipoprotein B labeled in vivo with a [3H]leucine tracer.

Apolipoproteins B↗
PubMed1985

Medically directed at-home rehabilitation soon after clinically uncomplicated acute myocardial infarction: a new model for patient care.

Medically directed at-home rehabilitation was compared with group rehabilitation which began 3 weeks after clinically uncomplicated acute myocardial infarction (AMI) in 127 men, mean age 53 +/- 7 years. Between 3 and 26 weeks after AMI, adherence to individually prescribed exercise was equally high (at least 71%), the increase in functional capacity equally large (1.8 +/- 1.0 METs) and nonfatal reinfarction and dropout rates equally low (both 3% or less) in the 66 men randomized to home training and the 61 men randomized to group training. No training-related complications occurred in either group. The low rate of reinfarction and death (5% and 1%, respectively) in the study as a whole, which included 34 patients with no training and 37 control patients, reflected a stepwise process of clinical evaluation, exercise testing at 3 weeks and frequent telephone surveillance of patients who underwent exercise training. Medically directed at-home rehabilitation has the potential to increase the availability and to decrease the cost of rehabilitating low-risk survivors of AMI.

Adult↗