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Biomedical subjects

R Cohen

Publications and source records attributed to R Cohen.

At least 397 records · Page 22Linked to original sources
PubMed1989

Compliance with isoniazid prophylaxis in jail.

The incidence of tuberculosis in New York City has risen dramatically in the last decade, an increase that has also been seen in the incarcerated population on Rikers Island, New York City's principal jail. We have investigated the establishment and maintenance of compliance with isoniazid prophylaxis in this population. Factors affecting compliance were studied in a sample of young men who were found to be tubercullin-reactive at the time of their incarceration. Compliance was quantified by determining the number of doses taken divided by the total number of available doses. Mean compliance for the 74 subjects was 37.5%. Two factors were important determinants of compliance: (1) the building where the inmate was incarcerated and (2) his knowledge of tuberculoses and the isoniazed regimen. The influence of the housing unit on compliance suggests that administrative responses to prison overcrowding, an increasingly prevalent condition in the nation's jails and prisons, may have an unintended and detrimental effect on medical care and public health.

Adolescent↗
PubMed1989

The health consequences of multiple morbidity in the elderly. The Alameda County study.

Longitudinal data from the Alameda County Study are used to examine three health consequences of multiple or co-morbidity, defined as the coexistence of two or more chronic conditions and/or symptoms. Age-adjusted analyses of the consequences of baseline co-morbidity show significant associations in both age groups with 17-year mortality, and with the development of multiple new conditions and the occurrence of depression over a 9-year follow-up. After adjustments for sociodemographic characteristics and health behaviors, all associations with multiple new conditions remain significant. The association with depressive symptoms, however, remains significant for the younger age group only and the association with mortality become nonsignificant in both age groups.

Adult↗
PubMed1989

Effects of the somatostatin analog BIM 23014 on the secretion of growth hormone, thyrotropin, and digestive peptides in normal men.

BIM 23014 (BIM) is a long-acting octapeptide somatostatin analog. We studied the effects of this analog on the secretion of GH, TSH, and gastroenteropancreatic hormones [secretin, motilin, and pancreatic polypeptide (PP)] in normal men. In the first protocol three BIM doses (125, 250, and 500 micrograms) and vehicle were administered sc in random order at 2000 h to eight normal young men. Plasma GH concentrations decreased during the first part of the night only after the highest dose (P less than 0.05). Plasma secretin levels did not change, while plasma motilin decreased after the 250- and 500-micrograms doses (P = 0.05 and P = 0.02, respectively), and plasma PP decreased after all three doses (P less than 0.05, P less than 0.01, and P less than 0.01, respectively) during the first part of the night. In the second protocol, eight men received BIM, administered by constant sc infusion during the night in a dose of 2 mg/12 h, or vehicle, either alone or in association with a 10 ng/kg.min iv GHRH or vehicle infusion. Nocturnal GH secretion was suppressed by the BIM infusion (P less than 0.001). GH secretion, stimulated by GHRH infusion (P less than 0.001), was reduced by concomitant BIM infusion (P less than 0.001) and was pulsatile during the combined infusions. BIM infusion suppressed the physiological nighttime rise in plasma TSH levels. Plasma motilin and PP levels were reduced by BIM, when administered either alone or in combination with GHRH. We conclude that: 1) BIM is capable of reducing GH secretion when administered sc in a dose of 500 micrograms and of abolishing nocturnal GH secretion when constantly infused at a dose of 2 mg/12 h; 2) BIM, constantly infused, reduces the nocturnal rise in TSH secretion; and 3) motilin and PP secretion are more sensitive than that of GH to BIM, as they are reduced by a lower dose.

Adult↗
PubMed1989

Tumor-associated aphasia in left hemisphere primary brain tumors: the importance of age and tumor grade.

Although one-quarter of patients with primary brain tumors have language disturbances at the time of initial presentation, the factors contributing to their aphasia are not clear. A group of 32 patients with primary tumors of the left hemisphere was collected retrospectively and the relationship between clinical, radiographic, and pathologic factors and tumor-associated aphasia was examined. We assessed language function before beginning any treatment including steroids. The factor that best predicted language disturbance was greater patient age; the only other significant factor was tumor grade. Tumor size made a nearly significant impact, but tumor location within the left hemisphere did not correlate with aphasia.

Adult↗
PubMed1989

[Treatment of acute otitis media in infants using an amoxicillin-clavulanic acid formulation (in the form of an oral suspension for pediatric use)].

In a multicenter study, Augmentin pediatric suspension was given to 1,227 young children (3 months - 3 years) with otitis media seen in private practice. Patterns of otitis included first episodes, recurrences, and forms that had failed to respond to previous antimicrobial therapy. The study medication was given as a first-line treatment, on the basis of epidemiologic data, in a daily dose of 40 mg/kg for 7 to 10 days. In the 3 months to 3 years age group, two micro-organisms are prevalent, ie. Haemophilus influenzae, which is the most common agent and may produce beta-lactamases (10 to 18% of strains), and Streptococcus pneumoniae. Among our patients, the otitis-conjunctivitis syndrome caused by Haemophilus influenzae was fairly frequent (8.7% of cases). Clinical effectiveness as evaluated between D8 and D11 was good or very good in 91.2% of cases. Tolerance was satisfactory in 83% of patients. Side effects were uncommon and consisted primarily in gastrointestinal symptoms. We point out the potentially deleterious effect of concurrent anti-inflammatory treatment. Acceptability of the suspension was judged satisfactory by the parents in 91.6% of cases. Augmentin proved well-suited to epidemiologic data, outstandingly effective, well tolerated, and easy to use because of its presentation as a pediatric suspension; it is therefore an appropriate first-line drug in the common indication addressed in our study.

Acute Disease↗
PubMed1989

Nail changes in the seropositive and seronegative arthridities.

There are a number of nail changes that can represent the presence of an underlying arthritic pathology. The changes may be secondary to the underlying pathology or its treatment. The astute practitioner should learn to recognize these findings in addition to other clinical presentations of the disease to aid in making a diagnosis. The podiatrist sees hundreds of nails each day. Knowledge of nail changes along with the salient features of these arthridities will aid the practitioner in diagnosing the appropriate arthritic process.

Arthritis↗
PubMed1989

[Imaging and the first urinary infection in children. Respective role of each test during the initial evaluation apropos of 122 cases].

122 pediatric patients with a first urinary tract infection underwent renal ultrasonography (US) and voiding cystourethrography (VCUG) to evaluate the usefulness of this association. The US was always the first examination undertaken, its sensitivity seems to be very good in detecting renal abnormalities. The major finding on the VCUG was the vesico-ureteral reflux: 25% of cases. When the sonogram and the VCUG are normal, 60% of cases, excretory urography is not considered necessary.

Child↗
PubMed1989

Cardiovascular disease hospitalization rates in Negev communities: are differences due to differential prevalence or differential use of health care?

Goldsmith and Pilpel found the rate of hospitalization for cardiovascular disease (CVD) in Beer Sheva in 1981 to be approximately twice that of five development towns in the Negev. In order to determine whether this difference was due to differences in the prevalence of heart disease, data on heart disease mortality hospitalization for 1981, 1983 and 1985 was studied, and hypertension prevalence in these communities were examined. From 1981 death records, age-adjusted CVD rates for the male population greater than 30 years were 397.7/100,000 in Beer Sheva and 344.4 in development towns; for women the rates were 351.5 and 411.2, respectively. Myocardial infarction rates for men were the only subset of CVD to be significantly different (Beer Sheva 174.3 vs. development towns 115.7). Beer Sheva residents with CVD were significantly more likely to die in the hospital or another health care facility than residents of development towns. The rates of emergency room use were higher in Beer Sheva than in development towns, but the proportion of those patients who came to the emergency room because of chest pain who were hospitalized was the same for both communities. Data from a sample study of hypertension recorded for patients in primary care clinics in 1983 showed no differences in prevalence or treatment status between Beer Sheva and development town residents. Overall CVD hospitalization rates were 27.7% greater for BS men and 33.3% for BS women. We conclude that: a) the higher rate for myocardial infarction in Beer Sheva merits further investigation, but cannot account for the differential rates of hospital use; and b) distance from the hospital and c) culturally associated attitudes toward hospitalization on the part of both patients and physicians are likely explanations that should be further investigated.

Adult↗
PubMed1988

Non-gynaecological metastases to the vulva and vagina.

A retrospective study of 1513 vulval and vaginal biopsy specimens was undertaken to determine the frequency of non-gynaecological metastases to the vulva and the vagina; 7 cases were found. These were reviewed and an attempt was made to determine the mode of spread.

Female↗
PubMed1988

Comprehensive pediatric primary care vs traditional care in an Israeli population: their influence on pediatric emergency room use and hospitalization.

Emergency room (ER) utilization and hospitalization were studied as indicators of the impact of improvements in pediatric primary care services in an Israeli development town, Ofakim, population 12,000. One of the two pediatric services was upgraded in 1976 through the introduction of pediatric faculty, integration of preventive and curative services and conversion of the medical records to a problem-oriented format ("experimental" clinic "B"). The primary care system remained unchanged in the second clinic ("traditional" clinic "A"). During 1980, ER utilization by the "B" clinic population was 9.3/100 compared with 17.6/100 for the "A" clinic population. Fifty two percent of the "B" clinic population patients reaching the ER were hospitalized compared with 25% of "A" clinic patients. The lower ER utilization rate represents a significant saving for the health services, and educational interventions are suggested from the study. Analysis of ER utilization data seems to offer useful information for overall planning and monitoring of ambulatory services for a community.

Adolescent↗
PubMed1988

Hypertension Control Program of the Negev: evaluation after two years of intervention.

In 1981 a nationwide effort to control high blood pressure was implemented. One of the first programs was the "Hypertension Control Program of the Negev." The program's major objective was to introduce early detection and improve diagnostic, treatment, and follow-up procedures to 27 primary-care clinics of the area. The evaluation was based on the program's three levels of intervention: (a) basic training program and written protocol, containing guidelines for diagnosis, treatment, and follow-up; (b) additional consultation in the primary-care clinics by internal medicine specialists from the regional medical center, and (c) additional consultation in the primary-care clinics by the hypertension unit's medical team. In 1981 (prior to any intervention) a random sample of 5,717 medical records of the target population (30 years or older) was reviewed. High blood pressure was found in 1,032 patients (18%); however, a written diagnosis of hypertension was recorded in only 57% of these cases, and of these only 37% were being regularly treated for high blood pressure. In 1983, a second, independent random sample of 7,791 records was reviewed. High blood pressure was again found in 18% (1,428) of the cases, but 69% of these had a recorded high blood pressure diagnosis (a relative increase of 21% from 1981), and 85% of these were treated for high blood pressure (a relative increase of 130%). Improved performance in the steps of care provided for high blood pressure was observed in all the clinics. Surprisingly, the percentage of well-controlled patients increased only in those clinics where the staff gave consultation services.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Placebo injections and surveillance of alcohol intake during inpatient treatment of female alcoholics.

Institutions for treating alcoholics differ widely with respect to how restrictively they apply psychopharmacological agents and how rigorously they control patients for intake of alcohol. This study investigates the impact of such policies on relapse rates. During a three month inpatient treatment, 70 female alcoholics were assigned to one of four conditions: (a) strict surveillance of alcohol intake by means of breath tests and frequent checks of patient's rooms as well as injections of a placebo purportedly reducing craving, (b) no surveillance but placebo injections, (c) surveillance but no placebo injections, and (d) neither surveillance nor placebo injections. The amount of surveillance did not influence relapse rates. However, during inpatient treatment more relapses occurred among patients who received the placebo injections than among those who did not. Although this effect was no longer significant following treatment, the increase of relapse rates suggests caution in the application of nonspecific medication in the treatment of alcoholics.

Adult↗
PubMed1988

Esophageal bougienage technique for coin ingestion in children.

An analysis was performed of 46 consecutive children who received esophageal bougienage for an ingested coin lodged in the esophagus. All patients met the following clinical criteria necessary for performance of this procedure: an acutely ingested single coin, radiographically localized in the esophagus; no previous history of an esophageal disease process, surgical procedure performed or foreign body removed; and no respiratory compromise upon physical examination. All coins were successfully advanced distally into the stomach after one pass of the bougie dilator. No complications were noted during or after performance of any procedure. Esophageal bougienage is a safe and effective method used to dislodge and pass an ingested coin from the esophagus when criteria for its performance are adhered to rigidly.

Adolescent↗
PubMed1988

Airborne endotoxin associated with industrial-scale production of protein products in gram-negative bacteria.

Human and animal proteins of therapeutic value can be produced in E. coli, a gram-negative bacteria. Endotoxin, a cellular component, is reported to have clinically significant health effects. Operations--including culturing the microbe, separating solids by centrifugation, and mixing/homogenizing--had associated endotoxin levels ranging from 0.07 ng/m3 to 12.8 ng/m3. Utilizing a 10-fold safety factor under the threshold where clinically significant changes can be detected, an action level of 30 mg/m3 for large scale operations involving the use of E. coli was established. Operations conducted without engineering controls had maximum airborne endotoxin levels of 1812 ng/m3.

Air Pollutants, Occupational↗