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Biomedical subjects

R Rothenberg

Publications and source records attributed to R Rothenberg.

At least 19 recordsLinked to original sources
PubMed1992

Ischemic heart disease prevention: estimating the impact of interventions.

The potential impact of ischemic heart disease intervention programs has usually been assessed using the dichotomy between those programs targeted to high risk groups and those that are population based, but this distinction does not adequately describe the spectrum of possibilities. Using data from the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study (NHEFS), we assessed the effect of a spectrum of 27 potential interventions on mortality reduction and on an Intervention Index (defined as the number of persons whose risk must change to prevent one death). Using combinations of cholesterol reductions of 20% and decreases in the prevalence of smoking and hypertension of 50%, reductions in mortality varied from 1 to 27% and the Intervention Index varied from 26 to 520. A number of potential interventions were equivalent in their mortality reduction of their Intervention Indexes, despite their affecting differing proportions of the population. The Intervention Index provides some measure of the relative efficiency of programs and points to the comparability of different interventive approaches. In addition, this analysis suggests that the potential impact of intervention programs on mortality will be modest, but that a focus on certain subgroups, such as those aged 40-59 years, can achieve substantial results within those groups, even though the population effect would be minimal.

Adult↗
PubMed1992

The quality of life in the year before death.

OBJECTIVES: Most Americans wish to live a long healthy life, but fear disease and dependency in their last years. Until recently, little has been known about the prevalence of opposite extremes of health in old age, particularly in the period leading up to death. METHODS: We used results from the 1986 National Mortality Follow-back Survey to estimate proportions of elderly decedents who were "fully functional" or "severely restricted" in the last year of life. Estimates were based on responses from proxies to questions regarding the decedent's functional status, mental awareness, and time spent in institutions. RESULTS: Approximately 14% of all decedents aged 65 years and older were defined as fully functional in the last year of life; 10% were defined as severely restricted. Proportions varied with the decedent's age and sex, the underlying cause of death, and the presence of other preexisting conditions. CONCLUSIONS: Results from this survey and future surveys can be used to learn more about "successful agers"--their medical histories, their life-styles, and whether their relative number is increasing or decreasing overtime.

Activities of Daily Living↗
PubMed1991

Population aging patterns: the expansion of mortality.

We used the hypothesis of mortality compression as a framework to examine patterns of mortality from 1962 to 1984. Data from national vital statistics records were used for analysis of the changing age at death for percentiles of the population. Data from the Social Security Administration and the U.S. Census Bureau were used to calculate the force of mortality. The mean age at death for all percentiles, including the oldest groups, has risen during the interval. Examination of the coefficient of variation for the mean age at death suggests that there is a relative increase in the variability of age at death among the oldest old. The available data do not fit a hypothetical sequence of normal density distributions with an increasing mean and declining standard deviation. The force of mortality in those over 85 years appears to be decreasing in a pattern similar to that for those under 85 years. Current mortality patterns suggest an "expansion," rather than compression, of mortality at the oldest ages. Further refinement of these observations, with improved data on mortality among the oldest old, will be helpful in delineating mortality patterns.

Adolescent↗
PubMed1990

Case-control study of in situ and invasive carcinoma of the vagina.

A case-control study of 41 patients with carcinoma in situ (CIS) or invasive cancer of the vagina and 97 community controls was undertaken to identify potential risk factors. Although vaginal and cervical cancers often occur as multiple primaries, only a few common risk factors prevailed. Similar to cervical cancer, low education and family income were risk factors for vaginal CIS and invasive cancer. In addition, history of genital warts was strongly related (RR = 2.9), although other sexual factors were not. Previous genital abnormalities related to subsequent cancer risk, with significant associations seen for vaginal discharge or irritation (RR = 6.1), a previous abnormal Pap smear (RR = 3.8), or an early hysterectomy (RR = 6.7). In addition, there was some evidence that vaginal trauma might be involved, with nonsignificant and independent associations relating to regular douching with preparations other than water or vinegar (RR = 2.7) and frequent washing of the genital area (RR = 2.7). Further studies are needed to determine whether our findings persist among a larger series of cases.

Adult↗
PubMed1989

Full dose subcutaneous heparin therapy.

Anticoagulation is used extensively for the treatment and prevention of thromboembolic disease. Full dose anticoagulation with heparin is usually administered intravenously via continuous 24-hour infusion to avoid complications with intermittent intravenous administration. Continuous intravenous therapy is costly and cumbersome for nurses and patients. Subcutaneous administration of heparin in full dosage offers an attractive therapeutic alternative. This study examines the safety, efficacy, and cost considerations of this form of therapy. Fifteen patients admitted to the hospital for myocardial infarction were evaluated. After the patients were transferred from the cardiac intensive care unit, intravenous heparin was discontinued, while therapeutic anticoagulation was maintained via the subcutaneous route. Complications were limited to local hematoma formation. A cost comparison revealed substantial savings with subcutaneous administration.

Aged↗
PubMed1987

Survival with the acquired immunodeficiency syndrome. Experience with 5833 cases in New York City.

In a cohort of 5833 subjects in whom the acquired immunodeficiency syndrome (AIDS) was diagnosed in New York City before 1986, the cumulative probability of survival (mean +/- SE) was 48.8 +/- 0.7 percent at one year and 15.2 +/- 1.8 percent at five years. The group with the most favorable survival rate--white homosexual men 30 to 34 years old who presented with Kaposi's sarcoma only--had a one-year cumulative probability of survival of 80.5 percent; that group was used as the reference group in assessing the effect of five variables: sex, race or ethnic background, age, probable route of acquiring AIDS (risk group), and manifestations of AIDS at diagnosis. The range in the mortality rate was greater than threefold, depending on these variables. Black women who acquired the disease through intravenous drug abuse, for example, had a particularly poor prognosis. The manifestations of disease at diagnosis had the most influence on survival, accounting on average for 56.3 percent of the excess risk. This variable was followed in importance by age (12.2 percent), race or ethnicity (10.6 percent), risk group (8.4 percent), and sex (8.0 percent), with 4.5 percent of the risk attributable to interactions between variables. When we compared subcohorts based on the year of diagnosis (1981 through 1985), we found a significant improvement in the one-year cumulative probability of survival among subjects with Pneumocystis carinii pneumonia, but not among subjects without P. carinii pneumonia.

Acquired Immunodeficiency Syndrome↗
PubMed1986

The role of hospice in reducing the impact of bereavement.

Survivors of patients in a randomized controlled trial of a hospital-based hospice were followed for 18 months after the patient's death. There were no significant differences in the anxiety or depression between hospice survivors (N = 56) and controls (N = 40). Neither were there significant differences in bed days, physician visits or scores on a 6-item health scale, even when the survivor's initial health status was held constant. No clear pattern of differences emerged in social participation, contacts with friends or relatives, smoking or drinking behaviors. We conclude that hospice care did not provide any protective effect for the bereavement period.

Alcohol Drinking↗
PubMed1985

Hospice effectiveness in controlling pain.

Terminal cancer patients were randomly assigned to receive comprehensive hospice care or traditional medical care. Patients were followed up for two years or until death. Pain was measured by the McGill Pain Scale. Frequency and intensity of cancer-related symptoms were also noted. Over the course of the study, 34% of hospice patients and 21% of control patients never reported pain. No significant differences between the two groups could be detected in either the proportion of patients with pain at any time or the intensity of pain. Neither were there differences in the intensity or frequency of cancer-related symptoms. The presence of pain was associated with the presence of other symptoms; a significant correlation was found between the levels of depression and anxiety and pain scores.

Analgesics↗
PubMed1985

Hospice role in alleviating the emotional stress of terminal patients and their families.

Terminally ill cancer patients in a Veterans Administration hospital were randomly assigned to receive hospice care. Follow-up evaluation through the time of death revealed no significant differences in anxiety or depression between hospice or control patients, but hospice patients exhibited significantly greater improvement in two of three measures of satisfaction (interpersonal care and involvement in care decisions). Hospice patients' significant others (SOs) showed some decrease in anxiety and greater satisfaction with involvement in care than did control SOs. The differences were attributable in part to hospice staff better meeting SOs' perceived needs.

Anxiety↗
PubMed1985

Acute hospitalization in a home for the aged.

All acute hospitalizations from a 229-bed home for the aged for a four-year period were analyzed. Of 373 residents eligible for the study, 239 individuals were hospitalized a total of 503 times. Five patients were admitted seven times. Median length of stay was 9.4 days. Of 235 primary diagnoses, only nine occurred at least 1% of the time. Sixty-six different complications, representing 131 occurrences, were noted during hospitalization. Hospital mortality was 11.7%. Of first admissions 9.2% died and 19% of survivors required a higher level of care. One year later 40% had died and 17% were at a higher level of care. Logistic regression identified four variables significantly associated with death within six months of first hospitalization: age, hospital complication, surgical procedure, and diagnosis of acute myocardial infarction. Compared with nonhospitalized residents, hospitalized residents were more likely to be male, but no age effect was noted. Survival differences did not emerge until the third year of the study.

Acute Disease↗
PubMed1984

Health effects associated with exposure to radioactively contaminated gold rings.

This study was designed to assess the health risks associated with exposure to radioactively contaminated gold rings. A group of 135 exposed individuals, who were identified through a statewide jewelry screening program, were studied to determine the frequency of carcinoma and other skin problems on the ring finger. Severity of skin problems increased with increasing length of wear. Forty-one of the exposures were associated with mild to severe skin problems. Nine of the individuals studied were diagnosed as having histologically confirmed squamous cell carcinomas at the site of exposure. The incidence of skin cancer on the ring finger was eleven times that expected for men and forty-five times that expected for women. These data indicate that physicians who have patients with skin lesions of the ring finger should be aware of the possibility of exposure to a radioactive gold ring.

Adult↗
PubMed1980

Reporting of gonorrhea by private physicians: a behavioral study.

Physicians in the Denver Metropolitan Area were randomly assigned to study groups and exposed to an intervention designed to test current hypotheses concerning the reasons for underreporting of gonorrhea (lack of saliency in the request, patient interference, violation of the physician-patient relationship, insufficient rewards and excessive administrative cost to the reporter). A periodic telephone contact, initiated by the Health Department and requiring only contact between clerical personnel, more than doubled the number of reported cases. The effect was most striking for those who had not previously reported, and for doctors who practiced alone. An estimate of 42 per cent was obtained for the proportion of cases reported, substantially higher than that produced by retrospective surveys based on recall. The impact of undernotification on total morbidity will vary with the preexisting mix of public and private reporting. The telephone reporting system appears to be an inexpensive and effective program tool for determining that impact locally.

Behavior↗
PubMed1979

Chlamydial infection of mothers and their infants.

In 340 women, cultured prospectively during their pregnancies, the rate of infection with Chlamydia trachomatis was 8.8%. The women with positive cultures tended to be younger and more often single and black than their counterparts with negative cultures. There were no statistically significant clinical differences between the two groups. Eighteen children born to Chlamydia culture-positive women and 16 born to negative women were followed for nine months to examine the potential effects of maternal infection on infant growth, development, and illness. Eleven of 18 study patients had culture or tear antibody evidence of Chlamydia infection, as opposed to one of the control subjects (P = 0.00093). Eight of these 11 had clinical conjunctivitis, and two of the eight developed pneumonia. Growth retardation and developmental abnormalities were not detected in either group. It is concluded that maternal carriage of C. trachomatis is associated with a high incidence of clinical illness in the offspring.

Adolescent↗