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Biomedical subjects

R Schilling

Publications and source records attributed to R Schilling.

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

Type, prevalence, and significance of core promoter/enhancer II mutations in hepatitis B viruses from immunosuppressed patients with severe liver disease.

Little is known about the functional significance of hepatitis B virus (HBV) sequence heterogeneity. Here we analyzed the type, frequency, and function of mutations in the core promoter/enhancer II region of HBV in immunosuppressed patients. The major HBV population in immunosuppressed patients with severe liver disease had deletions, insertions, and/or base changes in this region. Such mutations were not found in immunosuppressed patients with mild disease. Except for two mutations, all created a hepatocyte nuclear factor 1 (HNF1) binding site or a potential HNF3 binding site. Occasionally, known binding sites for C/EBP and HNF4 were additionally duplicated. Eleven mutated core promoter prototype sequences were functionally tested in the context of a wild-type genome by transfection in Huh7 cells. Despite the diversity of mutations tested, all decreased steady-state levels of pre-C mRNA drastically and increased those of the C mRNA/ pregenomic RNA. This correlated with reduced levels of secreted hepatitis B e antigen and increased intracellular levels of core and Pol proteins and replicative HBV DNA intermediates. The levels of secreted HBV DNA-containing particles were also increased although most of the mutations reduced the levels of pre-S/S mRNA and pre-S1, and pre-S2 proteins as well as secretion of hepatitis B surface antigen. These data reveal a novel class of HBV variants with HNF1 binding sites in the core promoter which are characterized by a defect in hepatitis B e antigen expression, enhanced replication, and altered protein levels, all probably mediated by altered transcription factor binding. The phenotype of these variants and their prevalence only in immunosuppressed patients with severe liver disease may indicate that they play a role in pathogenesis.

Amino Acid Sequence↗
PubMed1996

Patients with personality disorders: functional status, health care utilization, and satisfaction with care.

BACKGROUND: Personality disorders are believed to occur in approximately 10% of the adult population, yet they are rarely diagnosed in primary care settings. This study compares the functional status, health care utilization, and satisfaction with care for patients who were at high risk for a personality disorder with those who were at low risk. METHODS: Patients at high risk for personality disorders were identified using a standardized psychometric instrument, the Structured Clinical Inventory for DSM-III Axis II (SCID-II). After assigning patients to risk categories, responses were compared on the Medical Outcomes Study Short Form-36, the Beck Depression Inventory, the CAGE alcohol use questionnaire, and an adapted version of the RAND Patient Satisfaction Questionnaire. RESULTS: Patients who were at high risk for any personality disorder had lower functional status, higher risk for depression or alcohol abuse, and lower levels of satisfaction with care. These differences could not be explained by demographic or socioeconomic differences between high- and low-risk patients. Being at high risk for specific personality disorders, such as borderline, schizoid, and dependent disorders, was associated with higher degrees of functional impairment and greater risk for depression and alcohol abuse. Patients at high risk for other disorders, such as obsessive-compulsive, narcissitic, and schizotypal, consistently showed no appreciable degree of impairment as compared with patients at low risk for any personality disorder. Medical care utilization was no higher when personality disorders were examined in aggregate, but a marked increase in utilization was noted among patients at high risk for histrionic and dependent disorders. CONCLUSIONS: Among primary care patients, having a personality disorder is associated with lower functional status, lower satisfaction with health care, and higher risk for depression and alcohol abuse.

Adult↗
PubMed1996

[Significance of isthmic spondylolisthesis in expert assessment of occupational disease of the lumbar spine].

In Germany, disc-related disease of the lumbar spine is eligible for workmen's compensation if caused by long-standing work requiring heavy lifting or carrying or extreme trunk-bending (BK 2108). The appraisal of causality is particularly difficult if conditions like isthmic spondylolisthesis preexist. 250 consecutive appraisals in nurses concerning the BK 2108 were analysed, 12 applicants (4.8%) had isthmic spondylolisthesis (4.6% of females and 5.9% of males). The literature about the natural history of isthmic spondylolisthesis is reviewed. A person who has isthmic spondylolisthesis is up to 25% more likely to have significant back trouble during his life than one who does not. Back pain in adults associated with spondylolisthesis is usually heralded by back pain in the late teens or early twenties. Progression of the slip is rarely seen after maturity. Due to the loss of protection by the posterior elements the disc is prone to premature degeneration which, however, does not become clinically apparent in most cases. Longstanding vocational heavy lifting or excessive stooping can negatively influence the natural history of isthmic spondylolisthesis. It can produce symptomatic disease in a person who would otherwise have remained asymptomatic, or it can cause a deterioration in those with preexisting symptoms. Criteria for the appraisal of causality are proposed. It is stressed that the course of the disease in relation to age and vocational strains has to be analysed in each individual case.

Adolescent↗
PubMed1995

Urban rape survivors: characteristics and prevalence of human immunodeficiency virus and other sexually transmitted infections. Multicenter Crack Cocaine and HIV Infection Study Team.

OBJECTIVE: To determine the prevalence of recent rape, the characteristics or recent rape survivors, and the seroprevalence of human immunodeficiency virus (HIV), syphilis, and genital herpes (HSV-2) among recent rape survivors. METHODS: We surveyed women 18-29 years old who were recruited from places unassociated with medical or drug treatment or the criminal justice system in three urban communities where illicit drug use is common. We compared characteristics and HIV, syphilis, and HSV-2 seroprevalence of women who reported recent rape with those of women who denied recent rape. RESULTS: One hundred fifty-one of 1104 (13.7%) women reported having been raped in the year before our interview. Rape survivors were more likely than women who denied recent rape to smoke crack cocaine (86.8 versus 56.7%; odds ratio [OR] 5.0, 95% confidence interval [CI] 3.2-7.8), to be homeless (17.2 versus 6.1%; OR 3.2, CI 2.0-5.2), to report a recent sexually transmitted disease (38.7 versus 18.7%; OR 2.7, CI 1.9-3.9), and to be infected with syphilis (42.4 versus 28.4%; OR 1.9, CI 1.3-2.6) and HSV-2 (71.9 versus 57.5%; OR 1.9, CI 1.3-2.8). Survivors were more likely to acknowledge any HIV risk behavior (including sex work) (85.4 versus 49.5%; OR 5.9, CI 3.9-9.0) and to be HIV-infected (23.3 versus 13.4%; OR 1.9, CI 1.3-2.9). Rape was not independently associated with HIV (OR 0.8, 95% CI 0.4-1.3), syphilis (OR 0.9, 95% CI 0.6-1.3), or HSV-2 (OR 1.3, 95% CI 0.9-2.0) infections after adjustment for confounding factors. CONCLUSION: One in seven women reported being raped recently. Rape was most common among sex workers, crack smokers, and the homeless. Most survivors reported HIV risk behaviors, and many were HIV-infected. Programs to prevent repeated rape, voluntary HIV counseling and testing, and other medical and social services may benefit survivors in these and similar communities.

Adolescent↗
PubMed1994

Levels of physician involvement with patients and their families. A model for teaching and research.

BACKGROUND: We present an educational model that describes physician skills for addressing psychosocial concerns of patients, ranging from basic medical questions to in-depth psychotherapy. This model improves upon previously published models by integrating into one hierarchy levels of physician involvement with individual patients and levels of involvement with families. METHODS: Ten faculty family physicians were videotaped during 200 office visits. Interviews were categorized according to the model, with a 79% interrater agreement. RESULTS: Most visits involved the lower three levels of physician involvement (41%, level 1; 35.5%, level 2; and 23%, level 3). Discussion of family context occurred in a majority (58.5%) of visits, primarily when another family member was in the room and during preventive care visits. Higher levels were associated with longer visits--about 3 minutes more for each additional level. CONCLUSIONS: This investigation suggests that the levels of physician involvement model can be reliably measured. This model may be a useful tool for education and research, particularly the study of physician interview skills appropriate to family medicine.

Adult↗
PubMed1992

[Calcium, phosphorus and vitamin D administration in infancy. Unsolved questions].

In premature infants calcium and phosphate supplementation should be continued until the infants weigh more than 2000 g, because osteopenia of prematurity has been described after discontinuation of the supplements at body weights of < 1800 g. Premature infants generally receive substantially more vitamin D than their daily requirements (> 400 IU), but then are no studies on the side effects of high vitamin D intake (hypercalciuria?). The extremely high calzitriol concentrations in plasma of premature infants who receive Ca/P supplements indicate that maximal stimulation of Ca/P absorption is necessary and present supplementation could still be inadequate. The daily vitamin D requirements of term infants are between 100 and 400 IU and no supplements are necessary if the infants are fed vitamin-D-fortified formulas. The high prevalence of rickets in infants on macrobiotic or vegetarian diets indicates that those infants should receive calcium and vitamin D supplements.

Bone Diseases, Metabolic↗
PubMed1991

Pernicious anaemia in the textile industry.

The objective was to examine whether the observed excess mortality from anaemia in textile and clothing workers was associated with any specific anaemia type or occupational activity. The design was a death certificate based case-control study of textile and clothing workers who died in England and Wales in the years surrounding the decennial censuses of 1961, 1971, and 1981. The main outcome measures were type of anaemia, place of residence, place of birth, and occupation. The frequency of the different types of anaemia in textile and clothing workers differed from that of England and Wales with relatively more deaths from pernicious anaemia than in the country as a whole (74 observed v 55 expected deaths). Within the industry, those whose death was attributed to pernicious anaemia were more than twice as likely as other textile and clothing workers to have worked in textile mills (odds ratio = 2.4, 95% confidence interval 1.4-4.2). These results could not be explained by age, sex, place of residence, or place of birth, and review of the death certificates did not suggest that pernicious anaemia as a cause of death had been recorded in error. Historical support for the finding was found in the Registrar General's 1931 decennial supplement on occupational mortality, in which the standardised mortality ratio from pernicious anaemia in male textile mill workers was estimated to be twice that of the general population. In conclusion, occupational factors, specifically work in textile mills, could be implicated in the pathogenesis of pernicious anaemia. The aetiology of this disease is not well understood and further study of pernicious anaemia in textile mill workers is required.

Adolescent↗