Search PubMed⌕ Search

Biomedical subjects

S Belle

Publications and source records attributed to S Belle.

At least 37 records · Page 2Linked to original sources
PubMed1993

Cognitive impairment and the use of health services in an elderly rural population: the MoVIES project. Monongahela Valley Independent Elders Survey.

OBJECTIVE: To describe the patterns of use of health and human services by elderly rural individuals and to determine whether cognitively impaired persons had a distinctive pattern of service utilization. DESIGN: An epidemiological survey and cognitive screening of an age-stratified random community sample. SETTING: The mid-Monongahela Valley, a rural community in Southwestern Pennsylvania. PARTICIPANTS: 1366 non-institutionalized persons aged 65 years and older, fluent in English, and with at least a sixth grade education. MEASUREMENTS: We administered a battery of cognitive screening tests (the Mini-Mental State Examination; Immediate and Delayed Recall of a Story; Immediate and Delayed Recall of a Word List; CERAD modification of the Boston Naming Test; Verbal Fluency for initial letters P and S and for names of Fruits and Animals; Temporal Orientation; Praxis; Clock Drawing; and Trailmaking Tests A and B.) We also obtained basic demographic information and inquired about the use of health and human services in the previous year. RESULTS: Approximately 10% of the sample was classified (by operational criteria) as cognitively impaired. In univariate analyses, cognitive impairment was found to be significantly associated with the use of certain health services: hospitalization in the previous 6 months (odds ratio, OR = 2.1; 95% CI = 1.3, 3.3), previous nursing home use (OR = 9.3; 95% CI = 3.8, 22.9), home health care (OR = 4.6; 95% CI = 2.7, 8.0), social services (OR = 6.5; 95% CI = 3.4, 12.4), mental health services (OR = 2.8; 95% CI = 1.2, 6.2), and the regular use of prescription medications (OR = 2.0; 95% CI = 1.3, 3.2). Visits to physicians were not significantly different between the impaired and unimpaired groups. In a multiple regression model, which included age and educational level, the use of home health care (OR = 3.4; 95% CI = 1.8, 6.4) and social services (OR = 2.3; 95% CI = 1.1, 4.9) remained significantly associated with cognitive impairment. CONCLUSIONS: The association of cognitive impairment with the use of these health and human services underscores the general frailty of the impaired group. These findings also point to potential target groups in the community for further evaluation and services for dementia. The findings support the need for education regarding cognitive impairment and dementia to be made available to providers of these services, particularly informal social services such as those provided by church groups.

Aged↗
PubMed1991

Reactivation of Epstein-Barr virus during early infection with human immunodeficiency virus.

Reactivation of Epstein-Barr virus (EBV) in early human immunodeficiency virus (HIV) infection was investigated in 49 homosexual men who seroconverted to HIV (cases) as compared with 49 matched controls who remained seronegative to HIV during a longitudinal study. EBV infection was reactivated in cases 6 months, but not 12 months, prior to HIV seroconversion as compared with controls and remained reactivated during 18 months of follow-up after HIV seroconversion, as shown by increases in immunoglobulin (Ig) G antibody titers to EBV early antigen. Antibody titers to EBV viral capsid antigen did not differ between cases and controls prior to the time of seroconversion to HIV but were significantly increased among cases by the first seropositive study visit and remained elevated during the 18 months after HIV seroconversion. Total serum IgG levels were increased in cases at the visit of seroconversion, and during 18 months of follow-up, but did not correlate with enhanced IgG production specific for EBV antigens. Significant decreases in numbers of CD4+ cells and increases in numbers of CD8+ cells during this early phase of HIV infection were not associated with changes in patterns of EBV antibody responses. Reactivation of EBV beginning 6 months before HIV seroconversion may have implications regarding the role of this herpesvirus in the pathogenesis of HIV.

Antibodies, Viral↗
PubMed1991

Effects of age, gender, and education on cognitive tests in a rural elderly community sample: norms from the Monongahela Valley Independent Elders Survey.

A random sample of 1,350 persons aged 65 years and older in a rural community underwent cognitive screening as part of a survey to establish a population-based registry of dementing disorders. The screening battery included the neuropsychological tests of the assessment protocol used in the National Institute on Aging multicenter Consortium to Establish a Registry for Alzheimer's Disease (CERAD). This paper reports a large body of normative neuropsychological data from this sample with members of relatively low socioeconomic status. Age, sex, and educational level were found to have statistically significant effects on test scores. The implications of these findings for the establishment of screening cutoff scores are discussed.

Aged↗
PubMed1991

Establishing criterion validity of a computer-based clinical simulation.

Clinical simulations, depictions of real-life patient care situations, have been used extensively in medical education. This study determined the criterion validity of a computer-based simulation which permits natural language interface and runs interactively with videotape to be fair to good (K = .61).

Computer-Assisted Instruction↗
PubMed1989

A histometric analysis of chronically rejected human liver allografts: insights into the mechanisms of bile duct loss: direct immunologic and ischemic factors.

Conspicuous pathologic features of chronic liver allograft rejection include bile duct loss and chronic obliterative arteriopathy. A quantitative histometric analysis was performed to document the extent of bile duct loss, the size of the "vanished" ducts and the extent of chronic obliterative arteriopathy and to determine whether there was any relationship between chronic obliterative arteriopathy and bile duct loss. All failed liver allograft specimens with chronic rejection were reviewed and categorized according to the degree of chronic obliterative arteriopathy, assessed by the degree of luminal narrowing of hilar hepatic artery branches. Histometric analysis of the grafts revealed: (i) there was a loss of small portal arterioles (less than 35 microns); (ii) bile ducts which should accompany arteries less than 35, 35 to 54 or 55 to 74 microns in diameter were missing, with the greatest decrease occurring among the smallest ducts; (iii) bile duct loss was seen in the absence of significant large vessel chronic obliterative arteriopathy, and (iv) the severity of arteriole and bile duct loss, as well as the size of the vanished ducts, was directly proportional to the degree of chronic obliterative arteriopathy. Furthermore, the size of the "vanished" bile ducts in liver allografts appeared to differ from the size of ducts destroyed in primary biliary cirrhosis. These studies offer indirect, but suggestive proof that two mechanisms are operative in the bile duct loss seen in chronic rejection: direct lymphocytotoxicity and ischemic damage.

Adolescent↗
PubMed1989

Reproductive history of women dying of sudden cardiac death: a case-control study.

Reproductive history events may be risk factors for sudden coronary death (SCD) among women. A retrospective case-control study of SCD among women aged 25-64 was conducted in Allegheny County, Pennsylvania. The present analysis focused on a description and analysis involving the childbearing and reproductive history of 67 ever-married female SCD cases and 73 ever-married neighbourhood controls with a mean age of 54.6 and 53.4 years respectively. Information included: age and number of years married, number of children, age at first birth, cardiovascular risk factors, obstetric and gynaecological history. Age and the risk factors, history of hypertension or diabetes, cigarette intake, death of significant other and psychiatric disease, were controlled for in the analysis. More cases than controls experienced their first birth before age 20 (14 of the SCD and 7 controls). However, after adjustment for cigarette smoking status, a strong predictor of sudden cardiac death, the effect of early childbearing did not remain significant for this population. In women less than or equal to 50 years of age, childlessness was not a risk factor for SCD (1 of 16 cases and 2 of 26 controls were childless). However in women greater than 50 years of age, childlessness was a significant predictor of SCD (OR = 6.7 (1.3-32] 12 of 51 cases were childless compared to 2 of 46 controls. After adjustment for aged and other coronary heart disease (CHD) risk factors, the relationship of nulliparity with sudden cardiac death remained in this age group. There was no difference in hysterectomy or miscarriage history or in the total years married between cases and controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Hepatic artery thrombosis after pediatric liver transplantation--a medical or surgical event?

Hepatic artery thrombosis (HAT) is one of the most serious complications after orthotopic liver transplantation, and is associated with a high morbidity and mortality. This study retrospectively reviewed 66 liver transplants in children under the age of 10 years during a year-long period at a single institution. A total of 28 perioperative variables were analyzed to identify responsible factors of HAT. Of the 66 children, 18 (26%) developed HAT within 15 days after the transplant (HAT group); 29 (42%) had an uneventful postoperative course (control group). To avoid the possible influence of other complications 19 patients were excluded. Of the variables compared between the 2 study groups, three surgical factors (diameter of the hepatic artery--greater or less than 3 mm; type of arterial anastomosis--end-to-end versus the use of an iliac graft or aortic conduit; and number of times the anastomosis was redone--one versus more than one), were found to be significantly different (P less than .05) between HAT and control groups. Two medical factors also were significantly different: the use of intraoperative transfusion of fresh frozen plasma (FFP) and the administration of postoperative prophylactic anticoagulant treatment. A heparin and dextran-40 protocol appeared to be effective in preventing HAT (P less than .02). Moreover, after multivariate analysis, anticoagulation therapy was demonstrated to be the major independent variable influencing HAT. A better definition of factors responsible for the occurrence of HAT is required. This study should help in formulating effective methods to decrease the incidence of this dreaded complication after liver transplantation.

Anastomosis, Surgical↗
PubMed1988

Antibody-mediated rejection of human orthotopic liver allografts. A study of liver transplantation across ABO blood group barriers.

A clinicopathologic analysis of liver transplantation across major ABO blood group barriers was carried out 1) to determine if antibody-mediated (humoral) rejection was a cause of graft failure and if humoral rejection can be identified, 2) to propose criteria for establishing the diagnosis, and 3) to describe the clinical and pathological features of humoral rejection. A total of 51 (24 primary) ABO-incompatible (ABO-I) liver grafts were transplanted into 49 recipients. There was a 46% graft failure rate during the first 30 days for primary ABO-I grafts compared with an 11% graft failure rate for primary ABO compatible (ABO-C), crossmatch negative, age, sex and priority-matched control patients (P less than 0.02). A similarly high early graft failure rate (60%) was seen for nonprimary ABO-I grafts during the first 30 days. Clinically, the patients experienced a relentless rise in serum transaminases, hepatic failure, and coagulopathy during the first weeks after transplant. Pathologic examination of ABO-I grafts that failed early demonstrated widespread areas of geographic hemorrhagic necrosis with diffuse intraorgan coagulation. Prominent arterial deposition of antibody and complement components was demonstrated by immunoflourescent staining. Elution studies confirmed the presence of tissue-bound, donor-specific isoagglutinins within the grafts. No such deposition was seen in control cases. These studies confirm that antibody mediated rejection of the liver occurs and allows for the development of criteria for establishing the diagnosis.

ABO Blood-Group System↗
PubMed1987

The neurologic examination in patients with probable Alzheimer's disease.

Abnormal findings on a standardized neurologic examination were compared between patients with a clinical diagnosis of probable Alzheimer's disease (AD) and healthy control subjects. Aside from mental status findings, the most useful examination findings for differentiating AD from control subjects were the presence of release signs, olfactory deficit, impaired stereognosis or graphesthesia, gait disorder, tremor, and abnormalities on cerebellar testing. These abnormalities probably reflect the different areas of the central nervous system that are affected pathologically in AD. In the clinical diagnosis of AD, particular attention should be given to these aspects of the neurologic examination.

Aged↗
PubMed1982

Current surgical management of in situ cancer of the female breast.

Surgical procedures for breast cancer were compared in 468 cases with in-situ and 4,967 cases with invasive lesions. The cases were obtained from the Michigan Cancer Foundation Registry, a Surveillance, Epidemiology, and End Results (SEER) participant, and were incident-resident cases diagnosed from 1973-1978. For single, primary in situ or invasive cancer, the preferred mastectomy was modified radical. Partial and simple resections were used more often than radical procedures for non-infiltrating, especially lobular lesions. For cases with bilateral primates, with at least one in situ, the mastectomy of choice was the simple procedure for the in situ malignancy and modified radical for the invasive cancer. The change in preferred surgery for in situ lesions, from modified radical to simple mastectomy, was not due to any change in strategy for treatment of bilateral invasive disease, which remained modified radical resection.

Adult↗
PubMed1982

Breast parenchymal patterns: analysis of 332 incident breast carcinomas.

A detailed analysis of 332 incident breast carcinomas is presented. The study results indicate that there is validity to the breast parenchymal patterns as an indication of risk for developing breast cancer and that risk is independent of length of follow-up and age of patient. All cases were drawn from a referral-type practice at Hutzel Hospital, Detroit, MI. The cases were compared to controls for computation of relative risk up to and beyond a follow-up period of 48 months. They were also compared to a consecutive series of prevalent breast carcinomas seen at Hutzel Hospital during the 6 years 1975-1980. The extent of disease in the cases described in this report is somewhat more favorable than in a consecutive series of prevalent cancers operated on a Hutzel Hospital. Most breast cancers occur in the P2 breast, a smaller number in the DY, and only 12% in the combined N1P1 type. The conclusions of other investigators regarding parenchymal patterns as risk indicators are reviewed. Particular attention was paid to comparing the length of follow-up and age of patient. There was no diminution of proportions of cases in the P2/N1-P1 or DY/N1-P1 after a 48 month follow-up. There was a significant diminution in the proportion of cases falling into DY/N1-P1 after age 50, and less so in P2/N1-P1. Furthermore, relative risk was unaffected by time or age.

Adult↗
PubMed1980

Familial influences on breast parenchymal patterns.

Some studies accomplished thus far have indicated that mammographic patterns may serve as risk indices for breast cancer. The present investigation was undertaken to determine whether patterns are familial. Mammograms from 110 mothers and their daughters and 122 sister pairs and a like number of unrelated controls matched for patient age, reproductive history, and personal and family history of breast cancer and drawn from the files of the Radiology Department of Hutzel Hospital, Detroit, Michigan, were compared. A familial influence was indicated by the finding that pattern similarities were significantly stronger in test cases than in unrelated controls. This influence appeared to be manifested by premature age changes in daughters and younger sisters and consisted, primarily, of a decrease in DY and an increase in P2 patterns. The data suggest that performing mammography on first degree relatives of women with high risk P2 and DY patterns should be considered.

Adult↗
PubMed1978

Noncancer deaths in cancer and noncancer lineages.

Starting with white probands who were potential milk donors in a program of human milk collection, a series of 2411 family health histories were obtained of the first degree relatives of the probands' parents. A lineage is defined as the parents and siblings of a parent of the proband as well as the parent. 2090 cancers were identified in the 31,939 people. Of the 21,712 persons without cancer in the parents' generation, age-specific death rates were significantly higher in those lineages with at least one cancer. This was true in infants, children and adults for both males and females (p less than 0.001). Cancer may be linked to other morbid conditions by a commonality of heredity, family environment, or perhaps both as necessary antecedents--neither sufficient by itself.

Adolescent↗