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Biomedical subjects

S Brooks

Publications and source records attributed to S Brooks.

At least 55 records · Page 3Linked to original sources
PubMed1995

The immunization of children enrolled in the Special Supplemental Food Program for Women, Infants, and Children (WIC). The impact of different strategies.

OBJECTIVE: To assess the impact of different interventions to increase measles vaccination coverage among preschool children enrolled in the Special Supplemental Food Program for Women, Infants, and Children (WIC). DESIGN: Public health intervention trial. SETTING: Six volunteer WIC sites in New York City. STUDY PARTICIPANTS: Children aged 12 to 59 months presenting for WIC certification between April 1 and September 30, 1991, who were eligible for measles vaccination. INTERVENTIONS: Two WIC sites were assigned at random to one of three immunization strategies: (1) escort: child was escorted to a nearby pediatric clinic for immunization; (2) voucher incentive: the family returned monthly, rather than every 2 months, to pick up WIC food vouchers until the child was immunized; or (3) referral: the family was passively referred for immunization. MAIN OUTCOME MEASURE: Proportion of eligible children receiving measles vaccination. RESULTS: Of children eligible for measles immunization, 74% (618/836) were immunized. Children at escort sites were 5.5 times (relative risk [RR] = 5.5; 95% confidence interval [CI], 3.7 to 8.1) and those at voucher incentive sites were 2.9 times (RR = 2.9; 95% CI, 1.9 to 4.5) more likely to be immunized than children at referral sites. Children were immunized more rapidly at escort sites (median, 14 days) and voucher incentive sites (median, 26 days) than at referral sites (median, 45 days; P < .001). CONCLUSIONS: Both escort and voucher incentive models resulted in more children being immunized more rapidly than passive referral. Because of ease of administration, voucher incentives may be a more suitable immunization intervention for use at WIC sites, with addition of escort where feasible.

Female↗
PubMed1995

Haematological and acute-phase responses associated with delayed-onset muscle soreness in humans.

Delayed-onset muscle soreness following unaccustomed or eccentric exercise is associated with inflammation, tissue necrosis and the release of muscle enzymes (Newham et al. 1983). We have investigated the time course of changes in circulating leucocytes and serum levels of some acute phase reactants, serum creatine kinase activity (CK) and muscle pain after a 40-min bout of bench-stepping exercise in eight healthy untrained subjects. Leg muscle soreness was greatest 2 days after the exercise bout. Peak serum CK values [mean (SD) 540 (502) IU.1-1] occurred 1-7 days post-exercise. Serum C-reactive protein (CRP) was unchanged from pre-exercise levels [7.8 (3.4) mg.1-1] immediately post-exercise [7.9 (2.3) mg.1-1] but rose to a peak of 17.0 (3.9) mg.1-1 1 day post-exercise, thereafter declining to basal levels. Serum levels of iron and zinc fell below pre-exercise levels for 1-3 days post-exercise. Serum albumin, IgG and IgM fell below pre-exercise levels from 1 day post-exercise, reaching minimal values (about 80% of basal levels) at 7 days post-exercise. The exercise did not appear to significantly affect serum levels of alpha-1-antitrypsin and alpha-1-acid glycoprotein. Two and three days after the exercise bout the circulating numbers of total leucocytes, neutrophils, monocytes and basophils fell 15-20% below pre-exercise levels, whereas lymphocytes, eosinophils and platelets were unchanged. The results indicate that a rapid acute phase inflammatory response is initiated within 1 day of a bout of exercise that induces delayed-onset muscle soreness, and that any later tissue necrosis that may occur is not accompanied by further marked changes in acute-phase reactants such as CRP.

Acute-Phase Proteins↗
PubMed1995

Cardiorespiratory, hormonal and haematological responses to submaximal cycling performed 2 days after eccentric or concentric exercise bouts.

Eccentric muscle actions are known to induce delayed-onset muscle soreness (DOMS) and muscle weakness (reduced static strength and dynamic peak power output) that may persist for several days. The aim of the present study was to determine whether DOMS-inducing exercise affects physiological responses to subsequent submaximal dynamic exercise. Physiological and metabolic responses to a standardized exercise task were measured 2 days after the performance of an eccentric or concentric exercise bout. Six healthy, untrained male subjects aged 30 +/- 7 years (mean +/- S.D.) performed repeated eccentric contractions during 30 min of bench stepping (47-cm step, 15 steps min-1). On another occasion, they performed concentric contractions by walking uphill (8% incline) for 30 min at 5 km h-1, which elicited a similar heart rate response to bench stepping. Two days after the eccentric or concentric exercise, the subjects cycled for 15 min on an electrically braked cycle ergometer at a work rate (172 +/- 37 W) equivalent to 80% VO2 max. The order of the preceding treatments was randomized and the treatments were carried out 2 weeks apart. Two days after the eccentric exercise, all subjects reported leg muscle soreness and exhibited elevated levels of serum creatine kinase activity (P < 0.01) and plasma cortisol concentration (P < 0.05). After uphill walking, the subjects were not sore and serum creatine kinase activity was unchanged. Minute volume, breathing frequency, respiratory exchange ratio, heart rate, rating of perceived exertion, venous blood lactate concentration and plasma cortisol concentration were all higher (P < 0.05) during cycling after eccentric exercise compared with after uphill walking. Increases in plasma catecholamine concentrations and numbers of circulating leucocytes after cycling at 80% VO2 max for 15 min were similar under both experimental conditions, but the delayed leucocytosis (at 150 min post-exercise) was significantly greater (P < 0.01) for the post-eccentric exercise condition. We conclude that dynamic submaximal exercise performed 2 days following exercise with a large eccentric component produces physiological responses that are indicative of a higher relative exercise stress. It is likely that such effects will significantly limit the level and duration of exercise that can be achieved in subsequent training bouts over several days.

Adult↗
PubMed1994

The physician decision-making process in transferring nursing home patients to the hospital.

BACKGROUND: Each year more than 25% of nursing home patients are transferred to the emergency department or hospital for evaluation and treatment of infection. These transfers may have an adverse impact on the quality and cost of patient care. This study examined physician assessment and management of acute infections in the nursing home. METHODS: A cross-sectional study was conducted of all acute urinary tract infections and lower respiratory tract infections occurring from February through June 1991 in eight randomly selected urban nursing homes. The numbers of transfers to the emergency department of hospital were recorded along with identification of the clinical, psychosocial, and institutional factors that influenced the physician's decision to transfer. RESULTS: Three hundred fifty-nine patients had 258 urinary tract infections and 219 respiratory tract infections. Eighty-one (17%) of these events resulted in transfer to a hospital for evaluation (16/81) and/or admission (65/81). Less than one third (30.4%) of the events caused the patient to be examined in the nursing home by a physician before the decision to transfer to the hospital. The mean time between the staff notification of an acute event and physician response by telephone was 5.12 hours. Independent mobility (P < or = .05), a transfer to the hospital during the previous 6 months (P < or = .01), and fewer nursing home laboratory tests and treatments (P < or = .01) were all associated with hospital transfer. CONCLUSIONS: In this sample of acutely ill nursing home patients, physicians collected limited clinical data before the decision to transfer. Although some transfers may be appropriate, a reduction in the transfer rate may reduce health care costs and limit the risk of iatrogenesis, thus improving the outcome of acute illnesses occurring in the nursing home.

Acute Disease↗
PubMed1994

AIDS: the unwelcome visitor.

AIDS beds are still hard to find outside of a few big cities, because operators are concerned that the stigma of the disease will cause them to lose staff members and geriatric residents. But as the epidemic worsens, more facilities will be expected to admit persons with AIDS. Caregivers who have begun to address the unique social and medical needs of this patient group have experienced satisfaction in helping those truly in need.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Risk factors and mortality among black, Caucasian, and Latina women with acute myocardial infarction.

The purpose of this study was to examine the clinical outcome of acute myocardial infarction among women of three ethnic/racial groups and to determine whether observed differences in outcome are explained by differences in associated risk factors. Nine hundred seventeen (917) consecutive admissions occurred among 810 women, of whom 347 (42.8%) were Caucasian, 258 (31.9%) were black, and 205 (25.3%) were Latina. The overall mortality rate was 13%; the Caucasian rate was significantly higher than the Latina rate (16.9% vs 7%, p < 0.01), as was the black rate (13.8% vs 7%, p < 0.05). Comparing survivors with nonsurvivors among the three groups, hypertension was more common for survivors among blacks, as was a history of angina; in-hospital congestive failure was associated with a higher mortality for blacks and Caucasians, as was in-hospital angina for Caucasians. Univariate and multivariate logistic regression for the outcome variables of congestive failure, in-hospital angina, and mortality, showed race to be a significant factor in the lower mortality rate for Latinas in the univariate analysis. In the multivariate analysis, only in-hospital angina and congestive failure significantly influenced mortality. In this study of myocardial infarction among women of lower socioeconomic status, factors other than race were the primary influences on outcome.

Aged↗
PubMed1993

Does the addition of pre-operative skin preparation with povidone-iodine reduce groin sepsis following arterial surgery?

Sixty-four consecutive patients undergoing elective vascular surgery involving exposure of the femoral artery at the groin were randomized to one of two groups. Group A (N = 34) received twice-daily skin preparation with 10% aqueous povidone-iodine for 48 h preoperatively, while group B (N = 30) did not. Both groups were examined on a daily basis following surgery and any discharge from the wound was recorded and sent for bacteriological culture. The groups were well matched for age, sex and the type of vascular graft material used. In group A there were six (18.7%) groin wound infections and in group B there were five (17.2%). In this series of patients the addition of preoperative skin preparation with 10% povidone-iodine to standard peri-operative prophylaxis had no effect on the incidence of postoperative groin wound sepsis.

Adult↗
PubMed1993

Human muscle metabolism during intermittent maximal exercise.

Eight male subjects volunteered to take part in this study. The exercise protocol consisted of ten 6-s maximal sprints with 30 s of recovery between each sprint on a cycle ergometer. Needle biopsy samples were taken from the vastus lateralis muscle before and after the first sprint and 10 s before and immediately after the tenth sprint. The energy required to sustain the high mean power output (MPO) that was generated over the first 6-s sprint (870.0 +/- 159.2 W) was provided by an equal contribution from phosphocreatine (PCr) degradation and anaerobic glycolysis. Indeed, within the first 6-s bout of maximal exercise PCr concentration had fallen by 57% and muscle lactate concentration had increased to 28.6 mmol/kg dry wt, confirming significant glycolytic activity. However, in the tenth sprint there was no change in muscle lactate concentration even though MPO was reduced only to 73% of that generated in the first sprint. This reduced glycogenolysis occurred despite the high plasma epinephrine concentration of 5.1 +/- 1.5 nmol/l after sprint 9. In face of a considerable reduction in the contribution of anaerobic glycogenolysis to ATP production, it was suggested that, during the last sprint, power output was supported by energy that was mainly derived from PCr degradation and an increased aerobic metabolism.

Adenosine Triphosphate↗