Biomedical subjects
S J Cutler
Publications and source records attributed to S J Cutler.
The methodology of social scientific research in gerontology: progress and issues.
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Successful in-vitro cultivation of Borrelia recurrentis.
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Acrodermatitis chronica atrophicans: a case report and review of the literature.
We report a 55-year-old woman with acrodermatitis chronica atrophicans (ACA) and a peripheral sensory neuropathy. ACA is an uncommon late cutaneous manifestation of Lyme disease, which follows disseminated Borrelia burgdorferi infection. This is the second published case from the U.K. since serological diagnosis has been available. In this patient the diagnosis was confirmed by serology using a sensitive enzyme-linked immunosorbent assay and immunoblotting techniques. B. burgdorferi DNA was demonstrated in the affected skin using the polymerase chain reaction, although staining and cultures for the organism were negative. Recommended treatment of ACA is with oral doxycycline 100 mg twice daily for 28 days, but our patient did not respond well to this regimen. She was therefore treated with ceftriaxone intravenously for 21 days, which resulted in a rapid symptomatic and clinical response.
Predictive value of serology in diagnosing Lyme borreliosis.
AIMS: To compare the predictive value of immunoblotting and enzyme linked immunosorbent assay (ELISA) in diagnosing Lyme borreliosis. METHODS: An ELISA using a whole cell sonicate of the B31 strain of Borrelia burgdorferi was used to screen samples submitted for Lyme borreliosis serology. A total of 1222 serum samples reactive in the ELISA were tested by immunoblotting also using the B31 strain. Patients with other spirochaetal diseases were tested by both methods to assess specificity, while those with erythema migrans were used to evaluate sensitivity. Subjects with different clinical conditions, which may have been associated with Lyme borreliosis, were tested using both techniques. RESULTS: Only 16.3% of serum samples from patients submitted for Lyme borreliosis serology which were reactive by ELISA were confirmed as positive by immunoblotting. This is unlikely to represent a sensitivity problem as 51% of samples from 53 patients with erythema migrans were detected by immunoblotting compared with only 28% by ELISA. Patients whose samples were negative by ELISA were also negative by immunoblotting. Serum samples from patients with relapsing fever were reactive in both ELISA and by immunoblotting, but for other test groups immunoblotting offered increased specificity. CONCLUSIONS: Not all ELISA results could be confirmed by immunoblotting. Yet immunoblotting was both more sensitive and specific than ELISA techniques. As a result of these observations all ELISA results should be serologically confirmed by immunoblotting. Though immunoblotting is not suited to large scale screening of samples, it can be used satisfactorily in conjunction with ELISA methods to improve the predictive value of serological tests for Lyme borreliosis.
Predictors of use of paid help among older people living in the community.
We examined the impact of level of impairment, access to informal services, and household income on the use of paid help by impaired older people using data from the Supplement on Aging to the 1984 National Health Interview Survey. Consistent with previous research, results indicate that impaired elders turn to paid help when informal resources are unavailable. Paid help is more prevalent among elderly people with adequate economic resources and with access to entitlements. Income exerts the greatest impact on situations in which older people have the most discretion regarding acceptance of and sources of help.
Simplified method for the interpretation of immunoblots for Lyme borreliosis.
Interpretation of immunoblot results for Lyme borreliosis remains an area of controversy. This study was undertaken to devise a simple method which incorporated distinctions between specific and non-specific bands. A numerical value was assigned to bands reflecting their relative importance. This scheme was evaluated with sera from 61 forestry workers, which were previously tested by immunoblotting and interpreted subjectively. These results were reported as five separate categories representing levels of reactivity. A total of 72% (44) of sera fell into the same categories as they were originally reported. The method was also assessed with 40 sera routinely submitted for Lyme borreliosis serology. These were interpreted by two members of staff without previous experience of immunoblotting. Their results gave 80% and 72.5% agreement with those of an experienced person used to reading immunoblots for Lyme borreliosis.
Small-fiber dysfunction in a Borrelia burgdorferi infection.
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Availability of personal transportation in households of elders: age, gender, and residence differences.
Using data from the 1% Public Use Microdata Sample of the 1980 Census of Population and Housing, we examined correlates of the availability of personal transportation in the households of elders. Results indicate that the availability of vehicles decreases with age, is highest for rural farm and lowest for central city residents, and is lower for women. Only 1.3% of rural farm men 65-74 lack access to a vehicle, but 57.8% of central city women 85 + are without personal transportation in their households.
Predictors of self-reported problems of confusion among the aged.
Responses to questions on the 1984 Supplement on Aging to the National Health Interview Survey (NHIS) about the experience of personal confusion revealed that two-thirds of those interviewed reported never having an episode of confusion during the preceding year. Of those who reported episodes, fewer than one in five said they were happening with increased frequency. The many meanings of confusion found in the literature prompted a modest local study of what respondents understood by the term when asked the NHIS questions. Of those who admitted occasional confusion, almost two-thirds gave definitions that included memory loss or forgetfulness. Consequently, increased frequency of memory problems and difficulty in remembering were included with other variables in the analyses to identify significant predictors. They emerged the single best predictors of how often a respondent reported getting confused. Others were change in health status, number of functional limitations, educational attainment, and vision problems.
Lyme disease and localized scleroderma--no evidence for a common aetiology.
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Correlates of senior center participation: a national analysis.
This paper presents results of a logit regression analysis of the correlates of senior center participation for a national sample of 13,737 elders from the Supplement on Aging of the 1984 National Health Interview Survey. Significant characteristics were higher levels of social interaction, decreasing income, living alone, fewer ADL-IADL difficulties, being female, and living in suburbs and rural nonfarm areas. Curvilinear relationships between center use and age and education were found. Race, self-reported health status, and residence in urban and rural farm areas were nonsignificant when the other variables were controlled.
Fatal Lyme carditis and endodermal heterotopia of the atrioventricular node.
A fatal case of Lyme carditis occurring in a Suffolk farmworker is reported. Post-mortem examination of the heart showed pericarditis, focal myocarditis and prominent endocardial and interstitial fibrosis. The additional finding of endodermal heterotopia ('mesothelioma') of the atrioventricular node raises the possibility that this could also be related to Lyme infection and account for the relatively frequent occurrence of atrioventricular block in this condition. Lyme disease should always be considered in a case of atrioventricular block, particularly in a young patient from a rural area. The heart block tends to improve and therefore only temporary pacing may be required.
Differences in the household composition of elders by age, gender, and area of residence.
Using a new procedure for coding the relationships of elders to other household members, we examined age, gender, and area-of-residence differences in household type and generational composition. The majority of elders live in some form of family household; most prevalent are two-person, married-couple-only households at ages 65-79, one-person households at ages 80-89, and two-generation households at ages 90+. Overall, elders are more likely to live in two- than in three-generation households.
Comparison of immunofluorescence and enzyme linked immunosorbent assays for diagnosing Lyme disease.
A new enzyme linked immunosorbent assay (ELISA) method was assessed in parallel with an indirect immunofluorescence assay (IFA) for the serological testing of specimens submitted for detection of Lyme disease. Wells of an ELISA microtitre plate were coated with sonicated whole cells of Borrelia burgdorferi in carbonate buffer. After overnight incubation at 4 degrees C the plates were washed three times, then incubated at 37 degrees C for an hour sequentially with a blocking solution, diluted test serum, anti-human IgG horseradish peroxidase conjugate, and finally for half an hour at room temperature with o-phenylenediamine substrate before being read at 492 nm. Absorbance results were converted into arbitrary ELISA units. Of a total of 1760 sera, 146 (8.3%) were positive: of these 92 (63%) were positive by both methods, five (3.4%) by IFA alone, and 49 (33.6%) by ELISA alone. The ELISA was better suited for testing large numbers of specimens and easier to interpret than IFA.
Informal and formal health care systems for the rural elderly.
The preceding sections have been an attempt to touch on a broad spectrum of issues related to the health care of older persons living in the rural United States. This article was intended to be an overview of research issues and, as a consequence, we have been unable to go into great depth in any one area of inquiry; we have certainly not included all of the research questions on areas where present knowledge is incomplete. In broad terms, we suggest that future rural health services research on the elderly be concentrated on the following five major categories of inquiry: --A better understanding of the location and distribution of the elderly in rural America --A better understanding of the life conditions affecting the health of the rural elderly --A better understanding of the health status of the rural elderly --A better understanding of the development, delivery, and impact of health services for the rural elderly, and --A better understanding of the methodological and theoretical difficulties of studying the health and health care of the rural elderly.
Evaluation of the oxoid signal system for detection of mycobacteria.
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Investigation of the effect of heat enhancement on the growth of mycobacteria in radiometric medium.
The enhancement of the growth rate of 11 clinical isolates of mycobacteria, covering six species, were investigated in vials of Middlebrook 7H12 medium which had previously been heated to 60 degrees C, 70 degrees C or 80 degrees C. The optimal temperature which enhanced growth was 70 degrees C. The enhancing effect remained stable for over 3 months. Trypsin treatment of the medium abolished the enhancing effect of heat, but this could be restored by the addition of heated or unheated bovine serum albumin. Protein electrophoresis demonstrated altered electrophoretic mobility of heated bovine serum albumin. It is suggested that this altered bovine serum albumin is the component which promotes enhanced mycobacterial growth.