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Biomedical subjects

S Rabinowitz

Publications and source records attributed to S Rabinowitz.

At least 19 recordsLinked to original sources
PubMed2002

The use of an oral fluid immunoglobulin G ELISA for the detection of Helicobacter pylori infection in children.

BACKGROUND: Enzyme linked immunosorbent assay (ELISA) evaluation of oral fluid immunoglobulin G (IgG) antibodies to Helicobacter pylori is a unique approach for both epidemiological studies and the diagnosis of infection, especially in children. The use of oral fluid sampling to evaluate specific H. pylori IgG antibodies has advantages over serum, including reduced biohazard risk and noninvasive collection. Oral fluid sampling is fast and involves minimal patient discomfort. Since children facilitate transmission of H. pylori infection, a simple, accurate, noninvasive diagnostic test is necessary for large epidemiologic studies. The aim of our study was to evaluate a new oral fluid ELISA for detection of IgG antibodies to H. pylori in children. MATERIALS AND METHODS: We compared this new oral fluid ELISA with the HM-CAPTM serum ELISA and gastric biopsy histology using 779 oral fluid samples from children collected at 11 clinical sites across the United States. This cohort included 315 children symptomatic for abdominal pain and 464 asymptomatic. All samples were evaluated in a double blind manner. The oral fluid ELISA demonstrated a sensitivity of 76.2% and a specificity of 94.0% in children 2 months old to 201/2 years, as compared with the HM-CAPTM serologic assay. The assay's sensitivity improved to 81.3% in children aged 5 or greater and the specificity remained at 94.0%. When compared with gastric biopsy histology in the same age group, the oral fluid ELISA demonstrated a sensitivity of 71.7% and a specificity of 90.4%. RESULTS: This new oral fluid ELISA is moderately sensitive and offers a very specific method for detecting H. pylori infection in older children, but it is of little value in children under the age of 5 years. CONCLUSIONS: Overall, we conclude that this oral fluid ELISA does not appear to be a helpful clinical tool for the diagnosis of H. pylori infection in children.

Adolescent↗
PubMed2001

Diagnosis and treatment of feeding disorders in children with developmental disabilities.

OBJECTIVES: To determine the results of diagnostic evaluation and the effects of nutritional intervention on energy consumption, weight gain, growth, and clinical status of children with neurodevelopmental disabilities and suspected feeding disorders. METHODS: We studied 79 children with moderate to severe motor or cognitive dysfunction (male:female, 38:41; age, 5.8 +/- 3.7 years) who were referred for diagnosis and treatment of feeding or nutritional problems. Initial assessments included a 3-day calorie intake record, videofluoroscopic swallowing study (VFSS), 24-hour intraesophageal pH monitoring, milk scintigraphy, and esophagogastroduodenoscopy. RESULTS: These studies demonstrated gastroesophageal reflux (GER) with or without aspiration in 44 of 79 patients (56%), oropharyngeal dysphagia in 21 (27%), and aversive feeding behaviors in 14 (18%). Diagnosis-specific approaches included medical GER therapy in 20 patients (25%), fundoplication plus gastrostomy tube (GT) in 18 (23%), oral supplements in 17 (22%), feeding therapy only in 14 (18%), and GT only in 10 (13%). After 24.6 +/- 3.0 months, relative calorie intake, expressed as intake (kcal/d)/recommended daily allowance (RDA, kcal/d), improved significantly (initial:final = 0.78 +/- 0.36:1.23 +/- 0.27). The z scores increased significantly for both weight (initial:final = -2.80 +/- 1.33:-0.81 +/- 0.69) and height (-3.14 +/- 0.98:-2.00 +/- 0.67). Improved subcutaneous tissue stores were demonstrated by increased thickness of both subscapular skinfolds (change = 71% +/- 26%) and triceps skinfolds (38% +/- 17%). After nutritional intervention, the acute care hospitalization rate, compared with the 2-year period before intervention, decreased from 0.4 +/- 0.18 to 0.15 +/- 0.06 admissions per patient-year and included only 3 admissions (0.02 per patient-year) related to feeding problems. CONCLUSIONS: In children with developmental disabilities, diagnosis-specific treatment of feeding disorders results in significantly improved energy consumption and nutritional status. These data also indicate that decreased morbidity (reflected by a lower acute care hospitalization rate) may be related, at least in part, to successful management of feeding problems. Our results emphasize the importance of a structured approach to these problems, and we propose a diagnostic and treatment algorithm for children with developmental disabilities and suspected feeding disorders.children, developmental disabilities, fundoplication, gastroesophageal reflux, gastrostomy, hospitalization, nutrition.

Adolescent↗
PubMed1999

Flexor tendon repair using a stainless steel external splint. Biomechanical study on human cadaver flexor tendons.

A stainless steel external tendon splint was used in repair of cadaver tendons and compared with standard tendon repairs with suture. The splint was combined with a Kessler repair and tested against the Kessler, Becker, and Savage repairs in fresh human cadaver flexor digitorum profundus tendons. Biomechanical testing was done on a tensile testing machine, and load-displacement curves were generated. The repairs using the external tendon splint demonstrated a range of improvement of 32 to 146% in mean maximal tensile strength and a 20 to 185% improvement of mean ultimate tensile strength compared with all other repairs. The external tendon splint is relatively easy to apply to a tendon. The repair is strengthened and becomes capable of withstanding early active range of motion exercises. In vivo testing will be needed to assess the potential clinical usefulness of such a device.

Finger Injuries↗
PubMed1998

Flexor tendon repair using a stainless steel internal anchor. Biomechanical study on human cadaver tendons.

We have developed a stainless steel internal tendon anchor that is used to strengthen a tendon repair. This study tested its use in vitro to produce a repair that can withstand the tensile strength demands of early active flexion. Fresh human cadaver flexor digitorum profundus tendons were harvested, divided, and then repaired using four different techniques: Kessler, Becker or Savage stitches, or the internal tendon anchor. The internal splint repairs demonstrated a 99-270% increase in mean maximal linear tensile strength and a 49-240% increase in mean ultimate tensile strength over the other repairs. It is hoped that this newly developed internal anchor will provide a repair that will be strong enough to allow immediate active range of motion.

Cadaver↗
PubMed1996

Usefulness of the protection motivation theory in explaining hearing protection device use among male industrial workers.

The present study examined the usefulness of personal variables: noise annoyance, and components of the protection motivation theory (R. W. Rogers, 1983) along with social-organizational factors in explaining hearing protection device (HPD) use among Israeli manufacturing workers. Participants were 281 men exposed to harmful noise levels for which routine HPD use is required by regulation. In practice, 3 HPD user groups were identified: nonusers (n = 38), occasional users (n = 125), and regular users (n = 118). HPD use was objectively verified. HPD use was primarily related to the personal variables but not to management pressure, coworker pressure, or family support. The most powerful predictors of HPD use were perceived self-efficacy (for long-term HPD use), perceived susceptibility (to hearing loss), and noise annoyance, together explaining 48% of the outcome variance. These findings have implications for interventions aimed at motivating workers to use HPDs regularly.

Adolescent↗
PubMed1996

Hostility and hearing protection behavior: the mediating role of personal beliefs and low frustration tolerance.

The authors examined whether hostility would negatively be associated with occupational health behavior, namely, the use of hearing protection devices (HPDs). Also examined as possible mediators were the protection motivation theory (PMT) components and low frustration tolerance (LFT). Participants were 226 male industrial workers, all exposed to potentially hearing-damaging noise. Hostility was negatively related to HPD use. It moderately correlated with the PMT components: negatively with perceived susceptibility, severity, effectiveness, and self-efficacy and positively with perceived barriers. Hostility correlated highly with LFT. Regression analyses confirmed the mediating role of perceived barriers, low self-efficacy, and LFT in the negative relationship between hostility and the use of HPDs. Thus, intrapsychic characteristics of hostile people may be significant for hearing protection behavior.

Adolescent↗
PubMed1996

Endoscopic-assisted midface lift utilizing retrograde dissection.

Endoscopic facial surgery is gaining wide acceptance, as results are providing comparable if not superior to the standard, superficial musculoaponeurotic system rhytidectomy, with minimal scarring. Frontal branch facial nerve injury remains a troublesome complication. The purpose of our study was to determine if a subciliary retrograde dissection would decrease facial nerve injury and allow for more accurate midfacial suspension. Fresh cadaver dissections were performed using endoscopic equipment. Anterograde temporal incisions in the scalp and retrograde subciliary incisions were studied. The anterograde temporal dissection was developed deep to the superficial layer of the deep temporal fascia. Retrograde subciliary dissection was subperiosteal. Forty-nine endoscopic-assisted midface lifts were performed. Midfacial suspension was accomplished with nonabsorbable sutures placed in the suborbicularis oculi fascia, anchored to the deep temporal fascia. Two of three endoscopic-assisted procedures done in the anterograde fashion, without a subciliary incision, experienced transient frontal branch injury, which resolved within 6 weeks. The remaining forty-six patients, operated with a combined subciliary and temporal approach, experienced no frontal branch injuries. We have found that the retrograde dissection through a subciliary incision substantially reduced the incidence of facial nerve injury, provided direct visualization of the suborbicularis oculi fascial layer (allowing more accurate midfacial suspension), and reduced total operative time.

Aged↗
PubMed1996

Intestinal perforation 14 years after abdominal irradiation and chemotherapy for Wilms tumor.

A 3-year-old girl underwent left nephrectomy and removal of a tumor thrombus from the inferior vena cava and right atrium in 1978 because of Wilms tumor. Her treatment consisted of tumor bed irradiation (4,000 cGy) and chemotherapy with actinomycin D, vincristine, and doxorubicin. The patient underwent laparotomy 2 months after completion of abdominal irradiation to relieve intestinal obstruction. Fourteen years later, she underwent another laparotomy because of an "acute abdomen" and was found to have perforation of the jejunum in the radiation field. Histopathological examination of resected intestine revealed evidence of severe chronic radiation enteritis, A diagnosis of chronic radiation enteritis should be considered in patients who had received abdominal irradiation and who manifest abdominal pain/vomiting even several years after irradiation.

Abdomen↗
PubMed1996

Preventing burnout: increasing professional self efficacy in primary care nurses in a Balint Group.

Nursing is reported to be a stressful occupation, and chronic stress is often associated with burnout. Many ways of reducing stress have been proposed. Of these, the Balint group method provides a forum in which health professionals can present and attempt to resolve stressful situations with clients, coworkers, or other professionals. Balint groups help health professionals improve coping with psychosocial stressors in a supporting and accepting group atmosphere. This article reports changes in professional self efficacy associated with reduced burnout in a group of 13 nurses working in community based primary care clinics. Results showed significant increases in awareness and ability cognitions after the Balint group and reduced emotional exhaustion and cognitive weariness. The ramifications of these findings are discussed.

Adaptation, Psychological↗
PubMed1995

Correction of congenital indirect hyperbilirubinemia by small intestinal transplantation.

INTRODUCTION: Crigler-Najjar syndrome, type I, is a disease characterized by complete absence of hepatic bilirubin glucuronidation. The congenital indirect hyperbilirubinemia is due to an autosomal recessive deficiency of the enzyme, uridine diphosphate glucuronosyl transferase (UDPGT). The inbred homozygous Gunn rat is also deficient in UDPGT, exhibits unconjugated hyperbilirubinemia, and is an excellent animal model of the Crigler-Najjar syndrome. This study was performed to test the ability of transplanted intestine from normal Wistar rat donors to correct the deficiency in hepatic bilirubin conjugation. MATERIALS AND METHODS: In phase 1, Gunn rats underwent 40-cm heterotopic small-bowel transplants from either Wistar (experimental) or Gunn (control) rats. In phase 2, 15- to 20-cm Wistar-to-Gunn jejunal transplants were placed either heterotopically or orthotopically (in intestinal continuity). All rats were treated with cyclosporin A (CsA), 5 mg/kg per day. Serum bilirubin levels were determined spectrophotometrically at weekly intervals posttransplantation. In phase 2, UDPGT activity was quantitated at 0, 2, 4, and 8 weeks using known quantities of bilirubin as substrate. RESULTS: Total bilirubin levels decreased significantly in the 40-cm heterotopic transplant recipient rats. From the initial values of 7.12 +/- 0.59 mg/dL, levels reached the nadir of 4.23 +/- 0.27 mg/dL. A parallel drop in serum levels of indirect bilirubin was noted (5.04 +/- 0.54 mg/dL to 2.74 +/- 0.23 mg/dL). After 6 weeks, bilirubin levels began to rise toward pretransplant values. In contrast, there was no significant change in bilirubin levels in the control Gunn-to-Gunn rats. Fifteen- to 20-cm heterotopic Wistar-to-Gunn transplants caused a qualitatively similar drop in total and indirect bilirubin levels. Orthotopic (in continuity) Wistar-to-Gunn transplants lowered serum bilirubin levels more rapidly, and the effect was sustained throughout the 8-week study period. By 1 week posttransplantation, total bilirubin levels dropped from 5.11 +/- 0.48 mg/dL to 2.41 +/- 0.16 mg/dL (P < 0.05); data at 8 weeks averaged 1.84 +/- 0.35 mg/dL. Respective data for indirect bilirubin levels were 4.81 +/- 0.45 mg/dL, 2.26 +/- 0.18 mg/dL, and 1.35 +/- 0.39 mg/dL. Wistar rat UDPGT activity in intestine and liver averaged 0.61 +/- 0.05 and 1.88 +/- 0.06 mg bilirubin conjugated/mg tissue per hour, respectively. Enzyme activity in the transplanted intestine persisted throughout the course of the study. CONCLUSION: Transplants of small intestine with known UDPGT activity partially corrected the deficiency in Gunn rats and allayed the hyperbilirubinemia. Since the small intestine is known to contain small but significant amounts of a large number of predominantly hepatic enzymes, bowel transplantation may be an appropriate treatment for this and other similar genetic enzyme deficiencies.

Animals↗
PubMed1994

Teaching interpersonal skills to occupational and environmental health professionals.

An innovative course for teaching communication and interpersonal relationships was delivered to 29 environmental and occupational health professionals. This course aimed to highlight interpersonal and emotional aspects in the professional-client interaction and incumbent communication aspects when consulting team members, colleagues, and nonprofessionals in the occupational arena. Various experiential and other teaching techniques were used. Assessment showed that participants reported the positive features of such a course although few changes in either psychosocial abilities or awareness were evident. Possible ramifications of the findings are discussed.

Adult↗
PubMed1994

Noise exposure, noise annoyance, use of hearing protection devices and distress among blue-collar workers.

OBJECTIVES: This study tested the hypotheses that, in high noise levels [> or = 85 dB(A)], hearing protection devices are used largely by workers sensitive to noise, as reflected by reports of noise annoyance, and that the usage would reduce distress symptoms. METHODS: Data collected from 1587 healthy male blue-collar workers included noise exposure level, noise annoyance, use of hearing protection devices, distress symptoms (somatic complaints and poststress irritability), and possible confounding by age, education and ethnic origin. RESULTS: Multiple logistic regression results indicated that the use of hearing protection devices was related to noise exposure level [odds ratio (OR) 2.94, 95% confidence interval (95% CI) 2.58--3.30], but more so to high noise annoyance (OR 3.03, 95% CI 2.77--3.29), even after control for age, education, and ethnic origin. No interaction was found between noise level and noise annoyance. These findings highlight the contribution of noise annoyance to the use of hearing protection devices. Of the 42.6% of workers using hearing protection devices in the presence of high ambient noise, 60% were highly annoyed. Noise-annoyed workers also tended to wear hearing protection devices even in low noise levels. The use of hearing protection devices was associated with lower distress symptoms among the low and moderately annoyed workers, but among the highly annoyed workers the reverse was true. CONCLUSIONS: Thus, for the highly annoyed workers, the use of hearing protection devices was perhaps an additional source of stress. One immediate implication of this study is that future intervention procedures should focus on unannoyed workers who tend to use hearing protection devices less.

Adult↗
PubMed1994

Treatment of post-traumatic stress disorders: an applied rear-echelon approach.

This paper presents an applied innovative rear-echelon approach for the treatment of recalcitrant soldiers suffering from post-traumatic stress disorder in the 1982 Lebanon-Israel War. This was used as an alternative to psychiatric hospitalization. Use was made of a short-term, goal-directed, multidisciplinary treatment approach within the confines of a clear military setting. Reintegration into military and civilian life was an integral part of the program. Results indicated that at discharge, all soldiers showed a markedly improved clinical picture. Follow-up results 2.5 years later indicated that the percentage of regulars who returned to combat units doubled, whereas the reservists showed a slight tendency toward deterioration. Follow-up 6 years later showed the continuation of the same tendency. Ramifications of our findings are extensively discussed.

Adolescent↗
PubMed1994

Developing psychosocial mindedness and sensitivity to mental health issues among primary care nurses using the Balint group method.

This study empirically evaluated the impact of a Balint group for primary care nurses on awareness of mental health and psychosocial issues and professional psychosocial efficacy. Thirteen female primary care nurses working in community clinics participated in a year-long fortnightly Balint group led by two psychologists at a regional school of nursing. Cases were presented and analyzed to highlight emotional and cognitive components and processes. Changes in professional psychosocial efficacy were assessed with the Psychological Medical Inventory (PMI). Efficacy components were (a) psychosocial abilities, (b) psychosocial sensitivity. Changes in these components and in perceived mental health topics were assessed over three time points: at initial interview, midway through group and at the end. Significant positive changes were found on both efficacy components at the final measure compared to baseline. This study indicates the beneficial effects of this method in training primary care nurses in psychosocial efficacy. It also highlights the importance of ongoing long-term training programs for mental health and psychosocial efficacy in this professional group.

Adult↗