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Biomedical subjects

S Shapiro

Publications and source records attributed to S Shapiro.

At least 703 records · Page 39Linked to original sources
PubMedDate not supplied

Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus.

CONTEXT: Current evidence that breastfeeding is beneficial for infant and child health is based exclusively on observational studies. Potential sources of bias in such studies have led to doubts about the magnitude of these health benefits in industrialized countries. OBJECTIVE: To assess the effects of breastfeeding promotion on breastfeeding duration and exclusivity and gastrointestinal and respiratory infection and atopic eczema among infants. DESIGN: The Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial conducted June 1996-December 1997 with a 1-year follow-up. SETTING: Thirty-one maternity hospitals and polyclinics in the Republic of Belarus. PARTICIPANTS: A total of 17 046 mother-infant pairs consisting of full-term singleton infants weighing at least 2500 g and their healthy mothers who intended to breastfeed, 16491 (96.7%) of which completed the entire 12 months of follow-up. INTERVENTIONS: Sites were randomly assigned to receive an experimental intervention (n = 16) modeled on the Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children's Fund, which emphasizes health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support, or a control intervention (n = 15) of continuing usual infant feeding practices and policies. MAIN OUTCOME MEASURES: Duration of any breastfeeding, prevalence of predominant and exclusive breastfeeding at 3 and 6 months of life and occurrence of 1 or more episodes of gastrointestinal tract infection, 2 or more episodes of respiratory tract infection, and atopic eczema during the first 12 months of life, compared between the intervention and control groups. RESULTS: Infants from the intervention sites were significantly more likely than control infants to be breastfed to any degree at 12 months (19.7% vs 11.4%; adjusted odds ratio [OR], 0.47; 95% confidence interval [CI], 0.32-0.69), were more likely to be exclusively breastfed at 3 months (43.3% vs 6.4%; P<.001) and at 6 months (7.9% vs 0.6%; P =.01), and had a significant reduction in the risk of 1 or more gastrointestinal tract infections (9.1% vs 13.2%; adjusted OR, 0.60; 95% CI, 0.40-0.91) and of atopic eczema (3.3% vs 6.3%; adjusted OR, 0.54; 95% CI, 0.31-0.95), but no significant reduction in respiratory tract infection (intervention group, 39.2%; control group, 39.4%; adjusted OR, 0.87; 95% CI, 0.59-1.28). CONCLUSIONS: Our experimental intervention increased the duration and degree (exclusivity) of breastfeeding and decreased the risk of gastrointestinal tract infection and atopic eczema in the first year of life. These results provide a solid scientific underpinning for future interventions to promote breastfeeding.

Adult↗
PubMedDate not supplied

Reasons for delay in breast cancer diagnosis.

BACKGROUND: A study of system delay, the time between the initial medical consultation and the establishment of a diagnosis, in breast cancer patients revealed that almost 40% of women reported delays of at least 4 weeks. The objective of this study was to explore the reasons for these prolonged intervals between initial medical consultation and establishment of a diagnosis. METHODS: A total of 367 female breast cancer patients from the National Cancer Institute's Black/White Cancer Survival Study were studied. Medical systems involved in the diagnosis and treatment of these women included hospital outpatient and emergency room, private clinic, public clinic, private doctor, and health maintenance organization. RESULTS: In about 25% of the cases, the delay was attributed by the woman to the patient herself, and the most common reason she gave was that she felt that the problem was not important. In about 45% of the cases, the provider and the health care system were said to be responsible for the delay through difficulties in scheduling or physician inaction, while in another 17% both the patient and the system were responsible. CONCLUSIONS: This study looked at the issue of how the behaviors of women and their providers contribute to the timing of breast cancer diagnosis. It is one of the only studies to examine the woman's role in delay. It is clear from this study that additional work is needed to look at this question. However, the results of this study suggest that efforts must be made to reduce the time needed to get an appointment with a physician or a diagnostic test, as well as to educate physicians and the women themselves regarding the importance of breast symptoms and the value of prompt evaluation, diagnosis, and treatment.

Adult↗
PubMedDate not supplied

The status of breast cancer screening: a quarter of a century of research.

This article begins with a summary of the methods and results of the first randomized, controlled trial conducted to test the efficacy of periodic screening in reducing breast cancer mortality. The study was started in December, 1963 and the final phases of follow-up to determine the screening's long-term effect ended in 1986. Over 60,000 women aged 40-64 years, who were members of the Health Insurance Plan of Greater New York (HIP), were assigned at random to either a study group or a control group. The study group was offered screening examinations consisting of mammography and a clinical examination of the breast. About 67% accepted the invitation for an initial screening; a large proportion returned for 3 reexaminations at annual intervals. The control group continued to receive their usual medical care. By 10 years from entry, breast cancer deaths were reduced 30% among the study group women; over the long run of 18 years from entry, the decrease was 23-24%. The benefit from screening was found to be more certain among women who were over 50 years of age at the start of screening than among those aged 40-49 years. This article also describes research on efficacy of breast cancer screening started more recently in Sweden, the Netherlands, United Kingdom, and Canada, and reviews available findings which reinforce the results of the HIP project. Information is given on policies and guidelines being adopted in many countries regarding modalities, frequency, and ages to be included in breast cancer screening programs.

Breast Neoplasms↗
PubMedDate not supplied

Disseminated coccidioidomycosis with rapid progression to effusive-constrictive pericarditis.

This case reports coccidiomycosis presenting as pericarditis with tamponade rapidly progressing to effusive-constrictive pericarditis and death over 72 hours. Coccidiomycosis pericarditis is a rapidly progressing disease requiring early and complete pericardiectomy to avoid the hemodynamics of constriction. We illustrate the use of echocardiography in this case and demonstrate the histopathology. We review the literature and discuss therapy and management. Coccidiomycosis is often clinically unsuspected and unrecognized by the health care worker unfamiliar with the disease process.

Adult↗
PubMedDate not supplied

Classification of environmental estrogens by physicochemical properties using principal component analysis and hierarchical cluster analysis.

A structurally diverse assortment of 60 environmental estrogens was divided into two main clusters ("A", "B") and a pair of subclusters ("C1", "C2") by applying principal component analysis to selected 1D and 2D molecular descriptors and subjecting the PCs to hierarchical cluster analysis. Although clustering was predicated solely on physicochemical properties, the dependence on particular physicochemical parameters of xenoestrogen binding affinities (pK(i)) to murine uterine cytosolic estrogen receptor (ER) proved greater for compounds within (sub)clusters than for compounds between (sub)clusters. Quantitative structure-binding affinity relationships derived using molecular descriptors and PCs suggested differences in the driving forces for xenoestrogen-ER binding for different (sub)clusters. The modeling power for xenoestrogen-ER binding affinities of a combination of TLSER and WHIM 3D indices was much greater than that of combinations of 1D and 2D molecular descriptors or the PCs derived therefrom. The clusterings obtained using PCs also proved applicable to the 3D-QSARs.

Chemical Phenomena↗