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Biomedical subjects

S Shapiro

Publications and source records attributed to S Shapiro.

At least 721 records · Page 40Linked to original sources
PubMedDate not supplied

Economic impact of using an immunostimulating agent to prevent severe acute exacerbations in patients with chronic obstructive pulmonary disease.

RATIONALE: OM-85 BV, an immunostimulant made from bacterial extracts, has been shown to reduce the risk of hospitalization for acute exacerbation in patients with chronic obstructive pulmonary disease, as well as to reduce the length of stay for all hospitalizations. METHODS: In conjunction with a placebo controlled, randomized clinical trial, a cost effectiveness analysis was carried out to assess the economic impact of using OM-85 BV. In the analysis, effectiveness was defined as the difference in the number of severe acute exacerbations, assessed by the number of hospitalizations for a respiratory problem, between the placebo and OM-85 BV-treated groups. RESULTS: The median cost to prevent one day of hospitalization for a respiratory condition was CDN$45, with a 95% CI of CDN$18 to CDN$210. Bootstrap of the study population and sensitivity analyses showed that the results were robust and not likely due to random fluctuation; 98.8% of the cost effectiveness and 96.8% of the cost-benefit ratios favoured the use of OM-85 BV. Indirect costs, defined as a need for help, were reduced by 36% in the group treated with OM-85 BV: 779 h of help compared with 1212 h in the placebo group. This trend, while not significant, is consistent with other results and suggests a decrease in the severity of exacerbations in the OM-85 BV-treated group. CONCLUSION: Given the high prevalence of chronic obstructive pulmonary disease worldwide and the high cost of acute exacerbations, immunostimulants may become a key element in the improved control of this condition.

Adjuvants, Immunologic↗
PubMedDate not supplied

An in vitro oral biofilm model for comparing the efficacy of antimicrobial mouthrinses.

The ability of commercial mouthrinses to reduce total viable counts of mixed microbial populations was examined using a previously developed in vitro model of supragingival plaque. Exploratory experiments aimed at fine-tuning the model indicated that optimal correspondence between in vitro and clinical results for chlorhexidine-containing formulations were obtained at a saliva:medium ratio of 70:30 (v/v); moreover, expanding the microbial population from 5 bacterial species to 5 bacterial species + Candida albicans had no noticeable impact on overall results. The efficacies of 12 different mouthrinse proprietary products containing chlorhexidine, hexetidine, octenidine, Triclosan, plant extracts, or aminefluoride/stannous fluoride vis-à-vis biofilm clearance were compared. All mouthrinses promoted a statistically significant reduction in microbial load compared to distilled water. The herbal- and phenolic-based products were substantially less effective than most chlorhexidine-containing mouthrinses, or mouthrinses containing hexetidine or octenidine. No significant difference between the plaque-clearing plaque-clearing abilities of Listerine and Meridol was observed. This polyspecies biofilm model can be a valuable tool for preclinical testing of antiplaque formulations, particularly during the product development stage.

Anti-Infective Agents, Local↗
PubMedDate not supplied

A randomized trial of team care following stroke.

A randomized controlled trial was conducted to examine the effects of interdisciplinary team care on acute hospitalized stroke patients. After obtaining baseline information on 42 stroke victims receiving conventional care in a general hospital, 130 stroke patients were stratified and randomly assigned either to Traditional or Team care. Assessments by independent evaluators permitted comparisons between Team and Traditional groups with reference to patient survival, motor performance and functional abilities. Data obtained prospectively from charts and treatment logs allowed the care process across groups to be compared. Results demonstrated that Team and Traditional patients fared similarly in survival. However there was an unexpected difference in survival depending upon sex. For motor performance, male survivors performed better with Team care and female survivors with the Traditional method. In terms of functional abilities, male patients receiving Team care again performed better than their Traditional counterparts, whereas in women there was no difference between the treatment groups.

Activities of Daily Living↗
PubMedDate not supplied

Obsessive-compulsive disorder in children and adolescents: a review.

Obsessive-compulsive disorder (OCD) is a common psychiatric illness that occurs across the entire life span. Although most research on OCD pertains to adults, studies of the disorder in children and adolescents have burgeoned over the last decade. A review of this literature suggests that OCD has a bimodal incidence pattern, with one peak of onset at approximately 10 years of age and another during adulthood, and that the juvenile and adult forms are equally prevalent. Important similarities and differences between the juvenile- and adult-onset forms of OCD can be seen: both show the same clinical phenotype, diagnostic nosology, and dose responsivity, but the early-onset disorder differs in being clearly male preponderant, more highly familial, and associated with a distinct pattern of comorbid psychopathology, including disruptive behavior and specific developmental disorders. These findings have implications both for clinical management and for future research, which could consider age of onset as an important factor in studies of all OCD patients.

Adolescent↗
PubMedDate not supplied

Pertussis infection in fully vaccinated children in day-care centers, Israel.

We tested 46 fully vaccinated children in two day-care centers in Israel who were exposed to a fatal case of pertussis infection. Only two of five children who tested positive for Bordetella pertussis met the World Health Organization's case definition for pertussis. Vaccinated children may be asymptomatic reservoirs for infection.

Adolescent↗
PubMedDate not supplied

Changes in American A.I.D. practice during the past decade.

We conducted a survey of donor artificial insemination (AID) practices within the United States. The survey document was sent to 360 practitioners listed by national infertility organizations as performing AID. In addition, we queried 100 practices that had responded to a similar survey in 1978. AID was actually performed during the survey year by 167 of the 282 respondents. Relatively few practices (23%) inseminated more than 10 patients per month. Donor payments increased from a mean of $25 to $40 over that period. A significant increase in the use of frozen semen was found. A majority of practices (52%) used a combination of basal body temperature and urinary LH to time inseminations. The fraction of practitioners who inseminated unmarried women increased substantially since the previous survey. The maximum number of pregnancies resulting from a single donor has not changed over the decade. However, on the average, a single donor is fathering fewer children. The percentage (39%) of practices that inseminate women because of genetic disease in the husband's family has remained about the same. Records of donors and AID children were maintained by 40% of the respondents, representing no change from the previous survey. Our data suggest that as many as 23,400 infants may have resulted from AID conceptions during the survey year. Further changes in the practice of AID can be expected as a result of the 1988 federal recommendations that all donor inseminations be undertaken with cryopreserved, quarantined semen.

Congenital Abnormalities↗
PubMedDate not supplied

Significance of increased efforts to gain participation in screening for breast cancer.

With increasing evidence of the effectiveness of mass screening in reducing mortality from breast cancer, the Breast Cancer Screening Study of the Health Insurance Plan of Greater New York is reviewed for its impact on increased efforts to gain participation among its target population. Initial contact efforts brought a 47% response rate, and further efforts increased this to 65%. The additional contact efforts increased response rates among most demographic groups. Women requiring minimum contact efforts were appreciably more likely than the increased effort group to participate in the full set of four screenings. Among those requiring increased efforts, more than 40% had the full set of screening examinations, and about 80% had at least one screening examination in addition to the baseline. Differences in breast cancer detection rates among contact effort groups were small, and there was little difference in mortality from breast cancer. Mortality rates from other causes, however, were higher among reluctant participants and highest among women who refused screening. Efforts to increase participation in screening for breast cancer should be linked to women's concerns with other health problems and to their medical care system.

Adult↗