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PubMed1993

Biochemical markers of bone turnover. II: Diagnosis, prophylaxis, and treatment of osteoporosis.

Osteoporosis is a major health problem and is becoming increasingly important in our aging society. In many of the Western countries, patients with hip fracture occupy more hospital beds than patients with any other disease. Measures to combat osteoporosis are urgently needed, but the best way of doing so is uncertain. Osteoporosis prevention can be targeted at a subgroup of the population at high risk of disease. Alternatively, the intervention can be aimed at the entire population. Both preventive strategies have been proposed for osteoporotic fractures. Some researchers advocate population programs to increase weight-bearing exercise and calcium intake or to reduce smoking, but there is little direct evidence of their effectiveness. The most widespread opinion is that bone mass measurement is the most accurate predictor of fracture risk. Prediction of fracture risk may mean treatment for several years with drugs with not only effects, but also adverse effects. This encourages attempts to optimize the diagnostic procedures.

Biomarkers↗

PubMed1994

High doses of oral contraceptives do not alter endometrial alpha 1 and alpha v beta 3 integrins in the late implantation window.

OBJECTIVE: To assess the effects of an emergency contraceptive agent on the distribution of integrin heterodimers during that part of the implantation window. DESIGN: Prospective, case-controlled study in a university-based Population Program. In the first ovulatory control cycle after the detection of LH surge, patients had endometrial sampling 11 days after the surge. In the next cycle the procedure was repeated 2 days after the administration of a postcoital contraceptive agent on day 9 after LH surge (100 g ethinyl E2 and 2 mg norgestrel). MAIN OUTCOME MEASURES: The effects of postcoital contraceptives on the expression of integrin heterodimers (alpha 1 and alpha v beta 3 subunits) reported to be unique to secretory phase was determined. RESULTS: All six specimens were consistent histologically with days 24 and 25 of the menstrual cycle by light microscopy. Using immunohistochemistry, strong membrane staining of endometrial glandular cells and superficial epithelium for both alpha 1 subunit and vitronectin (alpha v beta 3) receptor was observed in treatment and controls. No diminution of intensity or distribution was observed relative to pretreatment controls. CONCLUSIONS: There is no apparent change in the level of these two integrins in the human endometrium when high-dose oral contraceptives are given in the later stages of the implantation window. This suggests that the high doses of steroids used in emergency contraceptives may exert their effect through more complex mechanisms than endometrial cell surface changes.

Contraceptives, Oral↗

PubMed1987

Inducible polymorphic ventricular tachycardia and ventricular fibrillation in a subgroup of patients with hypertrophic cardiomyopathy at high risk for sudden death.

This investigation was undertaken to elucidate the underlying electrophysiologic substrate in hypertrophic cardiomyopathy and to identify possible predictors of sudden death in this patient population. Programmed stimulation was performed in 18 patients aged 14 to 64 years (mean 36) believed to be at high risk for sudden death on the basis of prior cardiac arrest or syncope, nonsustained ventricular tachycardia on Holter ambulatory electrocardiographic (ECG) monitoring or a family history of frequent sudden death. Polymorphic ventricular tachycardia that deteriorated to ventricular fibrillation was reproducibly induced in 8 (44%) of the 18 patients (Group A). This rhythm was induced in all three patients with a history of cardiac arrest. No sustained monomorphic ventricular tachycardia was induced. Group B comprised the 10 patients in whom a sustained arrhythmia could not be reproducibly initiated. The electrophysiologic substrate was distinctly different in patients with, than in those without, inducible sustained arrhythmia. The refractory period was shorter at the right ventricular outflow tract (232 +/- 22 ms) compared with the apex (264 +/- 12 ms) in Group A (p less than 0.005) whereas there was no difference in Group B (271 +/- 25 ms versus 271 +/- 13 ms). The local ventricular electrogram of most patients in both groups was prolonged and markedly multiphasic. However, 5 of the 8 Group A patients exhibited a double electrogram (V-V') with premature stimulation compared with 1 of the 10 patients in Group B (p less than 0.02). A positive R wave in lead aVR of the scalar ECG and poor R wave progression in the precordial leads were more common in Group A than in Group B (p less than 0.001 and p less than 0.001, respectively). The reason for the distinctly different electrophysiologic substrate and the high prevalence of inducible polymorphic arrhythmia is unclear. It may relate to the underlying myocardial architecture in these patients, characterized by myocardial cellular disarray and fibrosis.

Adolescent↗

PubMed2001

Rubella.

Rubella, also known as German measles or three-day measles, is a self-limited, mild viral illness that poses little danger to children or adults. For the developing fetus, however, infection with rubella virus is a grave threat, capable of inducing severe anomalies and permanent disability. Despite widespread vaccination programs, populations of susceptible individuals persist, among them women of childbearing age whose pregnancies remain vulnerable to congenital rubella syndrome. In the United States, the currently used rubella vaccine employs live-attenuated virus and is contraindicated in pregnancy. Nonpregnant women receiving rubella vaccination should be advised to use effective contraception for 3 months after inoculation. These warnings persist despite the fact that no clinically significant case of congenital rubella syndrome after maternal vaccination has been reported. Obstetrician/gynecologists must be familiar with rubella and the management of pregnancies complicated by exposure to the disease. Furthermore, practitioners must actively seek and vaccinate susceptible individuals to minimize this significant threat to public health.

Journal Article↗

PubMed1999

The intrauterine device and its dynamics.

In the past decade, attention has shifted from family planning (often made available through population programs) to reproductive health--a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters related to the reproductive system and its function and processes. Reproductive health has three components: the ability to procreate, regulate fertility and enjoy sex; the successful outcome of pregnancy through infant and child survival and growth; and the safety of the reproductive process. According to Mitchell et al., the following are key elements in a reproductive health program: (a) Family planning services that offer complete and accurate information about all contraceptive methods and that make contraceptive services, supplies and counseling accessible. (b) Antenatal care, which research suggests lowers rates of maternal mortality. (c) Safe delivery services, so that all women deliver under some type of supervised care and so that referral systems are established to provide emergency treatment of life-threatening complications of delivery. (d) Postnatal care that contributes to a woman's ability to have a speedy and complete recovery from the stress of pregnancy and childbirth, to enjoy sexual relations without pain and to have safe pregnancies and deliveries in the future. (e) Management of the complications of abortion where safe abortions are not available. (f) Infertility services that enable women to achieve their reproductive goals; and effective screening for or control of reproductive tract infections (RTIs), because RTIs are the most common preventable cause of involuntary infertility and ectopic pregnancy, as well as of chronic pelvic pain and recurrent infection. (g) Management and treatment of systemic sexually transmitted diseases (STDs), such as HIV and hepatitis B. (h) Symptomatic treatment of urinary tract infections. (i) Detection and treatment of breast and reproductive tract cancers, such as cervical cancer. (j) Attention to and treatment of dysmenorhea, which in some cases is the first sign of other problems, such as pelvic inflammatory disease, endometriosis, fibroids, endometrial cancer and ectopic pregnancy. (k) Nutritional supplementation to meet the special needs of adolescents, pregnant or lactating women, and women older than 50 years. (1) Services for menopause and other health problems that women encounter as they grow older. (m) Services for adolescents, including family planning and STD prevention and treatment. It shall be clear that many institutions delivering reproductive health services operate significantly below their physical capacity to see clients, and that much of the equipment required for expanding reproductive health services may already be available for use in family planning and other health services. In this context, we would therefore like to discuss the dynamics of IUDs.

Contraindications↗

PubMed2006

Dual selection enhances the signaling specificity of a variant of the quorum-sensing transcriptional activator LuxR.

The transcription factor LuxR activates gene expression in response to binding the signaling molecule 3-oxo-hexanoyl-homoserine lactone (3OC6HSL), an acyl-HSL with a carbonyl substituent at the third carbon of the acyl chain. We previously described a LuxR variant, LuxR-G2E, that activates gene expression by binding a broader range of acyl-HSLs, including straight-chain acyl-HSLs to which LuxR does not respond. Here, we use a dual positive-negative selection system to identify a variant of LuxR-G2E that retains the response to straight-chain acyl-HSLs, but no longer responds to 3OC6HSL. A single mutation, R67M, reduces LuxR-G2E's response to acyl-HSLs having a carbonyl substituent at the third carbon of the acyl chain. This specificity-enhancing mutation would not have been identified by positive selection alone. The dual selection system provides a rapid and reliable method for identifying LuxR variants that have or lack the desired response to a given set of acyl-HSL signals. LuxR variants with altered signaling specificities might become useful components for constructing artificial cell-cell communication systems that program population level behaviors.

Cell Communication↗

PubMedDate not supplied

Mass-media-generated interpersonal communication as sources of information about family planning.

This study suggests that mass-media-generated interpersonal communication networks vary according to an individual's behavior-change stage. As people in Peru adopted modern family planning methods, they increasingly formed and perhaps relied on information from more technical interpersonal communication networks, which shifted from peers to doctors and other service providers. Moreover, information seeking and giving varied with adoption stages in unexpected ways. In collaboration with Apoyo a Programmas de Población (Advocacy for Population Programs) of Peru, we present a model of how interpersonal communication networks generated by mass media messages vary with stage of behavior change.

Adolescent↗

PubMed1984

The Collaborative Lipid Research Clinics Program Family Study. II. Response rates, representativeness of the sample, and stability of lipid and lipoprotein levels.

The Collaborative Family Study (1975-1978), the third phase of the Lipid Research Clinics Program Population Studies, covers 2405 probands and 15,693 of their relatives from nine North American communities. This sample was examined for participation differences across race, sex, locality, educational level, and reason for selection. The participation rates were somewhat lower for blacks, younger age groups, and subjects with lower educational levels. The probands' reason for selection into the study had little impact on the participation of probands or relatives. Moreover, based on information gathered at earlier examinations on eligible Family Study probands, the cornary risk factor profile appeared to be similar among participants and nonparticipants . The available longitudinal lipid data on probands indicated general consistency in lipid levels within subjects over short periods of time, in cholesterol even more so than in triglycerides. Among age strata, the younger subjects showed the least intrapersonal stability, especially for triglycerides.

Adolescent↗

PubMed1975

Assessment of maternal health care quality: conceptual and methodologic issues.

Past efforts in assessment of the quality of maternity care have been analyzed in order to develop an evaluation framework that will have utility and applicability beyond a specific program, population, or health discipline. Presently available evaluation approaches have focused attention on either "high risk" populations or upon women experiencing a complicated pregnancy or delivery. Quality has been defined as the extent to which normative or empirically derived standards of obstetrical care have been applied. An alternative approach is suggested which conceives of the pregnancy as a normal physiological event but with the potentiality of either causing or exacerbating social or health problems. Maternity care quality is viewed as the application of those necessary health and health-related services that are required to safeguard the health of the mother and offspring, minimize the noxious consequences of pre-existing or concurrent health hazards or conditions, and upgrade the health and social functioning of those women who require it. Additionally, the system of services should be functionally organized to optimize care. Indicators of quality are suggested which incorporate structural, process, and outcome variables, and which link medical and consumer criteria in a comprehensive community level approach to quality assessment.

Child Health Services↗

PubMed1999

Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs.

OBJECTIVES: To evaluate critically the evidence linking specific classes of cardiac and analgesic drugs to falls in older people. DESIGN: Fixed-effects meta-analysis. DATA SOURCES: English-language articles in MEDLINE (1966 - March 1996) indexed under accidents or accidental falls and aged or age factors; bibliographies of retrieved papers. STUDY SELECTION: Systematic evaluation of cardiac or analgesic drug use and any fall in people aged 60 years and older. DATA EXTRACTION: Study design, inclusion and exclusion criteria, setting, sample size, response rate, mean age, method of medication verification and fall assessment, fall definition, and the number of fallers and nonfallers taking specific classes of cardiac and analgesic drugs. RESULTS: Twenty nine studies met inclusion criteria. None were randomized controlled trials. For one or more falls, the pooled Odds Ratio (95% Confidence Interval) was 1.08 (1.02-1.16) for diuretic use, 1.06 (0.97-1.16) for thiazide diuretics, 0.90 (0.73-1.12) for loop diuretics, 0.93 (0.77-1.11) for beta-blockers, 1.16 (0.87-1.55) for centrally acting antihypertensives, 1.20 (0.92-1.58) for ACE inhibitors, 0.94 (0.77-1.14) for calcium channel blockers, 1.13 (0.95-1.36) for nitrates, 1.59 (1.02-2.48) for type Ia antiarrhythmics, and 1.22 (1.05-1.42) for digoxin use. For analgesic drugs, the pooled OR was 0.97 (0.78-1.20) for narcotic use, 1.09 (0.88-1.34) for nonnarcotic analgesic use, 1.16 (0.97-1.38) for NSAID use, and 1.12 (0.80-1.57) for aspirin use. There was no statistically significant heterogeneity of pooled odds ratios. There were no differences between the pooled odds ratios for studies with mean subject age <75 versus > or =75 years old or for studies in communities with <35% versus > or =35% fallers. In studies of the relationship between psychotropic, cardiac, or analgesic drugs and falls, subjects reporting the use of more than three or four medications of any type were at increased risk of recurrent falls. CONCLUSION: Digoxin, type IA antiarrhythmic, and diuretic use are associated weakly with falls in older adults. No association was found for the other classes of cardiac or analgesic drugs examined. The evidence to date, however, is based solely on observational data, with minimal adjustment for confounders, dosage, or duration of therapy. Older adults taking more than three or four medications were at increased risk of recurrent falls. As a result of the incidence of falls and their consequences in this population, programs designed to decrease medication use should be evaluated for their impact on fall rates.

Accidental Falls↗

PubMed1986

Effectiveness and application of partial hospitalization.

Especially during the past 15 years, partial hospitalization (PHP) has been studied extensively. This article reviews the effectiveness and applicability of PHP. To clarify where PHP might fit into the overall mental health care system, the results of empirical research are evaluated with special attention to topics such as treated population, program evaluation, comparison of PHP with inpatient treatment, PHP as alternative to outpatient treatment, comparison of different PHP's, cost effectiveness and burden on the family. The general conclusion is that PHP can be a reasonable alternative to inpatient as well as to outpatient treatment, taking into account factors such as symptomatology, cost and family burden. PHP seems in particular to enhance social role functioning, which might be attributed to the fact that contact between patient and environment is not disturbed by hospitalization. Suggestions for further research are presented. Furthermore it is recommended in order to improve generalizability of results to differentiate the different functions PHP can fulfil in the mental health care system.

Ambulatory Care↗

PubMedDate not supplied

The Attending Nurse: a new role for the advanced clinician.

The Attending Nurse Model as a unique role for the advanced practitioner was implemented and evaluated in an acute care psychiatric setting with an adolescent patient population. Program evaluation results demonstrated that the Attending Nurse role increased general satisfaction and role clarity while decreasing role tension. In addition, the role increased communication with patients' family members. Comparisons are made between the traditional primary nurse and the Attending Nurse roles.

Adolescent↗

PubMedDate not supplied

Simulation of primary cervical cancer screening by the PAPNET system in an unscreened, high-risk community.

OBJECTIVE: To evaluate the performance of the PAPNET system as a primary cervical cancer screening modality in an unscreened population with a high prevalence of cervical cancer and its precursor lesions. STUDY DESIGN: Consecutive cervical smears from 3,106 women, screened and reported in the usual manner, were submitted for analysis by the PAPNET system. The original manual screening diagnoses were compared with those obtained by PAPNET analysis. By inclusion of normal and abnormal smears, this evaluation not only provided quality assurance for the laboratory but also simulated primary screening by automation. RESULTS: Comparison of the two methods of screening showed statistically significant superiority of the PAPNET over conventional screening (89.6% vs. 63.8%, respectively) in low grade lesions, including atypical squamous and atypical glandular cells of uncertain significance (ASCUS and AGUS, respectively) and low grade squamous intraepithelial lesion. Conversely, there was no significant difference between PAPNET and manual detection (87.5% vs. 94.6%) for more significant abnormalities, including high grade squamous intraepithelial lesions and invasive carcinoma. CONCLUSION: The PAPNET system, which would probably not be affordable as a quality assurance modality only in the public health sector of this country, was shown to be more than sufficiently effective as a primary screening method for the large numbers of women likely to undergo cervical cancer screening in anticipated mass population programs.

Automation↗

PubMed1998

Prevalence of mental health and substance use disorders among homeless and low-income housed mothers.

OBJECTIVE: This study compared the prevalence of DSM-III-R disorders among homeless and low-income housed mothers with the prevalence of these disorders among all women in the National Comorbidity Survey. METHOD: The authors used an unmatched case-control design for assessing 220 homeless and 216 housed mothers receiving public assistance. RESULTS: Homeless and housed mothers had similar rates of psychiatric and substance use disorders. Both groups had higher lifetime and current rates of major depression and substance abuse than did all women in the National Comorbidity Survey. Both groups also had high rates of posttraumatic stress disorder and two or more lifetime conditions. CONCLUSIONS: The prevalence of trauma-related disorders among poor women was higher than that among women in the general population. Programs and policies designed for low-income mothers must respond to the high prevalence of DSM-III-R disorders.

Case-Control Studies↗

PubMed1988

Selection of high-risk groups for breast cancer screening. Evidence from an Italian multicentric case control study.

In recent years techniques for the selection of risk groups for high priority breast screening have been evaluated. We used data from a large multicentric case control study in Italy, recently published, to fit a reduced logistic model for predictive purposes, using variables which are easily collected. The predicted probability of being a case obtained through the logistic analysis was then used to classify the same set of data by calculating values of sensitivity and specificity at different cutoff points of the predicted probability. The results showed the low predictive power of the model. The selection of higher risk groups in a screening population program is discussed.

Adult↗

PubMed1989

Roentgenographic evidence for predominant left-sided location of unilateral pleural plaques.

The roentgenographic prevalence and anatomic distribution of pleural plaques were studied in the US Navy Asbestos Medical Surveillance Program population (105,064 individuals as of July 17, 1985). "Definite" or "probable" pleural plaques were noted in 4.4 percent of films. These were unilateral in 19.3 percent of roentgenograms with "definite" pleural plaque and 33.9 percent of films with "probable" pleural plaque. Unilateral findings were more often left-sided than right-sided; a ratio of 287:82 in the "definite" group and 625:287 in the "probable" group. Left-sided predominance of unilateral plaque is a consistent and unexplained epidemiologic finding that may provide clues to pleural pathogenesis following asbestos exposure.

Adult↗

PubMed2003

Idiopathic acute onset myelopathy in cheetah (Acinonyx jubatus) cubs.

Numerous cases of ataxia, hind limb paresis, and paralysis have occurred in cheetah (Acinonyx jubatus) cubs over the past 10 yr within the European Endangered Species Program population, including 12 in mainland Europe, two in the British Isles, one in Namibia, and one in Dubai. The condition is the most important medical factor limiting European cheetah population growth. Eight cubs at the Salzburg Zoo, Austria, were affected. They demonstrated upper motor neuron lesions when alive and bilateral, symmetrical myelin degeneration of the spinal cord on necropsy. Ballooning of myelin sheaths surrounded mostly preserved axons, and no spheroids, characteristic of acute axonal degeneration, were found. Myelin loss markedly exceeded axonal degeneration. The syndrome's etiology is unclear, although viral, bacterial, parasitic, genetic, nutritional-metabolic, toxic, and physical causes have been considered.

Acinonyx↗

PubMed1985

Design, findings and five-year follow-up of preventive medical lipid intervention clinic in Malmö.

In a separate lipid intervention clinic integrated within the framework of a multiphasic preventive medical population program in Malmö, 401 of 2431 screening attenders in a male birth-year cohort born in 1927 and 1928 had elevated values of triglyceride and/or cholesterol. Hypertriglyceridemia was more than three times as frequent as hypercholesterolemia. Of these attenders 20% had normal values at the second control, 5% did not attend the second test and 92 (31.2%) of the remaining were referred to other clinics because of other high risk factors. Thus, 209 (8.6% of the screening attenders) males born in 1927 and 1928 attended the lipid clinic for isolated hyperlipidemia. Disregarding a 5-year drop-out frequency of 13 sections, a significant reduction in the lipids was obtained during the follow-up period in those remaining in treatment. This study demonstrates the feasibility in taking care of hyperlipidemic individuals after a screening detection program. Detection and treatment of hyperlipidemia should of course also be initiated in the individual case in ordinary medical practice.

Cholesterol↗