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Biomedical subjects

A Feldstein

Publications and source records attributed to A Feldstein.

At least 19 recordsLinked to original sources
PubMed2005

Effect of lifestyle modifications on blood pressure by race, sex, hypertension status, and age.

Recommendations for control of high blood pressure (BP) emphasize lifestyle modification, including weight loss, reduced sodium intake, increased physical activity, and limited alcohol consumption. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern also lowers BP. The PREMIER randomized trial tested multicomponent lifestyle interventions on BP in demographic and clinical subgroups. Participants with above-optimal BP through stage 1 hypertension were randomized to an Advice Only group or one of two behavioural interventions that implement established recommendations (Est) or established recommendations plus DASH diet (Est plus DASH). The primary outcome was change in systolic BP at 6 months. The study population was 810 individuals with an average age of 50 years, 62% women, 34% African American (AA), 95% overweight/obese, and 38% hypertensive. Participants in all the three groups made lifestyle changes. Mean net reductions in systolic (S) BP in the Est intervention were 1.2 mmHg in AA women, 6.0 in AA men, 4.5 in non-AA women, and 4.2 in non-AA men. The mean effects of the Est Plus DASH intervention were 2.1, 4.6, 4.2, and 5.7 mmHg in the four race-sex subgroups, respectively. BP changes were consistently greater in hypertensives than in nonhypertensives, although interaction tests were nonsignificant. The Est intervention caused statistically significant BP reductions in individuals over and under age 50. The Est Plus DASH intervention lowered BP in both age groups, and significantly more so in older individuals. In conclusion, diverse groups of people can adopt multiple lifestyle changes that can lead to improved BP control and reduced CVD risk.

Adult↗
PubMed1999

In vivo renal vascular and tubular function in experimental hypercholesterolemia.

Hypercholesterolemia (HC) is often associated with impaired peripheral and coronary vascular responses to endothelium-dependent vasodilators, which are probably due to low bioavailability of nitric oxide. To examine the effect of HC on renal vascular and tubular function, 22 domestic pigs were studied after being fed a 12-week normal (n=11) or HC (n=11) diet. Renal regional perfusion and intratubular contrast media concentration in each nephron segment (representing fluid reabsorption) were quantified in vivo with electron-beam computed tomography before and after a suprarenal infusion of either acetylcholine (6 pigs of each diet) or sodium nitroprusside (SNP; 5 pigs of each diet). An increase in cortical perfusion, observed in normal pigs with acetylcholine (+35+/-6%, P=0. 002) and SNP (+12+/-4%, P=0.005), was blunted in the HC group (+8. 8+/-4.0, P=0.01, and -4.6+/-4.0%, P=0.1, respectively, P=0.003 and P=0.005 compared with normal) as was an increase in medullary perfusion (+58+/-21 in normal versus +24+/-11% in HC, P=0.04). A decrease in the intratubular contrast media concentration in the distal tubule and collecting duct of normal pigs was observed in all tubular segments (and was significantly enhanced in the proximal tubule and Henle's loop) in the HC group, which was associated with increased sodium excretion. The tubular and renal excretory responses to SNP were similar between the groups. In conclusion, early experimental HC in the pig attenuates renal perfusion response to both endothelium-dependent and -independent vasodilators possibly because of decreased bioavailability or decreased vascular responsiveness to nitric oxide. This vascular impairment may play a role in maladjusted renovascular responses and contribute to renal damage in later stages of atherosclerosis.

Acetylcholine↗
PubMed1998

Low back pain: predictors of absenteeism, residual symptoms, functional impairment, and medical costs in Oregon workers' compensation recipients.

BACKGROUND: Wide variations in disability duration and magnitude have been noted among recipients of workers' compensation for low back pain. Findings from recent studies have indicated that inclusion of a broad array of variables (i.e., physical, occupation, social, economic) is needed to understand differences in workers' responses to occupational low back pain. METHODS: Workers' compensation and questionnaire data from 340 Oregon workers with low back claims were merged to develop multivariate models predicting: (1) absenteeism days, (2) residual symptoms, (3) functional impairment, and (4) medical costs. RESULTS: Forty-two percent of the variation in low back symptoms was explained by: discontinuing physical fitness activities post-injury (beta = -.419), self-reported low energy/high fatigue (beta = -.227), poorer general health (beta = .137), and attorney involvement in claim (beta = .117), (adjusted R2 = .418, p < 0.001). Survival curves revealed significantly longer claim durations among workers who discontinued physical fitness activities post-injury, compared with workers who did not; these differences remained significant even after controlling for severity of the initial injury. CONCLUSION: Continuation of physical fitness activities during the recovery process was found to be a significant predictor in three of four regression models, providing evidence on behalf of a relationship between fitness and positive health outcomes. However, it was not possible to clearly differentiate pre-morbid from post-injury fitness, nor to determine if this relationship was due to a therapeutic effect on the back, the general restorative benefits of remaining active, or represents a proxy variable for workers' self-care efforts during recovery.

Absenteeism↗
PubMed1998

Prevention of work-related disability.

INTRODUCTION: The cost of work-related injury is large and is rising in many states. Managed care providers are being asked to assist with solutions, particularly in the area of facilitating return to work. Kaiser Permanente of the Northwest responded by developing the Kaiser on-the-job program, which includes processes to facilitate the primary, secondary, and tertiary prevention of work-related disability. METHODS: This paper describes the role that managed care can play in the prevention of work-related disability through consultation, training, immunization programs, and targeted screening and case management interventions. A quality and case management system is described, which gives physicians feedback on modified work and time-off authorization by diagnosis. RESULTS: The results demonstrate statistically significant decreasing physician-authorized average time loss for low back cases from 1991 through 1995 (17.8 disability days per case in 1991 and 15 per case in 1995, P = .01). According to Oregon State Accident Insurance Fund (SAIF Corporation) data, the Kaiser on-the-job average total claims cost was reduced 33% for disabling cases as compared to two other health care organizations (P = .002). CONCLUSION: The methods utilized here to prevent work-related disability appear effective. They are relevant to many managed care program models and their efforts to improve workplace health and productivity.

Accidents, Occupational↗
PubMed1997

Occupational injuries among urban recyclers.

In this article, we describe the emergence of urban recycling as a new trade and discuss the new pattern of injuries among its practitioners. We conducted a retrospective chart review and convenience survey at an urban homeless health center. We found a high prevalence of severe, costly injuries, many of which are amenable to prevention. Lacerations, infections, needle sticks, and blunt trauma are all common in this group. Some cases are extremely expensive or even lethal. We conclude that a new trade and a new pattern of injuries associated with it have emerged around recycling.

Accidents, Occupational↗
PubMed1997

The success of the Washington Department of Labor and Industries Managed Care Pilot Project: the occupational medicine-based delivery model.

The Washington State Managed Care Pilot Project (MCP) tested the effects of experience-rated capitation on medical and disability costs, quality of care, worker satisfaction with medical care, and employer satisfaction in MCP-covered workers, compared with matched fee-for-service controls. In the MCP, medical costs were reduced by approximately 27%, functional outcomes remained the same, workers were less satisfied with their treatment and access to care initially, and employers were-much more satisfied with the quality and speed of the information received from the providers. The authors believe that it was the occupational medicine-based delivery model, working in conjunction with the method of reimbursement and the cultural context of managed care, that was the most significant innovation leading to the MCP successes. This article describes the occupational medicine-based delivery model implemented for the MCP.

Government Agencies↗
PubMed1997

Managed occupational health care in an HMO.

This paper describes the efforts of an HMO to improve its delivery of occupational health services. Customer needs identification, occupational health structure, data systems, case management, clinical guidelines, and quality management are outlined. Our experience suggests that high-quality occupational health services can be integrated into managed care systems thereby offering cost-effective care to large numbers of workers. Comparing 1991 to 1995, physician authorization of total disability days was reduced 17.9% per disability case (p < .0001). Based on July 1994 to June 1995 Oregon State Accident Insurance Fund (SAIF Corporation) data, HMO average total claim cost was $916/claim representing respectively, a 21% and a 20% reduced cost compared to two PPO model programs (MCO 00 and MCO 01). Patient satisfaction data indicated that 90% of patients were satisfied or very satisfied with the physician they saw. The savings appear to be due to cost-effective treatment and rapid return to work.

Case Management↗
PubMed1993

The Back Injury Prevention Project pilot study. Assessing the effectiveness of back attack, an injury prevention program among nurses, aides, and orderlies.

The Back Injury Prevention Project was a pilot study of "Back Attack," an educational program designed to prevent back injuries among nurses, nurses' aides, and orderlies. The pilot tested program feasibility, developed and tested instruments, and generated preliminary data measuring program effectiveness. Fifty-five nurses, aides, and orderlies on two medical/surgical units at two Kaiser Permanente medical centers in Portland, Oregon participated in the study. Intervention group scores on the composite back pain and composite fatigue scales decreased relative to the control group, but this did not reach statistical significance. A 19% improvement in scores for quality of patient transfer was observed for the intervention group (P < .0003), while the control group did not show any significant improvement during the same time period. Results of the pilot suggest that the Back Attack program changes behavior at least in the short term. Further study will be necessary to determine if the behavior change persists and back pain and injury rates are subsequently reduced.

Accidents, Occupational↗
PubMed1990

Evaluating the patient-handling tasks of nurses.

Nurses, nurses' aides, and orderlies are among the occupational groups at highest risk for back injury. The Kaiser Permanente Northwest Region developed a Back Injury Prevention Project (BIPP) to try to reduce the back injury rate among these groups. To obtain early data on program effectiveness, we developed an instrument, the BIPP Transfer Evaluation, to evaluate patient-handling tasks. Use of the BIPP Transfer Evaluation during the BIPP pilot study revealed a 19% +/- 5% SE (P = .0003) improvement in the quality of patient transfer in the intervention group. The BIPP Transfer Evaluation is an inexpensive way to get early, objective information about the quality of an intervention to reduce back injuries among nurses, nurses' aides, and orderlies.

Accidents, Occupational↗
PubMed1978

Handedness and smoking.

This article reports the observation that proportionately more left-handed persons smoke than dextrals, and a greater proportion of left-handers than right-handers smoke 10 or more cigarettes daily, regardless of sex, race, stress of residence (or social class), and prior history of smoking. This association is especially strong among males and persons residing in residence areas of high stress (low income, low education), and weak among black females and persons who smoke 30 or more cigarettes daily. The sample was drawn from four census areas in Detroit differing by race, socioeconomic levels, and crime rates. Respondents and their spouses were 25 to 60 yr. old, married, and had relatives in the metropolitan area (N = 1496).

Adult↗