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Biomedical subjects

A Forsythe

Publications and source records attributed to A Forsythe.

At least 19 recordsLinked to original sources
PubMed1997

Work hours, sleep patterns and fatigue among merchant marine personnel.

A field study of work and sleep patterns among commercial merchant marine personnel is reported. Data collected over a 10-30-d period from 141 subjects aboard eight ships included information concerning work-rest schedules, sleep timing, alertness on the job and critical fatigue. The data indicate that watchstanders on the 4-on, 8-off schedule show considerable disruption in their sleep. The average sleep duration for all mariners is 6.6 h; watchstanders obtain their sleep in fragmented periods that are frequently less than 5 h in duration. Analysis of critical fatigue shows an incidence of 1-24% across personnel and measures. Of particular concern are the watchstanders on the 04.00-08.00 schedule, who sleep less than 4 h per 24-h period 22% of the time. Potential countermeasures, including changes in scheduling and staffing are proposed.

Adult↗
PubMed1995

Perinatal outcomes in the pregnancies of asthmatic women: a prospective controlled analysis.

Prior studies have found an increased incidence of adverse perinatal outcomes of pregnancies in asthmatic mothers, but these studies have been poorly controlled for asthma therapy and other confounding factors. The purpose of this study was to assess perinatal outcomes in actively managed pregnant asthmatic women as compared with matched nonasthmatic controls. Using an inception cohort design, we studied a volunteer sample of 486 pregnant (< 28 wk) women with documented asthma and 486 pregnant nonasthmatic controls with normal pulmonary function. Cases and controls were matched for age, smoking status, parity, and year of delivery. Asthma was managed with step therapy to prevent acute asthmatic episodes and asthma symptoms that interfered with sleep or normal activity. Chronic hypertension was significantly more common (p = 0.007) in asthmatic subjects (3.7%) than in matched controls (1.0%). However, no significant differences in incidences of preeclampsia, perinatal mortality, preterm births, low-birth-weight infants, intrauterine growth retardation, or congenital malformations were observed in the pregnancies of the asthmatic women as compared with the matched controls. Trends were observed toward relationships between more severe asthma requiring emergency therapy or corticosteroids and increased incidences of preeclampsia and low-birth-weight infants, but these associations were not statistically significant. These data suggest that the overall perinatal prognosis for women with actively managed asthma during pregnancy is comparable to that for the nonasthmatic population.

Adult↗
PubMed1989

Epilepsy and mental retardation following febrile seizures in childhood.

In an unselected group of children who were seen following an initial febrile convulsion, the frequency of subsequent afebrile seizures was 3.5% and of mental retardation 1%. The most common afebrile seizure type was generalized major (86%). About 3/4 of the children who developed afebrile seizures did so by three years and all by five years following the initial febrile seizure. The children with afebrile seizures differed from those without afebrile seizures in the frequency of neonatal abnormality, family history of mental retardation, focal initial febrile convulsions, and delay in psychomotor milestones before the initial febrile seizure. Only about 1/3 of the children who developed afebrile seizures ever had a recurrent febrile convulsion and none had complex recurrent febrile seizures. Half the children with mental retardation had histories of delay in psychomotor milestones prior to the initial febrile seizure, and no child with mental retardation had any seizure longer than five minutes. The administration of daily phenobarbital did not reduce the frequency of epilepsy, in spite of a significant reduction in the incidence of recurrent febrile seizures. There remains no evidence that the prevention of recurrent febrile convulsions significantly decreases the frequency of afebrile seizures or mental retardation.

Child↗
PubMed1988

Remote prognosis of preeclampsia in women 25 years old and younger.

Twenty-six primiparous women less than or equal to 25 years old who delivered between 1963 and 1978 and met the following criteria were studied: (1) The first obstetric visit was at less than or equal to 30 weeks' gestation with diastolic blood pressure less than or equal to 85 mm Hg; (2) diastolic blood pressure before delivery was greater than or equal to 95-mm Hg, rising at least 15 mm Hg; (3) 24-hour urine protein measured at least 1.0 gm; and (4) patients were enrolled in the Kaiser Health Plan in 1982. Each of the 26 patients was paired with a primiparous woman by year delivered, age, race (black versus nonblack), and weight +/- 1/3. In 23 pairs blood pressure follow-up was available in 1980 or thereafter, which was at least 3 1/2 years after delivery (average interval between delivery and follow-up = 10 years). Three in the preeclampsia group and two in the matched control group had hypertension, with diastolic blood pressure greater than or equal to 90 mm Hg. Mean systolic blood pressure (123.7 mm Hg) was 9.3 mm Hg higher in the preeclampsia group than in the matched controls (114.4 mm Hg), with a standard error of 4.15 mm Hg (p = 0.04). Mean diastolic blood pressure (77.0 mm Hg) was 2.9 mm Hg higher in the preeclampsia group than in the controls (74.1 mm Hg), with a standard error of 3.0 mm Hg (p = 0.345). We conclude that no significant difference in frequency of hypertension or diastolic blood pressure and a small but significant difference in systolic blood pressure is shown in follow-up between patients with preeclampsia and matched controls.

Adolescent↗
PubMed1988

Long-term weight loss maintenance: assessment of a behavioral and supplemented fasting regimen.

This analysis assessed 18-30-month weight loss maintenance following treatment with both behavior modification and supplemented fasting procedures for 400 patients. Fifty-five per cent of the patients who started treatment discontinued prior to completing the program. Patients who completed treatment lost a mean of 83.9 per cent of their excess weight, but regained an average of 59 per cent to 82 per cent of their initial excess weight by 30 months following start of treatment. The combination of behavior modification and supplemented fasting regimens was a successful means of effecting weight loss. However, there appeared to be limited weight loss maintenance. Behavioral epidemiological studies are needed to identify variables responsible for maintenance of weight loss.

Adult↗
PubMed1988

A comparison of the Papanicolaou smear and the cervigram: sensitivity, specificity, and cost analysis.

A total of 3271 gynecology patients between the ages of 18-50 years were screened for cervical intraepithelial neoplasia and invasive cervical cancer by simultaneous Papanicolaou smears and cervigram, a noninvasive photographic method recently introduced for screening. The accuracy of each screening test, when positive or suspicious, was evaluated independently and the results compared with colposcopically directed biopsy results. The cervigram was significantly more sensitive than the Papanicolaou smear (P less than .001), whereas the Papanicolaou smear was significantly more specific than the cervigram in detecting cervical intraepithelial neoplasia (P less than .001). Cost analysis integrating sensitivity and specificity with cost per procedure indicated a greater yield of cervical intraepithelial neoplasia with the cervigram than with the Papanicolaou smear, by 3.7:1 case per dollar.

Adolescent↗
PubMed1988

The course of asthma during pregnancy, post partum, and with successive pregnancies: a prospective analysis.

We studied 366 pregnancies in 330 prospectively managed women with asthma to determine the effect of pregnancy on asthma. Asthma activity was assessed by (1) daily symptom and medication diaries and (2) monthly auscultation and spirometry during pregnancy and for 3 months post partum. At 3 months post partum, subjects were asked to assess the overall course of their asthma during pregnancy compared to the usual course for them, and the course of their asthma during the 3 months post partum compared to the asthma during pregnancy. Asthma worsened during pregnancy in 35% of the women, improved in 28%, and was unchanged in 33%. Based on diary-card analysis, asthma was significantly less frequent and less severe during the last 4 weeks of pregnancy than during any other gestational interval. In women whose asthma improved during pregnancy, diary-card analysis revealed a gradual improvement with progressive pregnancy, whereas in women whose asthma worsened during pregnancy, there was an increase in asthma symptoms during 29 to 36 weeks gestation. During labor and delivery, asthma symptoms occurred in 10% of women with approximately equal proportions of these women receiving either no treatment or inhaled bronchodilators; only two subjects required intravenous aminophylline. During the 3 months post partum, asthma reverted toward its prepregnancy course in 73% of women. In 34 subjects prospectively studied for two successive pregnancies, there existed a significant concordance between the asthma course during the first and second pregnancies. The mechanistic and clinical implications of these findings are discussed.

Asthma↗
PubMed1987

Somatization in the community.

We examined the prevalence of somatization disorder symptoms elicited with the Diagnostic Interview Schedule in 3132 community respondents interviewed in Los Angeles by the Epidemiologic Catchment Area program. The variables age, gender, ethnic background, and the presence of a psychiatric diagnosis significantly influenced the number of somatization symptoms reported. An introductory review on conceptual and nosological aspects of somatization phenomena led to the formulation of a less-restrictive operational definition of the somatizer. We found that 4.4% of the respondents met criteria for this abridged cutoff score of somatization, whereas only 0.03% of the respondents met criteria for the full DSM-III somatization disorder diagnosis. This abridged cutoff score was associated with sociodemographic factors and psychiatric diagnosis in the direction predicted.

Acculturation↗
PubMed1986

Use of the Mini-Mental State Examination (MMSE) in a community population of mixed ethnicity. Cultural and linguistic artifacts.

The Mini-Mental State Evaluation (MMSE) was used in an epidemiological survey of a community of mixed ethnicity (Hispanic, white non-Hispanic) as part of the Los Angeles Epidemiologic Catchment Area Program. Results of the study showed that age, educational level, ethnicity, and language of the interview influenced the number of MMSE errors. Items on which the effects of ethnicity and language were most pronounced were identified, and suggestions on ways to minimize such sociocultural artifacts are provided in efforts to improve the epidemiological significance of the instrument, particularly as it concerns cross-cultural research.

Age Factors↗
PubMed1982

Radiotherapy for prostatic carcinoma: post-irradiation prostatic biopsy and recurrence patterns with long-term followup.

From 1968 through 1975, 159 patients with stages A, B and C adenocarcinoma of the prostate were treated with supervoltage radiation therapy. A median dose of 7,200 rad was given. The influence upon survival of grade, stage and a positive biopsy result after irradiation is analyzed. Over-all survival is a patently imprecise test of local treatment because patients die of intercurrent disease and are alive with metastases for significant intervals. The classification of survival with no evidence of recurrent disease excluded those patients dying of intercurrent disease. Therefore, the rate of survival free of disease always will be greater than the over-all survival rate in these patients, and a certain percentage of the patients without evidence of cancer will harbor subclinical disease. The 5 and 10-year survival rates free of disease were 80 and 69 per cent, respectively, in 51 patients with stages A and B cancer, and 66 and 47 per cent, respectively, in 108 with stage C disease. The 5 and 10-year over-all survival rates were 72 and 56 per cent, respectively, in the former and 68 and 39 per cent, respectively, in the latter patients. Survival free of disease and death of prostatic carcinoma were influenced adversely by advancing grade and stage (p less than 0.05), while over-all survival was influenced adversely by grade (p equals 0.02) but not by stage (p greater than 0.05). A positive biopsy result after irradiation did not predict survival free of disease, over-all survival or death of prostatic cancer in patients followed for 10 years (p greater than 0.05).

Adenocarcinoma↗
PubMed1981

Long-term effect of phenobarbital on cognitive function in children with febrile convulsions.

Psychometric tests were performed on 50 children with a history of febrile convulsions. Twenty-five of these had received daily phenobarbital for a mean of 35 months; 25 had received no phenobarbital. The two groups were matched for sex, age at the time of testing, race, and socioeconomic status. The tests used were the Wechsler Preschool and Primary Scale of Intelligence (WPPSI), the Matching Familiar Figures Test, and the Children's Embedded Figures Test. There were no significant differences in test results between the two groups.

Child↗
PubMed1980

Maternal serum human chorionic gonadotropin concentrations and fetal sex prediction.

The feasibility of using maternal serum human chorionic gonadotropin (hCG) concentrations for prenatal sex prediction was examined. hCG was mesured in 822 serum samples from 560 women with uncomplicated pregnancies. Significantly higher hCG concentrations were found in the serum of women bearing female fetuses than in the serum of women bearing male fetuses during the third trimester, especially during the 10th lunar month. The data were utilized to construct probability graphs for fetal sex prediction based upon a single maternal serum hCG determination during the third trimester and during the 10th lunar month. However, the utility of these graphs is limited by the small proportion of pregnant women with serum hCG concentrations that were high or low enough to allow a prediction with high probability.

Chorionic Gonadotropin↗
PubMed1979

Prenatal and intrapartum high-risk screening. II. Risk factors reassessed.

A method of identifying the high-risk pregnancy by a quantitative assessment of prenatal, intrapartum, and neonatal factors is presented. Calculating the probabilities of neonatal risk can be done with a hand-held calculator. The technique described provides a method of assessing the importance of perinatal variables and determining the effect of the process of health care on outcome.

Female↗
PubMed1978

Mitoses in normal and psoriatic epidermis.

The morning count of mitoses in uninvolved epidermis of psoriatics is not significantly different from normal skin. The afternoon count is higher than the morning in both, and significantly higher in uninvolved than in normal epidermis. These results may be interpreted as favouring the existence of a non-cycling G2 population in human epidermis. This G2 population could be released into mitosis by the factors involved in diurnal variation, and might be larger and more labile in psoriatics than in normals. The pathogenesis and aetiology of psoriasis may be related to such a G2 population.

Adult↗
PubMed1978

Treatment of Bell palsy with prednisone: a prospective, randomized study.

Two hundred thirty-nine patients with Bell palsy were randomly distributed into prednisone-treated and control groups. Patients were followed until complete recovery or for 1 year. In the steroid-treated and control groups, respectively, incomplete recovery of facial strength occurred in 12 percent and 20 percent; motor synkinesis in 9 percent and 15 percent; autonomic synkinesis in 1 percent and 10 percent; and electromyographic evidence of severe denervation in 9 percent and 17 percent. The differences reached statistical significance only for autonomic synkinesis. In the total series recovery of facial strength was incomplete in 16 percent. Residual weakness was mild in 14 percent and moderate in 2 percent. No patient remained with severe weakness. Age, hyperacusis, and severity of the initial palsy were associated with an increased risk of poor outcome.

Adolescent↗
PubMed1978

Behavior disturbance, phenobarbital, and febrile seizures.

Of 109 children treated daily with phenobarbital following the first fibrile convulsion, 42% developed a behavior disorder, usually hyperactivity. Daily phenobarbital therapy was prematurely discontinued in 54% of the children with behavior abnormality (20% of those treated). The behavior disturbance usually appeared within several months, was no correlated with high blood barbiturate levels, disappeared in 73%, and improved in all children when barbiturate therapy was discontinued. No characteristics of the child, the initial febrile seizure, or recurrence of febrile seizures were significantly correlated with the occurrence of the behavior disorder except for behavioral abnormality preceding the initial febrile convulsion. Eighteen percent of the children who received no phenobarbital developed behavior disorder, most often hyperactivity. The behavior disturbance spontaneously disappeared in 52%. Among these children not given phenobarbital, the group with normal behavior had a greater frequency of family history of seizures, especially febrile convulsions, and a lower frequency of preseizure behavior disturbance; abnormalities of pregnancy, labor, delivery, and neonatal period; delayed milestones; long seizures; abnormal results of neurological examination; abnormal EEG; and recurrent febrile seizures.

Barbiturates↗