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Biomedical subjects

A J Apter

Publications and source records attributed to A J Apter.

16 recordsLinked to original sources
PubMed1999

The influence of demographic and socioeconomic factors on health-related quality of life in asthma.

BACKGROUND: Although health-related quality of life (HRQL) in asthma is strongly influenced by disease severity, demographic and socioeconomic variables may also be important factors. OBJECTIVE: We related demographics, asthma severity, and socioeconomic factors to HRQL. METHODS: We interviewed 50 patients with moderate or severe asthma recruited from outpatient health center-based clinics to determine demographics, socioeconomic status, asthma severity, medication use, and HRQL. For HRQL, the mean total score of the Asthma Quality of Life Questionnaire (AQLQ) and the Medical Outcomes Study Short-Form 36 questionnaires physical and mental component summary scores (PCS and MCS, respectively) were used. RESULTS: The mean patient age was 46 +/- 14 years, and the FEV1 was 75% +/- 21% of predicted value. Twenty-nine subjects had been hospitalized for asthma, 29 belonged to a minority racial/ethnic group, and 16 had less than 12 years of education. The mean total AQLQ score was 4.12 +/- 1.42, the PCS was 37 +/- 10, and the MCS was 45 +/- 13. In univariate analyses, severity (nighttime awakenings, prednisone use, and a history of emergency department visits), racial/ethnic group (African American, white, or Hispanic), and socioeconomic status (low educational level, unemployed, family income under $20,000, public assistance, or no health insurance) were related to HRQL. These factors explained 67% of the variance of AQLQ and 48% of the variance of the PCS. Much of the quality of life variance was shared among these variables. Explanatory variables were not related to MCS in multivariate analysis. CONCLUSION: Socioeconomic status is an additional important independent factor influencing HRQL in asthma. In this study it was difficult to separate out the unique effects of socioeconomic status and race/ethnicity.

Adult↗
PubMed1998

Parvovirus B19-induced anemia as the presenting manifestation of X-linked hyper-IgM syndrome.

Parvovirus B19 (B19) can cause chronic anemia due to persistent infection in immunocompromised hosts who cannot produce neutralizing antibody necessary for clearing B19. Three patients with X-linked hyper-IgM syndrome (XHIM), who were all asymptomatic until they developed B19-induced chronic anemia at the ages of 8, 14, and 17 years, respectively, were found to have mutations of the CD40L gene, including a missense mutation (T254M), a nonsense mutation resulting in a new initiation codon and loss of the intracellular domain (R11X), and a splice site mutation (nt 309+2t-->a). Antibody responses to the T cell-dependent antigen, bacteriophage phiX174, were impaired, but neutralizing antibody titers were higher than in XHIM patients with classic phenotype. All 3 patients responded to intravenous immune globulin (IVIG) treatment. Certain mutations of the CD40L gene result in a mild XHIM phenotype that may become apparent following B19 infection in patients not on IVIG therapy and therefore not protected from B19 infection.

Adolescent↗
PubMed1998

Adherence with twice-daily dosing of inhaled steroids. Socioeconomic and health-belief differences.

Poor adherence to medication regimens may be contributing to the recent increase in asthma morbidity and mortality. We examined patient characteristics that may influence adherence to twice-daily inhaled steroid regimens. Fifty adults with moderate to severe asthma completed questionnaires examining sociodemographics, asthma severity, and health locus of control. Adherence was electronically monitored for 42 d. Following monitoring, patients' understanding of asthma pathophysiology and the function of inhaled corticosteroids were assessed. Patient beliefs about the effectiveness and convenience of these medications, and their perception of communications with their clinician were measured. Mean adherence was 63% +/- 38%; 54% of subjects recorded at least 70% of the prescribed number of inhaled-steroid actuations. Factors associated with poor adherence were less than 12 yr of formal education (p < 0. 001), poor patient-clinician communication (p < 0.001), household income less than $20,000 (p = 0.002), Spanish as primary language (p = 0.005), and minority status (p = 0.007). In a multiple logistic regression analysis, less than 12 yr of formal education (OR: 6.72; CI: 1.10 to 41.0) and poor patient-clinician communication (OR: 1.2; CI: 1.01 to 1.55) were independently associated with poor adherence. These results emphasize the importance of socioeconomic status and adequate patient-clinician communication for adherence to inhaled-steroid schedules.

Administration, Inhalation↗
PubMed1997

Perception of airway obstruction in asthma: sequential daily analyses of symptoms, peak expiratory flow rate, and mood.

BACKGROUND AND OBJECTIVE: Studies have demonstrated a weak correlation between the degree of airways obstruction and the severity of asthma symptoms. Although the causes for this disparity are probably multiple, mood has been hypothesized to modulate symptoms. This investigation was designed to evaluate the effect of mood and other patient characteristics on the perception of airways obstruction. METHODS: We compared mood variables, symptom severity, albuterol use, and peak expiratory flow rate (PEFR) measured three times daily over a 21-day period in 21 adults with moderate to severe asthma. Electronic equipment was used for data collection. Analyses included both individual patient assessments and a within-subjects, time series, pooled regression of concurrent and time-lag data. RESULTS: After pooling 1323 observations, there was a weak concurrent relationship between symptoms and PEFR (beta = -0.17, p < 0.001). Only five patients (24%) were accurate perceivers, defined by a statistically significant relationship between symptoms and PEFR across time. Higher forced expiratory flow at 25% to 75% of capacity predicted perception accuracy (p = 0.004); active mood was marginally associated with accuracy (p = 0.06). These two variables together explained 41% of the variation in perception accuracy (p = 0.004). Mood did not independently predict symptoms, but conversely, increased symptoms predicted less pleasant mood (beta = 0.08, p < 0.001), less active mood (beta = -0.11, p < 0.001), and less active-pleasant mood (beta = 0.06, p < 0.001). PEFR did not predict mood, and only pleasant mood independently predicted higher PEFR (beta = 0.04, p < 0.05). Symptoms, but not PEFR, were concurrently associated with albuterol use (beta = 0.24, p < 0.001). CONCLUSION: The relationship between changes in PEFR and symptoms over time was generally poor. Those patients with lower FEF25-75 values tended to be less accurate perceivers. Mood states were influenced by asthma symptoms, but the converse was not true.

Adolescent↗
PubMed1997

Demographic predictors of asthma treatment site: outpatient, inpatient, or emergency department.

OBJECTIVE: To identify the demographic predictors of asthma treatment site: outpatient clinic, emergency department, or hospital. METHODS: From the November 1993 to July 1995 claims data of the University of Connecticut Health Center, asthmatic patient sex, age, racial/ethnic group, address, and health insurance status were examined to identify predictors of treatment site. Patient addresses generated maps and census data. RESULTS: 3288 visits were made by 1455 patients; 8%, 34%, and 58% came from poverty level, low, and higher income residential areas, respectively. Insurance type and then age were the most significant predictors of treatment site. Adults having commercial insurance or Medicare were most likely treated as outpatients, self-pay patients 5 times more likely in the emergency department, and those receiving public assistance 2.4 times more likely in the hospital. Only 9% of Medicaid children and 22% with commercial insurance were evaluated as outpatients. Neither sex nor race/ethnicity was an important predictor of treatment site. CONCLUSION: Although not population-based, this group of asthmatic patients represents a group diverse in socioeconomic status and racial/ethnic background. Insurance category was the most influential factor predicting asthma treatment site, suggesting that economic status may be the most important determinant of higher morbidity. Children were treated predominantly in acute care settings.

Adolescent↗
PubMed1996

The effect of inhaled albuterol in moderate to severe asthma.

BACKGROUND: Some recent clinical investigations suggest that regular use of inhaled bronchodilators may lead to deterioration in asthma control. OBJECTIVE: The purpose of this study was to evaluate the effect of albuterol dosing schedule on clinical outcome in subjects with moderate to severe stable asthma. METHODS: Seventeen adults were randomized to two 15-week treatment periods in a double-blind crossover design. Throughout the study, subjects were instructed to take two inhalations four times daily from an unlabeled "test" canister. In the four times daily and as-needed (QID + PRN) period, this canister contained albuterol; in the as-needed (PRN) period, it contained placebo. A "rescue" albuterol canister was available for as-needed use at all times. Inhaler actuations from both the test and rescue canisters were electronically recorded. Outcome measures included prednisone requirements, morning and evening symptoms and peak expiratory flow rates, total and nighttime rescue albuterol use, and asthma-specific quality of life. RESULTS: The two treatment periods did not differ in symptoms, nighttime albuterol use, or asthma quality of life. During the QID+PRN period both morning and evening peak expiratory flow rates were significantly higher (p < 0.01 and 0.001, respectively) and total rescue use of albuterol was significantly less (p < 0.05) than the PRN period. Days on prednisone tended to be lower in the regular dosing period (p = 0.08). CONCLUSION: In our sample of patients with moderate to severe asthma, four times daily dosing of albuterol did not lead to deterioration of asthma control.

Administration, Inhalation↗
PubMed1995

Allergic rhinitis and olfactory loss.

BACKGROUND: Allergic rhinitis is associated with reports of olfactory loss, but there are few formal investigations. Patients with diminished smell function frequently have nasal polyps or sinusitis, making it difficult to separate the impact of allergic rhinitis from the effects of these other problems. OBJECTIVE: The goals of this descriptive study were to establish the prevalence of positive skin tests in patients reporting rhinitis and olfactory deficiency, and to assess olfactory function and the results of skin testing in a patient group with chronic rhinitis but without concomitant sinusitis or nasal polyps. METHODS: Sixty-two patients reporting olfactory loss and chronic rhinitis were examined by history, physical examination, olfactory testing, skin testing with perennial and seasonal allergens, endoscopic rhinoscopy, and CT scan of the paranasal sinuses. RESULTS: Seventy-one percent of all the subjects had at least one positive skin test, 69% to a perennial allergen, and 58% to mite. Eighty-two percent of the 28 subjects with chronic rhinitis but no evidence of polyps or sinusitis had positive tests. The mean olfactory score for this rhinitis group was 4.35, consistent with moderate hyposmia. The mean olfactory score of 34 subjects with polyps and/or chronic sinusitis was 0.61, consistent with anosmia, and significantly lower (P < .001). Sixty-two percent of this group had positive skin tests. CONCLUSION: These subjects who experienced olfactory loss and rhinitis appeared to have a high prevalence of allergic rhinitis as suggested by the number of positive skin tests. Olfactory loss was observed in patients without polyps or sinusitis, which suggests that allergic processes may have affected olfactory function.

Adolescent↗
PubMed1994

How is anaphylaxis recognized?

Prompt recognition of anaphylaxis may be lifesaving. Although its presentation has been described, there are no criteria for making a rapid diagnosis. A systematic review of the literature was performed to develop objective clinical criteria aimed at improving the recognition of anaphylaxis. A MEDLINE search of the word anaphylaxis over a 1-year period identified all of the reports describing the initial manifestations. Of 160 reviewed articles, 116 contained a clinical description of anaphylaxis. Eighty-nine (77%) of these 116 articles were case reports. Hypotension (84 reports [72%]) and urticaria and/or angioedema (70 reports [60%]) were the most frequently described signs. Of the identified allergens, 73% were diagnostic or therapeutic agents. In 72 of the 80 articles in which a reaction time could be identified, the reaction occurred within 60 minutes. As a result of this analysis, we conclude that anaphylaxis recognition may be improved by the identification of one of the following criteria, which describe the presentation in 82% of the analyzed reports: (1) exposure to an allergen within 1 hour produces one or more systemic signs (hypotension, upper or lower respiratory tract compromise, or increased gastrointestinal tract motility), or (2) urticaria or angioedema accompanies at least one of these systemic signs.

Allergens↗
PubMed1994

Common measures of asthma severity lack association for describing its clinical course.

BACKGROUND AND OBJECTIVE: To address the problems of increasing asthma morbidity and mortality rates, reliable severity measures must be identified. Accordingly, we compared three measures and their relationship to beclomethasone compliance. METHODS: Three clinical measures (symptom scores, morning peak expiratory flow rates, and number of as needed albuterol inhalations with Nebulizer Chronologs [Forefront Technologies, Inc., Lakewood, Colo.]) were assessed daily in 13 adults with asthma for 8.9 +/- 2.1 weeks. The relationships among these three variables were analyzed in terms of Pearson correlation coefficients. These were evaluated for each of the three possible pairs of the three clinical measures for each of the 13 patients. The relationship between inhaled beclomethasone compliance and the pairwise correlations was studied with the use of nonparametric statistical procedures. RESULTS: In four of the 13 patients, no pairwise correlations between any of the three severity measures were observed. The peak expiratory flow rate-symptom score relationship was observed in eight patients, whereas peak expiratory flow rate-albuterol use and albuterol use-symptom score correlations were each seen in four patients. Mean beclomethasone compliance was 64% and was greatest in those patients whose albuterol use increased concurrently with symptom scores (94% vs 50%, p = 0.02). CONCLUSIONS: The commonly used measures of asthma severity, symptom scores, peak flow rate, and beta-agonist use may not be interchangeable in describing the clinical course. Patients whose beta-agonist use is driven by symptoms tend to be more compliant with use of inhaled corticosteroids.

Administration, Inhalation↗
PubMed1992

Olfactory loss and allergic rhinitis.

Olfactory loss is of importance for allergists to investigate in their patients, because if it is due to either allergic rhinitis or nonallergic rhinitis, it is potentially reversible. One should be sure to consider nasal polyposis and inflammation from chronic sinusitis, especially of the ethmoidal sinuses. Simple screening in the office can be achieved with an odor identification test of widely available substances as described above. Should there be no response to treatment or if the patient has a history of chronic sinusitis, recalcitrant nasal polyposis, or previous otolaryngologic procedures, further evaluation including rhinoscopy may be required. Recent olfactory loss in the absence of nasal symptoms and in the absence of abnormalities in the nasal cavity should suggest further investigation to look for a more central process. Morphologic investigation with electron microscopy of the olfactory epithelium and the superior nasal cavity is just beginning. The impact of inflammation in this area awaits investigation.

Adult↗
PubMed1992

An approach to immunologic reactions associated with plasma exchange.

Immunologically mediated anaphylactic-type events are not uncommon with PE. The pathogenesis of these reactions is not well understood and demands further investigation. If a technique or equipment-related phenomenon can be identified, it should be addressed (e.g., replace the membrane for a more biocompatible membrane and use better rinsing procedures to eliminate ethylene oxide). Testing for specific relevant immunogen, either by in vivo or in vitro methods, if these methods are available, should be considered. If infusion of essential blood products is the most likely cause, then a premedication regimen may be helpful in preventing such reactions. As the risks and benefits of treatment are weighed, it is important to remember that every hive need not be eliminated. Instead, the goal is to prevent compromise to oxygenation and perfusion in both mother and fetus while comfort is maintained and drug-induced adverse effects are avoided.

Adult↗
PubMed1991

Allergy consultation in the management of atopic dermatitis.

Allergists and dermatologists both care for patients with atopic dermatitis, and their roles may be complementary. Questions regarding food allergy, aeroallergens, and the interpretation of skin and RAST testing are answered by an allergist.

Allergens↗
PubMed1989

Fluctuations of serum IgA and its subclasses in allergic bronchopulmonary aspergillosis.

Exacerbations of allergic bronchopulmonary aspergillosis (ABPA) are characterized by chest roentgenographic infiltrates, peripheral blood eosinophilia, and elevation of total serum IgE. Also elevated are serum immunoglobulin antibodies directed against Aspergillus fumigatus, IgE-Af, serum IgG-Af, and serum IgA-Af. We measured serum IgA-Af, IgA1-Af, and IgA2-Af by ELISA to determine whether elevations of IgA-Af occurred before or during an exacerbation (like IgG-Af) or after (like IgE-Af). Ten exacerbations of ABPA were studied in seven patients with an average of 10 serial sera per patient analyzed. We used an indirect amplified ELISA with Af initially sensitizing microtiter wells. A "serologic" rise of immunoglobulin Af was identified when optical densities were twice the baseline sera. Serum IgA-Af was elevated over baseline before (n = 5) and during (n = 1) the time of an exacerbation. Serum IgA1-Af was elevated over baseline before (n = 5) or at the time (n = 5) of an exacerbation in all 10 cases. Serum IgA2-Af was elevated before (n = 2) and during (n = 5) exacerbations. Analogous to total serum IgE and IgG-Af, these experiments demonstrate substantial elevations of serum IgA-Af, IgA2-Af, and particularly, IgA1-Af before or during exacerbations characterized by roentgenographic infiltrates. The data are consistent with a contributory role of IgA-Af in the pathogenesis of ABPA.

Adolescent↗
PubMed1989

Outcomes of pregnancy in adolescents with severe asthma.

Asthma in adolescent pregnancies is not rare and may make patient management difficult, especially since mortality from asthma is of particular concern in the adolescent age group. We present a series of 21 pregnant adolescents with severe asthma. During 28 pregnancies, there were 56 exacerbations of asthma, including 22 hospitalizations and 20 emergency room visits. For 18 (64%) of the 28 pregnancies, outpatient systemic corticosteroids were administered, and inhaled corticosteroids were prescribed for 8 (29%). Factors associated with exacerbations included respiratory tract infections (59%) and noncompliance with medical regimens (27%). There were no maternal or fetal deaths or evidence for intrauterine growth retardation. Two infants were premature, with one experiencing acute respiratory distress syndrome. Aggressive treatment of asthma and associated respiratory tract infections, as well as careful ambulatory care, to encourage patient compliance are advisable to achieve a favorable maternal-fetal outcome.

Adolescent↗
PubMed1984

Carcinomas of the base of the tongue: diagnosis using double-contrast radiography of the pharynx.

A barium examination is frequently performed as the primary screening study on patients with carcinoma of the base of the tongue who present with dysphagia. Because of the limitations of the conventional barium study in visualizing the pharynx, double-contrast views of this region are routinely included as part of the standard barium examination on all patients with pharyngeal dysphagia. With this technique, six carcinomas of the base of the tongue were detected, including four ulcerating and two exophytic lesions. The normal and abnormal appearance of the tongue base on double-contrast radiography of the pharynx is described. The authors believe that this is a valuable technique for diagnosing malignant lesions of the base of the tongue in patients with pharyngeal dysphagia, and that radiologists should incorporate this technique into their routine examination in order to detect these lesions at the earliest possible stage.

Aged↗