PubMed Health⌕ Search

Biomedical subjects

A L Wright

Publications and source records attributed to A L Wright.

18 recordsLinked to original sources
PubMed1992

Maternal age as a risk factor for wheezing lower respiratory illnesses in the first year of life.

Postneonatal mortality due to respiratory illnesses is known to be inversely related to maternal age, but the possible role of young motherhood as a risk factor for respiratory morbidity in infants has not been thoroughly explored. The authors studied the incidence of lower respiratory tract illnesses during the first year of life, as ascertained by health plan pediatricians, in over 1,200 infants enrolled at birth between 1980 and 1984 in Tucson, Arizona. The incidence of wheezing lower respiratory tract illnesses increased significantly (p = 0.005) with decreasing maternal age, whereas the incidence of nonwheezing lower respiratory tract illness was independent of maternal age. A logistic regression was used to control for the effects of several known confounding factors. When compared with infants of mothers aged more than 30 years, adjusted odds ratios were 2.4 (95% confidence interval 1.8-3.1) for infants whose mothers were less than age 21 years (p < 0.0001), 1.8 (95% confidence interval 1.4-2.3) for infants whose mothers were aged 21-25 (p < 0.0001); and 1.4 (95% confidence interval 1.1-1.6) for infants whose mothers were aged 26-30 (p < 0.001). These results suggest that young motherhood is an important risk factor for wheezing lower respiratory tract illnesses during the first year of life. Both biological and social factors related to maternal age may explain these findings.

Adult↗
PubMed1992

Case and survival definitions in out-of-hospital cardiac arrest. Effect on survival rate calculation.

OBJECTIVE: To determine the effect of different case and survival definitions of out-of-hospital cardiac arrest on survival rate calculations. DESIGN: A 22-month case series of nontraumatic, out-of-hospital cardiac arrests. SETTING: Southwestern city (population, 400,000; area, 390 km2) with a two-tiered emergency response system consisting of emergency medical technicians and paramedics. PATIENTS: A consecutive sample of 372 patients found without palpable pulse of spontaneous respiration. MAIN OUTCOME MEASURES: Survival rate after cardiac arrest was calculated using three case definitions of arrest and two definitions of survival. RESULTS: Twenty percent of all patients survived to hospital admission and 6% survived to hospital discharge. Twenty-six percent of adults whose collapse was witnessed survived to hospital admission, and 10% survived to hospital discharge. Patients whose collapse was witnessed and who experienced initial ventricular fibrillation survived to hospital admission in 38% and to hospital discharge in 15% of cases. CONCLUSIONS: The survival rate after out-of-hospital cardiac arrest varies widely depending on the case and survival definitions selected. To facilitate intersystem comparison and assessment of interventions designed to improve outcome, the Utstein Consensus Conference recommended that case and survival definitions should be adopted by all prehospital emergency systems.

Aged↗
PubMed1992

Life events and daily hassles and uplifts as predictors of hospitalization and outpatient visitation.

Increased occurrence of major life events and daily "hassles" and "uplifts" have been shown to be associated with several measures of health status and health care utilization. In order to test for such an association with hospital admission, a prospective study was designed. Navajo Indians presenting for either inpatient or outpatient health care at a U.S. Indian Health Service facility were questioned regarding the occurrence of major life events in the preceding six months and of hassles and uplifts in the preceding week. Two years later the subsequent numbers of outpatient visits and of hospital admissions were determined for each subject. An increased number of either major life events (relative risk 1.66) or daily hassles and uplifts (relative risk 1.87) was found to be associated with an increased risk of hospital admission. The effects of major and daily life events were additive on the risk of admission. In addition, hassles were predictive of subsequent outpatient utilization. While further demonstrating the influence of major and daily life occurrences on health care utilization, this study also shows their importance in an additional cultural setting.

Adult↗
PubMed1992

Nickel sensitivity: the influence of ear piercing and atopy.

In a group of 612 consecutive patients undergoing routine patch tests for suspected allergic contact dermatitis, more than four-fifths of the 364 women had had their ears pierced, over half gave a history of cutaneous reactions to metallic jewelery and almost one-third were sensitive to nickel. The increase in the frequency of nickel sensitivity in women with pierced ears compared to those with unpierced ears was highly significant (P less than 0.001). In men, nickel sensitivity was much less frequent; occupational factors were often implicated and few cases were related to ear piercing. Jewelery dermatitis was more frequent in atopic than non-atopic women but atopy did not appear to influence the propensity for developing nickel sensitivity in either sex. Ear piercing seems to induce nickel allergy which may result in lifelong morbidity and difficulty in employment. Jewelery suppliers should be encouraged to provide nickel-free earrings to reduce the frequency of this apparently avoidable problem.

Adult↗
PubMed1992

Lymphocyte subpopulation number and function in infancy.

Normal values for percentages of lymphocyte subpopulations and functional responses to mitogen stimulation in infancy are not well established. In the present study, lymphocyte subpopulations were examined in umbilical cord blood samples and in peripheral blood samples drawn before 7 and 24 months of age (mean age 10.4 months) from a healthy population of infants born in Tucson, Arizona. Results indicate significant increases occurred from birth to later infancy in the percentages of total T cells (CD3), T-cell subsets (CD4, CD8) and B cells (CD20). The CD4/CD8 ratio and the functional responses to ConA and PWM mitogens significantly decreased from birth to later infancy. PHA responsiveness did not show a significant change. Results from cross-sectional analyses (n = 271) were supported in a smaller longitudinal subset (n = 37). There were no detectable ethnic- or gender-related differences in cord blood or samples obtained in later infancy. The normal values established in this study will be useful in studies of immune-system maturation and in the clinical evaluation of newborns, infants, and toddlers suspected of either acquired or congenital immune-deficiency states.

Cell Count↗
PubMed1991

Risk factors for respiratory syncytial virus-associated lower respiratory illnesses in the first year of life.

The relation of breast feeding and other factors to the incidence of respiratory syncytial virus-associated lower respiratory tract illness (RSV-LRI) in the first year of life is examined. The study population is 1,179 healthy infants enrolled at birth between May 1980 and January 1984 into the Tucson Children's Respiratory Study, Tucson, Arizona. Each subject's data were assessed at each month of age during the first year of life, during those months when respiratory syncytial virus was isolated. A number of significant relations were observed, particularly between 1 and 3 months of age. At this age, the risk of having a RSV-LRI increased in association with less than 1-month or no breast feeding, with being male, and with increasing numbers of others sharing the child's bedroom. In multivariate analysis, only sex and the number of others sharing the room remained as significant direct effects. However, a significant interaction demonstrated that breast feeding has a protective role in relation to RSV-LRIs for those infants of mothers with a lower education level. The risk of having a RSV-LRI increases with combinations of risk factors. Being in day care was a significant risk factor in the 7- to 9-month age range. The RSV-LRI rate also varies by birth month. A separate case-control study assessed relations of RSV-LRIs with cord serum RSV antibody. Those with lower cord serum RSV antibody, who also have minimal breast feeding, were found to be especially at risk for RSV-LRIs in the first 5 months of life.

Antibodies, Viral↗
PubMed1991

Relationship of parental smoking to wheezing and nonwheezing lower respiratory tract illnesses in infancy. Group Health Medical Associates.

The relationship between parental smoking and lower respiratory tract illness (LRI) was studied in a large cohort of infants followed prospectively from birth. Illnesses were diagnosed by physicians using agreed-on criteria, and parental smoking histories were obtained by questionnaire. The LRIs were differentiated into wheezing and nonwheezing episodes, and the age at first illness of either type was evaluated in relation to smoking by parents. The odds of having an LRI were significantly higher in children whose mothers smoked (odds ratio 1.52; confidence interval 1.07 to 2.15). The odds were higher if the mother smoked a pack of cigarettes or more per day and if the child stayed home rather than attending day care (odds ratio 2.8; confidence interval 1.43 to 5.5). Logistic regression indicated that the LRI rate was significantly elevated both in children exposed to heavy maternal smoke in the absence of day care, and in those who use day care but were not exposed to maternal smoking of a pack or more per day. These findings could not be attributed to other confounding variables. Neither paternal smoking nor smoking by other household members was consistently related to the LRI rate. The relationship of maternal smoking to LRI rate was evident for both wheezing and nonwheezing illnesses. Maternal smoking of a pack or more per day was also related to an early age at first LRI, for both wheezing (p less than 0.05) and nonwheezing (p less than 0.002) illnesses. In sum, maternal smoking is associated with a higher rate of LRIs in the first year, particularly when mothers smoked a pack or more per day and when the child did not use day care.

Bronchial Diseases↗
PubMed1991

Computer-assisted image analysis of skin surface replicas.

Using a rubber-based dental impression material, negative surface impressions were made of demarcated areas of skin and prepared as dry specimens for scanning-electron microscopy. Electron micrographs were taken at low magnification and, using a programmed computer-assisted image analyser, it was possible to represent quantitatively the topography of that particular body site according to the degree of circularity of the various geometric subunits. This technique was most applicable to skin topography with a reliable geometrical pattern of triangles and squares, a feature of hair-bearing surfaces in general and in particular, the antecubital fossa. Using standardized trauma of various types the origin of skin surface markings were found to be located in the dermis. The technique was applied to the healing of experimental trauma produced by tape stripping, the resolution of clinical eczema and a comparison of steroid-treated and untreated tape-stripped skin.

Eczema↗
PubMed1991

Quantification of allergic and irritant patch test reactions using laser-Doppler flowmetry and erythema index.

The laser-Doppler blood flow and erythema index were assessed in 16 patch test reactions caused by irritants (1% aq. sodium lauryl sulphate and 1% aq. benzalkonium chloride) and in 13 varied allergic reactions, at 2 or 4 days. Both irritant and allergic responses produced statistically significant increases in laser-Doppler flow index and erythema index compared to control sites (p less than 0.05 or less, using the Wilcoxon rank-sum test). A disproportionately greater increase in erythema index than in laser-Doppler flow was seen in mild irritant reactions, compared to allergic, though the two could not be reliably distinguished by these tests. 2 non-allergic nickel sulphate sites produced an increase in both blood flow and erythema without any clinical change. Petrolatum alone produced no significant change in either measurement. The laser-Doppler flow showed an overall correlation with the erythema index (product moment method; r = 0.55, p less than 0.001), but there was little correlation between these indices and patch test reactivity as judged clinically by conventional scoring. Generally, allergic and irritant patch test reactions could not be differentiated on the basis of laser-Doppler flow or erythema index. However, the disproportionate increase in erythema index over laser-Doppler flow index for mild irritant responses warrants further study in other irritant models.

Allergens↗
PubMed1991

Initial airway function is a risk factor for recurrent wheezing respiratory illnesses during the first three years of life. Group Health Medical Associates.

We recently reported a significant relationship between lung function measured prior to any lower respiratory tract illness and subsequent wheezing illnesses during the first year of life (N Engl J Med 1988; 319:1112-7). Follow-up has continued for this group of infants during the second and third years of life. When compared with never wheezers, infants who wheezed during the first year of life and had at least one additional lower respiratory illness had 22% lower initial levels of an indirect index of airway conductance derived from the shape of tidal breathing curves (p less than or equal to 0.01), 22% lower respiratory conductance (p less than or equal to 0.05), 25% lower maximal flows at the end-expiratory point (p less than or equal to 0.01), and 10% lower functional residual capacity (p less than or equal to 0.05). Infants who wheezed only once during the first 3 yr of life or who started wheezing during the second year of life had normal tidal breathing curves but significantly lower maximal expiratory flows (p less than or equal to 0.05). Their functional residual capacity was also lower than that of never wheezers (p less than or equal to 0.05). We conclude that diminished initial airway function may be a predisposing factor for recurrent wheezing respiratory illnesses starting in the first year of life. Infants who will have only one wheezing respiratory illness or who will start wheezing after the first year of life seem to have lower levels for some but not for all lung function tests performed in this study.

Age Factors↗
PubMed1990

Cost-effectiveness analysis of paramedic emergency medical services in the treatment of prehospital cardiopulmonary arrest.

STUDY OBJECTIVES: 1) Identification of marginal costs associated with prehospital resuscitation of cardiopulmonary arrest; 2) Determination of cost effectiveness for such resuscitation; and 3) Comparison of cost effectiveness of paramedic care with selected other medical interventions. DESIGN: Retrospective review of 190 cases of out-of-hospital cardiac arrest. SETTING: City limits of a midsized southwestern city. The events studied took place outside of medical facilities. TYPE OF PARTICIPANTS: Victims of out-of-hospital cardiac arrest for whom the EMS system was activated by a 911 telephone request for emergency medical assistance. MEASUREMENTS AND MAIN RESULTS: The cost, including training, personnel, equipment, and response time maintenance, per year of life saved was found to be $8,886.00 for paramedic care. This result was compared with published cost-effectiveness figures for heart transplantation, liver transplantation, bone marrow transplantation, and chemotherapy for acute leukemia. Paramedic care was more cost effective, as measured by cost per year of life saved, than organ transplantation and chemotherapy for acute leukemia. CONCLUSION: Out-of-hospital treatment by paramedics of cardiopulmonary arrest is more cost effective than heart, liver, bone marrow transplantation, or curative chemotherapy for acute leukemia.

Arizona↗
PubMed1990

Reticulate pigmentation due to bleomycin: light- and electron-microscopic studies.

An unusual case of extensive reticulate pigmentation due to bleomycin is reported. Light- and electron-microscopic studies showed a marked increase of melanin pigment in the basal keratinocytes and a number of melanophages in the upper dermis. The number of melanocytes appeared to be normal. Electron microscopy also revealed damage to subcellular organelles. The increase in pigmentation is thought to be a consequence of this focal damage.

Bleomycin↗
PubMed1990

Scarring alopecia in psoriasis.

Scalp biopsies were taken from 3 patients with a scarring alopecia associated with severe scalp psoriasis. The histological findings in each case showed inflammatory destruction of the infundibular region of the hair follicle. The similarity of these changes in each case strongly suggests an association with the psoriasis.

Adult↗
PubMed1979

Action on alcohol.

Explore the source record for details and available documents.

Alcohol Drinking↗
PubMedDate not supplied

The measurement of salivary cadmium by electrothermal atomic absorption spectrophotometry and its use as a biological indicator of occupational exposure.

We have examined the potential use of salivary cadmium measurements for the biological monitoring of occupational cadmium exposure, paying particular attention to the contamination risks associated with such measurements. We have developed a method for the direct determination of cadmium in saliva by graphite furnace atomic absorption spectrophotometry, which minimizes the risk of contamination during sample preparation and analysis. The limit of detection is 0.6 nmoll-1, which is sufficiently sensitive to discriminate between unexposed and occupationally exposed individuals. The method has been employed to measure cadmium levels in saliva samples collected by two different methods from an unexposed population, a group of ex-workers previously exposed to cadmium (Group 1), and two groups of currently exposed workers (Groups 2 and 3). Salivary cadmium levels were significantly raised in both of the groups of currently exposed individuals (group 2 median (Md) = 17 nmoll-1, group 3 Md = 70 nmoll-1, p greater than 0.0001), and in past workers with previous long-term exposure (Group 1 Md = 2.5 nmoll-1, p greater than 0.001) when compared with an unexposed population. The results suggest that the measurement of salivary cadmium may reflect recent exposure to the metal. However, considerable care must be taken in collecting samples because a risk of contamination during sampling is apparent with procedures commonly used for saliva collection, and for this reason the applicability of such measurements for biological monitoring is limited.

Cadmium↗