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Biomedical subjects

C L Joseph

Publications and source records attributed to C L Joseph.

At least 19 recordsLinked to original sources
PubMed2001

No supermassive black hole in M33?

We observed the nucleus of M33, the third-brightest galaxy in the Local Group, with the Space Telescope Imaging Spectrograph at a resolution at least a factor of 10 higher than previously obtained. Rather than the steep rise expected within the radius of gravitational influence of a supermassive black hole, the random stellar velocities showed a decrease within a parsec of the center of the galaxy. The implied upper limit on the mass of the central black hole is only 3000 solar masses, about three orders of magnitude lower than the dynamically inferred mass of any other supermassive black hole. Detecting black holes of only a few thousand solar masses is observationally challenging, but it is critical to establish how supermassive black holes relate to their host galaxies, and which mechanisms influence the formation and evolution of both.

Journal Article↗
PubMed2000

The burden of infection in long-term care.

Available data, although fragmentary, indicate that infections impose a large burden on long-term-care facilities (LTCFs) in the United States. Endemic infections occur with frequencies estimated to range between 1.64 and 3.83 million per year. These estimates rival or exceed the annual tally for nosocomial infections in acute-care settings. Infections associated with outbreaks caused by respiratory, gastrointestinal, and antimicrobial-resistant pathogens burden LTCFs even further. As judged by antimicrobial use, transfers to hospital, and mortality figures, infections in LTCFs are not trivial. Moreover, annual costs associated with these infections appear to exceed $1 billion. Recognition of the burden associated with infection in LTCFs helps to identify research priorities for this rapidly growing area of healthcare.

Bacterial Infections↗
PubMed2000

Racial differences in physiologic parameters related to asthma among middle-class children.

BACKGROUND: Asthma morbidity and mortality are higher in the United States for African-American (AA) children when compared to European-American (EA) children. STUDY OBJECTIVES: To explore racial differences in physiologic factors associated with pediatric asthma severity. DESIGN: Cross-sectional. METHODS: We analyzed data from two groups of children in suburban Detroit, one of which contains non-urban, middle-class AA children, a group not usually included in childhood asthma studies. All children were 6 to 8 years of age. Clinical evaluations included medical history, physical examination, skin testing, spirometry, and methacholine challenge. RESULTS: The study population (n = 569) was 14% African American, 51% of the participants were male, and the mean age was 6.8 +/- 0.4 years. Socioeconomic status (parental education) was similar overall by race, although some strata-specific differences were observed. The prevalence of physician-diagnosed asthma was 10% for both AA and EA groups. AA children were more reactive to methacholine than EA children (42% vs 22%, respectively; p = 0.001), and had significantly higher total IgE than EA children (geometric mean, 60. 6 vs 27.5 IU/mL; p = 0.001). Serum IgE was related to methacholine reactivity in EA children (p = 0.001), but not AA children (p = 0. 73). These differences remained after adjustment for gender, age, parental education, parental smoking, and maternal smoking during pregnancy. CONCLUSIONS: Our data support previous reports of racial differences in lung volume, airway responsiveness, and serum IgE concentrations. We found a racial difference in the relationship between total serum IgE and airway responsiveness that is unreported elsewhere. Overall, our results suggest that AA children may be predisposed to asthma.

Asthma↗
PubMed1999

Sensitivity and specificity of asthma definitions and symptoms used in a survey of childhood asthma.

We compared the ability of definitions/symptoms of asthma to identify urban, elementary schoolchildren with physician-diagnosed asthma and bronchial hyperresponsiveness (BHR) post-exercise challenge. Definitions of asthma from the literature were compared, including American Thoracic Society (ATS) and British Medical Research Council (BMRC) definitions. Modified ATS had the highest sensitivity (77%), whereas BMRC had the highest specificity (99%). The most sensitive symptom was "wheeze with cold" (89%). The most specific symptoms were "medication required," and "breathing normal between attacks" (95%). Definitions and symptoms were poor predictors of BHR. Researchers can use these estimates in selecting and defining specific populations of children with asthma.

Asthma↗
PubMed1998

Racial differences in emergency department use persist despite allergist visits and prescriptions filled for antiinflammatory medications.

BACKGROUND: African-American children use the emergency department (ED) for asthma care more than their Caucasian counterparts. OBJECTIVE: We sought to compare ED utilization for asthma care by race, adjusting for prescriptions filled for antiinflammatory medications, type of index visit (specialist vs nonspecialist), and demographic variables. METHODS: An index asthma visit was identified for a cohort of managed care enrollees aged 4 to 11 years. Information on asthma encounters and drug claims data was evaluated during a prospective observation period of 12 months. RESULTS: African-American race was associated with one or more ED visits during the observation period (relative risk [RR] = 1.8, 95% CI = 1.3 to 2.5, p < 0.01). After adjusting for index visit type, prescriptions filled, and selected demographic variables, African-American race remained associated with post-index ED utilization (adjusted RR = 1.6, 95% CI = 1.0 to 2.4, p = 0.05). Additional findings included an inverse relationship between African-American race and antiinflammatory medications among children with nonspecialist index visits (RR = 0.5, 95% CI = 0.3 to 0.9, p = 0.02) and a positive relationship between African-American race and hospitalization after an ED visit for asthma care (RR = 10.2, 95% CI = 1.4 to 74.8, p < 0.01). CONCLUSION: African-American children were more likely to use ED asthma care even after adjusting for the type of index visit, prescriptions filled for antiinflammatory medications, and selected demographic variables. Racial differences in ED utilization for asthma care could be caused by a higher prevalence of uncontrolled or undertreated disease among African-American children not receiving specialty care.

Anti-Inflammatory Agents↗
PubMed1997

Outcome of nursing home care for residents with alcohol use disorders.

OBJECTIVES: To describe the outcome of nursing home (NH) care for a previously established cohort of residents with active, inactive or no alcohol use disorder (AUD), and to examine demographic variables, health services utilization, mortality and drinking behaviors in this group. DESIGN: Retrospective cohort study with participant interviews at NH admission and 3 years later. SETTING: Urban Veterans Affairs (VA) Medical Center and Nursing Home Care Unit (NHCU). PARTICIPANTS: Patients older than age 50 admitted consecutively to a VA NHCU between July 1991 and February 1993 who completed a structured interview, N = 117. MAIN OUTCOME MEASURES: AUD as determined by DSM-III-R criteria. Demographics, health services utilization and mortality as abstracted from the VA medical record. RESULTS: Health service utilization as measured by care episodes was not significantly different in the three groups (active, inactive and no AUD), but subjects with AUD had documented health services use related to alcoholism, including hospitalizations for alcohol-related illness, placements in long-term care facilities to control drinking and death from alcohol-related causes. The mean age at death was significantly younger for study participants with active or inactive AUD compared to those with no AUD: 67.7, 70.4 and 77.9 years, respectively (p < 0.004). Of the 21 participants with active AUD at NHCU entry, 11 resumed drinking after discharge and six still met criteria for active AUD 3 years later. CONCLUSIONS: The subset of NHCU patients with active AUD continued to incur alcohol-related hospitalizations and institutionalizations following NHCU discharge and suffered early mortality relative to their peers. Effective models of care for this subset of patients should be sought.

Age Factors↗
PubMed1997

Ethnic differences in the prevalence of asthma in middle class children.

BACKGROUND: Studies have shown a higher prevalence of asthma among boys compared with girls and in blacks compared with whites, but it has been difficult to separate socioeconomic from racial effects because the blacks in the studied populations were more likely to have low socioeconomic status. OBJECTIVE: To compare the prevalence of asthma in a socioeconomically homogeneous, middle class, multiethnic population of schoolchildren. METHODS: Based on a telephone survey of all families of third-graders in Southfield, Michigan, we ascertained the prevalence of physician-diagnosed asthma and probable undiagnosed asthma. One reason Southfield was chosen for study was because the city comprises an integrated middle class population with only 4% blacks and 7% whites having incomes below federal poverty limits. RESULTS: The lifetime prevalence of asthma was 9.5% (12% for blacks and 6% for whites) and higher in boys (14%) than girls (5%), a pattern that was reflected in period prevalence estimates. The lifetime prevalence of probable undiagnosed asthma was greater in blacks (16.6%) than whites (10.8%), with little sex difference. Adjusting for sex and maternal education, the prevalence of physician-diagnosed asthma and probable asthma were associated independently with black ethnicity. CONCLUSIONS: Our study is unique in the similarity of the black and white families' socioeconomic status and residence in the same middle class community. Since access to medical care and macro-environmental conditions were similar across this study population, our results are consistent with the hypothesis that differences in biologic factors between blacks and whites and boys and girls play a role in asthma risk.

Adolescent↗
PubMed1997

Use of estrogen therapy in a patient with gastrointestinal bleeding secondary to arteriovenous malformations.

OBJECTIVE: To describe a patient with gastrointestinal (GI) bleeding caused by arteriovenous malformations (AVMs) that was treated with estrogen therapy. CASE SUMMARY: A 70-year-old white man was diagnosed with multiple AVMs in the cecum, duodenum, and stomach. Pharmacologic management included the use of ferrous sulfate; however, the patient continued to have recurrent bleeding that required multiple transfusions and endoscopic cauterization. Therapy was initiated with ethinyl estradiol 0.05 mg po qd; no further transfusions have been required for 10 months. DISCUSSION: It is estimated that AVMs of the GI tract account for 1-8% of upper GI bleeding episodes and up to 6% of lower GI bleeding episodes. Hormonal agents have been reported to decrease bleeding in patients with both hereditary and acquired AVMs. CONCLUSIONS: The role of estrogen therapy in treating AVMs of the GI tract is unclear and supported by only one clinical study.

Aged↗
PubMed1996

Prevalence of possible undiagnosed asthma and associated morbidity among urban schoolchildren.

OBJECTIVE: The extent to which urban children endure the symptoms and consequences of asthma without a physician diagnosis has not been well studied. Our objective was to obtain an estimate of the prevalence of possible undiagnosed asthma in a population of urban schoolchildren. DESIGN AND METHODS: A population-based cross-sectional study was conducted in urban schoolchildren, grades 3 to 5. Undiagnosed asthma was defined as caretaker report of symptoms and/or bronchial hyperresponsiveness, defined as a 15% or greater drop in baseline forced expiratory volume in 1 second, after exercise challenge. RESULTS: A total of 230 children (61% of those eligible) participated in the study. Forty children (17.4%; 95% Confidence interval (CI) = 12.5% to 22.3%) had reports of a physician diagnosis of asthma. Of these, 33 (14.3%; (95% CI = 9.8% to 18.9%) reported wheezing in the past 12 months. Among the remaining 189 eligible children, 11 (5.8%; 95% CI = 2.5% to 9.2%) met study criteria for undiagnosed asthma based on bronchial hyperresponsiveness (BHR). Another 16 (8.5%; 95% CI = 4.5% to 12.4%) met study criteria for undiagnosed asthma through modified American Thoracic Society symptom criteria. Overall, 27 children (27/189; 14.3%) fulfilled criteria for undiagnosed asthma. Children identified as having undiagnosed asthma were compared with children who had no BHR and no symptoms and who did not report a physician diagnosis of asthma (children without asthma). Children with BHR were more likely to have a report of allergies and eczema than children without asthma, odds ratios (OR) = 8.5 (95% CI = 2.4 to 30.7) and 6.4 (95% CI = 1.1 to 38.1), respectively. Children meeting symptom criteria were more likely to have a report of allergies, OR = 6.2 (95% CI = 2.0 to 19.1), and bronchitis, OR = 6.7 (95% CI = 2.0 to 22.4), and were also more likely to report sleep disruption, OR = 7.1 (95% CI = 2.3 to 21.8) and missed physical education classes, OR = 15.0 (95% CI = 4.8 to 46.7), compared with children without asthma. CONCLUSIONS: We estimated a prevalence of 14.3% for possible undiagnosed asthma among urban schoolchildren, grades 3 to 5, through caretaker report of symptoms or BHR postexercise challenge. Children with undiagnosed asthma reported more atopic disease than children without asthma. In addition, children meeting symptom criteria for asthma reported more bronchitis, sleep disruption, and missed physical education classes than did those without asthma. These results suggest that rates of undiagnosed asthma may be high in this predominantly black school-age population.

Asthma↗
PubMed1995

Screening for alcohol use disorders in the nursing home.

OBJECTIVES: To determine the prevalence of Alcohol Use Disorders (AUDs) among residents of a Veterans Affairs (VA) nursing home (NH) using DSM-III-R criteria for alcohol abuse and dependence, and to examine the demographic variables associated with AUDs among NH residents. A third objective was to assess the sensitivity, compared with DSM-III-R criteria, of three screening tests for AUDs in the NH: the CAGE, the MAST-G, and the two-question instrument developed by Cyr and Wartman. DESIGN: A cross-sectional design, with DSM-III-R criteria determined by the alcohol module of the Diagnostic Interview Schedule (DIS) as the criterion standard. PATIENTS: Patients older than age 50 admitted consecutively to a VA NH, n = 117. MAIN OUTCOME MEASURES: Sensitivities, specificities, positive predictive values for the CAGE, MAST-G, and Cyr and Wartman Screening questionnaires; receiver operating characteristic (ROC) curves for the CAGE and MAST-G. MAIN RESULTS: Forty-nine percent of study participants met DSM-III-R criteria for lifetime alcohol abuse or dependence (18% active, 31% inactive). The sensitivities and specificities of the three screening questionnaires were as follows: CAGE-82% and 90%; MAST-G-93% and 65%; Cyr and Wartman-70% and 92% respectively. The area under the ROC curve was 0.94 for the CAGE and 0.90 for the MAST-G. CONCLUSIONS: The prevalence of lifetime alcohol abuse and dependence was high in this VA NH population. Both the CAGE and MAST-G are sensitive to AUDs in this setting. The areas under the ROC curves were not significantly different and indicate both tests discriminated well between NH residents with and without AUDs.

Aged↗
PubMed1994

Small sacrifices.

Explore the source record for details and available documents.

Anecdotes as Topic↗
PubMed1994

Prevalence of HPV 16 and 18 DNA sequences in CIN III lesions of adults and adolescents.

Adolescents may be more susceptible to cervical human papillomavirus (HPV) infections and may have more rapid progression of cervical intraepithelial neoplastic (CIN) lesions than adults. We evaluated Papanicolaou (Pap) smears and cervical tissue specimens from a consecutive series of 25 adolescent (age 15-20 yr) and 17 adult (age 35-40 yr) patients with a histologic diagnosis of CIN III. The study patients were all Detroit residents enrolled in a health maintenance organization (HMO) affiliated with Henry Ford Hospital. The cervical tissue specimens were evaluated for HPV 6b/11, HPV 16, and HPV 18 using agarose gel electrophoresis and Southern hybridization following polymerase chain reaction (PCR) DNA amplification. While the small sample size precluded testing for statistical significance, HPV 16 and/or HPV 18 DNA was detected in specimens from 21/25 (84%) adolescents compared to 12/17 (71%) adults (odds ratio [OR] = 2.2; 95% confidence interval [CI] = 0.49-9.74). The relationship between adolescence and HPV infections appears to be stronger for HPV 18 and mixed HPV 16/18 infections (OR = 5.6; 95% CI = 0.7-42.4) than for HPV 16 infections (OR = 1.93; 95% CI = 0.4-8.8). None of the cervical specimens contained HPV 6b/11 DNA. Oral contraceptive (OC) use was associated with HPV infection in patients with CIN III, but there was no association between cigarette smoking and HPV infection. The effect of OC use on the relationship of age and HPV could not be evaluated due to small sample size. The effects of previous sexually transmitted disease (STD) on the relationship of age and HPV were assessed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Rehabilitation in the nursing home.

Despite the considerable challenges to providing high-quality rehabilitation in a long-term care facility, growing demographic and fiscal pressures are likely to push the nursing home into the forefront of rehabilitation for the frail elderly. Model programs have been implemented in recent years that present alternative ways to increase access to skilled services and improve quality of care in nursing homes without a drastic increase in costs. The teaching nursing home program has supported projects to make longterm care facilities centers for education, innovative clinical care, and research, thus bringing nursing homes into the mainstream of the medical establishment. A majority of US medical schools have recognized the need for training in long-term care and have formed affiliations with nursing homes. The Department of Veterans Affairs has a large national system of nursing homes, which has made a significant contribution to the training of health professionals in many fields. Demonstration projects such as the Social Health Maintenance Organization and On Lok have sought to decrease the fragmentation of health care services for the elderly and bring nursing homes into a continuum of care. The adoption of the OBRA regulations is building a base for comprehensive assessment and improved provision of care in nursing homes nationwide. Nursing home rehabilitation has the potential to decrease institutionalization in the short-term resident, whereas maintenance therapy can improve quality of life and decrease the cost of caring for patients who must be institutionalized. But to achieve this potential, significant barriers must be overcome. Negative attitudes about aging and nursing homes percolate through all levels of health care from lack of reimbursement at the federal and state levels to the professional priorities that continue to favor "high-tech" medicine and stigmatize nursing homes and those who work in them, to low expectations of caregivers and the residents themselves. For nursing homes to provide the level of rehabilitative care that is now expected of them, current funding mechanisms and negative attitudes must be changed, and nursing homes must be recognized as a legitimate part of mainstream health care.

Aged↗
PubMed1992

Risk of recurrent thromboembolic events in patients with focal cerebral ischemia and antiphospholipid antibodies. The Antiphospholipid Antibodies in Stroke Study Group.

Antiphospholipid antibodies are a marker for an increased risk of thrombosis, including stroke and transient ischemic attacks. Prior studies suggest that patients with these antibodies and thrombosis may be at increased risk for recurrent thrombotic events. We prospectively evaluated 75 patients with antiphospholipid antibodies and cerebral or ocular ischemia for recurrence of thrombosis. Twenty-six patients (35%) experienced a recurrent stroke or transient ischemic attack, with a mean time to recurrence of 1.18 years. Hypertension significantly increased the risk of a recurrent transient ischemic attack. Patients with coronary artery disease were three times as likely as those without to have a recurrent stroke or transient ischemic attack. There was a trend for treatment with a combination of aspirin and dipyridamole to reduce the risk of recurrent thrombotic events after adjusting for sex and ethnicity.

Antibodies↗
PubMed1990

Risk of colorectal cancer among automotive pattern and model makers.

Twofold to threefold increases in risk for colorectal cancer associated with pattern and model making in the automobile industry have been suggested by several reports. This paper reports the investigation of a cohort of 7545 General Motors pattern and model makers originally defined for the purpose of cancer screening. All-cause mortality for this cohort was lower than that of the US population (standardized mortality ratio [SMR] = 0.7; 95% confidence limits 0.6, 0.8). There were 22 colon cancer deaths v 10.9 expected, resulting in a significantly elevated SMR of 2.0 (95% confidence limits of 1.3, 3.0), consistent with previous studies. The colon cancer SMR for nonparticipants in the screening programs was 4.0 (95% confidence limits of 2.2, 6.7), emphasizing the importance of complete follow-up for all members of a defined cohort.

Adult↗
PubMed1989

Identification of factors associated with delayed antenatal care.

Research has shown that women who do not obtain adequate prenatal care significantly reduce their chances of a favorable pregnancy outcome. Because interventions aimed at circumventing unfavorable pregnancy outcomes, such as low birthweight, are most effective during prenatal care, the need to identify sociodemographic characteristics associated with a delay in the onset of such care is reinforced. In this study of 284 women seeking services at selected public clinics in Detroit, regression analysis was used to examine the simultaneous effects of change in income, insurance status, household members, age, and other variables on the prevalence of delayed prenatal care. Delayed care was found to be associated with a lack of insurance and an education of fewer than 12 years. Insurance status and household members (serving as an adjunct indicator of marital status) were found to be important predictors of late entry. Other variables such as age and race appeared to have no influence on the decision to delay care.

Adolescent↗