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Biomedical subjects

C L Roberts

Publications and source records attributed to C L Roberts.

36 records · Page 2Linked to original sources
PubMed1999

Trends in births at and beyond term: evidence of a change?

OBJECTIVE: To examine trends in the distribution of births at and beyond term in New South Wales and in particular, to determine whether any changes are associated with changes in the obstetric practices of induction and elective caesarean section. DESIGN: Cross-sectional analytic study. SETTING: New South Wales, Australia. POPULATION: All 540,162 women delivering a singleton cephalic-presenting infant of gestational age > or = 37 weeks from 1 January 1990 to 31 December 1996. METHODS: Data were obtained from the New South Wales midwives data collection, a population-based surveillance system covering all births in New South Wales. The data were analysed to examine changes over time and associations between gestational age, maternal factors and onset of labour. MAIN OUTCOME MEASURES: Induction of labour and elective caesarean section rates. RESULTS: From 1990 to 1996 there was a significant decrease in births reported as 40 weeks of gestation, from 35,670 (46.3%) to 30,651 (40.3%). These declines were offset by significant increases in births at 38 and 39 weeks. Births > or = 42 weeks declined from 3321 (4.6%) to 2132 (2.8%). The decline in prolonged pregnancies was associated with increasing induction rates at 41 weeks. The re-distribution of some births from 40 to 38-39 weeks was associated with increasing rates of elective caesarean sections and induction at 38 and 39 weeks, and increasing maternal age. CONCLUSIONS: Clinicians appear to be implementing the recommendations of randomised controlled trials to offer induction after 41 weeks of gestation. However the trend of performing elective caesarean sections at earlier gestational ages may be unnecessarily putting some infants at increased risk of respiratory morbidity.

Adult↗
PubMed1998

Penicillin resistance in laboratory isolates of Streptococcus pneumoniae, in Western Australia, 1990-1994.

Increasing frequency of penicillin resistance in Streptococcus pneumoniae has been reported worldwide. We report on clinical isolates of penicillin-resistant pneumococci (PRP) in Western Australia (WA) from 1990-1994. A retrospective survey of laboratories performing susceptibility testing, or receiving isolates referred from rural areas found resistant on oxacillin disc screening, was undertaken. Four of 11 laboratories could provide data for the five year time period inclusive. Information was provided on susceptibility to penicillin, type of specimen, date of isolation and; age, sex and race of individuals with PRP. Penicillin resistance increased from 1.3% to 9.0% over the five year period. PRP were rarely invasive. Highest age specific rates per 100,000 were found in children < 5 years (19.4) and adults > or = 60 years (5.1). Aboriginal ethnicity was associated with resistance. The increasing frequency of PRP in WA indicates the need for surveillance systems for their detection.

Adolescent↗
PubMed1998

Bilateral massive ovarian edema: a case report.

Massive ovarian edema is an unusual cause of ovarian enlargement in young patients. Most cases are thought to result from venous and lymphatic obstruction, producing edema. We report the case of a 15-year-old girl with bilateral massive ovarian edema, findings on ultrasound imaging, and a review of the literature. The sonographic appearance is non-specific and can mimic neoplasia, and the definitive diagnosis requires histological examination. It is, however, an important condition to consider in a young patient with a complex ovarian mass in an appropriate clinical setting, as conservative treatment with ovarian preservation is often possible.

Adolescent↗
PubMed1997

What do physicians know about cryptosporidiosis? A survey of Connecticut physicians.

BACKGROUND: Cryptosporidiosis, an intestinal parasitic infection, has gained considerable media attention since a 1993 waterborne outbreak in Milwaukee, Wis, in which more than 400,000 persons became ill. However, the incidence of and risk factors for human cryptosporidiosis in the general US population are unknown. It has been suggested, but not documented, that physicians are generally unaware of the need to specifically request testing for this organism. OBJECTIVE: To assess physician awareness of cryptosporidiosis and knowledge of laboratory testing for Cryptosporidium oocysts. METHODS: A self-administered questionnaire was mailed to a stratified random sample of Connecticut physicians. Specialties were limited to physicians in internal medicine, gastroenterology, infectious disease, pediatrics, and family or general practice. Responses were compared among specialties. RESULTS: While most physicians were aware that cryptosporidiosis causes watery diarrhea (range, 67%-98%), particularly in patients with acquired immunodeficiency syndrome (> 85% of all specialties), many did not know the symptoms or failed to identify other groups at increased risk. More than 75% of gastroenterologists, general or family practitioners, internists, and pediatricians never or rarely order diagnostic testing for Cryptosporidium even when their patients have symptoms consistent with cryptosporidiosis. More than 30% of physicians assumed Cryptosporidium testing was included in a standard ova and parasite examination. CONCLUSIONS: Cryptosporidiosis is likely to be unrecognized and underdiagnosed in Connecticut. This may occur because many physicians are unaware of cryptosporidiosis, unsure of the symptoms, do not test for it, or do not order the appropriate test. Unless there is more widespread use of specific tests, it will be difficult to evaluate specific preventive initiatives to limit the overall health impact of cryptosporidiosis.

AIDS-Related Opportunistic Infections↗
PubMed1997

Trends in infant mortality in Connecticut, 1981-1992.

Assessing infant mortality rates (IMRs) is important in public health planning. However, single year fluctuations in IMRs often receive attention without consideration of long-term trends. Trends in IMR over 12 years in Connecticut were examined using linked birth and death files. Overall, there was an exponential decline in IMR from 12.2/1,000 live births in 1981 to 7.3/1,000 live births in 1992. However, differential declines in IMRs resulted in an increased relative risk of infant death over time for infants of Black women compared with infants of White women. IMRs were also higher for infants of Black, teenaged, and less educated mothers. Targeted local maternal and child health programs are needed if IMRs are to continue to decline for all sections of the population in Connecticut.

Age Factors↗
PubMed1996

Underreporting of Lyme disease by Connecticut physicians, 1992.

To determine the magnitude of underreporting of Lyme disease, a random sample of Connecticut physicians was surveyed in 1993. The magnitude of underreporting was assessed by comparing physician estimates of Lyme disease diagnoses with reports of Lyme disease sent by physicians to the Connecticut Lyme disease surveillance system. Complete questionnaires were returned by 59 percent (412/698) of those surveyed. Of the 224 respondents who indicated that they had made a diagnosis of Lyme disease in 1992, only 56 (25 percent) reported a case of Lyme disease that year. Survey results suggested that, at best, only 16 percent of Lyme disease cases were reported in 1992. Physician underreporting of Lyme disease underestimates the public health impact of Lyme disease.

Connecticut↗
PubMed1996

Factors influencing Cryptosporidium testing in Connecticut.

To describe patterns of testing for Cryptosporidium oocysts in stool samples, Connecticut laboratories were surveyed. Different detection methods were used. Most laboratories examined stools specifically for Cryptosporidium only on physician request. The rate of positive tests varted widely (0 to 28%). Higher rates of positivity were associated with the use of monoclonal antibody methods, the use of two or more staining procedures, and testing of stool specimens in addition to those requested by physicians.

Animals↗
PubMed1996

A meningococcal vaccination campaign on a university campus: vaccination rates and factors in nonparticipation.

OBJECTIVES: This study was undertaken to determine an accurate vaccination rate and identify factors influencing nonvaccination in a meningococcal vaccination campaign on a Connecticut university campus in May 1993. METHODS: Vaccination and student data were merged to determine demographic factors associated with nonvaccination. A case-control study examined reasons for nonvaccination. RESULTS: The estimated vaccination rate for students returning to the campus was 93%. Lower rates occurred among older students, students living off campus, graduate and nondegree students, and married students. Perceived poor access to the vaccination center was the strongest predictor of nonvaccination. CONCLUSIONS: Higher vaccination rates may be achieved by specifically targeting students who live off campus and by providing multiple vaccination sites with extended hours.

Adolescent↗
PubMed1996

Predictors of positive tuberculin skin test results in a jail population.

The purpose of this analysis was to determine the prevalence and predictors of positive tuberculin skin tests (TSTs) in a jail population. TST results and demographic data were obtained for 996 male inmates of a Connecticut jail who were tested following identification of a case of multidrug-resistant Mycobacterium tuberculosis (MDR-TB). Inmates were predominantly young (median age, 26 years) and Black (51%) and were born in the United States (96%). Overall 109 (11%) inmates had positive TST results. TST positivity was strongly associated with being born outside the United States (adjusted odds ratio [aOR] = 11.3, 95% confidence interval [95% CI] 4.9-25.8), being Puerto Rican born (aOR = 3.7, 95% CI 1.9-7.4), and increasing age (15-24 years aOR = l [referent]; 25-34 years aOR = 2.1 95% CI 1.2-3.5; 35-44 years aOR = 4.3 95% CI 2.4-7.7; > or = 45 years aOR = 6.4 95% CI 2.8-14.6). The combination of being U.S.-born and Black was also associated with increased rates of positive TSTs. The prevalence of TST positivity was > 10% for all age groups of inmates born outside the United States or Puerto Rico and for Puerto Rican-born inmates aged > or = 25 years and U.S.-born inmates aged > or = 35 years. Analysis of routinely collected TST data allows predictors of TST positivity to be identified and may help determine population subgroups for whom anergy screening and preventive therapy should be considered.

Adult↗
PubMed1995

The role of heightened surveillance in an outbreak of Escherichia coli O157.H7.

After instituting laboratory screening for Escherichia coli O157.H7, a Connecticut hospital isolated the organism from four persons in September 1993. As a result, an outbreak of E. coli O157.H7 associated with a country club was detected. The club had served hamburger from the same shipment at two picnics. Attendees of two picnics were interviewed, stool cultures were obtained from symptomatic persons, and the remaining hamburger was cultured. Twenty (22%) of 89 persons who ate hamburger became ill, compared with 1 of 60 who did not eat hamburger (relative risk = 13.5, 95% confidence interval 3.2-56.3). Among persons who ate hamburgers, illness was strongly associated with eating hamburger that was not thoroughly cooked (P < 0.001). All 20 samples from 5 remaining boxes of patties yielded E. coli O157.H7. Isolates from hamburger and case-patients were indistinguishable by pulsed-field gel electrophoresis. Heightened surveillance can rapidly identify outbreaks and may mitigate their impact. However, continued review of food safety issues is necessary if E. coli O157.H7 outbreaks are to be prevented.

Adolescent↗
PubMed1994

Delayed childbearing--are there any risks?

OBJECTIVE: To determine whether women delivering their first child at age 35 years or older are at increased risk of adverse (non-genetic) pregnancy outcomes. DESIGN AND SETTING: A cross-sectional analytic study of singleton deliveries in Northern Sydney Area Health Service (NSAHS) hospitals. PARTICIPANTS: All women aged > or = 20 years delivering their first child between 1 January 1990 and 31 December 1991. MAIN OUTCOME MEASURES: Obstetric complications and procedures, type of delivery and neonatal outcomes. RESULTS: Compared with women aged 20-29 years, women delivering their first child at > or = 35 years were at increased risk of pre-existing maternal hypertension (adjusted odds ratio [OR], 3.5; 95% confidence interval [CI], 1.7-7.0), antepartum haemorrhage (adjusted OR, 2.4; 95% CI, 1.6-3.7), preterm delivery (33-36 weeks) (adjusted OR, 2.0; 95% CI, 1.5-2.8) and breech presentation (adjusted OR, 1.8; 95% CI, 1.3-2.4). Women aged > or = 35 years were also substantially more likely to have an operative delivery, induced labour and/or epidural anaesthesia. Neither these women nor their infants were at increased risk of pregnancy-induced hypertension, gestational diabetes, threatened premature labour, postpartum haemorrhage, very preterm delivery (< or = 32 weeks), perinatal death, low Apgar scores or the need for neonatal resuscitation. CONCLUSIONS: Women who delay the birth of their first child face some increased risks, but these risks, for the most part, are manageable in the context of modern obstetric care.

Adult↗
PubMed1994

Survival and short-term outcome in newborns of 23 to 25 weeks' gestation.

OBJECTIVES: We determined which factors are associated with survival and good short-term neurologic outcome in newborns of 23 to 25 weeks' gestation. STUDY DESIGN: We retrospectively reviewed the charts of all (n = 82) infants born alive at our hospital at 23 to 25 weeks' gestation from 1988 through 1991. We used univariate and multiple logistic regression analysis to compare survivors at hospital discharge with nonsurvivors and those with and without good short-term neurologic outcome. RESULTS: Survival rates were 19%, 59%, and 65% at 23, 24, and 25 weeks' gestation, respectively. A total of 90% of survivors had good short-term neurologic outcome. On multiple logistic regression analysis, female sex (odds ratio 8.7, 95% confidence limits 2.2 and 34), larger birth weight (odds ratio 2.5 per 100 gm increment, 95% confidence limits 1.3 and 4.9), and more advanced gestational age (odds ratio 5.3, 95% confidence limits 1.2 and 22 for 24 weeks; odds ratio 3.8, 95% confidence limits 0.6 and 22 for 25 weeks) were associated with survival. Female sex, more advanced gestational age, and larger birth weight were also associated with good short-term neurologic outcome. CONCLUSIONS: Good short-term neurologic outcome is possible in many survivors in this gestational age range. Factors other than gestational age may be considered when intervention in these pregnancies is contemplated.

Birth Weight↗
PubMed1972

Reduction of intraspecies aggression in rats by positive reinforcement of incompatible behaviors.

Fighting responses were elicited by response-independent shocks delivered to pairs of rats. Food pellets were presented following different non-fighting responses to shock: some pairs of rats received pellets dependent upon a specific non-fighting response to shock; others received pellets dependent upon any non-fighting response to shock; and control pairs never received pellets. The mean probability of an elicited aggressive response to shock was reduced to 0.2 by food reinforcement for a specific non-fighting response, and to 0.5 by food reinforcement for any kind of non-fighting response. These values contrasted with the 0.8 probability of elicited aggression when pairs of rats received no food reinforcement. Consistent findings were obtained when treatment conditions were changed for individual pairs of rats.

Aggression↗
PubMed1971

Elicitation and punishment of intraspecies aggression by the same stimulus.

Fighting responses were elicited in pairs of rats by shocks over a period of 46 days. During certain blocks of these days, "punishing" shocks were made contingent on the shock-elicited fights. Fighting frequency was reduced as a direct function of the intensity of the contingent shocks. Fighting frequency recovered completely when contingent shocks were removed.

Journal Article↗