Bronchodilator therapy in patients with acute bronchitis.
Explore the source record for details and available documents.
Acute Disease↗
Biomedical subjects
C M Sharkness
Publications and source records attributed to C M Sharkness.
The prevalence of tympanostomy tubes in children in the United States, 1988.
Information from the 1988 National Health Interview Survey Medical Device Implant Supplement was used to obtain the first population estimates of the prevalence of implanted tympanostomy tubes, a common treatment for otitis media. The prevalence rate was estimated to be 13 per 1000 children aged younger than 18 years. Statistically significant differences in prevalence were found for sex (boys, 15/1000; girls, 10/1000), race (Whites, 15/1000; others, 4/1000), and activity level ("limited," 44/1000; others, 11/1000). Thirty percent of the tubes were replacements; infection was the reason for 75% of the original implants. The morbidity and costs associated with tympanostomy tubes are of public health importance.
Adolescent↗
The prevalence of internal orthopedic fixation devices in children in the United States, 1988.
This study provides the first estimated prevalence of implanted orthopedic fixation devices (e.g., pins or wires) among children in the United States, based on the Medical Device Implant Supplement to the 1988 National Health Interview Survey. The overall prevalence was 27 per 10,000 children younger than 18 years; prevalence was highest (59/10,000) among those aged 12 to 17 years. The lower extremities were the most frequent body site (43%) and injury was the leading specific reason for implantation (37%). Some (10%) were replacement implants.
Adolescent↗
Racial differences in the prevalence of intraocular lens implants in the United States.
We generated population-based estimates of the prevalence of intraocular lens implants by using the 1988 Medical Device Implant Supplement to the National Health Interview Survey. This national survey of a probability sample of the civilian noninstitutionalized United States population comprised 47,485 households and 122,310 persons. To produce national projections, we used survey respondent-reported data based on 1,941 reported intraocular lenses in 1,337 persons. Projected to the United States population, an estimated 2.6 million people had a total of 3.8 million lens implants. The predominant reason for the implant was cataract. The intraocular lens replacement rate was 0.9%. The use of intraocular lens implants was statistically significantly different from the general population in persons with the following socioeconomic characteristics: age (65 years or older), race (white), gender (female), annual family income (less than $20,000, although more commonly at or above the poverty threshold), and education (less than high school). The prevalence rates per 1,000 persons according to age were as follows: 0.3 for persons 44 years old or younger, 9.9 for persons 45 to 64 years old, 33.3 for persons aged 65 to 69 years, 63.5 for persons aged 70 to 74 years, and 113.5 for persons 75 years old or older.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Features on initial computed tomography scan of infarcts with a cardiac source of embolism in the NINDS Stroke Data Bank.
BACKGROUND AND PURPOSE: The lack of valid criteria for the clinical diagnosis of cardiogenic embolism is a major problem in both patient care and research. The aim of this study was to identify features on the initial computed tomogram of the brain that discriminate between patient groups with and without a cardiac source of embolism. To gain insight into the neuroradiological features relevant to the diagnosis of cardiac embolic stroke, we studied the initial computed tomogram of the 1,267 patients with ischemic stroke and such a scan in the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Data Bank. METHODS: We analyzed the initial computed tomographic data from 1,267 patients with ischemic stroke in the NINDS Stroke Data Bank. Based solely on the presence of cardiac sources of embolism, we defined groups with high (n = 244), medium (n = 165), and low (n = 858) risk for cardiogenic embolism and compared the features on the initial computed tomogram among these three groups. RESULTS: Patients in the high-risk group were significantly more likely (p < 0.001) to have infarcts involving one half lobe or larger or infarcts involving both superficial and deep structures than patients in the medium- or low-risk groups. In contrast, deep small infarcts had a negative association (p = 0.004) with the presence of a cardiac source of embolism. There was no significant trend across risk groups in the percent with hemorrhagic infarction, regardless of whether patients with anticoagulant use at the time of the stroke were excluded. CONCLUSION: Although some features of the initial computed tomogram had highly significant associations with the presence of a cardiac source of embolism, the predictive value of these features for an embolic source was low.
Cerebral Infarction↗
Infarcts with a cardiac source of embolism in the NINDS Stroke Data Bank: neurologic examination.
To gain insight into neurologic signs relevant to the diagnosis of cardiogenic embolism, we analyzed data from 1,290 patients with cerebral infarcts in the NINDS Stroke Data Bank. Based solely on the presence of potential cardiac sources of embolism, we divided patients into groups of high (N = 250), medium (N = 167), and low (N = 873) risk of a cardiogenic mechanism for their stroke. Diminished level of consciousness was highly associated with the presence of a cardiac source of embolism. Of the four primarily cortical deficits assessed, three (visual field abnormalities, neglect, and aphasia) showed a highly significant graded relationship to the cardiac risk groups. For the fourth cortical deficit (other nonlanguage cognitive functions), this relationship did not attain statistical significance. Conversely, hemiparesis without sensory or cortical deficits had a strong inverse association to the presence of a cardiac source of embolism. This inverse association was weaker for sensorimotor strokes and nonexistent for pure sensory strokes. Although some neurologic findings had highly significant associations with the presence of a cardiac source of embolism, their predictive value for an embolic source was low.
Cerebral Infarction↗
Prevalence of artificial hips in the United States.
This report summarizes information about adults with artificial hips as derived from a national survey, the 1988 National Health Interview Survey Medical Device Implant Supplement. Based on extrapolation to the United States population from the survey sample, it is estimated that 674,000 adults are currently using 811,000 artificial hips. The prevalence rate is 3.8 persons per thousand (95% confidence interval, 3.2, 4.4). 91.5% of the implants are primary implants and 8.5% are revisions, with the predominant reason for revision being loosening. Arthritis and injury are the most common reasons for hip implantation. Almost 60% of the implants have been in use for 5 years or less. This prevalence information about adults with artificial hips is unique in that it represents the first such estimates based on a probability sample of the United States population.
Adolescent↗
Infarcts with a cardiac source of embolism in the NINCDS Stroke Data Bank: historical features.
To gain insight into the historical features relevant to the diagnosis of cardiac embolic strokes, we studied the 1,290 patients with cerebral infarcts in the NINCDS Stroke Data Bank. Based solely on the presence of cardiac sources of embolism, we divided the patients into groups of high (n = 250), medium (n = 166), and low (n = 874) risk of a cardiogenic mechanism for their stroke. There was a highly significant graded relationship between increasing risk of a cardiac source and a history, or presence of, systemic embolism, abrupt onset, and diminished level of consciousness at onset. These clinical features may be useful for assessing the likelihood of a cardiac embolic mechanism in patients with cerebral infarcts.
Cerebral Infarction↗
Predictors of rehabilitation outcome among patients with SCI.
Because rehabilitation medicine has undergone major changes with respect to patient management and case mix since 1980, it is important to determine whether the factors predictive of rehabilitation outcomes also have changed over time.
Activities of Daily Living↗
Secular changes in case mix of SCI patients at Montebello.
Explore the source record for details and available documents.
Adult↗
Risk factors for stroke subtypes.
Explore the source record for details and available documents.
Cerebrovascular Disorders↗
An estimation of squamous cell carcinoma risk from ultraviolet radiation emitted by fluorescent lamps.
The risk of squamous cell carcinoma (SCC) from ultraviolet radiation (UV) emitted by unfiltered fluorescent lamps was assessed. The assessment employed a mathematical power model based on human epidemiological data, which relates the SCC incidence in the United States white population to ambient solar UV. The annual numbers of new SCC on anatomical sites chronically exposed to solar UV (head/face/neck and hands) were estimated for indoor workers. Then the number of SCC that may be caused by additional UV exposure from indoor fluorescent lighting was estimated: the lifetime exposure of indoor workers to typical fluorescent lighting (if unfiltered) may add 3.9% (1.6-12%) to the risk from solar UV, resulting in the induction of an additional 1500 (600-4500) SCC per annum in the United States. This calculated projection must be compared with the 110,000 SCC caused by solar exposure. Thus, this analysis suggests there may be a small increased risk of SCC from exposure to UV-emitting fluorescent lamps.
Carcinoma, Squamous Cell↗
The patient's view of hypertension and compliance.
Noncompliance has been identified as the predominant reason for failure of hypertension therapy. Patients may perceive hypertension as a symptomatic condition, and this view may affect compliance. In a cross-sectional study of outpatients attending a hypertension clinic, we assessed 125 veterans' understanding of hypertension, hypertension history, comorbidities, and pharmacy refills for hypertension medications. Though over 70% viewed hypertension as a symptomatic condition, symptoms were not significantly associated with pharmacy compliance. In univariate analyses, variables significantly associated with better pharmacy compliance were perceived lifetime treatment of hypertension, greater than 5-year history of medication use, perceived cause of hypertension other than diet, use of more than one hypertension drug, lack of reported departure from the prescribed medication regimen, absence of drug abuse history, and race (Caucasian). In multivariate analyses, the best predictive model of pharmacy compliance included three variables: drug abuse history, perceived cause of hypertension, and pattern of medication use. This type of information should be included in the assessment of medication compliance among hypertensive patients.
Adult↗
Prevalence of artificial hip implants and use of health services by recipients.
Data from the 1988 Medical Device Implant Supplement to the National Health Interview Survey are used to summarize information about the prevalence of artificial hips among adults in the United States. The 1988 National Health Interview Survey was a cross-sectional survey of the civilian noninstitutionalized United States population, and included 122,310 persons in 47,485 households in a multistage probability sample. The supplement supplied the first population-based estimates of prevalence and morbidity of selected medical devices. Projected to the United States population, the survey results indicate that an estimated 674,000 adults were using 811,000 hip implants. Hip implant recipients were significantly more likely to be older, to be white, and to have lower educational, income, and activity levels than the general population of adults. After age-stratification, however, only differences in activity limitation and race remained. Current economic outlays for hip replacement surgery are substantial. With the aging population, use of health services by patients with artificial hips will probably increase unless measures to reduce the need for replacement surgery are instituted. These measures include reducing injuries and improving biomaterials. Further investigation is needed to examine the activity limitation and racial difference in prevalence found in this study.
Activities of Daily Living↗
Do we practice what we teach about childhood immunization in New Jersey?
BACKGROUND AND OBJECTIVES: Although childhood immunization is a benchmark for preventive service delivery in family practices, no data have been reported on childhood immunization in New Jersey family practice residencies. This study assesses immunization coverage among 2-year-olds in nine residencies and evaluates childhood immunization knowledge and barriers in 10 residency programs. METHODS: We performed a retrospective review of immunization records of 2-year-olds, using the Centers for Disease Control's Clinic Assessment Software Application, and analyzed a survey of knowledge and barriers to immunization completed by residents, nurses, and faculty. RESULTS: Among 726 children with four or more office visits, the mean percent of children immunized with the combination of four diphtheria-tetanus-pertussis, three polio, and one measles-mumps-rubella was 53% (range 31%-69%). The age-appropriate immunization rate was highest at 3 months (78%) and lowest at 16 months (29%). Among the 294 survey respondents, the mean knowledge score was 75% overall and 82% for faculty, 77% for nurses, and 71% for residents. There was moderate to good correlation of audit levels with knowledge, with 49% of the variation in immunization coverage explained by variation in knowledge. Lack of immunization records was reported by 47% as the most important office-related barrier. CONCLUSIONS: Immunization rates of 2-year-olds in nine New Jersey family practice residencies are below Healthy People 2000 goals. Low immunization rates in residency programs may improve with increased knowledge, an area for future study. Research into removing immunization-related barriers is also needed.
Adult↗