PubMed Health⌕ Search

Biomedical subjects

C Schechter

Publications and source records attributed to C Schechter.

30 records · Page 2Linked to original sources
PubMed1993

Decreased efficacy of inhaled pentamidine in the prevention of Pneumocystis carinii pneumonia among HIV-infected patients with severe immunodeficiency.

STUDY OBJECTIVE: To determine the relationship between the degree of immune deficiency and the risk of Pneumocystis carinii pneumonia (PCP) among HIV-infected patients receiving inhaled pentamidine prophylaxis. DESIGN: Retrospective chart review. SETTING: AIDS clinic of inner-city hospital. PATIENTS: Patients attending inhaled pentamidine clinic between 1989 and 1991. INTERVENTION: Review of medical records of patients receiving inhaled pentamidine, 300 mg/month, via nebulizer (Respirgard II) as primary or secondary prophylaxis of PCP. Statistical analysis of lymphocyte subset results and selected clinical data. RESULTS: Ten of 57 patients developed PCP during the period of analysis. Patients with CD4 counts less than 60/mm3 were significantly more likely to develop PCP (p = 0.01; Fisher's exact test) with a relative risk of 7.55 compared to patients with CD4 lymphocyte counts greater than 60/mm3. CONCLUSION: Failure of inhaled pentamidine prophylaxis is seen almost exclusively among patients with CD4 lymphocyte counts below 60/mm3.

AIDS-Related Opportunistic Infections↗
PubMed1992

Cost effectiveness of cervical cancer screening for the elderly.

OBJECTIVE: To analyze the costs and benefits of alternative cervical cancer screening schedules among elderly women. SETTING: Population-based screening programs. DESIGN: A Markov model predicts the outcomes of periodic screening, diagnosis, and treatment for cervical cancer among women from 65 to 109 years of age. PATIENTS: A hypothetical cohort of one million 65-year-old women; representative of the U.S. population. MEASUREMENTS: The costs and yields of screening. RESULTS: Triennial screening reduced mortality from cervical cancer among the elderly by 74% at a cost of $2254 per year of life saved. Annual screening increased costs to $7345 per year of life saved; less frequent schedules yielded lower costs but decreased savings in life. These results were most sensitive to the quality of the Papanicolaou smear and the characteristics of the women using the benefit. If the sensitivity of the Papanicolaou smear was reduced from a baseline estimate of 75% to 50% and the specificity was decreased to 87% from 95%, the cost effectiveness ratio increased by nearly $7000 per year of life saved. If triennial screening is targeted to women who have not had regular screening, the program will save money as well as years of life; however, screening women who have been screened regularly is considerably less efficient, increasing costs to $33,572 per year of life saved. CONCLUSION: The success of the new Medicare benefit depends substantially on physicians assuring that their elderly patients, particularly women without regular prior screening, obtain high quality Papanicolaou smears. The data also show that after a woman 65 years of age or older has a history of regular negative smears, screening is inefficient and can cease.

Aged↗
PubMed1991

Development of faculty consultants in a problem-based third year community medicine clerkship.

This paper describes the development of consultancy groups in behavioral science, epidemiology and biostatistics, and information science in a required community medicine rotation with a twenty year history. The addition of consultants to individual student tutors and field preceptors has led to a structure which promotes student-project flexibility, development of critical assessment skills and independent learning while maximizing faculty expertise and effectiveness.

Behavioral Sciences↗
PubMed1991

Clinical implications of screening for cervical cancer under Medicare. The natural history of cervical cancer in the elderly: what do we know? What do we need to know?

Despite the recent passage of coverage for Papanicolaou test screening under Medicare, several aspects of the natural history of cervical cancer in the elderly remain uncertain. This article reviews what we know about cervical cancer in elderly women to provide clinicians with the background necessary for assessments of screening recommendations, integration of new data into practice, and development of consensus approaches to screening in the elderly. Two central questions that affect a screening program for the elderly are how long the neoplastic process takes from preinvasive disease to the development of invasive cancer, and how likely is it that a given neoplastic state observed in an elderly woman will, in fact, progress to a more severe state. The ultimate success of the new Medicare benefit will also be affected by the use of Papanicolaou testing, the technique of obtaining the smear, and the adequacy of reporting and follow-up. The expansion of Medicare benefits to include early cervical cancer detection has the potential to improve the quality and the duration of older women's lives.

Aged↗
PubMed1991

Ambulatory blood pressure monitoring: is it cost-effective?

The detection and treatment of hypertension can prevent cerebrovascular disease and, to some extent, coronary heart disease. For mild hypertension this process is not efficient because many patients must be treated with antihypertensive medication to benefit only a few. The costs of identification, diagnosis and drug treatment of mild hypertension are significant. These costs have increased recently, in part due to changing patterns of drug selection favoring newer agents. Primary and secondary screening for hypertension has relied on casual blood pressure measurement which has high sensitivity, but low specificity, i.e. many false-positives can be expected. Incorporation of ambulatory blood pressure monitoring into secondary screening has potential for greater specificity by excluding from treatment 20-40% of those initially identified as having mild hypertension. Computer analysis of simulated populations selected for treatment by either casual blood pressure or by use of ambulatory blood pressure monitoring with echocardiography (for borderline cases) demonstrates no difference in calculated life expectancy for the two groups. However, the former strategy selected 23% of the subjects for treatment, while the latter selected 6%. These results imply that appropriate use of ambulatory blood pressure monitoring in secondary screening of mild hypertension may have a significant impact on cost-effectiveness.

Ambulatory Care↗
PubMed1984

Identification of some plasma membrane proteins of cultured rat pigment epithelial cells by labeling with 125I.

Cultured rat retinal pigment epithelial (PE) cells were labeled with 125I by lactoperoxidase (LPO)-catalyzed radioiodination. Examination of 125I-labeled cells by electron microscopic autoradiography suggested that 125I was incorporated into proteins at both the apical and basal surfaces of the PE cells, and into the extracellular matrix (ECM). Analysis of labeled cells by SDS-polyacrylamide gel electrophoresis and autoradiography showed that 125I was incorporated into at least 15 polypeptides. In order to determine which of these labeled proteins were derived from the plasma membrane. 125I-labeled cells were subjected to differential detergent extraction. Triton X-100 (2% v/v), which removed the cell plasma membrane, solubilized only three of the labeled proteins (152 000, 138 000, 123 000 daltons). SDS (0.25% w/v) completely removed cells from the tissue culture dish and solubilized all but four of the labeled proteins (225 000, 173 000, 87 000 and 72 100 daltons). When 125I-labeled PE cells were mechanically disrupted, and the resulting cell fractions separated by sucrose density gradient centrifugation, labeled proteins separated into two subcellular fractions. One fraction was especially enriched in the 152 000, 138 000 and 123 000 dalton labeled proteins, in addition to the plasma membrane marker enzymes Na+, K+-ATPase, and alkaline phosphodiesterase I. The second fraction was enriched in the 225 000, 196 000 and 173 000 dalton labeled proteins, the ECM proteins laminin and fibronectin, and the 43 000 actin band . It is proposed that 125I-labeled proteins in the former cell fraction are truly plasma membrane proteins, while those found in the latter cell fraction are a mixture of 125I-labeled ECM and basal plasma membrane proteins. The 152 000, 138 000 and 123 000 dalton labeled proteins of the plasma membrane fraction are glycoproteins and become firmly anchored to the Triton X-100 insoluble cytoskeleton when labeled cells are treated with concanavalin A.

Animals↗
PubMedDate not supplied

Occupational coronary heart disease among bridge and tunnel officers.

Traffic-control officers employed in New York City tunnels prior to 1981 have been at increased risk of mortality from coronary heart disease. In this study, the authors assessed current coronary heart disease prevalence and evaluated associations between coronary heart disease and occupational factors among New York City bridge and tunnel officers. A clinical cardiovascular disease surveillance and cross-sectional occupational epidemiologic study was conducted. The authors used comprehensive evaluations to identify current and prior incidences of coronary heart disease. Occupational risk factors evaluated included job strain, current and historic exposure to carbon monoxide, and occupational physical inactivity. Current carbon monoxide exposure was assessed via workshift changes in carboxyhemoglobin. Coronary heart disease occurred in 29 (5.5%) of the 526 bridge and tunnel officers examined. Risk of coronary heart disease was associated positively with total years each bridge and tunnel officer work had worked in that capacity (odds ratio = 1.64 for each decade of employment, adjusted for nonoccupational coronary heart disease risk factors). Carboxyhemoglobin levels were low in the subjects, and job strain and physical inactivity were very prevalent. Occupational factors contributed to the risk of coronary heart disease in New York City bridge and tunnel officers. The authors were unable to identify the specific factors that led to the increase in risk described.

Adult↗
PubMedDate not supplied

Evaluating women's attitudes and perceptions in developing mammography promotion messages.

Breast cancer is a leading cause of cancer deaths in women. Although mammography is recognized as the most effective early detection method for breast cancer, it remains underutilized. Communications theory and practice, with its emphasis on formative research, can provide a basis for developing strategies effective in changing mammography-related behaviors. Formative research, an important component of communications planning, can offer information useful in developing suitable messages and materials. The National Cancer Institute conducted small group discussions with white and black women, ages 40 to 75, to explore their attitudes, knowledge, and beliefs about mammography. Findings reinforced the results from quantitative surveys indicating that a perceived lack of their own need for the examination, lack of a physician referral, and procrastination were the main reasons that the women reported for not having mammograms. The discussions provided detailed information about the factors that can be used to guide development of messages and materials to promote mammography use. The results indicate that strategies for messages directed to either black or white women ages 40 years and older need to stress the same key message points. The points are that all women ages 40 and older are at risk for breast cancer; breast cancer can be treated successfully if it is detected early enough; mammography can detect breast cancer before a lump can be felt by a woman or her physician; women need to follow screening guidelines for age and frequency for screening; and mammography is a low-risk, quick, and painless procedure. Communication channels to reach women should include television, newspapers, magazines, and information available in physicians' offices.

Adult↗