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Biomedical subjects

D J Lerner

Publications and source records attributed to D J Lerner.

At least 19 recordsLinked to original sources
PubMed2000

A national survey of health-related work limitations among employed persons in the United States.

PURPOSE: To estimate the total prevalence of health-related work limitations among working people in the United States (US) as well as their condition-specific prevalence. METHODS: A new questionnaire measuring limitations in ability to perform specific work demands was administered to 940 employed people in a national household survey. The prevalence of specific work limitations is reported as are condition-specific risk estimates (odds ratios) based on logistic regression. RESULTS: In the US, 19.3% of working people (CI = 14.0, 24.6) were limited in their abilities to perform physical work demands; 24.1% (CI = 18.9, 29.2) were limited in performing psychosocial work demands; and 13.8% (CI = 8.3, 19.3) were limited in their abilities to function without difficulty within the ambient work environment. With successive increments in the number of conditions, the odds of having a limitation increased significantly. CONCLUSIONS: This study contributes new information concerning the implications of chronic health problems for working people and the significant risks for workers with multiple chronic conditions.

Adult↗
PubMed1999

The migraine work and productivity loss questionnaire: concepts and design.

Our objectives were to: (1) develop a self-report questionnaire for measuring the impact of migraine headache on work; and (2) qualitatively assess aspects of its performance. Two samples of migraine sufferers provided the data. Sample 1 (n = 18) participated in a structured discussion group designed to elicit examples of migraine's on-the-job impact. Sample 2 (n = 11) completed a mail survey and participated in in-depth phone interviews. Interviews addressed item comprehensibility, consistency of interpretation, the cognitive processes by which certain answers were generated and response burden. The participants were currently employed men and women, at least 18 years of age, who met the International Headache Society (IHS) criteria for migraine headache [1]. Discussion group participants indicated that migraine attacks substantially diminished their job performance. Pain, photophobia, phonophobia, mental impairment and fatigue were perceived as interfering with even routine or relatively simple job tasks. The Migraine Work and Productivity Loss Questionnaire, Version 1.0 (MWPLQ) was written. Next, it was assessed in the context of the in-depth interviews. Result indicated that the MWPLQ was comprehended without difficulty, interpreted consistently and easy to complete. Thus, qualitative results provide initial support for the new questionnaire.

Adult↗
PubMed1998

The Angina-related Limitations at Work Questionnaire.

This report describes initial experience with a new self-report questionnaire, the 17 item Angina-related Limitations at Work Questionnaire. Forty employed individuals with chronic stable angina pectoris completed the questionnaire which retrospectively examined the subjects' difficulty in performing specific work activities during the preceding 4 week period. The questionnaire performed well in this study and there was initial evidence of its validity and reliability. More than one-half of the respondents (52.5%) indicated at least some difficulty in performing one or more of the 17 work items due to angina during the preceding 4 weeks, with the greatest difficulty experienced in physically exerting tasks, handling stressful situations and feeling a sense of accomplishment. In contrast, only one-quarter of the sample missed any work time. In tests of convergent validity, the degree of work limitation correlated significantly with SF-36 physical and mental health component scores and with self-reports of angina symptoms. The questionnaire had internal reliability, with item to total score correlations of 0.75 or higher for 14 of the 17 items. In summary, the Angina-related Limitations at Work Questionnaire offers promise for quantifying work limitations among individuals with chronic stable angina.

Angina Pectoris↗
PubMed1996

Agonist recognition by proteinase-activated receptor 2 and thrombin receptor. Importance of extracellular loop interactions for receptor function.

Thrombin receptor and proteinase-activated receptor 2 (PAR2) define a family of G protein-coupled receptors that are activated by a novel proteolytic mechanism. Specific cleavage of their amino-terminal exodomains unmasks a new amino terminus which then serves as a tethered ligand, docking intramolecularly to the body of the receptor to effect signaling. Identification of the docking interactions between tethered ligand domain and receptor is critical for understanding transmembrane signaling by these receptors. Synthetic "agonist peptides" that mimic the tethered ligand domains of thrombin receptor and PAR2 act as agonists at their respective receptors. Toward defining the docking interactions which mediate receptor activation, we determined the specificity of the thrombin receptor and PAR2 for their respective agonist peptides and used receptor chimeras to identify the receptor domains responsible for such specificity. PAR2 responded to both thrombin receptor and PAR2 agonist peptides. In contrast, thrombin receptor was selective for its own agonist peptide. Substitution of the extracellular face of PAR2, its amino-terminal exodomain and three extracellular loops, for the cognate thrombin receptor structures yielded a chimeric receptor with PAR2-like agonist specificity. Substitution of individual extracellular domains revealed that the primary determinant of agonist specificity was extracellular loop 2. Strikingly, substitution of either the amino-terminal exodomain or third extracellular loop alone caused marked loss of receptor function, but the double substitution yielded a functional receptor. Thus, the extracellular domains of these G protein-coupled receptors are more than simply passive links between transmembrane domains. They participate in agonist recognition and must interact, directly or indirectly, for proper receptor function.

Amino Acid Sequence↗
PubMed1995

Physicians' assessment of functional health status and well-being. The patient's perspective.

BACKGROUND: Ascribing quality to medical care rests in part on the expectation of physician behavior and the content of care. The adoption of functional outcomes of care as legitimate measures of quality will require greater attention to patient-provided assessments of health and add new dimensions to medical practice and quality assessment. METHODS: We conducted a cross-sectional, national population survey of adults to obtain estimates of the frequency with which physicians reportedly inquire about patients' functional health status and emotional well-being, patients' attitudes about such assessments, and the perceived use of data thus obtained in the therapeutic process. RESULTS: The majority of physicians rarely or never ask about the extent to which patients' health limits their ability to perform everyday activities (64.7% to 78.7%); neither do they inquire about limitations imposed by emotional problems (71.4% to 84.4%). Physicians are more likely to make such inquiries in the presence of chronic illness or diminished health status, or with older patients, although such assessments remain the exception to usual practice and a large portion of functional impairment is undiscovered. More than 60% of respondents want their physicians to assess their functional health status and well-being. CONCLUSIONS: While individuals want their physicians to assess their functional performance and emotional well-being as a part of medical care, by their reports this occurs infrequently. The content of care may be less comprehensive than physicians believe to be the case.

Aged↗
PubMed1994

Breaking with tradition: the new groups in professional nursing.

Chronic shortages of registered nurses (RNs) have stimulated interest in locating non-traditional sources of RNs. A statewide survey of 2,315 newly graduated RNs compared three non-traditional groups in nursing with their traditional counterparts, identifying differences that have implications for successful recruitment and retention. Second career nurses, former LPNs and minorities comprised 41.9% of the population. Compared to the traditional groups, more second career nurses, former LPNs and some minority groups were older, married and had children. Second career vs. first career nurses placed less emphasis on selecting schools at the highest levels of academic quality, holding out for the most lucrative jobs or working with the most "interesting" patients (i.e., the acutely ill). Former LPNs, compared to other RNs, placed greater value on easy access to schools and jobs. Compared to whites, minority RNs were more inclined to value nursing's socioeconomic rewards. However, compared to non-Asian minorities in nursing, Asian RNs had higher expectations for professional advancement and were less altruistic. Our results indicate that several of the new groups view nursing less as a "calling," finding the field appealing for practical socioeconomic reasons and accessibility.

Adult↗
PubMed1994

Job strain and health-related quality of life in a national sample.

OBJECTIVES: Studies of the health effects of job strain have focused on morbidity and mortality as outcomes. This is the first study to examine the relationship of job strain to more comprehensive health status measures that encompass health-related quality of life. METHODS: In a national cross-sectional survey, 1319 working men and women, aged 18 through 64 years, completed a modified version of the Job Content Questionnaire that classified workers' jobs into four categories: high strain, passive, low strain, and active. Subjects also completed the Medical Outcomes Study Short-Form Health Survey and a health distress scale. Logistic regression analyses were employed that controlled for age, race/ethnicity, gender, and education. Both work and nonwork variables were included. RESULTS: Job strain was significantly associated with five of nine components of health-related quality of life: physical functioning, role functioning related to physical health, vitality, social functioning, and mental health. Job strain made a modest yet statistically significant contribution beyond the effects of chronic illness and psychosocial variables. CONCLUSIONS: The results provide justification for further investigating the role of job strain as an independent risk factor for health-related quality of life.

Adolescent↗
PubMed1989

Small-colon rupture attributable to granulosa cell tumor in a mare.

A large granulosa cell tumor was believed to be responsible for causing obstruction and subsequent rupture of the small colon in a 10-year-old Quarter Horse mare. Two months earlier, a mass, tentatively diagnosed as granulosa cell tumor of the left ovary, had been identified by means of rectal palpation and ultrasonography. The mare was evaluated for clinical signs of acute, severe, abdominal pain, increased heart rate, cyanotic mucous membranes, clinical dehydration, with high PCV, leukopenia, and extreme abdominal distension. A large soft tissue mass and taut band that constricted the lumen of the small colon were palpable per rectum. Septic peritonitis was diagnosed on the basis of results of abdominocentesis. Exploratory surgery revealed extensive fecal contamination of the abdominal viscera, and the mare was euthanatized because of the resultant poor prognosis. At necropsy, the small colon was occluded by a taut, left broad ligament and the ovarian mass that was proved to be a granulosa cell tumor. The occlusion had caused impaction of the small colon, with subsequent perforation at the level of the broad ligament.

Animals↗
PubMed1987

A randomized control trial of cardiac rehabilitation.

A randomized trial using controls tested whether psycho-social rehabilitation of acute myocardial infarction (MI) patients would improve significantly their return to work rate and assessed the importance of various psychological, social, occupational, socio-demographic, and medical factors in facilitating or impeding rapid return to work. Eighty-nine patients were assigned randomly to participate in an experimental cardiac rehabilitation program (rehab care), and 91 patients were controls who received conventional hospital rehabilitation (usual care). By the first follow-up interview at three months, patients assigned to experimental treatment were significantly less distressed psychologically and less dependent on family support than controls (P = 0.04 and P = 0.05, respectively). By the final follow-up interview at 13 months, there was a marginally significant difference in favor of the experimental group in the frequency of reported deterrents to work resumption (P = 0.07). However, the intervention did not result in a statistically significant difference in the return to work rate (P greater than 0.10). In each group, 88% were back at work by approximately the first year after infarction. In addition, the two groups were similar in the amount of time patients remained out of the workforce (median days rehab care = 75, usual care = 81; P greater than 0.10). A multi-stage data analysis procedure utilizing the Cox regression technique indicated that while several independent variables had significant univariate associations with the length of time patients convalesced, outcome was most influenced by the patient's initial cardiological status and clinical course, by the patterns of family support, and by the several variables measuring the presence of obstacles to resuming work. Our findings suggest that rehabilitation programs intervening on multiple levels (psychological, social, occupational, and physical) may best meet the needs of chronically ill cardiac patients. Results indicate that implementing measures addressing the patient's general psycho-social adjustment to MI may improve existing programs.

Adolescent↗
PubMed1987

When should Doppler-determined valve area be better than the Gorlin formula?: Variation in hydraulic constants in low flow states.

In low flow states, underestimation errors occur when the Gorlin formula is used to calculate valve area. A model of valvular stenosis designed to examine changes in the hydraulic discharge coefficient (Cd) and coefficient of orifice contraction (Cc) may explain these errors. Unsteady flow was examined in a pulsatile pump model and in a dog model. Valve areas were calculated from pressure and flow data using: a modified form of the Gorlin formula (assuming constant values for Cd and Cc) and a corrected formula (with values of Cd and Cc obtained from steady state data). Valve area was also calculated using the continuity equation with velocity and flow data (constant Cc). Flow velocities were measured using a newly designed ultrasound Doppler catheter capable of resolving flow velocities of up to 5.5 m/s. Both the corrected formula and continuity equation were highly predictive of actual valve area (r = 0.99, slope or M = 0.96 and r = 0.99, M = 1.06, respectively). The modified Gorlin equation was less accurate and tended to underestimate valve areas (r = 0.87, M = 0.83). This underestimation was most notable at low rates of flow (Gorlin: r = 0.94, M = 0.53; continuity: r = 0.93, M = 0.81 and r = 0.94, M = 0.89, respectively) more accurately than the modified Gorlin formula (r = 0.69, M = 0.49). In patients with low cardiac output, hemodynamic formulas, such as the Gorlin formula, which assume a constant value for the hydraulic discharge coefficient (Cd), may be less accurate than formulas using either a corrected value of Cd or Doppler-determined flow velocity and mean systolic flow.

Animals↗
PubMed1986

Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population.

A population-based survey, using data from the Framingham study, assessed sex-specific patterns of coronary heart disease occurring over a 26-year period of time. Among subjects ages 35 to 84 years, men have about twice the total incidence of morbidity and mortality of women. The sex gap in morbidity tends to diminish during the later years of the age range, mainly because of a surge in growth of female morbidity after age 45 years, while by that age, the growth in the male rate begins to taper off. An approximate 10-year difference between the sexes persists in mortality rates throughout the life span. The relative health advantage that is possessed by women, however, is buffered by a case fatality rate from coronary attacks that exceeds the male rate (32% vs 27%). Coronary disease manifestations differ between the sexes. Myocardial infarction is more likely to be unrecognized in women than in men (34% vs 27%). Angina pectoris in women more frequently is uncomplicated (80%), whereas in men angina tends to evolve out of infarction (66%). Also, sudden death comprises a greater proportion of male deaths than female deaths (50% vs 39%). Because women maintain a lesser probability of the disease than do men at any level of the major cardiovascular risk factors, distinctions in their risk factor profiles do not explain completely the observed disease patterns.

Adult↗
PubMed1984

Cardiac nuclear imaging. Adoption of an evolving technology.

A national survey was conducted to examine the extent of adoption and use of nuclear imaging procedures in cardiology in hospitals by 1979 and to develop estimates for 1983. The data are based on the responses of 171 hospitals from a representative 200-hospital sample stratified for region, bed-size, and teaching status. Extrapolating the data, it is estimated that 2,106 hospitals nationally use cardiac nuclear imaging. In 1979, hospitals with at least 200 beds performed an estimated 396,000 cardiac nuclear imaging studies at a cost of $93 million. By 1983, it is estimated that 4,061 hospitals had the capability to perform cardiac nuclear imaging and that national expenditures would exceed $200 million ( noninflated dollars). Although cardiac nuclear imaging procedures have been demonstrated to be valuable in detecting coronary artery disease or measuring ventricular function, these procedures were rapidly being adopted by the medical community at a time when only limited information about their effectiveness and efficiency are available.

Cardiology↗
PubMed1982

Differential effects of experience on house officers' admission diagnoses for patients with possible myocardial infarction.

The effect of the level of training on house staff's abilities to accurately diagnose acute ischemic heart disease (AIHD) and admit patients presenting in an emergency room was assessed. A validated mathematical instrument, which calculates patients' probabilities of AIHD, was used to retrospectively stratify admitted patients. Sensitivity rates of house staff were similar for patients with high probabilities (greater than or equal to 40%) of AIHD (ns). When probabilities of AIHD were low (less than 40%), junior residents correctly admitted a significantly higher proportion of patients with confirmed AIHD than did interns (86% versus 63%, respectively; p less than 0.06). Specificity was unaffected by the level of house staff training for patients with probabilities of AIHD less than 40% (ns). In the high probability group of patients, the interns' specificity rate (54%) was significantly better than the 20% for junior residents (p less than 0.03); however, when clinical severity was controlled for, no differences by level of training were found.

Adult↗