PubMed Health⌕ Search

Biomedical subjects

D L Katz

Publications and source records attributed to D L Katz.

At least 19 recordsLinked to original sources
PubMed2005

Parental IQ and cognitive development of malnourished Indonesian children.

A cross-sectional study of children in West Kalimantan, Indonesia, was conducted to examine the relationship between malnutrition history, child IQ, school attendance, socioeconomic status, parental education and parental IQ. In unadjusted analyses, severely stunted children had significantly lower IQ scores than mild-moderately stunted children. This effect was significant when stunting, school attendance and parental education were included in multivariable models but was attenuated when parental IQ was included. Our research underscores the importance of accounting for parental IQ as a critical covariate when modeling the association between childhood stunting and IQ.

Adult↗
PubMed2003

Technical skills for weight loss: 2-y follow-up results of a randomized trial.

OBJECTIVE: To investigate the sustained effectiveness of a novel skill-based intervention for weight loss. DESIGN: Randomized, controlled trial. SUBJECTS: A total of 80 overweight/obese women living in Connecticut. MEASUREMENTS: Absolute weight difference measured in pounds and absolute change in body mass index (BMI). Secondary outcomes included changes in food frequency questionnaire (FFQ) data and waist-to-hip ratio. RESULTS: In all 61, 35, and 34% of study participants completed the 6-, 12-, and 24-month assessments, respectively. At 6 months postintervention, both counseling-based (CBI) and skill-based (SBI) intervention groups had statistically significant decreases in absolute weight (4.0+/-3.6 and 1.7+/-3.0 kg, respectively). Compared to their baseline values, both CBI and SBI groups still maintained weight losses at 24 months (1.1+/-5.8 and 0.59+/-3.3 kg, respectively); however, the differences were not statistically significant. FFQ results showed that, within the SBI group, there was a significant decrease (P<0.05) in percent fat from baseline to 12 months and a nearly significant decrease in saturated fat from baseline to 24 months (P=0.07). CONCLUSIONS: Both the novel SBI and conventional dietary counseling demonstrated some residual weight loss benefit at 2 y. Effects of the SBI on dietary intake patterns are encouraging, and warrant further study.

Adult↗
PubMed2001

Behavior modification in primary care: the pressure system model.

The leading causes of death in the United States are predominantly attributable to modifiable behaviors. Patients with behavioral risk factors for premature death and disability, including dietary practices; sexual practices; level of physical activity; motor vehi cle use patterns; and tobacco, alcohol, and illicit sub stance use, are seen far more consistently by primary care providers than by mental health specialists. Yet models of behavior modification are reported, debated, and revised almost exclusively in the psychology literature. While the Stages of Change Model, or Transtheo retical Model, has won application in a broadening array of clinical settings, its application in the primary care setting is apparently quite limited despite evidence of its utility [Prochaska J, Velicer W. Am J Health Promot 1997;12:38-48]. The lack of a rigorous behavioral model developed for application in the primary care setting is an impediment to the accomplishment of public health goals specified in the Healthy People objectives and in the reports of the U.S. Preventive Services Task Force. The Pressure System Model reported here synthesizes elements of established behavior modification theories for specific application under the constraints of the primary care setting. Use of the model in both clinical and research settings, with outcome evaluation, is encouraged as part of an effort to advance public health.

Behavior Therapy↗
PubMed2001

Effects of oat and wheat cereals on endothelial responses.

BACKGROUND: This study was undertaken to determine the effects of month-long whole grain oat and wheat cereal supplementation on endothelial function following a fatty meal as measured by brachial artery reactivity studies. METHODS: Fifty healthy adult subjects underwent brachial artery reactivity studies before and after a high-fat meal along with alpha-tocopherol (vitamin E), oats, or a comparable bowl of wheat cereal and were again tested after the high-fat meal following month-long supplementation with oat or wheat cereal in a random crossover with interim washout. RESULTS: In the acute phase, the fatty meal attenuated the hyperemic brachial artery flow response when administered concurrently with wheat cereal (-13.4%; P = 0.02), whereas hyperemic flow was maintained by concurrent administration of either oatmeal or alpha-tocopherol. Following month-long supplementation, postprandial peak flow (wheat +3.88 +/- 5.62%; oat -10.78 +/- 7.15%), and peak diameter (wheat -1.40 +/- 0.96%; oat -0.86 +/- 0.88%) did not differ from preprandial values. Oat and wheat treatments did not differ when directly compared. CONCLUSIONS: Month-long, daily supplementation with either whole-grain oat or wheat cereal may prevent postprandial impairment of vascular reactivity in response to a high-fat meal.

Adult↗
PubMed2001

Acute effects of oats and vitamin E on endothelial responses to ingested fat.

OBJECTIVE: To assess the effects of oats and vitamin E on endothelial function following a high-fat meal in healthy adults as measured by brachial artery reactivity studies (BARS). METHODS: A total of 25 men and 25 women (N=50) were recruited from a community population to participate in this randomized, crossover study. All subjects were free of known vascular disease, and female subjects were postmenopausal. Subjects underwent BARS before and after a high-fat meal (50 gm fat) on three occasions 1 week apart, one each with vitamin E 800 IU, oatmeal containing 3 gm beta-glucan, or a comparable bowl of wheat cereal serving as a placebo, in random sequence. The ultrasonographer was blinded to treatment status. RESULTS: Endothelial function, as measured by brachial artery peak flow during one minute of post-occlusive hyperemia, declined significantly from baseline when the high-fat meal was consumed with the wheat cereal (-13.4%; p=0.02). There was no difference in brachial artery flow change before and after a high-fat meal with oats (+0.37%; p=0.77) or a high-fat meal with vitamin E (+1.87%; p=0.42). No significant differences in flow-mediated vasodilation before and after the high-fat meal were detected among the three supplements. CONCLUSIONS: Endothelial dysfunction induced by acute fat ingestion in healthy adults is apparently prevented by concomitant ingestion of oats or vitamin E, but not wheat. Nutrient distribution and meal composition may have important implications for cardiovascular health.

Adult↗
PubMed2001

Self-reported weight and height: implications for obesity research.

BACKGROUND: Self-reported weight and height are under- and over-reported, respectively, in epidemiologic studies. This tendency, which may adversely affect study operations, has not been evaluated among subjects being enrolled into a weight-loss program. METHODS: Self-reported weight, height, and body mass index (BMI) were compared to measured values in 97 overweight or obese (BMI>27.3) women being enrolled into a randomized, controlled trial of two behavioral interventions for weight loss. The effects of demographic factors, baseline weight, baseline height, and baseline BMI on weight and height reporting were assessed. RESULTS: There was a significant difference between measured and reported weight (mean difference=-3.75 lb, p=0.0001) and height (mean difference=+0.35 in., p=0.0007). The mean difference between measured and reported BMI was -1.14 kg/m(2) (p=0.0001). Unemployed, retired, or disabled women were more likely to under-report their BMI than employed women (p=0.001). Six percent of subjects who were initially considered eligible for the study on the basis of the self-report were eventually excluded from the study because they did not meet the inclusion criterion for BMI. CONCLUSIONS: Obese women who seek weight-loss assistance tend to under-report their weight and over-report their height, suggesting that self-reported data are likely to be inaccurate. Misreporting is apparently influenced by employment and disability and has the potential to complicate recruitment of subjects for research studies.

Adult↗
PubMed2001

Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature.

We report the results of 15 patients who underwent nerve transfer for restoration of shoulder and elbow function at our institution for traumatic brachial plexus palsy. We present these results in the context of a meta-analysis of the English literature, designed to quantitatively assess the efficacy of individual nerve transfers for restoration of elbow and shoulder function in a large number of patients. One thousand eighty-eight nerve transfers from 27 studies met the inclusion criteria of the analysis. Seventy-two percent of direct intercostal to musculocutaneous transfers (without interposition nerve grafts) achieved biceps strength > or =M3 versus 47% using interposition grafts. Direct intercostal transfers to the musculocutaneous nerve had a better ability to achieve > or =M4 elbow strength than transfers from the spinal accessory nerve (41% vs 29%). The suprascapular nerve fared significantly better than the axillary nerve in obtaining > or =M3 shoulder abduction (92% vs 69%). At our institution 90% of intercostal to musculocutaneous transfers (n = 10) achieved > or =M3 bicep strength and 70% achieved > or =M4 strength. Four of seven patients achieved > or =M3 shoulder abduction with a single nerve transfer and 6 of 7 regained > or =M3 strength with a dual nerve transfer. This study suggests that interposition nerve grafts should be avoided when possible when performing nerve transfers. Better results for restoration of elbow flexion have been attained with intercostal to musculocutaneous transfers than with spinal accessory nerve transfers and spinal accessory to suprascapular transfers appear to have the best outcomes for return of shoulder abduction. We conclude that nerve transfer is an effective means to restore elbow and shoulder function in brachial plexus paralysis.

Adolescent↗
PubMed2001

The activated partial thromboplastin time in early diagnosis of myocardial infarction.

Intracoronary thrombosis is fundamental to the pathogenesis of acute myocardial infarction (MI), yet few studies have examined the diagnostic value of routine coagulability markers, such as the activated partial thromboplastin time (aPTT), in patients with chest pain. We hypothesized that the initiation of thrombosis early in MI would shorten the aPTT, and conducted a retrospective cohort study of patients admitted with a diagnosis of chest pain through the emergency department of one community hospital between 1 January and 30 August 1998. Patients were diagnosed as MI positive or negative based on World Health Organization (WHO) criteria. The aPTT obtained on arrival (prior to anticoagulation therapy) was retrieved from the electronic medical record. Of 120 eligible patients (49% female, mean age 63.7 years), 27 (23%) were diagnosed with MI. Patients with an aPTT control (RR = 2.83, 95% confidence interval 1.15 to 6.96, P = 0.013). A shortened aPTT (<or= control) on presentation in patients with chest pain is associated with increased risk of acute MI. This information is available before other serum markers of MI, and may facilitate early treatment decisions. Further study is warranted.

Aged↗
PubMed2001

Community health promotion and the randomized controlled trial: approaches to finding common ground.

The randomized controlled trial is the model against which research designs are judged. Concurrent with rising standards of evidence, however, is a trend toward greater inclusiveness in community-based research, exemplified by the Centers for Disease Control and Prevention-funded Prevention Research Centers, a nationwide network of academic-community partnerships engaged in community-based health promotion and disease prevention research. The Yale-Griffin Prevention Research Center developed a replicable process for devising randomized trials in the context of community collaboration. Several examples of trials developed this way and their interim results are provided.

Cardiovascular Diseases↗
PubMed2001

Health risk behaviors and health perceptions in the Peruvian Amazon.

Behavioral health risk factor and health belief data for the indigenous population of the Peruvian Amazon are unavailable. Therefore, we conducted structured interviews of adults living in 5 towns in the remote Amazon region of Peru. Respondents (n = 179) were 67% women with a mean age of 35.4 years. The average household size was 6.7 people. A majority (72%) were unable to see a doctor when needed because of lack of money and distance. Only 6% reported excellent health, and nearly half (49%) reported fair health. Forty-eight percent drank alcohol and 73% smoked. Only 34% thought mosquitoes cause malaria, but 98% were using mosquito nets. In conclusion, our findings indicate the indigenous population of the Peruvian Amazon has limited access to basic health care. Although most of those surveyed use mosquito netting, few know that mosquitoes transmit malaria. Tobacco and alcohol use are major behavioral health risk factors.

Adolescent↗
PubMed2000

Physician-patient interactions regarding diet, exercise, and smoking.

OBJECTIVES: The objectives were to determine the rate of physician/patient discussions regarding diet, exercise, and smoking and to assess the effect of such discussions on behavior change. METHODS: In a telephone survey of Connecticut adults, respondents who had a routine checkup in the past year (n = 433) were asked whether their physicians had asked them about their dietary habits, exercise, or smoking, and about any efforts to modify these behaviors during the preceding year. RESULTS: Diet was addressed with 50% of the subjects, exercise with 56%, and smoking status with 77%. Respondents who were asked about their diet were more likely to have changed their fat or fiber intake in the past year than those not asked (64 vs. 48%, P = 0.002) and were somewhat more likely to have lost weight (46 vs. 37%; P = 0.061); the differences were even greater among 94 overweight subjects (64 vs. 47%; P = 0.099). No behavior change was associated with discussions of exercise or smoking. CONCLUSIONS: Physicians have the potential to impact health behaviors, especially those related to diet, through simple discussions during routine checkups, but only about half are using this opportunity.

Adolescent↗
PubMed2000

Peri-operative aspirin can prevent post-operative ischemia and thrombosis.

Of the 30 million patients in the USA who undergo non-cardiac surgery every year, approximately 1.5 million suffer post-operative cardiovascular events. Surgical trauma and associated catecholamine release leads to platelet activation in the immediate post-operative period, as evidenced by a rise in circulating platelet release products. Platelet activation promotes platelet aggregation and hypercoagulability. Aspirin is widely used for its platelet inhibiting effects to prevent myocardial infarction and stroke. However, aspirin is not routinely started in the immediate peri-operative period, and even in high-risk patients already taking aspirin, aspirin is generally discontinued before elective surgery to improve intra-operative hemostasis. The risk-to-benefit ratios of administering vs withholding aspirin in the immediate peri-operative period have never been assessed and compared. We hypothesize that aspirin given pre-, intra- or immediately post-operatively will reduce post-operative ischemia and thrombotic events, including myocardial infarction and stroke, and that risk-benefit analysis would favor the administration of aspirin. This hypothesis can and should be tested in a prospective, randomized trial.

Aspirin↗
PubMed2000

An integrated residency in internal and preventive medicine.

The importance of preventive and population-based principles in clinical practice is widely acknowledged. The challenge of imparting these principles in either undergraduate or postgraduate medical education has, however, not been fully met. The necessary skills are provided comprehensively by preventive medicine residency programs, but at the expense of clinical training. Sequential residencies in primary care and preventive medicine, the currently available means of obtaining thorough preparation in both clinical and population-based principles, represent an inefficient, generally unappealing, and non-integrated approach. In response to these concerns, and in an effort to make preventive medicine training appeal to a wider audience, the authors developed and implemented a residency program fully integrating internal and preventive medicine. The program meets, and generally exceeds, the requirements of both specialty boards over a four-year period. The program provides extensive training in clinical, preventive, and public health skills, along with case management and cost-effective care, conferring the MPH degree and leading to dual board eligibility. The model is ideally wed to the demands of the modern health care environment in the United States, is extremely attractive to applicants, and may warrant replication both to train academic and administrative leaders and to raise the standards of preventive and public health practice in primary care.

Accreditation↗
PubMed2000

Concordance of clinical findings and clinical judgment in the diagnosis of streptococcal pharyngitis.

OBJECTIVE: It is uncertain how reliably clinicians apply clinical predictors of group A beta hemolytic streptococcal pharyngitis (GABHSP) to form a clinical impression, and how reliably this impression predicts culture results. The objective was to study clinician accuracy in diagnosing GABHSP. METHODS: This was a prospective cohort study, conducted at an urgent care center of a major university. A convenience sample of 218 patients, aged 9-83 years, presenting with sore throat, was enrolled. Symptoms and signs of pharyngitis were documented on a standardized form; the likelihood of GABHSP was plotted on a visual analog scale; and throat culture was obtained. A comparison was then made between the clinical impression on presentation and the throat culture result. RESULTS: Throat cultures were positive for GABHSP in 41 patients (19%). The probability of GABHSP was related to node size and tenderness, tonsillar exudate and hypertrophy, and pharyngeal erythema (p<0.05); but not throat soreness, degree of fever, or cough. A strong clinical impression of GABHSP (>50% on the visual analog scale) was associated with tonsillar exudate and hypertrophy, tender nodes, and pharyngeal erythema. Together, these four predictors had a sensitivity of 71%, a specificity of 77%, and a positive predictive value of 46%. CONCLUSIONS: Clinicians in this study based their impression of GABHSP on the most reliable symptoms and signs. While a strong clinical suspicion of GABHSP predicted a greater probability of positive culture, the clinicians consistently overestimated the probability of GABHSP. Symptoms and signs predict GABHSP unreliably when used alone; they are helpful in modifying estimates of disease probability to facilitate optimal use of laboratory tests and antibiotics.

Acute Disease↗