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Biomedical subjects

G G Rhoads

Publications and source records attributed to G G Rhoads.

At least 19 recordsLinked to original sources
PubMed2000

Antibiotic susceptibility profiles for group B streptococci isolated from neonates, 1995-1998.

Antibiotic susceptibility profiles were analyzed for 119 invasive and 227 colonizing strains of group B streptococci isolated from neonates at 6 US academic centers. All strains were susceptible to penicillin, vancomycin, chloramphenicol, and cefotaxime. The rate of resistance to erythromycin was 20.2% and to clindamycin was 6.9%. Resistance to erythromycin increased in 1997. Type V strains were more resistant to erythromycin than were type Ia (P=.003) and type Ib (P=.004) strains and were more resistant to clindamycin than were type Ia (P<.001), type Ib (P=.01), and type III (P=.001) strains. Resistance rates varied with geographic region: in California, there were high rates of resistance to erythromycin and clindamycin (32% and 12%, respectively), and low rates in Florida (8.5% and 2.1%, respectively). Penicillin continues to be the drug of choice for treatment of group B streptococcus infection. For women who are penicillin intolerant, however, the selection of an alternative antibiotic should be guided by contemporary resistance patterns observed in that region.

Anti-Bacterial Agents↗
PubMed2000

Impact of geographic proximity to cardiac revascularization services on service utilization.

BACKGROUND: In a highly competitive health care environment, even microgeographic differences in availability of tertiary services might affect access to care. OBJECTIVES: To study the impact of (1) geographic distance from patient's residence to cardiac revascularization services and (2) the availability of cardiac revascularization services at the hospital nearest the patient's residence on utilization of these services in a geographically small, densely populated area. METHODS: Historical cohort study of 55,659 New Jersey residents hospitalized between 1992 and 1996 with primary diagnosis of acute myocardial infarction (AMI). MAIN STUDY OUTCOMES: Use of percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft surgery (CABG) within 90 days of initial hospitalization for AMI and in-hospital mortality. Distance from patient's residence to nearest hospital with cardiac revascularization services (PTCA and CABG) was a straight-line distance in miles, categorized as 0 to <2, 2 to <5, 5 to <10, 10 to <15, 15 to <20, 20 to <25, > or =25 miles. Adjusted odds of PTCA or CABG use at each distance category were compared with odds at > or =25 miles. RESULTS: A strong linear decline in adjusted odds ratios for PTCA use was found with increasing distance of this service from the patient's residence (p <0.05). Adjusted odds of PTCA use were 2.4, 2.1, 1.8, 1.5, 1.3, and 1.0 times higher for each increasing distance category in comparison with > or =25 for patients aged <65 and 3.1, 2.7, 2.2, 1.9, 1.7, and 1.1 for patients aged > or =65. Use of CABG was also higher for patients residing closer to cardiac revascularization services. The availability of these services at the hospital nearest to the patient's residence also increased utilization. In-hospital mortality was not associated with distance from services. CONCLUSION: Even across a relatively small geographic area, shorter distance to services and availability of services at the nearest hospital were strongly related to increased utilization of cardiac revascularization services.

Adult↗
PubMed2000

Seasonal influences on childhood lead exposure.

We conducted a study to examine seasonal changes in residential dust lead content and its relationship to blood lead in preschool children. We collected blood and dust samples (floors, windowsills, and carpets) to assess lead exposure. The geometric mean blood lead concentrations are 10.77 and 7.66 microg/dL for the defined hot and cold periods, respectively (p < 0.05). Lead loading (milligrams per square meter) is the measure derived from floor and windowsill wipe samples that is most correlated with blood lead concentration, whereas lead concentration (micrograms per gram) is the best variable derived from carpet vacuum samples. The variation of dust lead levels for these three dust variables (floor lead loading, windowsill lead loading, and carpet lead concentration) are consistent with the variation of blood lead levels, showing the highest levels in the hottest months of the year, June, July, and August. The regression analysis, including the three representative dust variables in the equations to predict blood lead concentration, suggests that the seasonality of blood lead levels in children is related to the seasonal distributions of dust lead in the home. In addition, the outdoor activity patterns indicate that children are likely to contact high leaded street dust or soil during longer outdoor play periods in summer. Consequently, our results show that children appear to receive the highest dust lead exposure indoors and outdoors during the summer, when they have the highest blood lead levels. We conclude that at least some of the seasonal variation in blood lead levels in children is probably due to increased exposure to lead in dust and soil.

Child, Preschool↗
PubMed2000

Ethnic and racial differences in prostate cancer incidence and mortality.

Prostate cancer (CaP) incidence and mortality vary strikingly among ethnic, racial, and national groups. There is evidence that genetic, environmental, and social factors jointly-and often in combination-contribute to the observed differences in various populations. Noteworthy is the high rate of both CaP incidence and mortality among African Americans. Changes in the epidemiology of CaP since the advent of prostate specific antigen testing suggest that improved access to screening and treatment may serve to reduce somewhat the differences between the white and African-American populations. However, because the causes of these differences are likely to be multifactorial, a variety of strategies addressing the range of causes will be necessary to reduce the excess African-American mortality from this disease.

Asian↗
PubMed1999

Placenta previa: preponderance of male sex at birth.

To determine the relation between placenta previa and male sex at birth, the authors conducted two types of analysis: 1) a historical cohort analysis of singleton live births in New Jersey hospitals during 1989-1992 (N = 447,963); and 2) a meta-analysis of previously published studies on the subject. For the cohort analysis, subject mother-infant dyads were identified from linked birth certificate and maternal and infant hospital claims data. The infant's sex for mothers with an International Classification of Diseases, Ninth Revision, Clinical Modification, code of 641.0-641.1 for placenta previa (n = 2,685) was compared with infant's sex for mothers without placenta previa (n = 445,270). For the meta-analysis, seven published articles were located and summary effects were calculated using both fixed-effect and random-effects models. In the present cohort study, the male:female ratio at birth was significantly higher in women with placenta previa (1.19) than in those without placenta previa (1.05) (p<0.001). The association of placenta previa with male sex persisted when the analysis was either stratified or adjusted for the effects of maternal age, maternal parity, maternal smoking during the index pregnancy, race/ethnicity, the infant's gestational age, and the infant's birth weight. The meta-analytic results from the fixed-effect and random-effects models showed a 14% excess of placenta previa when women were carrying a viable male fetus as compared with a viable female fetus during pregnancy. The results were the same regardless of whether the present cohort study was included in the meta-analysis. In conclusion, the evidence obtained from these analyses strongly argues for an association between placenta previa and male sex at birth. The mechanism for this association remains to be determined.

Cohort Studies↗
PubMed1999

Impact of availability of hospital-based invasive cardiac services on racial differences in the use of these services.

BACKGROUND: Reports indicate that black patients are less likely than white patients to receive invasive cardiac services after hospitalization for acute myocardial infarction (AMI). There is still uncertainty as to why racial differences exist and how they affect patient outcomes. This is the first study to focus on the availability of invasive cardiac services and racial differences in procedure use. Study objectives were to (1) document whether racial differences existed in the use of invasive cardiac procedures, (2) study whether these racial differences were related to availability of hospital-based invasive cardiac services at first admission for AMI, and (3) determine whether there were racial differences in long-term mortality rates. METHODS: A historical cohort study was conducted with discharge records from all acute care hospitals in New Jersey for 1993 linked to death certificate records for 1993 and 1994. There were 13,690 black and white New Jersey residents hospitalized with primary diagnosis of AMI. Use of cardiac catheterization within 90 days, revascularization within 90 days (percutaneous transluminal coronary angioplasty [PTCA] or coronary artery bypass graft surgery [CABG]), and death within 1 year after admission for AMI were the main outcome measures. Patterns for PTCA and CABG as separate outcomes were also studied. Hospital-based cardiac services available were described as no invasive cardiac services, catheterization only, or PTCA/CABG. To account for payer status and comorbidity differences, patients 65 years and older with Medicare coverage were analyzed separately from those younger than 65 years. RESULTS: Black patients aged 65 and older were generally less likely to receive catheterization and revascularization than white patients, regardless of facilities available at first admission. For patients younger than 65 years, the greatest differences between black and white patients in catheterization and PTCA/CABG use within 90 days after AMI occurred when no hospital-based invasive cardiac services were available. However, use of invasive cardiac procedures within 90 days after AMI was substantially increased if the first hospital offered catheterization only or PTCA/CABG services, among all patients, especially among blacks younger than age 65. No significant racial differences or interactions with available services were found in 1-year mortality rates. CONCLUSIONS: Availability of invasive cardiac services at first hospitalization for AMI was associated with increased procedure use for both races. However, use of invasive cardiac procedures was generally lower for black patients than for white patients, regardless of services available. Long-term mortality rates after hospitalization for AMI did not differ between blacks and whites.

Black or African American↗
PubMed1999

No difference in iron status between children with low and moderate lead exposure.

We compared the iron status between children 11 to 33 months old with confirmed blood lead levels of 20 to 44 microg/dL and demographically similar children with blood lead levels of <10 microg/dL. There were no differences. Laboratory investigation or empirical treatment for iron deficiency is not justified on the basis of moderately elevated blood lead levels alone.

Anemia, Iron-Deficiency↗
PubMed1999

The effect of dust lead control on blood lead in toddlers: a randomized trial.

BACKGROUND: Contaminated household dust is believed to be a major source of exposure for most children with elevated blood lead levels. To determine if a vigorous dust clean-up effort would reduce this exposure we conducted a randomized controlled field trial. METHODS: We randomized 113 urban children between the ages of 6 and 36 months: 56 children to a lead dust intervention composed of maternal education and biweekly assistance with household cleaning and 57 children to a control group. Household cleaning was done by two trained lay workers who focused their efforts on wet mopping of floors, damp-sponging of walls and horizontal surfaces, and vacuuming with a high-efficiency particle accumulating vacuum. Household dust lead levels, child blood lead levels, and maternal knowledge of lead poisoning and sources of exposure were measured before and after the intervention. RESULTS: Ninety-nine children were successfully followed for 12 +/- 3 months: 46 children in the lead group and 53 children in the control group. Age and blood lead were similar in the two groups at baseline and averaged 20 months and 12.0 micrograms/dL, respectively. Blood lead fell 17% in the intervention group and did not change among controls. Household dust and dust lead measures also fell significantly in the intervention group. Children in homes cleaned 20 or more times throughout the year had an average blood lead reduction of 34%. CONCLUSIONS: Regular home cleaning, accompanied by maternal education, is a safe and partially effective intervention that should be recommended for the large majority of lead-exposed children for whom, unfortunately, removal to lead-safe housing is not an option.

Air Pollution, Indoor↗
PubMed1998

The use of isotope ratios to apportion sources of lead in Jersey City, NJ, house dust wipe samples.

Lead stable isotope ratio (IR) analysis by inductively coupled plasma mass spectrometry was used to examine the relationship between sources of Pb in 22 dust wipe samples collected from 10 homes in Jersey City, NJ. Common lead sources examined included interior lead-based paints, exterior soils and street dusts, and indoor air. High correlations between IRs of wipe samples and both street dusts and exterior soils indicated these two exterior sources were indistinguishable. They were treated as a single exterior source in a source apportionment using IR matching and a simple mixing model. The upper-bound estimate of the contribution of interior lead-based paints to 10 floor- and eight sill-wipe samples was 56% and 50%, respectively. It was not possible to apportion sources in four of the 22 samples because wipe sample IRs were outside the range of measured sources. Examination of means obscures the variability in the data, however, as eight of the 18 apportioned samples matched interior or exterior source media. In most cases, however, sources from outside the home contribute as much Pb to house dust wipe samples as interior lead-based paints.

Dust↗
PubMed1998

Accuracy and reproducibility of blood lead testing in commercial laboratories.

OBJECTIVE: To assess the proficiency of commercial laboratories in analyzing lead in clinical blood samples from subjects without overt lead exposure. DESIGN: We submitted masked duplicate blood lead specimens to 8 masked laboratories. Each laboratory received blood aliquots immediately following drawing (time 1) and 2 weeks later (time 2) from 7 human subjects and 3 bovine blood samples with known lead levels of 0.26, 0.57, and 0.79 micromol/L (5.4, 11.8, and 16.4 microg/dL). Of the 8 laboratories, 5 were commercial laboratories, 1 was a state laboratory, 1 was a research laboratory, and 1 was the Centers for Disease Control and Prevention reference laboratory. OUTCOME MEASURES: Correlation coefficients were calculated, and differences within and between laboratories were assessed by analysis of variance. RESULTS: Results were obtained for all specimens, with all the human subjects' overall mean lead levels being less than 0.48 micromol/L (<10 microg/dL). Each laboratory reported all human blood specimens appropriately, as having lead levels less than 0.48 micromol/L (<10 microg/dL) and within 0.14 micromol/L (3 microg/dL) of the overall mean for that subject. All internal reproducibilities were very high (range, 0.92-1.00) except for one (0.60), possibly lower because of 1 pair of specimens. Mean differences between blood samples analyzed at time 1 and time 2 ranged from -1.4 to 1.2, with only 2 laboratories having significant differences (P<.01). CONCLUSIONS: Overall, there was strong reproducibility within and among laboratories, with no overall time trend or interlaboratory or intralaboratory variance. The storage conditions did not seem to affect the aggregate results. The data suggest that through implementation of the Centers for Disease Control and Prevention/Wisconsin Blood Lead Proficiency Testing Program, the Centers for Disease Control and Prevention's Blood Lead Laboratory Reference System, and mandated federal and state proficiency programs, laboratories in this geographic region have improved their performance as compared with previous published studies and an unpublished study.

Humans↗
PubMed1998

Childhood lead screening knowledge and practice. Results of a New Jersey physician survey.

CONTEXT: As the nation moves toward targeted childhood lead screening, CDC continues to recommend universal screening in states with no childhood lead poisoning prevalence data. OBJECTIVE: The study was conducted, prior to the new universal screening state law, to determine physician screening practices and their consistency with key CDC recommendations as a basis for future education activities. DESIGN/SETTING/PARTICIPANTS: A statewide cross-sectional self-administered multiple choice survey of 541 randomly selected New Jersey pediatricians and family practitioners. OUTCOME MEASURES: Risk assessment, screening and case management practices and their consistency with CDC recommendations. RESULTS: We obtained 333 usable responses (69.4%). Most respondents reported confirming blood lead level, initiating case management, and identifying medical emergencies at blood lead levels lower than recommended by CDC. More than half reported not assessing the risk of the majority of their patients. At least one third were not screening infants, children between 1 and 2 years, or children between 2 and 6 years of age. Physicians who assessed risk tended to screen high-risk children in all age groups. Only 42% of pediatricians and 24% of family practitioners said they screened the majority of the children in their practice by age 2 years. About 60% of all respondents reported not providing lead exposure education to half their patients. CONCLUSIONS: Passing a universal screening law, as New Jersey has done, is one way to obtain baseline childhood lead poisoning prevalence data. Private practice-targeted physician education led by preventive medicine specialists may also be helpful.

Child↗
PubMed1998

Empirical comparison of the results of randomized controlled trials and case-control studies in evaluating the effectiveness of screening mammography.

The gold standard for evaluating screening programs is the randomized controlled trial (RCT). Case-control studies are easier to perform but their role in this area is controversial. The purpose of this article is to compare empirically the results of RCTs and case-control studies conducted to evaluate the efficacy and effectiveness of screening mammography and examine possible explanations for differences in their results. We located eight RCTs and five case-control studies of screening mammography. For women aged 40-74 years at screening, comparison of the summary risk estimates of the RCTs (0.76, 95% CI: 0.69-0.83) with that of the case-control studies (0.44, 95%, CI: 0.38-0.50) showed RCTs to have a significantly higher summary risk estimate than case-control studies (ratio = 1.74, 95% CI: 1.48-2.04). It is notable that the RCTs were compromised in most instances by low compliance rates (50-80%) in the treatment groups and by significant use of screening in the control groups (20-30%). Adjustment of the RCT results for these cross-overs yields results that are in reasonable agreement with the summary estimate for the case-control studies. These findings support the use of case-control studies to estimate the efficacy of mammographic screening where RCTs are not feasible. They suggest that the efficacy of mammography in women aged 50 years and above is somewhat greater than the effectiveness measured by the intent-to-treat analysis of RCTs.

Adult↗
PubMed1998

Capsular polysaccharide types of group B streptococcal isolates from neonates with early-onset systemic infection.

The distribution of serotypes of group B streptococci (GBS) isolated from 67 infants with early-onset sepsis are described. Case-infants were assembled from 13 hospitals across the United States from 15 July 1995 to 5 February 1997 through prospective active surveillance. The distribution of GBS serotypes was Ia, 40%; Ib, 9%; II, 6%; III, 27%; V, 15%; and nontypeable, 3%. Type V occurred more frequently in the northeast region (New York and New Jersey) than in other regions (29% vs. 9%, P = .06). Conversely, type III occurred significantly less frequently in the northeast region than other regions (10% vs. 35%, P = .04). GBS types Ia, III, and V accounted for 82% of the isolates. This report supports previous observations about the emergence of GBS type V, but our data caution that conclusions about serotype distributions based on one geographic location or on a small number of patients may not be generally applicable. Continued monitoring seems necessary for the design of a GBS vaccine.

Bacterial Capsules↗
PubMed1998

Infant and maternal outcomes in the pregnancies of asthmatic women.

We examined the relationship between infant and maternal outcomes and asthma complicating pregnancy, using historical cohort analysis of singleton live deliveries in New Jersey hospitals between 1989 and 1992 (n = 447,963). Subject mother-infant dyads were identified from linked birth certificate and maternal and newborn hospital claims data. Women with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code (493) for asthma (n = 2,289) were compared with a fourfold larger randomly selected control sample (n = 9,156) from the remaining pool of women. After controlling for the effects of important confounding variables, maternal asthma was associated with the following adverse infant outcomes: preterm infant (odds ratio [OR] = 1.36; 95% confidence interval [CI], 1.18 to 1.55), low birth weight (OR = 1. 32; 95% CI, 1.10 to 1.58), small-for-gestational age (OR = 1.26; 95% CI, 1.10 to 1.45), congenital anomalies (OR = 1.37; 95% CI, 1.12 to 1.68), and increased infant hospital length of stay (OR = 1.44; 95% CI, 1.25 to 1.65). The adverse maternal outcomes associated with maternal asthma were: pre-eclampsia (OR = 2.18; 95% CI, 1.68 to 2. 83), placenta previa (OR = 1.71; 95% CI, 1.05 to 2.79), cesarean delivery (OR = 1.62; 95% CI, 1.46 to 1.80), and increased maternal hospital length of stay (OR = 1.86; 95% CI, 1.60 to 2.15). The results emphasize the need for maternal asthma to be added to the list of conditions that increase the risk of adverse pregnancy outcomes.

Asthma↗
PubMed1998

Maternal asthma and transient tachypnea of the newborn.

OBJECTIVE: To examine the relationship between transient tachypnea of the newborn and asthma complicating pregnancy. DESIGN: Historical cohort analysis. Setting. Singleton live deliveries in New Jersey hospitals during 1989 to 1992 (n = 447 963). PATIENTS: Mother-infant dyads were identified from linked birth certificate and maternal and infant hospital claims data. Women with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code (493) for asthma (n = 2289) were compared with a four-fold larger randomly selected control sample (n = 9156) from the remaining pool of women. MAIN OUTCOME MEASURE: Transient tachypnea of the newborn. RESULTS: In the overall sample, after controlling for the confounding effects of important variables, infants of asthmatic mothers were more likely [odds ratio (OR), 1. 79; 95% confidence interval (CI), 1.35-2.37] than infants of control mothers to exhibit transient tachypnea of the newborn. A stratified analysis by gestational age and sex revealed larger and statistically significant associations in term infants (OR, 2.02; 95% CI, 1.42-2.87) as opposed to preterm infants (OR, 1.51; 95% CI, 0.94-2.43) and in male infants (OR, 1.91; 95% CI, 1.35-2.71) as opposed to female infants (OR, 1.51; 95% CI, 0.92-2.47). On the other hand, after adjusting for important confounding variables, respiratory distress syndrome and maternal asthma were not found to be associated (OR, 1.14; 95% CI, 0.79-1.64). CONCLUSION: The results of this study provide evidence that maternal asthma is a risk factor for transient tachypnea of the newborn and differences in gestational age and sex were apparent in this association. The mechanism for this association remains to be determined.

Adolescent↗
PubMed1997

Vitamin A and birth defects.

OBJECTIVE: Our objective was to determine whether moderate doses of vitamin A are teratogenic. STUDY DESIGN: This was a geographically based case-control study. Women whose pregnancies produced offspring with neural tube defects (n = 548) or major malformations other than neural tube defects (n = 387) and normal control subjects (n = 573) were interviewed to determine periconceptional vitamin A supplement exposure levels. RESULTS: The proportion of women consuming doses of vitamin A between 8000 and 25,000 IU was no greater in the major malformations group or the group with neural tube defects than in the normal control group. For exposure from supplements and fortified cereals combined, women consuming >8000 and >10,000 IU daily had odds ratios for major malformations of 0.79 (95% confidence interval 0.40 to 1.53) and 0.73 (95% confidence interval 0.27 to 1.96), respectively, compared with women consuming <5000 IU. The results for neural tube defects were similar. For cranial neural crest defects the odds ratios were 0.76 (0.22 to 2.56) and 1.09 (0.24 to 4.98) for exposure to >8000 and >10,000 IU, respectively, versus exposure to <5000 IU. CONCLUSIONS: This study found no association between periconceptional vitamin A exposure at doses >8000 IU or >10,000 IU per day and malformations in general, cranial neural crest defects, or neural tube defects. If vitamin A is a teratogen, the minimum teratogenic dose appears to be well above the level consumed by most women during organogenesis.

Adult↗
PubMed1997

The importance of histologic type on breast cancer survival.

Breast cancer is a morphologically and genetically heterogeneous disease. The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute provides the large number of cases necessary to study individual histologic types of female invasive breast cancer that for practical reasons are otherwise unattainable. Attention was specifically focused on 4082 cases of mucinous adenocarcinoma and 139,154 cases of infiltrating duct carcinoma identified for the years 1973-1990. Life table analyses were conducted to compare survival by histologic type using death due to breast cancer as the outcome; Cox proportional hazards analysis was used to adjust for important covariates. Findings were that women diagnosed with mucinous adenocarcinoma have a rate of mortality due to breast cancer that is 0.38 that of the rate of women diagnosed with infiltrating duct carcinoma (95% confidence interval 0.34-0.42). We conclude that histologic type is important to consider in the prognosis and treatment of women diagnosed with breast cancer.

Adenofibroma↗