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Biomedical subjects

H Cabral

Publications and source records attributed to H Cabral.

At least 19 recordsLinked to original sources
PubMed2004

The 6-min walk distance: change over time and value as a predictor of survival in severe COPD.

The 6-min walk distance (6MWD) is used to evaluate the functional capacity of patients with chronic obstructive pulmonary disease (COPD). The change in 6MWD over time and its correlation with changes in spirometry and survival are unclear. Patients (n=198) with severe COPD and 41 age-matched controls were followed for 2 yrs, and anthropometrics, spirometry, 6MWD and comorbidities were measured. The 6MWD decreased in the COPD group from 238 +/- 107 m to 218 +/- 112 m (-26 +/- 37 m x yr(-1)), and increased in the control group from 532 +/- 82 m to 549 +/- 86 m (12 +/- 25 m x yr(-1)). In both groups, there was a poor correlation with changes in forced expiratory volume in one second (FEV1). Nonsurvivors in the COPD group (42%) had a more pronounced change in the 6MWD (-40 versus -22 m x yr(-1)) but a similar change in FEV1 (118 versus 102 mL x yr(-1)). The 6MWD independently predicted survival, after accounting for age, body mass index, FEV1 and comorbidities. In severe chronic obstructive pulmonary disease, the 6-min walk distance predicts mortality better than other traditional markers of disease severity. Its measurement is useful in the comprehensive evaluation of patients with severe disease.

Anthropometry↗
PubMed2000

Bioequivalence of a propylene glycol-based liquid dapsone preparation and dapsone tablets.

The bioequivalence of a proprietary liquid dapsone preparation and commercially available dapsone tablets was studied. Twelve adult volunteers received dapsone doses with 8 oz of water one to two hours after their usual breakfast. Each subject received an initial 100-mg dose of a propylene glycol-based liquid preparation of dapsone and, two weeks later, a 100-mg dapsone tablet (both from Jacobus Pharmaceutical Company, Princeton, NJ). Blood samples were collected before and at intervals up to 96 hours after the administration of each dose. Serum dapsone concentrations were determined by high-performance liquid chromatography, and pharmacokinetic values were calculated by model-independent analysis. The area under the concentration-versus-time curve and the maximum serum concentration for the two formulations met the criteria for bioequivalence. Time to maximum serum concentration tended to be lower for the liquid, but not significantly. The liquid and tablet formulations of dapsone studied were found to be bioequivalent and may be used interchangeably.

Adult↗
PubMed2000

Risk of basal cell and squamous cell carcinoma in persons with prior cutaneous melanoma.

BACKGROUND: Melanoma has been associated with an overall increase in actinic tumors, including actinic keratoses, as well as with noncutaneous malignancies. OBJECTIVE: Determine the risk of developing basal cell and squamous cell skin cancer in patients with prior cutaneous melanoma (actinic keratoses not encountered). METHODS: This retrospective study included 1396 white patients with prior cutaneous melanoma followed at the Roswell Park Cancer Institute in the period 1977-1978. The control group was the white population of the Detroit area in the same period (1977-1978). RESULTS: A total of 25 patients (18 males, 7 females) developed 35 basal cell and/or squamous cell carcinomas: 18 developed basal cell carcinomas, 2 squamous cell carcinomas, and 5 both. The calculated odds ratio was 3.49 (males 3.67, females 2.86, 95% confidence interval 1.52-8.00). No correlations were found with age, type, anatomic site, and length of follow-up of cutaneous melanoma. CONCLUSION: A history of cutaneous melanoma significantly increases the risk of basal cell and squamous cell skin cancer.

Adolescent↗
PubMed1999

Level of in utero cocaine exposure and neonatal ultrasound findings.

OBJECTIVE: To assess whether there is an association between the level of in utero cocaine exposure and findings on neonatal cranial ultrasound, controlling for potentially confounding variables. STUDY DESIGN: In a prospective longitudinal study, three cocaine exposure groups were defined by maternal report and infant meconium assay: unexposed, heavier cocaine exposure (>75th percentile self-reported days of use or of meconium benzoylecogonine concentration) or lighter cocaine exposure (all others). Neonatal ultrasounds from 241 well, term infants were read by a single radiologist who was masked to the exposure group. RESULTS: Infants with lighter cocaine exposure did not differ from the unexposed infants on any ultrasound findings. After controlling for infant gender, gestational age, and birth weight z scores and for maternal parity, blood pressure in labor, ethnicity, and use of cigarettes, alcohol, and marijuana during pregnancy, the more heavily cocaine-exposed infants were more likely than the unexposed infants to show subependymal hemorrhage in the caudothalamic groove (covariate adjusted odds ratio: 3.88; 95% confidence interval: 1.45, 10.35). CONCLUSIONS: This is the first study to demonstrate that ultrasound findings suggestive of vascular injury to the neonatal central nervous system are related to the level of prenatal cocaine exposure. Inconsistency in previous research in identifying an association between prenatal cocaine exposure and neonatal cranial ultrasound findings may reflect failure to consider dose effects.

Cocaine↗
PubMed1998

Blood pressure in children exposed prenatally to cocaine.

Prenatal exposure to cocaine may alter autonomic nervous system function resulting in hypertension. Blood pressure was measured oscillometrically in a convenience sample of cocaine-exposed (n = 32) and nonexposed (n = 23) children, aged 8 to 26 months, by examiners unaware of exposure status. The exposed and nonexposed groups did not differ in systolic pressure (mean +/- SD 102.3 +/- 9.9 mmHg vs 119.1 +/- 19.4). Prenatal exposure to cocaine does not appear to be associated with elevated blood pressure in young children.

Autonomic Nervous System↗
PubMed1997

Elevated plasma norepinephrine after in utero exposure to cocaine and marijuana.

OBJECTIVE: To compare plasma catecholamine concentrations between cocaine-exposed and unexposed term newborns and to determine the relationship between plasma catecholamines and newborn behavior. METHODS: Forty-six newborn infants participating in a prospective study of the neonatal and long-term effects of prenatal cocaine exposure were studied. Based on maternal self-report, maternal urine screening, and infant meconium analysis, 24 infants were classified as cocaine-exposed and 22 as unexposed. Between 24 and 72 hours postpartum, plasma samples for norepinephrine (NE), epinephrine, dopamine, and dihydroxyphenylalanine analysis were obtained. The Neonatal Behavioral Assessment Scale was administered at 1 to 3 days of age and at 2 weeks of age by examiners masked to the drug exposure status of the newborns. RESULTS: The cocaine-exposed newborns had increased plasma NE concentrations when compared to the unexposed infants (geometric mean, 923 pg/mL vs 667 pg/mL). There were no significant differences in plasma epinephrine, dopamine, or dihydroxyphenylalanine concentrations. Analysis for the effect of potential confounding variables revealed that maternal marijuana use was also associated with increased plasma NE, although birth weight, gender, and maternal use of alcohol or cigarettes were not. Geometric mean plasma NE was 1164 pg/mL in those infants with in utero exposure to both cocaine and marijuana compared to 812 pg/mL in those exposed to only cocaine and 667 pg/mL in those exposed to neither. Among the cocaine-exposed infants, plasma NE concentration correlated with an increased score for the depressed cluster (r = .53) and a decreased score for the orientation cluster (r = -.43) of the Neonatal Behavioral Assessment Scale administered at 1 to 3 days of age. Adjusting for marijuana exposure had no effect on these relationships between plasma NE and the depressed and orientation clusters. CONCLUSION: Plasma NE is increased in newborns exposed to cocaine and marijuana. Increased plasma NE is associated with selected neurobehavioral disturbances among cocaine exposed infants at 1 to 3 days of life but not at 2 weeks.

Cannabis↗
PubMed1996

Late dose-response effects of prenatal cocaine exposure on newborn neurobehavioral performance.

OBJECTIVE: To determine in a representative sample of full-term urban newborns of English-speaking mothers whether an immediate or late dose-response effect could be demonstrated between prenatal cocaine exposure and newborn neurobehavioral performance, controlling for confounding factors. METHODS: The Neonatal Behavioral Assessment Scale (NBAS) was administered by masked examiners to a total sample of 251 clinically healthy, full-term infants at 2 days and/or 17 days. Three in utero cocaine exposure groups were defined: heavily exposed (n = 44, > 75th percentile self-reported days of use during pregnancy and/or > 75th percentile of meconium benzoylecognine concentration); lightly exposed (n = 79, less than both 75th percentiles); and unexposed (n = 101, no positive biological or self-report marker). At the 3-week examination there were 38 heavily exposed, 73 lightly exposed, and 94 unexposed infants. Controlling for infant birth weight, gestational age, infant age at the time of examination, mothers' age, perinatal risk, obstetric medication, and alcohol, marijuana, and cigarette use, a regression analysis evaluated the effects of levels of cocaine exposure on NBAS performance. RESULTS: No neurobehavioral effects of exposure on the newborn NBAS cluster scores or on the qualifier scores were found when confounders were controlled for at 2 to 3 days of age. At 3 weeks, after controlling for covariates, a significant dose effect was observed, with heavily exposed infants showing poorer state regulation and greater excitability. CONCLUSIONS: These findings demonstrate specific dose-related effects of cocaine on 3-week neurobehavioral performance, particularly for the regulation of arousal, which was not observed in the first few days of life.

Cannabis↗
PubMed1995

Early neurodevelopmental growth in children with vertically transmitted human immunodeficiency virus infection.

OBJECTIVE: To examine mental and motor development in children with vertically transmitted human immunodeficiency virus (HIV) infection in the first 30 months of life. DESIGN: Prospective longitudinal study comparing two groups: children with HIV infection and HIV-exposed but uninfected children. SETTING: Pediatric Immunodeficiency Clinic at Boston (Mass) City Hospital, Boston University Medical Center. STUDY PARTICIPANTS: Twenty-four children with vertically transmitted HIV infection and 27 children who were born to HIV-infected mothers and became HIV negative served as controls. Socioeconomic status, gestational age, and prenatal drug exposure were comparable in the two groups. MEASUREMENTS/RESULTS: Using the Bayley Scales of Infant Development, all children were assessed at least once between 4 and 16 months and again between 17 and 30 months of age. Individual mean mental and motor scores were calculated for the early and later age span. Motor development in the infected group was delayed in comparison to the seroreverter group in both age spans and remained stable in both groups over time. Mental development was comparable in the two groups at 4 to 17 months, but HIV infection was associated with delay in mental development at 17 to 30 months of age. CONCLUSION: Early and persistent delay in motor development and deceleration in mental development in late infancy distinguishes many children who are HIV infected from exposed but uninfected children, but there is significant variability in early neurodevelopmental outcome among children with HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Relation between meconium concentration of the cocaine metabolite benzoylecgonine and fetal growth.

Among 95 term infants with benzoylecgonine, the cocaine metabolite, detectable in their meconium, there was an inverse relation between the concentration of benzoylecgonine and birth weight, length, and head circumference. Multiple regression analysis confirmed these relations after controlling for gestational age and maternal use of marijuana, cigarettes, and alcohol. These data suggest a dose-response relation between the magnitude of prenatal cocaine exposure and impaired fetal growth.

Birth Weight↗
PubMed1995

Company characteristics and workplace medical testing.

OBJECTIVES: This study measures the relative impact of company economic characteristics and workplace hazards on the prevalence of several types of medical testing. It uses the results to assess likely public health impacts of testing. METHODS: We used data on potential exposure to workplace hazards, medical testing, unionization, firm size, and turnover from the National Occupational Hazards Survey and the National Occupational Exposure Survey. Other sources provided industry-specific data on wages and turnover. Logistic regression analysis estimated the relationship of economic variables and workplace health risks to the prevalence of medical testing. RESULTS: Economic variables were related to the prevalence of testing. However, consistent positive relationships were not found between health hazards and testing. CONCLUSIONS: Employers' testing decisions may not be beneficial to the health of workers and may shift the costs of illness to workers or other employers. Safer firms may provide too much medical testing, and firms that are less safe may provide too little.

Data Collection↗
PubMed1993

Adolescent pregnancy in Portugal: effectiveness of continuity of care by an obstetrician.

OBJECTIVE: To improve health among newborn infants of pregnant adolescents in Portugal, we developed and evaluated a prenatal care intervention. METHODS: The study group consisted of 80 adolescents recruited as they registered for prenatal care at Hospital Santa Maria in Lisbon. The intervention consisted of three components: initiation of prenatal care at registration, continuity of care by the same obstetrician, and emphasis on the specific nutritional and other health needs of pregnant adolescents. Controls were recruited after delivery on the maternity ward of the same hospital and were matched for age at conception, race, socioeconomic status, years of education, planned versus unplanned pregnancy, and previous body mass index. Controls received the routine care provided to pregnant adult women, including initiation of prenatal care at some point after registration and care by different general practitioners at each visit. RESULTS: Twenty mothers in the control group did not receive prenatal care and were excluded from further analysis. Mothers in the intervention group had their first prenatal visit 2 weeks sooner (P = .02) and had on average almost twice the number of prenatal visits (P = .0001) as controls. They gained 2.0 kg more on average compared with controls (P = .05). Infants of the mothers in the intervention group weighed an average of 181 g more than those in the control group. Fewer infants in the intervention group needed care in the high-risk pediatric unit (P = .005). When potentially confounding variables were controlled in a multivariate analysis, infants in the intervention group weighed on average 174 g more than those in the routine-care group (P = .02). CONCLUSION: This intervention, based on traditional tenets of good medical care, is effective in improving the outcomes of infants born to adolescent mothers in Portugal.

Adolescent↗
PubMed1992

Psychosocial correlates of drug and heavy alcohol use among pregnant women at risk for drug use.

OBJECTIVE: To investigate the roles of life stress, depression, and social support in the use of drugs and alcohol among pregnant women at risk for substance use because they have a substance-using partner. METHODS: This is a secondary analysis of data collected for a study of the impact of health behaviors and psychosocial characteristics on the newborns of 1226 pregnant women. Participants were interviewed during pregnancy and postpartum using a questionnaire that included instruments such as the Life Experiences Survey, the Center for Epidemiologic Studies Depression Scale, and the Norbeck Social Support Questionnaire. Drug use by women was determined by self-report and urine toxicology screens. Drug use by partners was based on maternal report. RESULTS: Five hundred seventy-three women reported that they had a substance-using partner. These women were nearly five times more likely (odds ratio 4.87, 95% confidence interval 3.76-6.30) to be substance users compared with women who did not report substance use by a partner. Of these women, substance users reported more negative life events on average in the past year than did non-users (19.3 versus 15.8; P = .01). There was no difference in mean Center for Epidemiologic Studies Depression Scale scores (19.7 versus 18.7; P = .26) or in mean social support scores (78.2 versus 72.4; P = .14) between users and non-users. CONCLUSIONS: Women with substance-using partners have an increased likelihood of being users themselves. Among women with substance-using partners, substance use by a pregnant women is associated with more negative life events but not with depression symptomatology scores or social support scores.

Adult↗
PubMed1991

A preliminary report of prenatal cocaine exposure and respiratory distress syndrome in premature infants.

A prospective study of maternal drug use during pregnancy and newborn outcomes provided us with an opportunity to assess the relationship between prenatal cocaine use and respiratory distress syndrome among premature infants. Women were consecutively recruited from the prenatal clinics at Boston (Mass) City Hospital between 1984 and 1988 and were interviewed during the prenatal and postpartum period by trained bilingual interviewers. Urine specimens were collected at the time of each interview and were analyzed for marijuana and cocaine metabolites. Following delivery, one of five pediatricians who were "blinded" to the mothers' prenatal and drug history performed a physical examination and abstracted medical information, including the diagnosis of respiratory distress syndrome from the medical record. The study sample consisted of 33 infants born at 34 weeks' or less gestation who were appropriate for gestational age and not exposed to heroin or methadone prenatally. Eight of the mothers of these 33 infants used cocaine prenatally. One (12%) of eight cocaine-exposed infants was diagnosed as having respiratory distress syndrome compared with 13 infants (56%) not exposed to cocaine prenatally. Infants not exposed had an odds ratio of 8.9 (95% confidence interval: 0.9, 83.5) for respiratory distress syndrome compared with infants exposed to cocaine prenatally. When the analysis was controlled for prolonged rupture of membranes, black race, infant gender, or gestational age, the adjusted odds ratio was essentially unchanged. This preliminary observation of a decreased incidence of respiratory distress syndrome among premature infants prenatally exposed to cocaine appears to be biologically plausible and needs to be confirmed in future studies with larger numbers of subjects to control for potentially confounding variables.

Adult↗
PubMed1990

Neonatal body proportionality and body composition after in utero exposure to cocaine and marijuana.

The relationship of maternal use of marijuana and cocaine during pregnancy to measures of neonatal body proportionality and body composition was assessed in a multiethnic sample of 1082 newborn infants. Maternal use of marijuana and cocaine during pregnancy was ascertained by self-report and by an enzyme-multiplied immunoassay technique for screening of urine samples obtained prenatally and again post partum. After each substance was analytically controlled for use of the other and for other potentially confounding variables, detection of marijuana metabolites in maternal urine was associated (p less than 0.05) with depressed mean arm muscle circumference and nonfat area of the arm but not with any measure of neonatal fatness. In contrast, detection of cocaine in maternal urine was associated (p less than 0.05) with decrements of subscapular fat folds and of the fat and nonfat areas of the arm. Although both substances were associated with depressed birth weight, there was no decrement of neonatal ponderal index or of the arm circumference/head circumference ratio in association with exposure to either substance. We conclude that both marijuana exposure and cocaine exposure during pregnancy are associated with symmetric intrauterine growth retardation, but that deficits are in differing compartments of intrauterine growth. These findings suggest that marijuana may retard fetal growth through maternal-fetal hypoxia, whereas cocaine may alter nutrient transfer to the fetus and fetal metabolism.

Adipose Tissue↗
PubMed1990

Foreign-born and US-born black women: differences in health behaviors and birth outcomes.

We studied health behaviors and birth outcome among 201 foreign-born and 616 US-born Black women receiving prenatal care at Boston City Hospital. Foreign-born women had better pre-pregnancy nutritional status and prenatal health behaviors, and their infants had greater intrauterine growth. Black women are not a homogeneous group; culture and ethnicity, in addition to other variables, must be considered in the study of their birth outcomes.

Adolescent↗
PubMed1990

Violence during pregnancy and substance use.

Violent incidents were assessed as part of a prospective study of 1,243 pregnant women. Participants were predominantly poor, urban, minority group women. Seven percent (n = 92) of women reported physical or sexual violence during pregnancy. Most of the women (94 percent) knew their assailant. Victims of violence were at greater risk of having a history of depression and attempted suicide, having more current depressive symptoms, reporting less happiness about being pregnant, and receiving less emotional support from others for the current pregnancy. Comparisons of victims and non-victims showed that victims were more likely to be users of alcohol and drugs. In addition, partners of victims were more likely to use marijuana and cocaine. When possible confounders were controlled using multivariable analyses, a woman's alcohol use during pregnancy and her partner's drug use were independently associated with an increased risk of being a victim of violence during pregnancy. Results of this study highlight the importance of assessing exposure to violence during prenatal care, especially among women who are heavy users of alcohol or drugs or whose partners use these substances.

Adolescent↗
PubMed1990

Maternal depressive symptoms during pregnancy, and newborn irritability.

Maternal depression is associated with a wide range of adverse outcomes for children, including poor mother-infant interactions at 3 months post-partum. The aim of this study is to determine whether maternal depressive symptoms during pregnancy are associated with neonatal neurobehavioral functioning, as measured by the Neurologic and Adaptive Capacity Scale. The study population consists of 1,123 mothers and their term infants who were participants in a larger study of maternal health and infant outcomes. Women were administered the Center for Epidemiologic Studies-Depression (CES-D) questionnaire for depressive symptoms during their pregnancy. Their infants were subsequently assessed by a pediatrician blind to their CES-D scores. The CES-D score was associated with unconsolability and excessive crying (p less than 0.01). The higher the mother's CES-D score, the more likely it was that the infant would be unconsolable or cry excessively. Mothers with CES-D scores at the 90th percentile were 2.6 times more likely to have unconsolable newborns, compared with women with CES-D scores at the 10th percentile (95% C.I. = 1.54, 4.23). When potentially confounding variables, such as cigarette smoking, alcohol, marijuana, and cocaine use, poor weight gain, income, birth weight, and other drug use, were controlled, the relationship between CES-D score and newborn unconsolability and excessive crying remain unchanged. The results of this study suggest that the relationship between early childhood problems and maternal depressive symptoms may be part of a sequence that starts with depressive symptoms during pregnancy.

Adolescent↗