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Biomedical subjects

H Kushner

Publications and source records attributed to H Kushner.

At least 55 records · Page 3Linked to original sources
PubMed1995

Self-esteem and behavior in girls with Turner syndrome.

Data on social competence, behavior, and self-esteem were gathered from a large sample of girls with Turner syndrome to determine whether psychological difficulties were associated with Turner syndrome. Subjects included 97 girls with Turner syndrome, 7 to 14 years of age, and 93 girls without Turner syndrome recruited from public schools. The two groups of girls were similar in age, verbal intelligence scores, and racial composition. The girls with Turner syndrome were found, based on both parental and self-report, to be more immature than the girls in the comparison group, with weaker social relationships, school performance, and self-esteem. A decline in self-esteem was also documented for the girls with Turner syndrome, but not the comparison group, as they moved into early adolescence. Although the findings support an increased risk for subtle behavioral problems among girls with Turner syndrome, in most cases the problems endorsed were not severe enough to suggest clinical impairment.

Child↗
PubMed1994

Effect of intradialytic parenteral nutrition on mortality rates in end-stage renal disease care.

Several studies have now demonstrated that low serum albumin and/or low protein catabolic rates correlate with increased risk of death in the chronic hemodialysis patient. A study involving 81 patients receiving thrice-weekly hemodialysis treatments and who had either a low serum albumin and/or protein catabolic rate was conducted to compare the effect of intradialytic parenteral nutrition (IDPN) on mortality rates. Fifty patients received IDPN and 31 patients did not. Thirty-eight of the patients were black (47%), 34 were white (42%), and 9 were Hispanic (11%). The study included 33 diabetic patients (41%), 20 of whom received IDPN. Nondiabetic patients received an average of 725 kcal/hemodialysis treatment and diabetic patients received an average of 670 kcal/hemodialysis treatment. The average length of treatment was 9 months. The results of the study revealed a better survival rate (64% v 52%) for patients treated with IDPN. Using Cox analysis, the IDPN-treated group had a significantly better survival rate (P < 0.01). Serum albumin increased by 12% in the survivors. There was no difference in survival when considered separately for diabetic and nondiabetic patients who received IDPN (mortality rate for diabetics: 50% for treated patients and 54% for untreated patients; mortality rate for nondiabetics: 26% for treated patients and 44% for untreated patients). However, the nondiabetic treated patients had the lowest mortality rates. In conclusion, correction of hypoalbuminemia by IDPN significantly reduced mortality rates overall.

Body Weight↗
PubMed1994

Gender differences in insulin-stimulated glucose utilization among African-Americans.

The purpose of this study was to determine whether there are gender differences in plasma insulin levels or insulin resistance in young adult African-Americans. Male (n = 53) and female (n = 45) subjects (age 23 to 28 years) included normotensives (N, blood pressure [BP] < 135/85 mm Hg) and borderline hypertensives (BH, BP > 135/85 mm Hg). Plasma insulin concentration was measured during an oral glucose tolerance test (OGTT) in all subjects. In 50 cases, insulin clamps were performed. Plasma estradiol and free testosterone were analyzed in a subsample (n = 15) of women. Data were analyzed for BP and gender groups by two-way ANOVA. Compared to men, women in each BP group had higher plasma insulin: glucose ratios (P < .01) and sums of insulin on OGTT (P < .02). The insulin clamp data also demonstrated significantly lower insulin-stimulated glucose utilization (M) in women compared to men in each BP group (N males 7.28 +/- 0.72 v N females 4.94 +/- 1.2 mg/kg-min; BH males 5.28 +/- .56 v BH females 2.59 +/- 0.50 mg/kg-min; P < .004 for gender differences). Analysis of the sex hormone data found a significant correlation in the ratio of free testosterone/estradiol (T/E) with plasma glucose, insulin, insulin/glucose, and systolic BP (P < .05), and no correlation of T/E with body mass index or triceps skinfold thickness. These data indicate that there are significant gender differences in plasma insulin levels and in insulin sensitivity in African-Americans. The relationship of plasma insulin to sex hormones suggests that in females, hyperinsulinemia cosegregates with increased androgenicity.

Adult↗
PubMed1994

Interpreting HIV seroprevalence data from a street-based outreach program.

A total of 4,375 subjects were recruited through continuous street outreach over 31 months for interviews on HIV-related risk behavior and HIV-antibody testing. Changes over time among sampled subjects with respect to HIV infection and HIV-risk behavior have been examined retrospectively, and significant and consistent trends noted across successive cohorts. Although overall 42% of the sample tested HIV antibody-positive, HIV infection exhibited a consistent downward trend from 60% in the first quarter year of interviewing to 22% in the final quarter year. Scores on a multivariate index of HIV risk also declined significantly. Mean age, proportion of Black subjects, mean length of drug injection career, frequency of drug injection, and the use of shooting galleries all declined significantly across quarters as well. We argue that these observed differences result from a systematic sampling bias inherent in our outreach-driven sampling procedures, which initially favored recruitment of IDUs with greater behavioral and demographic risk for HIV.

Adult↗
PubMed1993

Racial differences in blood pressure among urban adolescents.

The purpose of this study was to determine if there are racial differences in the blood pressure patterns among urban adolescents. Blood pressure (BP) was measured according to Task Force guidelines in health-screening and education sessions conducted in urban public and parochial high schools. The prevalence of BP > or = 95th% (HBP) on initial screening was determined in a population of 3,349 students. Differences in prevalence of HBP among race, sex, and age groups were tested for significance by chi 2 analysis. The overall prevalence of HBP in this urban adolescent population was 8.1%. Significant race differences were present in females (blacks = 6.6% versus non-Hispanics = 2.9%, p < 0.01). Within the black females, HBP occurred more frequently among the girls attending predominantly black public schools (7.7%) compared to an interracial parochial school (2.0%) p < 0.001. This difference could not be explained by weight, height, or the occurrence of obesity. The observed BP differences within black females, by school, may reflect a family-environment effect on cardiovascular risk.

Adolescent↗
PubMed1993

Insulin-stimulated glucose utilization and borderline hypertension in young adult blacks.

The purpose of this investigation was to determine whether there is a relation between impaired insulin-stimulated glucose utilization, or insulin resistance, and blood pressure (BP) in a young adult black population. Clinically well, young black men and women, including normotensive (BP < 135/85 mm Hg, n = 23) and borderline hypertensive (BP > or = 135/85 mm Hg, n = 27) individuals, were studied. Each subject had an oral glucose tolerance test (OGTT) and underwent a euglycemic hyperinsulinemic clamp procedure. A two-way analysis of variance demonstrated a significantly greater fasting insulin plasma concentration (P < .02) and sum of insulin levels during the OGTT (P = .04) in the borderline hypertensive compared with normotensive subjects. In both BP groups, women had significantly higher fasting plasma insulin levels than men (P < .02 and P = .009). Body mass index was a significantly covariate of the plasma insulin concentration. Data obtained from the clamp demonstrated significant insulin resistance in borderline hypertensive compared with normotensive subjects (4.69 +/- 0.50 versus 6.57 +/- 0.63 mg/kg per minute, P = .002). A stepwise multiple linear regression analysis demonstrated that there are significant multiple correlations of insulin resistance with body mass index, clamped insulin level, BP group, and systolic BP (multiple R = .7862, P < .001). Application of this analysis to the nonobese sample (n = 33) found significant correlations of insulin resistance with sex, BP group, and systolic BP (multiple R = .6817, P < .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

The Fifth Edition of the Addiction Severity Index.

The Addiction Severity Index (ASI) is 12 years old and has been revised to include a new section on family history of alcohol, drug, and psychiatric problems. New items were added in existing sections to assess route of drug administration; additional illegal activities; emotional, physical, and sexual abuse; quality of the recovery environment; and history of close personal relationships. No changes were made in the composite scoring to maintain comparability with previous editions. This article discusses the clinical and research uses of the ASI over the past 12 years, emphasizing some special circumstances that affect its administration. The article then describes the rationale for and description of the changes made in the ASI. The final section provides "normative data" on the composite scores and severity ratings for samples of opiate, alcohol, and cocaine abusers as well as drug abusing inmates, pregnant women, homeless men, and psychiatrically ill substance abusers.

Adolescent↗
PubMed1992

Factors affecting survival of hemodialysis patients utilizing urea kinetic modeling. A critical appraisal of shortening dialysis times.

The objective of this study was to analyze risk factors affecting mortality rates (MR) in hemodialysis patients undergoing shortened dialysis time who were regularly kinetically modeled. Over a 14-month period, 180 in-center hemodialysis patients, 54% male, 46% female, 57% Black, 39% Caucasian, and 4% Hispanic, treated with rapid high efficiency dialysis (RHED = 2-3 h, 3 times/week) and conventional dialysis (3-4 h, 3 times/week) were studied. Median patient age was 56.7 years (16-84 years) and dialysis care ranged from 6 months to 18 years (mean +/- SD = 4.0 +/- 4.2 years). The patients underwent monthly urea kinetic modeling. The dialysis prescription was based upon normalizing Kt/V between 0.8 and 1.2 and the protein catabolic rate (PCRn) between 0.9 and 1.1. Thirty-three percent of the patients received recombinant human erythropoietin (r-HuEPO). The effects of various covariates, including primary diagnosis, post/predialysis BUN ratios, creatinine, albumin, calcium, phosphate, cholesterol, hemoglobin, r-HuEPO, Kt/V, and PCRn were analyzed using analysis of variance, chi 2 and linear discriminant function (DF) statistical methods. Several significant factors emerged as influencing outcome. The DF analysis produced a highly statistically significant (p < 0.0001) model to predict mortality based upon certain laboratory and dialysis parameters. Further, the linear DF correctly predicted mortality rate in 86% of cases. The results of the analysis revealed an overall mortality rate of 15.6%; hospitalization rates (HR) were 1.4 +/- 1.8 times/year. Length of dialysis time, i.e., dialysis times between 2 and 4 h, when adjusted for Kt/V has no correlation with MR or HR. Variables associated with survival were higher post/predialysis BUN ratios, normal Kt/V (0.8-1.2), normal albumin levels (> 3.5 g/dl), higher postdialysis BUN, creatinine, and cholesterol levels, and use of r-HuEPO. The use of r-HuEPO when analyzed by DF significantly improved MR, 8.3% as opposed to 19.2%. It is concluded that urea kinetic modeling permits shortening dialysis times without affecting mortality or hospitalization rates, and that low postdialysis BUN, post/predialysis BUN ratios, creatinine, and albumin values are correlated with a lower chance of survival.

Analysis of Variance↗
PubMed1992

Hyperinsulinemia and blood pressure sensitivity to sodium in young blacks.

The relationship of blood pressure sensitivity to sodium with plasma insulin concentration was examined in young adult (22 to 28 yr) blacks (N = 45). The study included normotensive and borderline hypertensive subjects. Blood pressure sensitivity to sodium was determined by the change in mean blood pressure after 14 days of sodium loading (10 g of NaCl daily plus usual diet). Plasma insulin concentration was determined during an oral glucose tolerance test (OGTT). The correlation of fasting plasma insulin concentration with blood pressure or blood pressure sensitivity to sodium was not statistically significant. There was a significant correlation (after adjustment for adiposity) of blood pressure sensitivity to sodium with both the sum of insulin (r = 0.41; P < 0.01) and the 60-min plasma insulin concentration during the OGTT. The plasma insulin concentration at 60 min during the OGTT correlated significantly with the change in mean arterial pressure over a 5-yr interval (r = 0.36; P < 0.02). There was a similar significant correlation of blood pressure sensitivity to sodium with change in mean arterial pressure over 5 yr (r = 0.48; P < 0.001). These data demonstrate an association of hyperinsulinemia and blood pressure sensitivity to sodium in the young. The data also suggest that insulin may contribute to the pathogenesis of hypertension in the black population.

Adult↗
PubMed1991

Interaction of sodium sensitivity and stress in young adults.

The interaction of sodium sensitivity and stress-induced cardiovascular reactivity was studied in white and black young adults aged 18-23 years. The cardiovascular response to difficult mental arithmetic was measured before and after 14 days of oral sodium loading (10 g NaCl/day added to the usual diet). A sodium-sensitive blood pressure response occurred in 18.4% of whites and 37.3% of blacks. A significant correlation between blood pressure change and sodium excretion occurred in the sodium-sensitive group (r = - 0.28, p less than 0.01). High sodium intake did not augment blood pressure or heart rate response to the beta-adrenergic-mediated stimulus of mental arithmetic in the population, which was grouped by blood pressure, race, or sodium sensitivity.

Adolescent↗
PubMed1991

Discriminant analysis of transmission of elevated blood pressure in first generation offspring of African green monkeys.

A linear discriminant analysis was applied to blood pressure data of 162 first generation colony-born offspring of normotensive (C), hypertensive (H), or borderline hypertensive (B) African green monkeys who were being selectively bred in an attempt to establish a strain of spontaneously hypertensive monkeys. The offspring were classified according to their parents' blood pressures as CC, HH, or Mixed (e.g. HC). Blood pressures were measured by indirect methods from unanesthetized offspring aged 0.5-6 years of age. The discriminant score was used to classify each of the 533 blood pressure measurements of the CC, Mixed, and HH offspring into one of three predicted groups: normotensive, borderline hypertensive, or hypertensive. The group means of the three predicted groups compared without regard to offspring type were significantly different (p less than .001). In addition, the percentage of blood pressure measurements predicted to be normal or elevated differed among the three offspring groups (p less than .001). 82% of the blood pressure measurements from CC offspring were classified as normotensive, compared with 58% and 40% of the blood pressure measurements from the Mixed and HH groups, respectively. In contrast, 25% of the blood pressure measurements from the HH groups were classified as hypertensive, compared with 10% and 4% from the Mixed and CC groups, respectively. Blood pressures of the normotensive, borderline hypertensive, and hypertensive subgroups derived from the CC group were consistently and significantly lower (p less than .001) than their respective counterparts in the Mixed and HH groups. The results of the discriminant analysis indicate a trimodal distribution of blood pressures in the first generation offspring and a significant separation of blood pressures among the offspring after a single generation.

Animals↗
PubMed1991

Clinical and electrophysiological assessments in ALS patients.

Since the relationships between traditional assessments in ALS patients have not been defined, three clinical and four electrophysiological assessments were performed in a cross-sectional study of 87 ALS patients. The clinical assessments produced Norris ALS scores, muscle strength scores and illness durations (DUR). The electrophysiological assessments produced scores for motor unit interference pattern, denervation potentials, compound muscle action potential, and fasciculations. The individual muscle scores were averaged to produce mean scores, and Spearman rank correlations were performed on the mean scores. The association between Norris ALS and mean muscle strength (MMS) scores is significant (p less than .001, rs = 0.84), and these scores are significantly correlated with mean interference pattern (0.77, 0.82), mean denervation potential (-0.63, -0.70), and mean compound muscle action potential scores (0.55, 0.60), respectively. Correlations between IP and DP scores (-0.71), IP and CMAP scores (0.62), and DP and CMAP (-0.56) scores are also significant. Scatterplots of the data and regression lines suggest linear relationships between each of these assessments. Illness duration and fasciculation scores are not strongly correlated (rs less than 0.55) with any of the other clinical or electrophysiological assessments.

Amyotrophic Lateral Sclerosis↗
PubMed1991

The impact of AIDS on recruitment in the health professions.

The occupational risk of AIDS has been identified as a possible factor in the decline of applicants to health professions programs. This study examined data obtained from 914 Philadelphia public and parochial high school students concerning their knowledge and attitudes about AIDS, and their knowledge and attitudes toward the health professions. The survey revealed that the majority of respondents demonstrated a good, basic understanding of the transmission of the virus. While fear of exposure to the virus may negatively impact some prospective students, the majority in this study did not express this concern. Rather, the results indicated that the respondents' lack of knowledge and understanding of the health professions is a major reason that they may not be selecting health careers. Notably, more than 50% of those surveyed responded that high schools do not provide enough information about the health professions. These findings reinforce the need for creative recruitment and career counseling programs that will foster an interest in the health professions.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Effect of chronic sodium loading on cardiovascular response in young blacks and whites.

The effect of long-term oral sodium loading on blood pressure and on stress-induced cardiovascular response was studied in normotensive and marginally hypertensive young adults. The 121 subjects, 18-23 years old, included 38 whites and 83 blacks. Blood pressure and heart rate response to the stress of mental arithmetic was measured before and after 14 days of sodium load, which consisted of 10 g NaCl/day added to the usual diet. A sodium-sensitive response to sodium load occurred in 18.4% of whites and 37.3% of blacks. Sodium-insensitive subjects had a higher rate of sodium excretion (p less than 0.001). Sodium-sensitive hypertensive subjects had a significantly greater weight gain (p less than 0.001). A significant correlation between blood pressure change and sodium excretion (r = -0.28, p less than 0.01) occurred in the sodium-sensitive group. The high sodium intake did not augment the blood pressure or heart rate response to the beta-adrenergic-mediated stimulus of mental arithmetic in the population when grouped by blood pressure, race, or sodium sensitivity. These results suggest that blood pressure increase in response to sodium load, particularly in blacks, is related to functional changes in peripheral vascular resistance.

Administration, Oral↗
PubMed1990

Insulin resistance and blood pressure in young black men.

Insulin resistance, independent of obesity or non-insulin-dependent diabetes mellitus, has been demonstrated to be associated with high blood pressure. To determine if insulin resistance could be an antecedent to hypertension in a high-risk population, we studied normotensive (112 +/- 12/70 +/- 10 mm Hg) and borderline hypertensive (135 +/- 8/85 +/- 5 mm Hg) lean young black men (22-26 years old) with the euglycemic hyperinsulinemic clamp technique. All subjects had clinically normal oral glucose tolerance. Body mass index and percent adipose mass were the same in both groups. Fasting plasma insulin concentration was significantly higher in the borderline hypertensive group (p less than 0.01). Insulin-directed exogenous glucose metabolism at the same degree of steady-state hyperinsulinemia was significantly lower in the borderline hypertensive group (5.98 +/- 2.22 versus 8.22 +/- 1.96 mg/kg/min; p less than 0.01). For the total population, a significant inverse correlation existed between the glucose infusion rate and systolic blood pressure (p less than 0.01). These data indicate that there is a relation between insulin-mediated glucose uptake and blood pressure. Furthermore, in this high-risk population insulin resistance may precede the onset of established essential hypertension.

Adult↗
PubMed1990

Cognitive functioning and treatment outcome in alcoholics.

The primary objective of this study was to determine whether cognitive functioning at intake into treatment was associated with completion of a 30-day day hospital alcoholism rehabilitation program and 1- and 6-month posttreatment functioning. None of our measures of sociodemographic characteristics, cognitive functioning, and life functioning was found to be significantly correlated with program completion. The measures of cognitive functioning included four cognitive factors--language ability, auditory verbal learning, logical memory, and complex cognitive functioning--as well as an objective measure of within-treatment learning. Canonical correlation analyses were performed to estimate associations among 14 independent variables and seven measures of both 1- and 6-month follow-up outcomes. The independent variables included the five cognitive measures described above, race and age, and seven baseline Addiction Severity Index (ASI) interviewer ratings of severity of alcohol, drug, family/social, legal, medical, employment, and psychological/psychiatric problem levels. The dependent variables at each follow-up evaluation point consisted of the difference between the baseline and follow-up ASI composite (factor) scores in the seven areas of functioning described above. The findings revealed the relative independence of improvement in alcohol problem level at both followup periods, as contrasted with the relative interdependence of the other areas of functioning. Greater baseline alcohol problems and poorer complex cognitive functioning were most consistently associated with improved alcohol-related outcome. Other cognitive measures ere not significantly associated with treatment outcome in the other areas of functioning described above.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Adenotonsillectomy. A safe outpatient procedure.

Traditionally, adenotonsillectomy in children and tonsillectomy in adults have been performed as inpatient procedures. Our experience with this procedure as outpatient started in 1975 at the University of Miami-Jackson Memorial Medical Center. From 1975 to 1987, 1428 cases performed in Florida and Cleveland were reviewed to evaluate the safety and efficacy of the technique used. Bismuth subgallate and epinephrine mixture for hemostasis is used without relying on electrocautery, ties, or suture technique to control bleeding. The incidence of immediate and delayed postoperative bleeding in a series of patients was extremely low (four [0.28%] of 1428 cases). Our technique has good hemostatic properties allowing vessels to contract and retract into the muscle of the tonsillar fossae and adenoid bed. Bismuth subgallate activates factor XII (Hageman factor) and, therefore, markedly accelerates the cascade of blood clotting. Outpatient adenotonsillectomy is safe, cost-effective, and minimizes psychologic implications, which may be an important factor, especially in children. Ambulatory adenotonsillectomy has not been well emphasized in the literature.

Adenoidectomy↗