PubMed Health⌕ Search

Biomedical subjects

J F Jekel

Publications and source records attributed to J F Jekel.

At least 37 records · Page 2Linked to original sources
PubMed1990

Infection control practices in Connecticut's skilled nursing facilities.

Questionnaires were sent to all skilled nursing homes in Connecticut as part of a larger study of nosocomial infections, infection risks, and infection control programs. This article describes surveillance practices, isolation practices, control measures, and employee health activities of skilled nursing homes in Connecticut. The overwhelming majority of skilled nursing homes used written criteria to determine nosocomial infections, and all undertook surveillance; the majority did surveillance at least weekly and 21% did on a daily basis. The most frequent source of information for reporting infections were microbiology reports and information from the charge nurse. Three fourths of the skilled nursing homes stated that the responsibility of reporting communicable disease is that of the infection control practitioner. Two thirds of the skilled nursing homes stated that they had policies on the reporting of isolation practices, including the refusal or acceptance of patients with infections; 38% had residents under isolation precautions. Of all the patient care control measures, only that of changing urinary catheters on a routine basis was associated with facility size. More than 90% of facilities reported having an employee health program, but the benefit was limited.

Connecticut↗
PubMed1990

Infection control practitioners and committees in skilled nursing facilities in Connecticut.

All skilled nursing facilities (SNFs) in Connecticut were surveyed and more than 71% responded to a Centers for Disease Control-funded project, a component of which is reported herein. The study describes the infection control practitioner (ICP), assistance provided ICPs from external sources, and infection control committees. Almost all ICPs received some training in infection control and worked in the field for an average of 3 1/2 years. Both the number of hours devoted to infection control and the percentage of time spent by the ICP on infection control activities increased with the size of the facility. More than one half of the ICPs in SNFs have relationships with hospital ICPs. The majority of SNF infection control committees met quarterly. The chairperson most often was a physician, although ICPs held this office in almost one third of the reporting SNFs. We conclude that ICPs in Connecticut SNFs have increased in number and that they devote more time and effort to infection control than in previous years.

Aged↗
PubMed1990

"Rainbow reviews." IV: Recent publications of the National Center for Health Statistics.

I am always impressed at the wealth of interesting and useful information available from the NCHS, if one knows where to look. The Center tries to adapt to the changing needs of the potential users of their data, including health planners and policy analysts, and academicians. This is illustrated by the increasing emphasis on medical care utilization, especially in long term care, on disease prevention and health promotion issues and on international comparisons. Clinical investigators should be familiar with the NCHS reports, if only to avoid duplication of effort. But beyond that, the information they present can be used to develop hypotheses, estimate variances for sample size determinations, and provide useful model instruments and methods. Beyond that, the NCHS does not analyze and report exhaustively on these data, if only because of lack of resources, so that it makes most of these data available for further research at a nominal charge. Many doctoral dissertations have been based on these tapes as the primary data source for detailed content analysis and/or for methodologic innovation.

Government Publications as Topic↗
PubMed1990

Infant feeding patterns during the first year of life in Denmark: factors associated with the discontinuation of breast-feeding.

We prospectively studied 500 infants born consecutively in a university-affiliated community hospital in Copenhagen, Denmark, over the first 12 months of life using a detailed monthly mailed questionnaire (overall response rate = 73%) which focused on feeding practices and illnesses. Seventy-seven percent of respondents breast-fed their infants at 1 month of life compared to 19% at 12 months of life. Analysis of breast-feeding behavior using survival analysis showed that 50% of the mothers who breast-fed since the first month of their infant's life were still breast-feeding at 7 months of life. Also, there was a greater than two-fold increase in the rate of discontinuation of breast-feeding for infants in daycare compared to infants not attending daycare (RR = 2.08, 95% CI = 1.43, 3.01). Discontinuation of breast-feeding was not significantly associated with the number of children in the family or with social class. These results give insight into infant feeding patterns in a developed country and suggest that: (1) breast-feeding is the dominant method of feeding during the infant's first year of life, and (2) the rate of discontinuation of breast-feeding is increased by the entry of these infants into daycare.

Age Factors↗
PubMed1990

Influenza outbreaks in nursing homes: how effective is influenza vaccine in the institutionalized elderly?

During the 1984-1985 influenza season, outbreaks of influenza A (H3N2) occurred in three Connecticut nursing homes. Influenza vaccination rates were 67% (96 out of 144), 35% (30 out of 85) and 69% (332 out of 483), respectively. The relative risk of illness for vaccinated compared to unvaccinated residents was 1.8 (95% confidence interval, 0.6, 5.9), 1.6 (95% confidence interval, 0.8, 3.0) and 1.1 (95% confidence interval, 0.8, 1.7) for each of the three nursing homes, respectively. In the third outbreak, 22 vaccinated residents without clinical illness had a geometric mean titer of hemagglutination-inhibition (HI) antibody of 20. Although low, this titer was significantly higher than that of nine unvaccinated residents without clinical illness (12, p less than .05); only three (14%) vaccinated residents had HI titers of greater than or equal to 40. These results suggest that levels of HI antibody in vaccinated residents were not protective at the time of the third outbreak, four to five months after vaccination. In general, the study of vaccine effectiveness in nursing homes is limited by sample size and statistical power. Despite these limits, the retrospective investigation of influenza outbreaks in nursing homes is often the only practical way to evaluate influenza vaccine effectiveness in the elderly on a yearly basis.

Adult↗
PubMed1990

Relationship between infant feeding and infectious illness: a prospective study of infants during the first year of life.

Prior studies investigating the relationship between infant feeding and infectious illnesses in developed countries have provided conflicting data about whether breast-feeding protects against common infectious illnesses early in life. These conflicts may in part be due to the failure to consider the following methodologic issues: (1) collecting data prospectively at frequent intervals for active surveillance of the detection of infections and of feeding practices, (2) specifying what is meant by infectious illnesses and breast-feeding, (3) controlling for confounding variables such as social class or presence of siblings in the household, and (4) applying appropriate analytical strategies to a population in which both feeding and exposure to illness change over time. A total of 500 infants born consecutively in a university-affiliated community hospital in Copenhagen, Denmark, were studied prospectively for the first 12 months of life by means of a detailed, monthly, mailed questionnaire that focused on feeding practices and illnesses (overall response rate, 73%). The percentage of infants who were completely or mostly breast-fed decreased from 88% at 1 month to 20% at 12 months of age. After adjustment for major covariates, no statistically significant relationship was found between the type of infant feeding and the incidence of four categories of infectious illnesses: gastroenteritis, upper respiratory illness, otitis media, and lower respiratory illness. The adjusted incidence density ratio for gastroenteritis was 1.067 (95% confidence interval = 0.982, 1.226) and for upper respiratory illnesses 0.984 (95% confidence interval = 0.883, 1.096).(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗
PubMed1988

The value and hazards of standardization in clinical epidemiologic research.

The statistical standardization of rates produces a single summary value that converts crude rates of occurrence into "standardized" rates that are adjusted for differences in the composition of compared populations. Although the process is well described in the epidemiologic literature and is regularly applied in comparisons of large populations, many investigators are not familiar with three important hazards that are magnified for the smaller groups studied in clinical epidemiologic research. This report contains a new "symmetrical" outline of the direct and indirect standardization processes, and an illustration of three pragmatic hazards: (1) Because the direct standardizing factor uses the observed stratum-specific rates, and because any stratum-specific rates that depend on small denominators may be misleading or unstable, the indirect method is preferred when the observed strata have small denominators. (2) Both the direct and indirect standardizing methods are highly vulnerable both to the choice of reference population and to the boundaries chosen when strata are demarcated or consolidated. The standardized rates can be altered dramatically according to differences in the stratum proportions of the reference population, or to distinctions produced when standardizing strata are consolidated. (3) If the stratum-specific rates and stratum proportions have different patterns of variation across the strata of the compared groups, the use of a single summary value--no matter what method of standardization is applied--may obscure cogent patterns of variation and significant differences in the stratum-specific rates. These hazards can be overcome if the studied group and the reference population are carefully compared for inconsistent variations in the stratum-specific rates and proportions before any standardizing procedure is applied. In many instances, the best approach may be to compare the unaltered stratum-specific rates, without standardization.

Adult↗
PubMed1986

Epidemic free-base cocaine abuse. Case study from the Bahamas.

Beginning in 1983, a sharp increase was noted in the number of new admissions for cocaine abuse to the only psychiatric hospital and to the primary outpatient psychiatric clinic in the Bahamas. For the two facilities combined, new admissions for cocaine abuse increased from none in 1982 to 69 in 1983 and to 523 in 1984. Although there was some evidence for a rise in cocaine use during this time, as the drug became cheaper and more available, a primary cause of this medical epidemic seemed to be a switch by pushers from selling cocaine hydrochloride, which has a low addictive potential, to almost exclusive selling of cocaine free base, which has a very high addictive potential and causes medical and psychological problems. Although the use of free cocaine base is rising around the world, this is the first report of a nationwide medical epidemic due almost exclusively to this form of the drug, although similar problems are reported with smoking coca paste in South America.

Adolescent↗
PubMed1985

Associations between unfavorable outcomes in successive pregnancies.

Spontaneous abortions in preceding pregnancies were associated with a significantly increased risk of preterm births (less than 37 weeks) and intrauterine growth retardation in the index pregnancies that followed next, even when the effects of risk factors for the index pregnancy were controlled. The predictive effect of the earlier spontaneous abortion was independent of the effect of the risk factors, even though the latter's effect was over twice as great as indicated by odds ratios. The most serious types of severe intrauterine growth retardation occurred more frequently in high-risk than in low-risk pregnancies. Among mothers whose previous pregnancy resulted in low birth weight, the current pregnancy almost always had one or more risk factors.

Abortion, Spontaneous↗
PubMed1984

Relations of smoking and diving experience to pulmonary function among U.S. Navy divers.

The relations of 4 pulmonary function parameters (measured from the forced expiratory spirogram) with diving experience (in years) and indices of cigarette smoking were examined in a group of 93 healthy U.S. Navy divers. Years of diving was not significantly related to lung function. The value for pack-years of smoking was inversely associated with both percentage of predicted forced expiratory volume in 1 s (FEV1) and percentage of predicted maximal midexpiratory flow rate (MMFR). Divers who have relatively heavy smoking histories may be at greater risk for developing significant decline in pulmonary function, and diving exposure factors other than years of diving may contribute to this risk.

Adult↗
PubMed1984

Health risk factors for the development of decompression sickness among U.S. Navy divers.

The relationship between the health status and physical characteristics of 185 U.S. Navy divers and their risk for experiencing decompression sickness was examined utilizing historical cohort design. Data on multiphasic medical examinations performed on these men between 1972-1978 were obtained. Cases of decompression sickness before and after examination were identified. Divers who did experience decompression sickness either before or after examination had significantly higher measures of skinfold thickness and weight when compared to those who remained free of decompression sickness. Those divers in the highest quartile of each of three significant skinfold thicknesses measured had risks for decompression sickness that were generally 9 to 10 times as great as those calculated for the combined lower 3 quartiles and 5 to 6 times as great as the average crude risk calculated for all Navy divers over the past 5 yr. These findings suggest that obesity may be a contributory factor to the occurrence of decompression sickness.

Body Weight↗
PubMed1984

Weight-height indices and percent body fat among U.S. Navy divers.

Weight, height, and other anthropometric measurements were obtained on a cohort of 194 U.S. Navy divers 20-42 years old. Percent body fat was computed for each man using an established prediction equation derived from a population of U.S. Marine Corps personnel whose age, height, and weight characteristics were comparable to those of the divers. Among the divers, weight, weight-height indices, and percent body fat increased across age strata. The body mass index (W/H2) was the best predictor of adiposity, as it had the highest correlation with percent body fat and the lowest correlation with height. Regression analysis quantified this relationship. The relative obesity of the divers (18.2% body fat) and the implications for using the body mass index as a measure of adiposity in the medical examination of divers are discussed.

Adipose Tissue↗
PubMed1982

Changes in age and sex specific tonsillectomy rates: United States, 1970-1977.

National estimates of tonsillectomy rates were generated from the Hospital Discharge Survey for the years 1970 and 1977. A comparison of the rates over the seven-year period revealed significant declines in T&A for all age and sex categories and in tonsillectomy alone for males aged 20 through 29. It was also observed that sex differences found in 1970 persisted in 1977. (Am J Public Health 1982; 72:488-491.)

Adenoidectomy↗