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Biomedical subjects

J L Kiely

Publications and source records attributed to J L Kiely.

At least 19 recordsLinked to original sources
PubMed2004

Intranasal corticosteroid therapy for obstructive sleep apnoea in patients with co-existing rhinitis.

BACKGROUND: Increased nasal airflow resistance (NAR) may contribute to the pathophysiology of obstructive sleep apnoea syndrome (OSAS) but studies investigating the effects of relieving nasal obstruction in OSAS have produced differing results. There are no reports of intranasal corticosteroid therapy in adult OSAS patients with reversible nasal obstruction. METHODS: We evaluated an intranasal corticosteroid, fluticasone propionate, in 24 consecutive snorers with associated rhinitis using a randomised, placebo controlled, crossover design. Patients underwent polysomnography, snoring noise, and NAR measurements at baseline and after each 4 week treatment period. RESULTS: Twenty three patients completed the protocol and were divided into an apnoeic group (group A; 13 patients) and a non-apnoeic snoring group (group S; 10 patients) based on an apnoea-hypopnoea frequency (AHI) of > or =10/h or <10/h. AHI was significantly lower following treatment with fluticasone than with placebo in the total population (median (quartile range) 11.9 (22.6) v 20 (26.3); p<0.05) and in group A (23.3 (21.3) v 30.3 (31.9); p<0.05). Median (95% confidence interval) within subject differences for AHI were -3.2 (-17.7 to -0.2) in the total population and -6.5 (-29.5 to 1.8) in group A. NAR was also lower on fluticasone (2.74 (1.21) v 3.27 (1.38), p<0.01), within subject difference being -0.45 (95% CI -0.87 to -0.21). The changes in AHI and NAR in group A were significantly correlated (r=0.56; p<0.05). Snoring noise and sleep quality were unchanged but daily diary records indicated subjective improvements in nasal congestion and daytime alertness with fluticasone (p<0.02). CONCLUSIONS: Intranasal fluticasone is of benefit to some patients with OSAS and rhinitis. The data suggest that this form of nasal obstruction may contribute to the pathophysiology of OSAS.

Administration, Intranasal↗
PubMed2001

Controlled oxygen therapy and carbon dioxide retention during exacerbations of chronic obstructive pulmonary disease.

Hypoxaemic patients with exacerbations of chronic obstructive pulmonary disease (COPD) are at some risk of carbon dioxide (CO2) retention during oxygen therapy. We quantified the risk of CO2 retention with oxygen therapy in COPD in 24 consecutive patients presenting to the accident and emergency department with acute exacerbations associated with hypercapnic respiratory failure (partial arterial pressure of oxygen [PaO2] < 8 kPa and partial pressure of CO2 [PaCO2] > or = 6.5 kPa). Only three patients developed clinically important CO2 retention (defined as a rise in PaCO2 > 1 kPa) with controlled oxygen therapy (24-40% by Venturi mask to maintain the oxygen saturation at 91-92%). These patients presented with more severe hypercapnia, but all three required only low-flow oxygen (24-28%). These findings suggest only a small risk of aggravating hypercapnia with controlled oxygen supplementation.

Aged↗
PubMed2001

A comparison of recent trends in infant mortality among twins and singletons.

Overall infant mortality rates have steadily declined in recent years. The goal of this study was to examine whether recent declines in infant mortality were similar for twins and singletons, and to assess the impact of differing birthweight distributions on these relationships. Linked birth and infant death records for 1985-86 and 1995-96 were used to calculate infant mortality rates for twins and singletons for the two time periods. Bootstrap simulations were used to estimate rates of decrease between the two time periods and to determine whether these rates differed between twins and singletons. Between 1985-86 and 1995-96, infant mortality among twins declined significantly faster than among singletons (36% vs. 29%, P < 0.05). This difference was true for both black and white infants (black: 28% for twins vs. 22% for singletons; white: 38% for twins vs. 31% for singletons). Within birthweight categories, infant mortality declined more rapidly among twins than among singletons, although differences were not always significant. Factors and circumstances that contributed to the infant mortality decline in the United States have benefited twins to a greater extent than singletons.

Humans↗
PubMed2001

Epidemiological trends in multiple births in the United States, 1971-1998.

The astounding rise in multiple births in the United States continues. We analyzed live birth files from the U.S. National Center for Health Statistics. Twin, triplet, quadruplet, and quintuplet+ rates were calculated for the period 1971-1977 and for each year between 1990 and 1998. Triplet rates were also computed within categories of mother's education and age. The twin rate increased from 1.8% in 1971-77 to 2.8% in 1998. The rate of triplets increased 5.9-fold, quadruplets 11.9-fold, and quintuplets+ 5.3-fold between 1971-77 and 1998. Increases in triplet rates were much more marked among births to university-educated women and women 30 years and older. Among women 45 years and older, the triplet rate was approximately fifty times higher in 1998 than in 1971-77. This group of older women (> or = 45 years) had the highest multiple birth rate in 1998.

Adult↗
PubMed2001

Maternal race/ethnicity and twinning rates in the United States, 1989-1991.

OBJECTIVE: To utilize United States birth certificate data (years 1989-1991) to examine the effects of race/ethnicity on twinning rates. STUDY DESIGN: We used a database of birth certificate data for the United States (years 1989-1991) available on CD-ROM from the United States National Center for Health Statistics. This linked birth/infant death data set included a total of 12,036,234 birth records, of which 279,073 were twins. Excluded from the analysis were 15,086 twin birth records (5.4%) based upon previously described exclusion criteria. Statistical analysis included a series of univariate analyses to determine the rates of twinning between different racial/ethnic groups correlated with maternal age, education, marital status and place of birth. Comparisons were analyzed using the chi 2 test, with significance at P < .05. RESULTS: The overall twinning rate was 2.26%, with the lowest rate observed in the group denoted non-Hispanic other (1.67%) and highest among non-Hispanic blacks (2.69%). Twinning rates within various groups representing Hispanics ranged from 1.76% to 2.08%. The twinning rate was significantly higher among U.S.-born as compared to non-U.S.-born women (2.34% vs. 1.88%, P < .005) except for Puerto Ricans, Cubans and Central/South Americans, for whom the reverse was true. Women aged 35-39 had the highest twinning rate (3.05%), whereas women aged 15-19 had the lowest; that trend persisted in all racial/ethnic groups. The study showed a nonsignificant relationship between marital status or education and twinning rate. CONCLUSION: Race/ethnicity studies can be useful in designing programs that may maximize health outcomes of twins in a racially diverse population.

Adult↗
PubMed2000

Risk of preterm birth in multiparous teenagers.

BACKGROUND: Previous studies of teenage primiparas have found little or no association between young maternal age and preterm birth. However, the risk of preterm birth in teenage multiparas should not be overlooked because of the high rate of repeat teenage pregnancies. OBJECTIVE: To compare the risk of preterm birth in teenage and adult multiparas. DESIGN: Cross-sectional analysis of US Natality Files, 1990 to 1996. METHODS: We calculated the risk of very preterm birth (<33 weeks' gestation) for multiparas aged 10 to 20 years compared with 25-year-olds, stratified by age and race/ethnicity. Adjusted odds ratios (AORs) were estimated controlling for maternal education, marital status, prenatal care, and previous preterm births. Effects of smoking and interpregnancy interval were analyzed separately. RESULTS: Throughout adolescence, multiparas face higher AORs for very preterm births. For white non-Hispanic multiparas compared with 25-year-old multiparas, 10- to 14-year-olds had an AOR of 4.22 (95% confidence interval [CI], 2.26-7.88), 15- to 17-year-olds had an AOR of 2.19 (95% CI, 1.99-2.42), 18- and 19-year-olds had an AOR of 1.69 (95% CI, 1.58-1.80), and 20-year-olds had an AOR of 1.33 (95% CI, 1.24-1.41). A similar pattern of decreasing AOR with increasing maternal age was observed for black non-Hispanic and Hispanic mothers, although wide race/ethnicity disparities exist. Adjusting for maternal smoking and short interpregnancy interval did not change these results. CONCLUSIONS: Risk of very preterm birth in teenage multiparas is associated with young age after controlling for other risk factors. Interventions to prevent repeat pregnancies and the associated risk of premature birth deserve high priority.

Adolescent↗
PubMed2000

Multiple births and outcome.

The rate of multiple-gestation pregnancies has grown exponentially over the last few decades and is responsible for the steady increase in the birth rate of low-birth weight infants. As a group, infants of multiple-gestation pregnancies have higher mortality and morbidity than singleton pregnancies. The increase in adverse outcomes is related directly to the increased risk for preterm delivery and low-birth weight, and not to the multiple gestation itself. Outcomes for multiple-gestation infants appear to be similar whether conceived spontaneously or through artificial reproductive technology. Efforts to reduce the birth rate of low-birth weight infants should target multiple-gestation pregnancies.

Birth Rate↗
PubMed2000

Cardiovascular risk factors in patients with obstructive sleep apnoea syndrome.

Cardiovascular disorders are common in patients with obstructive sleep apnoea syndrome (OSAS) but there is debate as to whether OSAS is an independent risk factor for their development, since OSAS may be associated with other disorders and risk factors that predispose to cardiovascular disease. In an effort to quantify the risk of OSAS patients for cardiovascular disease arising from these other factors, the authors assessed the future risk for cardiovascular disease among a group of 114 consecutive patients with established OSAS prior to nasal continuous positive airway pressure therapy, using an established method of risk prediction employed in the Framingham studies. Patients were 100 males, aged (mean+/-SD) 52+/-9.0 yrs, and 14 females, aged 51+/-10.4 yrs, with an apnoea/hypopnoea index of 45+/-22 x h(-1). Based on either a prior diagnosis, or a mean of three resting blood pressure recordings >140 mmHg systolic and/or 90 diastolic, 68% of patients were hypertensive. Only 18% were current smokers, while 16% had either diabetes mellitus or impaired glucose tolerance, and 63% had elevated fasting cholesterol and/or triglyceride levels. The estimated 10-yr risk of a coronary heart disease (CHD) event in males was (mean+/-SEM) 13.9+/-0.9%, 95% confidence interval (95% CI) 12.1-16.0, and for a stroke was 12.3+/-1.4%; 95% CI 9.4-15.1, with a combined 10 yr risk for stroke and CHD events of 32.9+/-2.7%; 95% CI 27.8-38.5 in males aged >53 yrs. These findings indicate that obstructive sleep apnoea syndrome patients are at high risk of future cardiovascular disease from factors other than obstructive sleep apnoea syndrome, and may help explain the difficulties in identifying a potential independent risk from obstructive sleep apnoea syndrome.

Blood Pressure↗
PubMed2000

Maternal sociodemographic characteristics as risk factors for preterm birth in twins versus singletons.

Many studies have examined associations between sociodemographic variables and preterm birth in singletons. However, almost no research has been published on whether variables such as maternal age, race, ethnicity, level of education and smoking are associated with preterm birth among twins in the same way. The purpose of this study was to examine such associations in twins and singletons comparatively. The study population consisted of all 567796 twins and 23297909 singleton births recorded in the US birth records for 1990-95. Gestational age data were rigorously 'cleaned' to solve the problem of biologically implausible birthweight/gestation combinations in vital records. Preterm birth was defined as gestational age < 35 weeks. Some 25.8% of twins and 3.2% of singletons were preterm by this definition. Crude and adjusted relative risks (RR) were estimated using a modified Mantel-Haenszel procedure. We found several characteristics associated with preterm birth in both twins and singletons, e.g. for twins: race (black adjusted RR = 1.30 compared with white non-Hispanic); marital status (unmarried adjusted RR = 1.15 compared with married); and age (< or = 17 years adjusted RR = 1.39 compared with 20-29 years). A similar analysis of singletons revealed stronger associations between the same characteristics and preterm birth, e.g. the adjusted RR for black race was 2.3. These differences in RRs suggest that sociodemographic characteristics have weaker effects on preterm birth among twins than among singletons. Care must be taken in interpreting differences in preterm birth in twins and singletons, as their gestational age distributions differ so markedly.

Adolescent↗
PubMed1999

Subjective efficacy of nasal CPAP therapy in obstructive sleep apnoea syndrome: a prospective controlled study.

The response to nasal continuous positive airways pressure (nCPAP) of a wide variety of symptoms recognized to be associated with obstructive sleep apnoea syndrome (OSAS) was examined. Fifty-six consecutive patients with OSAS, confirmed by polysomnography (mean (SD) apnoea-hypopnoea index (AHI) 49.6 (22.6) events x h(-1), Epworth score 15.4 (5.0)), were asked to complete paired symptom evaluation questionnaires, before treatment and again after 4 months of nCPAP. The response rate was 80%. A control group of 21 consecutive OSAS patients of similar age, body mass index (BMI), AHI and Epworth score to the treated group but managed with conservative measures, completed the same questionnaires on two occasions, 4 months apart. The nCPAP-treated group showed significant reductions (Wilcoxon matched pairs test) in the symptoms of daytime sleepiness, restless sleep, heartburn, nocturia, enuresis, headache and nocturnal sweating, whereas controls showed no significant changes in these symptoms. There were no changes in BMI, smoking, alcohol consumption or exercise habits in either group. It was concluded that, in addition to improvements in symptoms of daytime sleepiness and restless sleep, a wide range of other symptoms may improve significantly with nasal continuous positive airways pressure therapy.

Case-Control Studies↗
PubMed1998

Efficacy of nasal continuous positive airway pressure therapy in chronic heart failure: importance of underlying cardiac rhythm.

BACKGROUND: Some previous reports have indicated beneficial cardiac effects of nasal continuous positive airway pressure (NCPAP) in patients with severe congestive heart failure (CHF), but others have reported deleterious cardiac effects, particularly among patients in atrial fibrillation (AF). The aim of this study was to determine if differences in cardiac rhythm influence the acute cardiac response to NCPAP. METHODS: Eleven consecutive patients with CHF were recruited, six in atrial fibrillation (AF) and five with sinus rhythm (SR). Cardiac index was measured during awake NCPAP application by the thermodilution technique during cardiac catheterisation. NCPAP was applied in a randomised sequence at pressures of 0, 5, and 10 cm H2O with three 30 minute applications separated by 20 minute recovery periods without NCPAP. RESULTS: Significant differences were found between the AF and SR groups for cardiac index responses to NCPAP (p = 0.004, ANOVA) with a fall in cardiac index in the AF group (p = 0.02) and a trend towards an increase in the SR group (p = 0.10). Similar differences were seen between the groups in stroke volume index responses but not in heart rate responses. Changes in systemic vascular resistance were also significantly different between the two groups (p < 0.005, ANOVA), rising in the AF group but falling in the SR group. CONCLUSIONS: These data indicate an important effect of underlying cardiac rhythm on the awake haemodynamic effects of NCPAP in patients with CHF.

Aged↗
PubMed1998

Chest radiographic staging in allergic bronchopulmonary aspergillosis: relationship with immunological findings.

The question of whether a chest radiographic severity staging system could be correlated with standard blood/serum diagnostic indices in allergic bronchopulmonary aspergillosis (ABPA) was addressed in 41 patients. Asthma and positive Aspergillus fumigatus (AF) serology were considered essential diagnostic inclusion criteria. Eosinophil count, serum immunoglobulin (Ig)E and immediate skin hypersensitivity were also tested to grade patients as "definite" or "likely" ABPA. Definite cases had all five of these factors present, whereas likely cases had three or more. Chest radiographs were examined by experienced radiologists blinded to the clinical data. The six-stage radiographic score (0-5) was based on the severity and duration of changes seen: stage 0: normal; stage 1: transient hyperinflation; stage 2: transient minor changes; stage 3: transient major changes; stage 4: permanent minor changes; and stage 5: permanent major changes. Significant positive correlations (p<0.05) were observed between peak AF titres (expressed as an index), peak eosinophil count and radiographic severity stage. When considered as subgroups, these correlations approached, but did not reach, significance for the group with "likely" ABPA (n=28), but in the group with definite ABPA (n=13), there was a high correlation between radiographic score and peak AF index (r=0.59), as well as peak eosinophil count (r=0.62). This study suggests that the peak Aspergillus fumigatus index and eosinophil counts correlate best with the severity of radiographic stages in allergic bronchopulmonary aspergillosis. This chest radiographic staging system may be useful in the clinical assessment and management of patients with allergic bronchopulmonary aspergillosis, particularly in those patients with more severe radiographic stages.

Antibodies, Fungal↗
PubMed1998

Resolution of obstructive sleep apnoea with growth in the Robin sequence.

A 12 year old female with the Robin sequence presented with a one year history of snoring, witnessed apnoeas and daytime sleepiness. Surgery in early childhood had consisted of cleft palate repair, tonsillectomy and adenoidectomy and, later, revision palatoplasty. Overnight polysomnography (PSG) demonstrated severe obstructive sleep apnoea syndrome with an apnoea/hypopnoea index (AHI) of 49 events x h(-1), and repetitive oxygen desaturations below 50%. Nasal continuous positive airway pressure (nCPAP) effectively controlled her sleep abnormalities. After 3 yrs of nCPAP therapy, she requested discontinuation and was fully reassessed. PSG without nCPAP revealed an AHI <5 events x h(-1) with no desaturations below 90% and normal sleep quality. A repeat lateral cephalometrogram showed increased mandibular length and posterior airway space and reduced soft palate length. The patient remains asymptomatic 9 months following nCPAP discontinuation. This case indicates that nasal continuous positive airway pressure is an effective nonsurgical therapy in children with obstructive sleep apnoea syndrome and the Robin sequence. It is likely that mandibular growth, increase in mandibular length and enlargement of the posterior airway space was responsible for the resolution of obstructive sleep apnoea syndrome in this case.

Cephalometry↗
PubMed1997

Birth weight and age-specific analysis of the 1990 US infant mortality drop. Was it surfactant?

OBJECTIVE: To examine birth-weight-specific and age-specific mortality among US infants to determine if the large infant mortality decrease in 1990 was due to surfactant use. DESIGN: Population-based analysis of data from the 1983-1991 National Linked Birth and Infant Death files. Mortality trends from 1983 to 1989 were used to calculate expected infant mortality rates for 1990 to 1991. SETTING: United States. PARTICIPANTS AND STUDY POPULATION: All singleton infants with known birth weight born in the United States from 1983 to 1991. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Mortality at less than 1 day of life, 1 to 6 days, 7 to 27 days, or 28 to 364 days. Observed mortality rates were divided by the expected rates in 250-g birth-weight categories to create mortality ratios. RESULTS: The observed infant mortality rate in 1990 was 8.05, significantly lower than the expected rate of 8.36. Infants weighing 750 to 1749 g had mortality ratios of approximately 0.8 for 1- to 6-day mortality, with ratios significantly less than 1.0 for mortality in all age groups except less than 1 day. Observed mortality among infants weighing less than 750 g or from 1750 to 2499 g was not significantly lower than expected at any age. Postneonatal mortality among infants weighing 2500 g or more was significantly lower than expected. Infants weighing less than 1500 g accounted for almost 700 fewer infant deaths than predicted in 1990. Infants weighing 2500 g or more accounted for approximately 550 fewer deaths than expected. CONCLUSIONS: The hypothesis that surfactant was partially responsible for the overall infant mortality drop in 1990 is supported by the lower than expected mortality among infants weighing 750 to 1749 g. However, the unexpected improvement in postneonatal mortality among infants weighing 2500 g or more was responsible for a substantial portion of the overall decline and suggests that other factors also acted to decrease US infant mortality in 1990.

Age Distribution↗
PubMed1997

The association between nulliparity and gestational hypertension.

The association between nulliparity and gestational hypertension was examined by analysis of the 1988 National Maternal and Infant Health Survey. Gestational hypertension was defined as the occurrence of two consecutive diastolic blood pressure readings > or = 90 mm Hg after 20 completed weeks gestation in the absence of proteinuria in subjects normotensive prior to pregnancy. Preeclampsia was defined as gestational hypertension in the presence of significant proteinuria. Using logistic regression, 110 subjects with gestational hypertension and 34 subjects with preeclampsia were compared with 4371 subjects free of all hypertensive disorders. Nulliparity was weakly associated with an increase in the risk of gestational hypertension among whites (odds ratio, 95% confidence interval: 1.58 [0.92-2.74]) and not associated with risk among blacks (1.09 [0.51-2.35]). Preeclampsia was strongly associated with increased risk among whites (2.86 [0.94-8.73]) and blacks (2.94 [0.94-9.18]). The small increase in risk of gestational hypertension associated with nulliparity in contrast with the large increase in risk of preeclampsia suggests that these disorders may have a different etiology.

Adolescent↗
PubMed1997

Racial differences in perceived barriers to prenatal care.

OBJECTIVES: It is well known that black women are less likely to receive adequate prenatal care than white women. This study examines whether there are differences in barriers to prenatal care reported by black and white mothers. METHOD: Data from the 1988 National Maternal and Infant Health Survey were used to measure relationship between race and reported financial, service, and personal barriers to prenatal care use, adjusting for maternal age, parity, education, poverty level, and insurance coverage during pregnancy. All analyses were stratified by marital status because of substantial effect modification. RESULTS: Among married women, 12.1% of black women reported at least one barrier to prenatal care compared to 9.8% of white women. However, after adjustment for demographic and socioeconomic factors, black women were less likely to report a barrier odds ratio [OR] of 0.8; 0.6-1.0). Unmarried black women were less likely to report any barriers to care than white unmarried women (17.9% vs. 25.6%). After adjustment, the OR was 0.4 (0.3-0.5). CONCLUSIONS: This study suggests that though black women are less likely to receive prenatal care than white women, they are less likely to report barriers to such care. This may be due to differing expectations from the health system. The investigation of perceived barriers to care is important to the consequent understanding of what steps must be taken to assure that pregnant women do not experience obstacles to the receipt of prenatal care.

Adolescent↗