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Biomedical subjects

J R Hebel

Publications and source records attributed to J R Hebel.

At least 19 recordsLinked to original sources
PubMed1992

Psychoactive substance dependence among trauma center patients.

INTRODUCTION: The practice of assessing only trauma patients with elevated blood alcohol concentrations (BACs) or positive drug screens for psychoactive substance use disorders (PSUDs) was evaluated. METHODS: Twenty-four BAC-negative (BAC-) (BAC, 0) and 21 BAC-positive (BAC+) (BAC, greater than or equal to 22 mmol/L or 100 mg/dL; mean, 41 mmol/L; range, 24.3 to 79 mmol/L) adult trauma patients were evaluated for alcoholism and other PSUDs using the Structured Clinical Interview (SCI) from the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R). Approximately half were vehicular crash victims and 78% were men. RESULTS: A total of 64 PSUDs were diagnosed in 31 (68.9%) of the 45 patients; all but one was for dependence (vs abuse). Of the BAC+ patients, 14 (66.7%) met DSM-III-R criteria for alcohol dependence, 11 (78.6%) of whom also had other PSUDs not related to alcohol. Two other BAC+ patients had nonalcohol PSUDs. Of the BAC- patients, 11 (45.8%) had alcohol dependence, six (54.5%) of whom also had nonalcohol PSUDs. Another four BAC- patients had nonalcohol PSUDs. Overall, 76.2% of the BAC+ patients and 62.5% of the BAC- patients had a diagnosis of psychoactive substance dependence. CONCLUSION: All patients admitted to trauma centers should be assessed for alcoholism and other PSUDs.

Alcoholism↗
PubMed1991

Prevalence and characteristics of nursing home-acquired infections in the aged.

OBJECTIVES: This study provides estimates of the prevalence of infections in all patients from a representative sample of 53 Maryland nursing homes; identifies risk factors for these infections; and describes diagnostic procedures carried out. METHODS: The records of 4,259 patients in a stratified random sample of 53 Maryland nursing homes were reviewed for diagnostic procedures, medical, functional, and behavioral status. Infections were identified by signs, symptoms, and laboratory findings. RESULTS: Study patients were characteristic of aged patients in US nursing homes. The prevalence of infections actually acquired in the nursing home (80% of all infections) was 4.4%. Multivariate analysis revealed that skin infections (35% of nursing home-acquired infections) were associated with skin ulcers and inversely with urine incontinence. Fevers of uncertain source (13%) were associated with bladder catheters. Symptomatic urinary infections (12%) and lower respiratory infections (12%) were associated with bedfast status, and the latter with tracheostomy and lung disease. Skin ulcers, urethral catheters, and bedfast status were markers for nursing home-acquired infection. The prevalence of infection in patients with all three markers was 32%; in patients with none, 2%. Fewer than a quarter of the four most common nursing home-acquired infections received an evaluation which met minimal diagnostic criteria established by a panel of infectious disease specialists and geriatricians. Patients with dementia, those in large homes (greater than 150 beds), and those in urban homes were less likely to be evaluated in a manner meeting these criteria. CONCLUSIONS: Use of three characteristics (ie skin ulcers, urethral catheters, bedfast status) to identify patients at risk for nursing home-acquired infections may allow targeted infection surveillance and prevention programs. In addition, nursing home-acquired infections are not evaluated uniformly across patients and facilities, suggesting the need to establish, through further study, guidelines for such evaluations.

Aged↗
PubMed1990

Black-white differences in stroke incidence in a national sample. The contribution of hypertension and diabetes mellitus.

Although national data have consistently shown an increased risk of death from stroke among blacks, few studies have addressed the reasons for this excess mortality. We compared the incidence of stroke among 1298 blacks and 7814 whites, aged 35 to 74 years, in the 10-year follow-up of the respondents from the First National Health and Nutrition Survey. Blacks had a higher estimated incidence of stroke than whites even after adjustment for age, hypertension, and diabetes mellitus; the relative risk was 1.4 (95% confidence interval, 1.0 to 2.0) for black women and 1.1 (95% confidence interval, 0.8 to 1.6) for black men. The relative risks for stroke associated with hypertension and diabetes mellitus were unrelated to race. Although efforts to treat hypertension and diabetes are among the most important public health measures for reducing stroke, a more complete understanding of the determinants of stroke may be required to account for the excess stroke risk experienced by blacks.

Adult↗
PubMed1990

Reliability of proxy response on mental health indices for aged, community-dwelling women.

The correspondence between respondent and proxy response was evaluated on 4 mental health measures (Affect Balance Scale, Center for Epidemiological Studies Depression Scale, Mental Status Questionnaire, and Mini-Mental State Examination) with a sample of 538 respondent-proxy pairs. Results indicated that respondent and proxy responses were strongly associated, particularly for the cognitive measures. This association was found even for respondents classified as depressed or cognitively impaired. Although there was evidence of proxy bias, with proxies underrating affective status and overrating cognitive status, the magnitude of the bias proved small for all scales but the Mental Status Questionnaire. Examination of response comparability by proxy characteristics showed that choice of proxy affected agreement and bias. Implications of these findings for survey research are discussed.

Aged↗
PubMed1990

Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study.

This study evaluates predictors of recovery in walking ability, PADLs, and IADLs one year following hospital discharge for hip fracture. The sample consisted of 536 hip fracture patients aged 65 and older admitted from the community to one of seven Baltimore area hospitals between 1984 and 1986 and surviving one year post-hospital discharge. A large proportion of hip fracture patients do not regain pre-fracture PADL and IADL levels; most recovery in walking ability and ability to perform PADL and IADLs occurs by 6 months. Those who are older, have longer hospital stays, and are rehospitalized, exhibit poorer recovery, as do those displaying chronic or acute cognitive deficits and depressive symptomatology while hospitalized. Also, contact with one's social network following hospital discharge is associated with greater recovery. Findings point to the importance of psychosocial factors for recovery and suggest areas where hospital-based interventions and discharge planning efforts should focus.

Activities of Daily Living↗
PubMed1990

Prenatal exposure to tobacco: I. Effects on physical growth at age three.

The height and weight of 714 children whose mothers smoked at the beginning of their pregnancies were assessed at three years of age. The children of women who quit smoking during pregnancy were taller and heavier than those of women who continued to smoke throughout pregnancy. Adjustment for maternal postpartum smoking status reduced the difference in weight, but had little effect on height. The differences in both height and weight at three years of age were greatly reduced when adjusted for size at birth and length of gestation. These results suggest that deficits associated with maternal smoking are not overcome by three years of age and that at least some of the observed anthropometric deficits may be extensions of deficits in fetal growth.

Body Height↗
PubMed1990

Prenatal exposure to tobacco: II. Effects on cognitive functioning at age three.

Three-year-old children, born to women who smoked ten or more cigarettes at the beginning of pregnancy and identified at the time of registration for prenatal care, were assessed by the McCarthy Scales of Children's Abilities and the Minnesota Child Development Inventory. Children whose mothers quit smoking during pregnancy relative to children whose mothers persisted in smoking performed at a statistically significant higher level on the General Cognitive Index of the McCarthy and on each of the three subscales from which the General Cognitive Index is derived. The scores on the Minnesota Child Development Inventory were similar in showing a higher performance in the children of quitters. Statistical adjustment for environmental factors, characteristics of the child, and fetal maturity did not account for the observed differences between children of women who quit smoking and those of women who continued to smoke.

Child Development↗
PubMed1990

Health care costs for employed hypertensives.

Health care insurance claims were used to track costs associated with hypertension for an employed population. Employees were classified as hypertensive (n = 373), high normal (n = 363), or normotensive (n = 2,411) on the basis of hypertension screening done at the worksite. Claims activity was monitored for the three groups during a three-year period, including periods before, during, and after the screening done at the worksite. The average amount claimed per employee was significantly higher for the hypertensives as compared with the normotensives or high normals, even after adjustment for age, race, sex, salary, marital status, and duration of insurance coverage. There was no significant difference in the average amount claimed per employee between high normals and normotensives. The health care costs for hypertensives are estimated to be about 80% more than those for normotensives. Hospital, physicians, and nursing care accounts for about 50 percentage points of this increment while the remaining 30 percentage points derive from drug costs.

Adult↗
PubMed1990

The use of urethral, condom, and suprapubic catheters in aged nursing home patients.

In this study of 4,259 aged patients in 53 randomly selected nursing homes in Maryland, we found that 10% of women and 15% of men used a urine collection device. Among bedfast patients, 47% of women and 58% of men and, among patients with decubitus ulcers, 37% of women and 33% of men were using a urine collection device. The indwelling urethral catheter was the most commonly used device. Indeed, for women, few other options were available: 93% of women used this device. In women, multiple logistic regression analysis indicated that presence of a decubitus ulcer and occupation of a long-term care bed were the attributes most strongly associated with the use of the urethral catheter. Of men with urine collection devices, 43% were using the urethral catheter; poor mobility status was the characteristic most strongly associated with its use. Long-term urethral catheterization has been well studied and is associated with universal bacteriuria and with a number of complications. Options need to be further explored, particularly external urine collection devices for women. Furthermore, because urethral catheterization may be used as a management technique for decubitus ulcers, prevention of the latter may diminish the use of urethral catheters and their subsequent complications.

Activities of Daily Living↗
PubMed1989

Carcinoma of the esophagus: a comparison of the results of transhiatal versus transthoracic resection.

The cases of 78 patients with primary esophageal carcinoma treated from 1977 to mid-1987 were retrospectively analyzed. Fifty-two of the patients underwent transthoracic esophagogastrectomy (TTE) and 26, transhiatal esophagectomy (THE). The two groups were statistically similar in preoperative characteristics except that more of the THE group had received chemotherapy; this group had relatively more tumors of the upper esophagus; and 20 (77%) of the THE group, compared with 50 (96%) of the TTE group, had tumors in stages III and IV. The incidence of major postoperative complications did not differ significantly between the two groups. There were five (19%) anastomotic leaks in the THE group, but only one led to a prolongation of hospital stay by more than 14 days, whereas all three (6%) of the leaks in the TTE group caused hospital stay to be prolonged several weeks. Overall morbidity was high: 75% (39/52) for the TTE patients and 85% (22/26) for the THE patients (p greater than 0.10). Hospital mortality was 6% (3/52) in the TTE group and 8% (2/26) in the THE patients (p greater than 0.10). There was no significant difference in actuarial survival either between the two groups as a whole or between those patients in each group who had stage III or IV tumors. We conclude that THE, among the types of patients for whom we used the procedure, provides long-term survival comparable with that provided by TTE without causing a significant increase in hospital mortality or morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1989

The reliability of self-reports of smoking and alcohol consumption by pregnant women.

The reliability of self-reports of prepregnancy smoking and drinking habits was assessed in over 700 pregnant smokers who participated in a randomized clinical trial of smoking cessation intervention. The participants provided self-reports of their prepregnancy smoking and drinking habits prior to the 18th week (test) and again in the eighth month of gestation (retest). About half the subjects gave identical reports of prepregnancy smoking habits at test and retest. Among those who changed their estimates, the changes were usually small. The reliability of reports of prepregnancy alcohol intake was also high. The reliability of reports by the treatment group - which experienced an anti-smoking intervention and extensive contact with study personnel - was very similar to that of the control group.

Adult↗
PubMed1989

Acute pulmonary response in healthy, nonsmoking adults to inhalation of formaldehyde and carbon.

Formaldehyde (HCHO) is a common chemical found in occupational and residential environments and has been suggested as a cause of asthmalike symptoms in some individuals. Clinical and animal studies suggest that HCHO adsorbed on respirable particles may elicit a greater pulmonary physiologic and inflammatory effect than gaseous HCHO alone. The purpose of this study was to determine if respirable carbon particles have a synergistic effect on the acute symptomatic and pulmonary physiologic response to HCHO inhalation. We randomly exposed 24 normal, nonsmoking, methacholine-nonreactive subjects to 2 h each of clean air, 3 ppm formaldehyde, 0.5 mg/m3 respirable activated carbon aerosol, and the combination of 3 ppm formaldehyde plus activated carbon aerosol. The subjects engaged in intermittent heavy bicycle exercise (VE = 57 l/min) for 15 min each half hour. Measures of response included symptom questionnaires, spirometry, body plethysmography, and postexposure serial peak flows. Formaldehyde exposure was associated with significant increases in reported eye irritation, nasal irritation, throat irritation, headache, chest discomfort, and odor. We observed synergistic increases in cough, but not in other irritant respiratory tract symptoms, with inhalation of formaldehyde and carbon. Small (less than 5%) synergistic decreases in FVC and FEV3 were also seen. We observed no HCHO effect on FEV1; however, we did observe small (less than 10%) significant decreases in FEF25-75% and SGaw which may be indicative of increased airway tone. Overall, our results demonstrated synergism, but the effect is small and its clinical significance is uncertain.

Administration, Inhalation↗
PubMed1989

Effect of nitrogen dioxide exposure on susceptibility to influenza A virus infection in healthy adults.

The effect of NO2 exposure and human susceptibility to respiratory virus infection was investigated in a placebo-controlled, randomized, double-blind trial conducted in an environmentally controlled research chamber over 3 yr. Healthy, nonsmoking, young adult volunteers who were seronegative to influenza A/Korea/82 (H3N2) virus were randomly assigned to breathe either filtered clean air (control group) or NO2 for 2 h/day for 3 consecutive days. The NO2 concentrations were 2 ppm (Year 1), 3 ppm (Year 2), and 1 or 2 ppm (Year 3). Live, attenuated cold-adapted (ca) influenza A/Korea/82 reassortant virus was administered intranasally to all subjects immediately after the second exposure. Only one of the 152 volunteers had any symptoms; this person had a low grade fever. Pulmonary function measurements and nonspecific airway reactivity to methacholine were unchanged after NO2 exposure, virus infection, or both. Infection was determined by virus recovery, a fourfold or greater increase in serum or nasal wash influenza-specific antibody titers, or both. The infection rates of the groups were 12/21 (2 ppm NO2) versus 15/23 (clean air) in Year 1, 17/22 (3 ppm NO2) versus 15/21 (clean air) in Year 2, and 20/22 (2 ppm) and 20/22 (1 ppm) versus 15/21 (clean air) in Year 3. Each group exposed to 1 or 2 ppm NO2 in the last year became infected more often (91%) than did the control group (71%), but the differences were not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Survival experience of aged hip fracture patients.

Hip fracture has long been considered a major threat to survival in aged populations. This report describes the survival experience of 814 aged, community dwelling hip fracture patients treated in seven Baltimore hospitals between 1984 and 1986: 4.3 per cent died during hospitalization; 8.2, 12.6, and 17.4 per cent died within three, six, and 12 months after fracture, respectively. The mortality rate for the entire population approaches expected mortality approximately six months post-fracture, but varies by age and sex. The most important factors predicting mortality are presence of serious concomitant illness and marked delirium (in the absence of dementia) at the time of hospital admission. The authors suggest that medical factors that may contribute to patient disorientation be investigated and treated, when possible, in an effort to improve the survival status of hip fracture patients.

Age Factors↗
PubMed1989

The prevalence of urethral catheterization in Maryland nursing homes.

Urinary incontinence is common in the increasing numbers of aged people and is often the precipitating factor for nursing home admission. Recalcitrant incontinence may be managed by urethral catheters. In this study of a random stratified sample of Maryland nursing homes (4259 patients), we found that the daily prevalence of urethral catheter use in Maryland nursing homes was 7.5%. More than 80% of urethral catheter users were women. Among men, we found equal prevalences of urethral and condom catheter use. Previous studies have demonstrated long-term use of urethral catheters to be associated with almost universal bacteriuria of a polymicrobial and dynamic nature. Combining these data suggests that long-term catheter-associated bacteriuria is the most common infection in American health care facilities.

Aged↗
PubMed1988

The probability that long-term mean diastolic blood pressure is extreme: tables for black individuals.

With use of a large data base and a statistical model for diagnosis developed earlier, we have constructed the among-individual conditional distribution of the long-term mean diastolic blood pressure, md, of an individual, given the means of several measurements of systolic and diastolic blood pressure on the individual. Using this conditional distribution we provide tables and a simple algorithm for computation of the conditional probability that md for an individual exceeds a specified value (for example, 90 mmHg), given the measured values of systolic and diastolic pressure.

Adult↗
PubMed1988

Dose-response of birth weight to various measures of maternal smoking during pregnancy.

Thus far little is known about the dose-response relationship between birth weight and the amount of maternal smoking during pregnancy. The purpose of this report is to describe the effects of smoking intensity, duration, and timing on birth weight with the use of three measures of exposure: self-reported daily consumption, self-reported cumulative consumption, and salivary thiocyanate. Data were obtained on 867 single live-born infants and their mothers who participated in a randomized anti-smoking intervention trial. Smoking was measured for the women at about 15 weeks gestation and again during the eighth month. Although all indicators of dose, as derived from early or late pregnancy smoking measures, were significantly associated with birth weight, whether or not the mother had quit smoking by the time of the 8th month follow-up was almost as predictive as any dose variable. For women who quit smoking before 30 weeks gestation, neither the duration nor the amount of smoking earlier in pregnancy was an important determinant of birth weight.

Adolescent↗