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Biomedical subjects

J S Marks

Publications and source records attributed to J S Marks.

At least 91 records · Page 5Linked to original sources
PubMed1983

Neonatal transport in Georgia: implications for maternal transport in high-risk pregnancies.

We analyzed population-based data from the Georgia Neonatal Surveillance Network from 1974 to 1978 to determine the effect of the hospital of delivery on the neonatal mortality rate (NMR) of infants later admitted to neonatal intensive case units (NICUs). The NMR of 3,524 infants transported from primary centers to NICUs was significantly higher [relative risk (RR) = 2.1; 95% CL = 1.9 to 2.3] than that of 10,764 infants born in tertiary centers and admitted directly to an NICU. This effect persisted even after adjustment for birth-weight differences (RR = 1.6; 95% CL = 1.5 to 1.8). The relative risk in favor of delivery in a tertiary center increased with increasing birth weight. However, the proportion of infants of less than 1,000 gm surviving was higher for transported infants and increased with distance transported. This finding suggests that, at these very low birth weights, the hardiest infants were selectively transported. A surprising finding was the very low proportion of low-birth-weight infants delivered in primary centers and transported to NICUs (eg, 32% of infants weighing between 1,001 and 1,200 gm). Our findings support previous reports that delivery in a hospital with an NICU is preferable to later neonatal transport and suggest that efforts to increase the rate of maternal transport in high-risk pregnancies can lead to a substantial reduction in infant deaths.

Adolescent↗
PubMed1983

Normal joint mobility in mitral valve prolapse.

Thirty-seven adults (19 male, 18 female) with mitral valve prolapse (MVP) were examined for evidence of joint hypermobility scored on a 0-9 scale. None of the patients had hypermobility scores exceeding 3, and comparison with 37 healthy age and sex matched controls recruited from hospital staff failed to show an increased prevalence of hypermobility in MVP. There was no evidence that the MVP syndrome is a forme fruste of a heritable disorder of connective tissue.

Adolescent↗
PubMed1982

Genetic services in the United States.

In fiscal years 1979 and 1980, the Genetic Diseases Service Branch of the Health Services Administration funded 34 state genetic service programs in the United States through monies from the National Genetic Diseases Act (PL 94-278) of 1976. During the two-year period, 131,818 at-risk individuals were provided with genetic counseling. Analyses of amniotic fluid were performed on 42,003 specimens, with 436 abnormal fetuses (1%) detected. Utilization ratios of amniocentesis for advanced maternal age ranged from a low of 5% to a high of 49%. Screening programs for inborn errors of metabolism reported testing 3, 158,521 specimens. The numbers of affected children detected nationally were 195 with phenylketonuria (1:16,000), 536 with hypothyroidism (1:5,900), 25 with galactosemia (1:39,685), eight with maple syrup urine disease (1:86,984), and eight with homocystinuria (1:139,008).

Adult↗
PubMed1982

Methodologic issues in the evaluation of vaccine effectiveness: measles vaccine at 12 vs. 15 months.

Initial studies of vaccine effectiveness are usually controlled clinical trials. Subsequent serologic and epidemiologic investigations cannot be as carefully controlled, and methodologic rigor must be considered when evaluating their results. The authors reviewed the methodologic features of greatest importance in the design of field investigations of vaccine efficacy and examined how different methodologic approaches may have influenced the results of studies of measles vaccine efficacy at 12 vs. 15 months of age. Among the serologic studies, time since vaccination was not controlled, so that children vaccinated several years ago at 12 months of age may have been compared with children vaccinated much more recently at later ages. Most studies included children vaccinated at several years of age as controls rather than children vaccinated only at the pivotal ages of 13-15 months. Finally, studies using a single clinic as their vaccine source found smaller differences in efficacy than studies using multiple vaccine sources, suggesting that variation in handling and storage may affect the results. Among the epidemiologic studies, no single methodologic feature clearly influenced whether there was significantly improved vaccine efficacy with increasing age at vaccination. However, studies differed with respect to intensity of effort to detect cases unreported through the usual channels; definition of what constituted a case of measles; whether the effect of midoutbreak clinics on overall estimates of vaccine efficacy was considered; and inclusion of revaccinated children in the analysis. These methodologic variations can make it extremely difficult to evaluate the size and clinical importance of relatively small differences in vaccine efficacy. Greater attention to the methodologic features discussed here will be needed in future studies of vaccine efficacy.

Epidemiologic Methods↗
PubMed1982

An outbreak of Norwalk gastroenteritis associated with swimming in a pool and secondary person-to-person transmission.

In June 1977 an outbreak of acute gastroenteritis affected 103 students and teachers at an elementary school in Ohio. The illness typically lasted 24 hours or less and was characterized by vomiting (86%) and cramping (70%), but more than half of the persons involved also reported having nausea, diarrhea, and headache. Similar illness frequently followed in household members (29%) of families with primary cases. Investigation revealed that 70% of the children and teachers who swam in a pool at an all day outing June 1 (4 classrooms) and 55% of those who swam during a similar outing June 2 (2 classrooms) had the onset of acute illness from 12--48 hours later. None of the children who attended the outings but did not swim had a similar illness. The evidence suggested that the primary outbreak was caused by contaminated water in the pool and that person-to-person spread of illness followed. Results of a microbiologic study of pool water were negative for bacterial and viral pathogens. Throat washings, stool specimens, and paired blood samples studied for evidence of pathogens were negative initially, but subsequent serologic studies suggested that infection by Norwalk virus was the cause of the outbreak. The pool chlorinator which was inadvertently unconnected at the time of the school visits was reconnected and an underground leak in the water supply pipes was corrected. No more cases were reported after the pool was drained, cleaned, and reopened.

Disease Outbreaks↗
PubMed1982

Chloroquine retinopathy: is there a safe daily dose?

Published case reports of chloroquine retinopathy rarely include details of daily dosage, but 30 reports where this information was available included 78 patients who developed impaired visual acuity an 13 had received daily doses of 250 mg or less. Eleven cases of ocular toxicity attributed to chloroquine were reported to the Committee on Safety of Medicines but only 2 developed impaired vision on 250 mg daily. A postal questionnaire among 41 rheumatology and 33 ophthalmology centres showed 2 patients who developed impaired vision as a result of treatment with chloroquine in a daily dose not exceeding 250 mg. Serious visual impairment related to chloroquine rarely occurs if the daily dose does not exceed 250 mg.

Adolescent↗
PubMed1981

Saturday night fever: a common-source outbreak of rubella among adults in Hawaii.

During the summer of 1977, an epidemic of rubella occurred among adults in Hawaii. The highest attack rate was in women 20-24 years old (226/100,000), with almost total sparing of young schoolchildren. A case-control investigation implicated a specific discotheque as a common place of exposure for persons with onset of disease during the epidemic peak (chi 2 = 12.9,p less than 0.001). A piano player/singer at the discotheque was the apparent source of the virus transmission. The large number of cases linked to this musician suggests that airborne transmission occurred while he was singing rather than by direct person-to-person contact. Rubella vaccine was given to 6523 women in public clinics held during the epidemic. Despite screening for pregnancy and birth control usage, 23 women (3.5/1000) became pregnant within three months after receiving the vaccine. Eleven of 12 women who reportedly contracted natural rubella while pregnant elected to terminate their pregnancies; the 12th had a normal appearing infant. The susceptibility rate for all adults tested for rubella hemagglutination inhibition antibody was 36.9%, a rate similar to the found in earlier surveys in Hawaii. The occurrence of this epidemic confirms the changing epidemiology of rubella with respect to age distribution and supports the view that vaccination of young children may not be sufficient to protect adult women from exposure to rubella, especially in areas where a high proportion of adults remain susceptible.

Adolescent↗
PubMed1981

Rh hemolytic disease of the newborn: using incidence observations to evaluate the use of RH immune globulin.

During the 1970s, the crude incidence of Rh hemolytic disease of the newborn (RhHDN) in the United States dropped 65 per cent---from 40.5/10,000 total births in 1970 to 14.3/10,000 total births in 1979. Since the risk of RhHDN is directly associated with birth order, changes both in birth order-specific RhHDN incidence rates and in the birth order distribution would be expected to influence crude RhHDN incidence. Review of birth order-specific incidences ascertained in Connecticut, 1972-1977, shows that incidence was stable for first and second births, whereas it dropped significantly for third and fourth births. Due to the nearly complete use of Rh immune globulin (RhIG) in Connecticut during these years, the drop in these specific rates is best attributed to this prevention strategy. Nationwide, during the 1970s, the annual percentages of fourth and higher order births decreased from 18 per cent to 10 per cent. We estimate that some 30 per cent to 40 per cent of the 1970-1979 drop in the crude rate is attributed to changes in the birth order distribution, whereas 60 per cent to 70 per cent of the drop is attributed to RhIG. However, comparison of pooled incidences for 1972-1974 and 1975-1977 observed in Connecticut for first births and births to 15-19 year olds showed significant increases for both groups in 1975-1977. Further study of specific trends from other areas is needed to confirm these observations. Also needed is investigation of likely causes of sensitization among these teenaged, primiparous women.

Birth Order↗
PubMed1981

Rheumatoid cervical myelopathy.

The mode of presentation and the factors which influenced the diagnosis and outcome in 31 patients with rheumatoid cervical myelopathy were reviewed. The presenting features included paraesthesiae and /or numbness (23 cases) weakness (six) flexor spasms (five) and incontinence (two). Isolated sensory loss presenting in a glove and stocking distribution was often misdiagnosed as a peripheral neuropathy. Multiple neurological deficits were eventually present in all patients and included spastic quadriparesis (17), spastic paraparesis (seven), bladder disturbance (nine), and cranial nerve deficits (six). Twenty-seven patients had impaired light touch and pin prick sensation but the sensory level did not correlate with the presumed level of spinal cord compressions. Twenty-one patients had dissociation between loss of position and vibration sensation. All patients had one or more cervical luxations; five patients had atlanto-axial luxation alone, five had subaxial luxation alone and the remainder multiple luxations. Neurological improvement was more frequent and of longer duration in those treated by occipito-cervical fusion than in those treated conservatively but fitness for surgery may have selected a group with a better prognosis.

Aged↗
PubMed1980

Guillain-Barré syndrome in recipients of A/New Jersey influenza vaccine.

In late 1976, when 32% of the eligible population of Ohio received the A/New Jersey influenza (swine flu) vaccine, systematic contact of neurologists was used to evaluate the possible association of Guillain-Barré syndrome (GBS) with receipt of the vaccine. The overall rate of GBS was significantly higher among vaccine recipients (13.3/10(6)) than in nonrecipients (2.6/10(6)). Peak time of onset was two to three weeks after receiving the vaccine, and cases among vaccinees were less likely to have a history of antecedent infection than were cases in unvaccinated persons. Even when the effect of one highly associated vaccine lot was removed, an elevated risk of GBS remained in vaccinees regardless of manufacturer or vaccine type (bivalent or monovalent). Systematic surveillance is needed for rare serious reactions from all vaccines.

Humans↗
PubMed1980

Measles in rural Ohio county.

Between December 23, 1975, and March 31, 1976, 169 cases of measles were reported from Defiance County, Ohio, a small rural county in the northwest corner of the State. The outbreak spread from a single junior high school basketball player to eventually involve 19 of the 28 county schools. Among the affected schools, measles attack rates varied from 0.3-7.2% with a mean of 2.0%. A likely source of illness was determined for 160 of the 169 cases (95%). Intraschool transmission was most common, accounting for 97 of the 169 cases (57%) followed by sibling contact for 23 cases (14%). The pattern of measles spread was complex and would have been difficult to predict in advance even if surveillance systems reported each case the day it occurred. A control program held between February 2 and February 20, 1976, vaccinated 5145 of the 11,114 (46.3%) county schoolchildren. Forty-four cases of measles occurred 4 or more days following school clinics, 22 (50%) in children who requested measles vaccine at school clinics, 17 of whom were actually vaccinated. Most of the other cases occurred in students whose parents thought their children to be protected. Measles is a disease which spreads rapidly in a complex pattern over wide geographic areas. A control program vaccinating a large proportion of the children without definitive history of adequate vaccination or disease was apprently effective in curtailing the outbreak.

Adolescent↗
PubMed1980

Reye syndrome in Ohio, 1973-1977.

Some major epidemiologic features of Reye syndrome have been elucidated since the first description of this clinical entity. Multiple studies have shown an association with epidemic influenza B and endemic varicella. Little population data are available on age, sex, race, geographic distribution, and secular trends. A five-year retrospective population-based study of 190 Ohio residents diagnosed with Reye syndrome from January 1, 1973-December 31, 1977, is reported here. The temporal relationships between the occurrence of Reye syndrome and influenza B and varicella were confirmed; however, a high number of blacks and city dwellers with Reye syndrome were found in this study.

Adolescent↗
PubMed1980

Effectiveness of a mailed reminder on the immunization levels of infants at high risk of failure to complete immunizations.

The Ohio Department of Health initiated a program of mailing an immunization reminder to the mothers of six-month-old children predicted to be at high risk of failure to receive vaccinations based on birth certificate information. The evaluation results indicated a 50% gain in immunizations amongst children whose parents received the letter when compared with those not receiving the letter.

Evaluation Studies as Topic↗
PubMed1979

Is chloroquine obsolete in treatment of rheumatic disease?

Retinal changes associated with chloroquine occurred in 22 out of 222 patients on long-term therapy for rheumatic diseases and were related to patient age, total dose, and duration of treatment. Ophthalmic review showed progression of the retinopathy with deterioration of visual acuity in only 1 case while the remainder retained normal vision. The results suggest that the risks of ocular toxicity related to chloroquine therapy are acceptably low.

Adult↗
PubMed1979

Primary osteoathrosis of the hip and Heberden's nodes.

One hundred patients with primary osteoarthrosis of the hip were examined for evidence of generalised arthrosis associated with Heberden's nodes, and in addition their hips were graded by the radiographic pattern of loss of joint space. Twenty-nine patients had bilateral concentric loss of joint space, and 18 in this group had Heberden's nodes. None of the 17 patients with bilateral upper pole changes had Heberden's nodes, and only 7 of the 31 patients with unilateral upper pole changes had Heberden's nodes. None of the 6 patients with medial loss of joint space had Heberden's nodes. This study has shown an association between Heberden's nodes had primary osteoarthrosis of the hip where this is characterised by concentric loss of joint space. The association is most marked where hip changes are bilateral, suggesting that hip involvement in generalised osteoarthrosis is part of a generalised disorder with possible genetic or biochemical abnormalities.

Aged↗
PubMed1979

Clinical and radiographic features of spondylitic hip disease.

The clinical and radiographic features of hip disease in 76 patients with definite ankylosing spondylitis have been studied. Symptomatic hip involvement occurred late in the course of the disease, with a mean delay after the onset of 12 years in males and 7 years in females. Patients with disease onset before the age of 20 developed hip symptoms at an earlier stage. Associated diseases included uveitis (13%), colitis (4%). Bilateral concentric loss of hip joint space with a relatively undeformed femoral head was the commonest radiological change (61%). Localised loss of joint space at the upper pole (16%) was associated with femoral head destruction and a greater degree of osteophytosis, suggesting coincidental or secondary osteoarthrosis. Bony ankylosis of the hips (10%) was present only in women, and the absence of osteophytes, cysts, and bone lesions of the iliac crests and ischial rami suggests that it is a distinct radiographic manifestation of female ankylosing spondylitis.

Adolescent↗