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Biomedical subjects

J Tobin

Publications and source records attributed to J Tobin.

At least 37 records · Page 2Linked to original sources
PubMed1996

Association of hand and knee osteoarthritis: evidence for a polyarticular disease subset.

OBJECTIVE: To examine the association between hand and knee osteoarthritis (OA) in a community based population. METHODS: Radiographs of 695 participants aged > or = 40 years in the Baltimore Longitudinal Study of Aging were read for changes of OA, using Kellgren-Lawrence grade > or = 2 as the case definition. RESULTS: Logistic regression analyses, adjusting for age, gender and body mass index, revealed a significant association between OA in the knee and the following joint groups: distal and proximal interphalangeal (DIP, PIP) and Hand2 (OA in two or more hand joint groups) for grade 2-4 and grade 3-4 disease, and the first carpometacarpal (CMC1) joint for grade 3-4 disease. CONCLUSION: There is an association between OA in hand sites and the knee. The strength of the associations increases with increasing disease severity. For the PIP site, there is a trend toward increasing strength of association for increasing numbers of affected joints and bilateral disease.

Adult↗
PubMed1995

An STS content map of human chromosome 11: localization of 910 YAC clones and 109 islands.

Physical mapping of human chromosomes at a resolution of 100 kb to 1 Mb will provide important reagents for gene identification and framework templates for ultimately determining the complete DNA sequence. Sequence-tagged site (STS) content mapping, coupled with large fragment cloning in yeast artificial chromosomes, provides an efficient mechanism for producing first-generation, low-resolution maps of human chromosomes. Previously, we produced a set of standardized STSs for human chromosome 11 regionally localized by fluorescence in situ hybridization or somatic cell hybrid analysis. In this paper, we used these as well as other STS content, and identify 109 islands spanning an estimated 218 Mb on the 126-Mb chromosome. Since about 62% of the islands contain markers ordered on chromosome 11 by genetic or radiation hybrid analysis, this data set represents a first-order approximation of a physical map of human chromosome 11. This set of clones, contigs, and associated STSs will provide the material for the production of a continuous overlapping set of YACs as well for high-resolution physical mapping based upon sampled and complete DNA sequencing.

Base Sequence↗
PubMed1994

Follow-up study of young attenders at an alcohol unit.

A follow-up study of all under 21 year olds satisfying DSM-III-R criteria for alcohol dependence treated as in-patients at an alcohol treatment unit over a 10-year period was conducted. A total of 52 individuals were identified and of these 80% (44) were traced. The mean period of follow-up was just over 4 years. A poor outcome (no abstinence or controlled drinking for the past 6 months) was adjudged in 61.4% (27) of the cases. This was associated with indicators of early personality difficulties and unsatisfactory schooling experiences. There was considerable concurrent illicit drug use associated with continuing problem drinking. Both good and poor outcome groups initially had striking forensic histories and significant differences developed over the follow-up period with the poor outcome group continuing to have marked legal problems. In addition the poor outcome group continued to make heavy demands on the medical services over the period. One person died from an alcohol related cause. Greater attention to the specific needs of this group is required and specialized treatment units for young problem drinkers is suggested.

Adolescent↗
PubMed1994

Hypothermia in children with severe neurological disabilities.

Four severely disabled children who developed hypothermia during acute illness are described. A central defect in thermoregulation in the hypothalamus is likely, based on clinical observation and limited investigations, as well as similarities to sporadic cases reported in the literature. Disturbance of temperature regulation appears to be a rare complication of major brain injury in children, without necessarily occurring in association with pituitary dysfunction. It is of clinical importance because subnormal temperature may indicate severe sepsis.

Body Temperature Regulation↗
PubMed1993

Altered sensory function and balance in older persons.

The effects of three different visual inputs (eyes open, eyes closed, and inaccurate) while standing on an unstable surface (respectively, UEO, UEC, UI) were compared in a group of healthy elderly community dwellers (N = 239; mean age 76) and young (N = 34; mean age 34) adults. Subjects with medical factors known to affect balance were excluded. Body sway and loss of balance measured dynamic force platform (EquiTest, NeuroCom International). Visual and somatosensory inputs were rendered inaccurate through tilting of the standing surface and/or the visual surround proportional to the subject's angle of sway (sway-referencing). The elderly group had significantly more difficulty balancing during UEC and UI, and a larger proportion lost their balance during UI. These findings are compared to those of other dynamic posturography studies in which sensory inputs were controlled. Issues of age, frailty, screening, and test protocol are addressed in order to account for differences in results among studies.

Aged↗
PubMed1992

Improving health status in extremely low birthweight children between two and five years.

The 5-year outcome of 101 extremely low birthweight (ELBW, < 1000 g) children discharged from the Neonatal Intensive Care Unit was reported. Over this period, there were four post-discharge deaths. The neurodevelopmental impairment rate was 18% overall: cerebral palsy 7%, blindness 3%, deafness 3% and developmental delay 10%. Seventy-one percent of children were readmitted to hospital. The mean number of admissions was 2.4 per child and the mean duration of total hospital stay was 11.3 days per child in the 5-year period. A trend was observed in a reduction in the readmission rate and hospital days in the 2-5-year period compared to the period between discharge and 2 years, though the differences were not statistically significant. The most common reason for readmission was for surgical procedures, primarily aural ventilation tube insertion and tonsillectomy and adenoidectomy. Significant health problems included recurrent wheezing episodes, stridor and croup in the period up to 2 years and otitis media and tonsillitis between 2 and 5 years. There was some catch-up growth, especially in height, between 2 and 5 years. Children with < 800 g birthweight had similar rates of neurodevelopmental impairment and hospital readmission to those of 800-999 g birthweight. However, they experienced more otitis media and pneumonia, had more ear, nose and throat operations, and at 5 years of age, more were below the 3rd centile for weight. This study showed that the health status of ELBW children had improved between 2 and 5 years, but they continued to experience recurrent health problems and hospital readmissions which would have resulted in added financial and emotional burdens to their families.

Child Development↗
PubMed1992

Feeding the ultraendurance athlete: practical tips and a case study.

With the rising popularity of ultradistance sports events lasting from 6 to 24 hours or multiple days, athletes are consulting registered dietitians for specialized dietary advice. Many dietitians, however, lack experience with these types of events. This article provides basic guidelines ffor fueling the ultradistance athlete. The goals are to maintain normal hydration and blood glucose levels, which can be done by enforcing programmed drinking (approximately 250 to 500 mL/15 minutes, depending on the athlete's sweat rate and environmental temperature) and programmed eating (1 to 1.5 + g of carbohydrate per kilogram of body weight per hour, depending on the athlete's acceptance of and tolerance to solid and/or liquid foods during exercise). Athletes who compete longer than 6 to 8 hours should consume adequate electrolytes, particularly sodium (approximately 1 g/hour) through either sports drinks or foods. These guidelines are applied to a case study of the 1991 women's winner of the Race Across America, a 2,930-mile biking event.

Bicycling↗
PubMed1990

Continuing diet trends in men: the Baltimore Longitudinal Study of Aging (1961-1987).

Due to increasing evidence for the role of nutrition as a cause of illness and of the efforts of health agencies to induce Americans to change their diets, it is important to monitor populations for changes in their nutrient intakes. Seven-day diet records were collected from 105 free-living men in the 1960s, 1970s, and 1980s. Age range was initially 27 to 65 and finally 50 to 88 years. The men were divided into age groups so that longitudinal, time series, and cross-sectional analyses could distinguish among differences due to aging, cohort, and secular change. Longitudinal decreases over three decades of time include height, intakes of kcal/day, kcal/kg, kcal from fat, and cholesterol (all p less than .0001). Longitudinal increases over time include body weight, intakes of kcal from alcohol (p = .002), kcal from carbohydrate, and polyunsaturated to saturated fatty acid ratio (P/S) (all p less than .0001). Values that correlated cross-sectionally with age in the 1960s were height, kcal/day, kcal/kg, kcal from protein, and P/S ratio; height, intakes of kcal from protein, and fiber in the 1970s; and body weight, height, intakes of kcal from carbohydrate and fiber in the 1980s (all p less than .05). Protein consumption remained constant while carbohydrate increased as time passed. The more striking secular changes were in type and amount of fat consumed (42% to 34% of kcal, a 37% decline in cholesterol and a 72% increase in P/S ratio). Voluntary changes in the diets of these community-dwelling men indicate that, at any age, men can make beneficial changes in intake of nutrients that affect health.

Adult↗
PubMed1989

Bone mass in Guamanian patients with amyotrophic lateral sclerosis and parkinsonism-dementia.

Bone mass, as assessed by measurements of total subperiosteal diameter and medullary width of the second metacarpal bone on hand-wrist radiographs, was evaluated for 31 Guamanian patients (15 males, 16 females) with amyotrophic lateral sclerosis (ALS), 67 patients (39 males, 28 females) with parkinsonism-dementia (PD), and 66 (34 males, 32 females) nonaffected Guamanian controls. Comparisons between the two disease groups and between each disease group and the nonaffected controls were made taking into account the sex, age, and disability status of each participant. At all ages, ALS patients of both sexes had significantly lower percent cortical areas (PCA) than did nonaffected controls. The ALS males also had significantly lower PCA than PD males, although no significant differences were observed between female ALS and PD patients. The PD patients of either sex had a lower PCA when compared to controls, but the differences were not statistically significant. The observed differences in PCA were due solely to increased medullary width, suggesting that the diminished cortical bone thickness resulted from greater bone resorption rather than differential bone growth. Longitudinal studies support the cross-sectional findings of accelerated bone loss among ALS patients. It is not possible to determine from the present data whether the observed differences in PCA of the second metacarpal of the ALS patients are due to atrophy of the first interosseous muscle, to a generalized resorption process inherently associated with the development and progression of ALS, or to factors not accounted for by the present analysis.

Adult↗
PubMed1989

Validation of a retrospective questionnaire assessing diet 10-15 years ago.

In 1985, 216 men, participants in the Baltimore Longitudinal Study of Aging, were asked to report on their usual diet during the period 1971-1975. The reference data for past diet consisted of multiple seven-day records collected between 1971 and 1975. The group was randomly assigned to complete the diet history either by personal interview or by mailed self-administered questionnaire. The items and response categories were identical in both cases. For both groups, the mean nutrient intake estimated by questionnaire was within +/- 10 per cent of the past diet record values for most nutrients. When the questionnaire was administered by an interviewer, correlations with past diet were approximately as good as those obtainable with present diet in other studies and indicate that useful studies of past diet can be performed with this questionnaire. Correlations for the mail group were considerably lower and suggest that assessment of past diet using this questionnaire format without personal instruction or callbacks may yield poor results. The effect of age was negligible, but response errors and change in diet since the target period had important effects on correlations with past diet in both interview and mail groups.

Aged↗
PubMed1988

The clinical use of nuclear exercise tests.

In the mid-1970s, after decades of clinical use, the utility of electrocardiographic exercise testing for the evaluation of patients with suspected ischemic heart disease was critically examined and questioned. Concurrent with this critique, two sophisticated, more expensive and powerful "nuclear" exercise tests were introduced sequentially for clinical use: myocardial perfusion imaging with thallium-201 and radionuclide ventriculography with technetium 99m. The published indications for the two tests are similar, and both have been shown to offer advantages over ECG stress testing in selected populations. However, few data are available regarding the comparative utility of thallium versus ventriculographic imaging. As part of a prospective study to assess the efficacy of cardiovascular nuclear medicine studies, we undertook the present analysis to assess the clinical evolution of these tests and to elucidate factors responsible for clinicians' choice for the often competing examinations. The study examined 213 consecutive patient referrals for thallium scintigraphy and 183 referrals for ventriculography, ranging from patients with no symptoms or highly non-specific chest pain syndromes (21% of referrals) to patients with proven coronary disease (28% of the referrals). Twenty-one percent of patients were referred to confirm the clinical impression that the patient did not have coronary disease, 40% to confirm its presence, and 37% to determine its severity. Analyses were undertaken to determine the factors that dictated a preference for thallium scintigraphy rather than ventriculography; only the physician's intent in testing and level of training were significant predictors for a particular nuclear test.

Coronary Disease↗
PubMed1987

Nuclear scans: a clinical decision making tool that reduces the need for cardiac catheterization.

We have assessed the impact of cardiovascular nuclear medicine studies (CVNMS) on physicians' decisions to send patients with suspected ischemic heart disease (N = 439) on to cardiac catheterization at three Bronx hospitals. A change in management plans with respect to catheterization was observed in 31% of cases. Catheterization rates were reduced by 25% among patients referred for resting studies and by 49% for exercise studies (thallium perfusion or exercise wall motion studies). Results of CVNMS had little impact on catheterization decisions for resting study patients (N = 192). Among exercise study patients (N = 247), those with normal results had a relative reduction in catheterization post-CVNMS of 82% vs 27% for patients with abnormal results (p less than 0.001). However, impact of exercise CVNMS test results on post-CVNMS catheterization rates obtained for men only; women with abnormal exercise study results were much less likely to undergo subsequent catheterization (7.7%) than men with abnormal results (41.9%), p less than 0.005, independent of age. The apparent discrepancy in referral for catheterization based on sex needs to be investigated further.

Adolescent↗
PubMed1985

Longitudinal studies on the rate of decline in renal function with age.

Serial creatinine clearances (5 to 14 studies) were obtained for 446 normal volunteers in the Baltimore Longitudinal Study of Aging followed between 1958 and 1981. When those subjects with possible renal or urinary tract disease and subjects on diuretics and antihypertensives were removed from the study, leaving a group of 254 "normal" subjects, the mean decrease in creatinine clearance was 0.75 ml/min/year. The slopes of the creatinine clearance vs. time fell into a normal (Gaussian) distribution around this mean. One third of all subjects followed had no absolute decrease in renal function (positive slope of creatinine clearance vs. time) and there was a small group of patients who showed a statistically significant increase (P less than 0.05) in creatinine clearance with age.

Adult↗
PubMed1982

Chronic constipation in children: can it be managed by diet alone?

Chronic constipation is a common childhood problem. In a study of 60 children aged 2 to 12 years, a special diet that involved daily intake of raw bran and high-fiber foods and exclusion of milk and other constipating foods was found to be successful. Within six weeks, the problem resolved in all 60 patients. Milk and other restricted foods were returned slowly to the diet if they were found not to be a contributing factor to constipation. We believe our clinical observations support the prescription of a special diet for childhood constipation. For patients in whom specified organic causes have been excluded, we recommend a trial of this diet before other, more complex therapeutic efforts are undertaken. Implementation of the diet necessitates careful explanation to the child and family, as well as long-term follow-up.

Child↗
PubMed1981

A collaborative study of cytomegalovirus antibodies in mothers and young children in 19 countries.

Regional variations in the incidence of cytomegalovirus (CMV) injections in mothers and young children were investigated by testing cord blood and serum samples from infants and children up to four years old for the presence of CMV antibodies in 19 different regions of the world. The samples were tested by both the local virus laboratory and the reference laboratory, using the same batch of complement-fixing CMV antigen and techniques which were validated by comparison of the titres recorded for samples of coded sera sent to each laboratory. The incidence of CMV antibodies varied from 44-100% in mothers and from 3-95% in young children. The number of children with CMV antibodies increased with age in five areas; suggesting that there was some child to child transmission of CMV infection between children in these regions. In the other regions, the absence of any significant age-related increase indicated that the main pathway of CMV infection in early life was by transmission from mothers to their infants. The significance of these findings is discussed.

Adult↗
PubMed1977

Familial hemochromatosis: characteristics of the precirrhotic stage in a large kindred.

Ffty asymptomatic members of a kindred with familial hemochromatosis were studied in an effort to clarify some of the physiologic abnormalities present in the pre-cirrhotic or latent stage of the disease. Using excess hepatic iron as a marker for inheritance of hemochromatosis, results of liver biopsies on 31 family members suggest an auto-somal dominant mode of inheritance with incomplete expressivity. In addition to a relationship between alcohol intake and excess liver iron, there was a strong association between the level of alcohol intake and the presence of hepatic fibrosis in those subjects with excess iron stores. Both serum iron and transferrin saturation were significantly higher in family members with iron overload than in those who were not affected. Only transferrin saturation was significantly correlated with the severity of hepatic iron deposition. Studies of glucose tolerance (OGTT, IVITT, glucose clamp studies) demonstrated a defect in carbohydrate metabolism associated with deficient insulin secretion and insulin resistance, both of which were related to the degree of hepatic iron depostion. In this kindred we have found no evidence for a contribution of inheritance to the carbohydrate intolerance of hemochromatosis. Iron overload was not related to activity of hepatic collagen proline hydroxylase or urinary excretion of peptide-bound hydroxyproline. Serum ferritin, previously thought to be a reliable marker of reticuloendothelial iron stores, was normal in 19 of 20 family members with iron overload.

Adolescent↗
PubMed1976

Age differences in vitamin B6 status of 617 men.

The effect of age on vitamin B6 metabolism was studied in 617 community-dwelling subjects, ages 18 to 90. These are, for the most part, clinically healthy, educated men whose intake of nutrients is not limited by economic factors. Plasma pyridoxal phosphate (PLP) was used as the primary criterion of vitamin B6 status. About one-third of the subjects were taking supplementary vitamins on their own initiative. The amount of pyridoxine-HCl varied from 0.1 to 105 mg/day. The average plasma PLP of the men not taking a supplement (N = 414) was 12.3 +/-0.3 ng/ml, with 25% of the values below 7.5 ng/ml and 7% below 5 ng/ml. There was a statistically significant decrease in plasma PLP with age of 0.9 ng/ml per decade. For those taking a supplement, the average plasma PLP was 20.5 +/- 1.0 ng/ml, with only 8% of the values below 7.5 ng/ml and none below 5 ng/ml. Glutamic-oxaloacetic transaminase activity in plasma (PGOT) and erythrocytes (EGOT) was determined on all subjects. The ratio of EGOT with in vitro stimulation by PLP to EGOT actual (alpha-EGOT) was also studied. These studies provide the most extensive normative data on vitamin B6 status available on men in the adult years of life.

Adolescent↗