PubMed Health⌕ Search

Biomedical subjects

K Damus

Publications and source records attributed to K Damus.

At least 19 recordsLinked to original sources
PubMed1995

Human immunodeficiency virus disease in pregnancy.

Since the early 1990s, the number of women diagnosed with the human immunodeficiency virus (HIV) has exploded. Heterosexual women have become one of the fastest-growing populations of newly diagnosed cases. However, the full impact of HIV infection and acquired immunodeficiency syndrome (AIDS) on women's health and the optimal management of symptomatic and asymptomatic cases have yet to be delineated. The urgency to establish effective management protocols is underscored by the fact that AIDS has recently become the leading cause of death for minority women in many urban areas. The administration of antepartum and intrapartum zidovudine (azidothymidine, AZT) has advanced efforts to minimize perinatal transmission and produced promising results. However, important issues pertaining to prevention of HIV infection in women, mandatory testing of women of reproductive age, and the management of HIV-positive women during the interconceptional period remain controversial. Addressing HIV throughout the continuum of reproductive health is a major priority and a concern of all health care providers. Women's health care must assume the lead in counseling all women about their risk of HIV, ensuring that HIV-positive women make informed decisions about their reproductive health and that HIV-negative women modify high-risk behavior to avoid becoming infected. Since obstetricians and gynecologists, nurse practitioners, and midwives are often the first care providers whom at-risk and HIV-infected women contact, they must be able to identify, assess, and optimally manage these patients. This article reviews the epidemiology, virology, pathology, preconceptional counseling/testing, and management of women with HIV infection in pregnancy, thereby providing the practitioner with information and tools to enhance women's health.

Female↗
PubMed1995

Impact of an inner-city, hospital-based preterm prevention program on preterm births in twin gestation.

The objective of this study was to determine the impact of an inner-city, hospital-based preterm-birth prevention program on the outcome of twin pregnancies. A retrospective study of delivery outcomes from 1985 to 1992 of eligible consecutive twin deliveries that were > or = 20 weeks' gestation compared two inner-city hospitals in the Bronx, New York: one with a preterm prevention program for twin births and a comparable site offering conventional prenatal care. A group of patients receiving no prenatal care was also included. Outcomes were evaluated by prenatal-care site, except for those who received no prenatal care and delivered at either site. Data were analyzed by chi-square analysis and analysis of variance. Of the 377 twin pregnancies, 330 pregnancies were eligible deliveries. One hundred thirty-four women received prenatal care from the preterm prevention program, 161 received conventional prenatal care at a comparable site, and 35 received no prenatal care. Maternal age, parity, and mode of delivery were similar in the two delivery sites. There was an increased incidence of complications in the no-prenatal-care group compared with the groups who received the preterm prevention or conventional prenatal care. The percentage of low-birth-weight (< 2500 g) and very-low-birth-weight (< 1000 g) infants was similar in the preterm prevention and the conventional care groups. The percentage of extremely low-birth-weight (< 1000 g) infants was significantly lower in twin births of the preterm prevention site (9.7%) and the conventional site (11.3%) compared with the no-prenatal-care group (28.6%) (P < .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Are there differences in information given to private and public prenatal patients?

OBJECTIVES: In 1989 the United States Public Health Service Expert Panel on the Content of Prenatal Care reported that health education should become a more integral part of prenatal care. Key questions about providing this education have not been examined. Our study compared the type of information provided to women who sought prenatal care in a public clinic and to those who were seen in a private practice and the degree to which the patients were satisfied with the information they received. STUDY DESIGN: One hundred fifty-nine pregnant women (80 seen in a public clinic, 79 seen in a private practice) completed two questionnaires about 38 topics commonly cited as important during pregnancy. At the first prenatal visit, the women reported their level of interest in each of the topics. At 36 to 40 weeks' gestation the women completed a second questionnaire to assess whether information was provided for each topic and whether they had learned as much as desired. RESULTS: Overall, the women in the public sector received more information than did the women who were cared for privately. This was statistically significant at the p < 0.05 level for 25 of the 38 topics. Satisfaction with information learned was highly correlated with information received during prenatal care, but, surprisingly, it was not shown to be associated with the patient's interest level at the first visit. Fewer than 50% of private patients reported having received information about such important topics as acquired immunodeficiency syndrome, sexually transmitted diseases, preterm birth prevention, family planning, and family violence. CONCLUSIONS: The one-on-one approach to health education in pregnancy usually used in the private setting may not facilitate addressing many topics believed to be important components of contemporary prenatal care. Providers of private prenatal care should initiate discussion of prenatal health education topics rather than relying on patient interest in requesting information. Just as public prenatal care programs have devoted significant resources to more comprehensive prenatal education, the providers in the private sector must assure that pregnant women receive the same comprehensive information. In so doing, these providers can help promote an optimal outcome for their patients, their patients' unborn children, and the family unit.

Adolescent↗
PubMed1990

Lifestyle modification as an intervention for inner city women at high risk for preterm birth.

This study details a programme which emphasized nursing interventions for women at high risk for preterm birth. Preterm birth continues to be a major health problem, with ongoing research being conducted both in the United States and internationally in an effort to find causative factors. Programmes designed to prevent preterm birth have been described often in the literature, with lifestyle factors being implicated in the incidence of preterm birth by many researchers. The purpose of this study was to determine the lifestyle factors most often associated with preterm birth in a high risk population of inner city women, and to examine the effect of change in lifestyle when change was possible. Women at high risk for preterm birth were interviewed extensively for prevalence of 12 lifestyle factors most often cited in the literature as being associated with preterm birth. Counselling and education were offered to each woman, with emphasis on symptom recognition and modification of lifestyle activities. Comprehensive prenatal care was administered by programme personnel. A profile of the women's reported lifestyle activities and stress factors is presented along with the relationship to outcome. The data suggested that, when change in lifestyle activity or stress was possible, women who decreased the activity or stressor were more likely to deliver at term. This study represents one of the first efforts in the United States to produce a prospective database to quantify risk and analyse the impact of change in activities associated with symptoms of preterm labour in high risk women.(ABSTRACT TRUNCATED AT 250 WORDS)

Counseling↗
PubMed1990

A "PROPP" for the Bronx: preterm birth prevention education in the inner city.

As one component of the multifaceted community-wide preterm prevention program known as "A PROPP for the Bronx" (Program to Reduce Obstetric Problems and Prematurity), a prenatal education videotape in both English and Spanish was developed. Its impact was evaluated in 615 high-risk patients at the Bronx Municipal Hospital Center. The 12-minute videotape focused on the implications of preterm birth, the signs and symptoms of preterm labor, and behavioral modification to reduce life-style risk factors. An instrument was constructed to examine baseline knowledge, information transfer, and knowledge retention, and was validated and tested for reliability (r = 0.95). The results demonstrated a statistically significant knowledge transfer for patients viewing the videotape (P less than .0001) and significant knowledge retention through the postpartum period (P less than .0001) for Spanish-speaking as well as English-speaking parturients. These data emphasize the importance of the educational component of a preterm prevention program in an impoverished population at risk for early delivery.

Adolescent↗
PubMed1990

Uterine contractility patterns after an episode of preterm labor.

Uterine contractility patterns were studied in an attempt to identify those women on tocolytic therapy at risk for preterm delivery. One hundred sixteen women treated successfully after an episode of preterm labor were followed with an ambulatory tocodynamometer system. Contractions were monitored twice daily for 1 hour until delivery or until 36 completed weeks of gestation. In this group, 52 women (45%) delivered preterm and 64 (55%) delivered at term. The analysis revealed that 1) from 24-29 weeks' gestation, there was no significant difference in the uterine activity between the two groups; and 2) beginning at 30 weeks' gestation and continuing until the end of the 36th week of gestation, uterine activity was significantly greater in women destined to deliver preterm. These observations suggest that the patterns of daily uterine contractility observed in patients after an episode of preterm labor can identify those at greater risk for a preterm delivery.

Adult↗
PubMed1989

Effectiveness of patient education to reduce preterm delivery among ordinary risk patients.

Patient education is an important component of all preterm birth prevention programs, but studies of these programs have not examined the independent contribution of patient education to preterm birth prevention. The Program to Reduce Obstetrical Problems and Prematurity in the Bronx, New York, is a multifaceted preterm birth prevention program that includes a half hour combined videotape and nurse discussion session, which was offered to all patients. In evaluating the outcome of pregnancies in patients not at high risk for preterm delivery (ordinary risk patients) we found that patients who received instruction to recognize early signs of preterm labor had babies with a higher birthweight (3255 +/- 548 gm) than patients who were not so instructed (3200 +/- 599 gm, p = 0.03). Average length of gestation in the instructed and noninstructed patients was 276 +/- 15 days and 275 +/- 18 days (p = 0.12), respectively. The preterm delivery rate among patients receiving the instruction was 9.5% compared with 11.5% among those who did not receive it. We conclude that specific prenatal education about early warning signs of preterm labor is an important component of preterm birth prevention programs that can be demonstrated to have an independent contribution to prenatal care.

Adult↗
PubMed1988

The urban community as the client in preterm birth prevention: evaluation of a program component.

Education of communities about preterm birth is essential because preterm birth is a major perinatal health problem, contributing 60-80% of the perinatal mortality in the United States. Preterm birth impacts on the health of the community through the increased morbidity and mortality of the affected children, which leads to higher health care costs and compromised future productivity. The role of early enrollment into prenatal care in the improvement of perinatal outcomes has been established by many investigators. A health education strategy using a communication in the form of a videotaped program was designed in order to increase community awareness about this serious health problem and about the importance of early prenatal care. The purpose of this investigation was to evaluate that strategy by: determining the validity of the communication; analyzing its impact on related behavioral intentions of Community Board members; and assessing the association between behavioral intentions and reported behaviors in those Community Board members. A panel of experts in the fields of prenatal care/preterm birth or health education/communication was used to evaluate the face validity of the communication, using the Communication Rating Scale, an instrument developed by James Malfetti, Ed. D. The Fishbein Linear Regression Model was utilized in ascertaining attitudes and social normative factors predictive of behavioral intentions. A nonequivalant control group design was used to measure the impact of the communication on the behavioral intentions of 10 Community Boards in the Bronx, New York. The findings included high ratings by the expert panel; a positive significant difference between behavioral intentions of Community Board members before and after viewing the communication; and significant correlation between behavioral intentions and reported behaviors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

The application of uterine and umbilical artery velocimetry to the antenatal supervision of pregnancies complicated by maternal sickle hemoglobinopathies.

To assess the efficacy of Doppler flow velocimetry in predicting fetal compromise and neonatal outcome in pregnant women with sickle cell hemoglobinopathies, a prospective study was conducted of 96 patients, 48 with sickle cell hemoglobinopathy (8 with SS and 40 with AS hemoglobin) and 48 low-risk AA hemoglobin controls. All subjects were followed biweekly from the third trimester of pregnancy through delivery with uterine and umbilical artery velocimetry, nonstress, tests, and hematocrit and blood pressure measurements. An abnormal systolic/diastolic ratio was defined as a value greater than or equal to 3. The incidence of abnormal systolic/diastolic ratios for uterine or umbilical arteries was significantly higher in pregnant women with SS hemoglobin (88%) when compared with patients with AS (7%) and AA (4%) hemoglobin. In addition, the abnormal systolic/diastolic ratios for both umbilical and uterine arteries are correlated with abnormal nonstress test results. The nonstress test results became abnormal on average 3 weeks after the systolic/diastolic ratios did. The presence of abnormal systolic/diastolic ratios for umbilical and uterine arteries is predictive of fetal distress and infants small for gestational age. The high incidence of concordant uterine and umbilical artery abnormal systolic/diastolic ratios in pregnant women with SS hemoglobinopathy, which were identified earlier than were abnormal nonstress results, suggests an important parameter in the monitoring of these high-risk pregnancies.

Adult↗
PubMed1988

Risk factors associated with immobility.

In nursing homes, immobility and related complications are major problems with profound health care and financial implications. We conducted a retrospective study to identify risk factors associated with immobility. We compared factors in 34 nonambulatory residents with those in 12 independent ambulatory residents who served as controls. Factors associated with immobility included contractures, severe dementia, poor vision, and history of hip/leg fractures. Factors not associated with immobility included age, osteoarthritis, mild to moderate dementia, weight gain, and broad categories of selected medications. The immobile patients were further analyzed by subgrouping into those with and without contractures. Contractures were significantly associated with severe dementia. The finding that immobility was not identified on problem lists for 85% (29) of the immobile residents and that for 29% (10) reasons for immobility could not be ascertained suggest that immobility is frequently not documented as a major problem in medical records nor adequately evaluated.

Activities of Daily Living↗
PubMed1987

Diphtheria-tetanus-pertussis immunization and sudden infant death: results of the National Institute of Child Health and Human Development Cooperative Epidemiological Study of Sudden Infant Death Syndrome risk factors.

The possible association between diphtheria-pertussis-tetanus (DTP) immunization and the subsequent occurrence of sudden infant death has been examined using data from the National Institute of Child Health and Human Development (NICHD) Sudden Infant Death Syndrome (SIDS) Cooperative Epidemiological Study, a large multicenter, population-based, case-control study. In a preliminary report based on the first 400 eligible singleton SIDS victims and 800 matched living control infants, no temporal association between SIDS and DTP immunization was found. From the final sample of 800 eligible singleton SIDS victims, 95% (n = 757) were defined as definitely or probably having died of SIDS on the basis of pathology data. Data from these 757 case infants and their corresponding control infants (n = 1,514) are presented in this report. Two control infants, both living, were randomly selected for each case infant: an age-matched control A and an age-, race-, and low birth weight-matched control B. Overall, case infants were less likely to have received any DTP immunization. Only 39.8% of case infants had received at least one DTP immunization compared to 55.0% of control A infants and 53.2% of control B infants. Based on maternal interviews and postnatal medical records, 1.8% of case infants (five infants) immunized with DTP died within the first 24 hours following immunization. Similarly, 5.0% of control A infants (n = 21) and 2.2% of control B infants (n = 9) had been immunized within 24 hours of the maternal interview, which represents the comparable time frame for the age-matched control infants. These results confirm the earlier preliminary findings from the NICHD SIDS Cooperative Epidemiological Study and suggest that DTP immunization is not a significant factor in the occurrence of SIDS.

Black or African American↗
PubMed1986

A link between relative hypoglycemia-hypoinsulinemia during oral glucose tolerance tests and intrauterine growth retardation.

Early identification of the intrauterine growth-retarded fetus is a key factor in improving associated perinatal morbidity and mortality. We investigated, in a prospective study of 43 patients at high risk of intrauterine growth retardation, the predictive value of a derived glucose index and whether hypoglycemia accompanied by hypoinsulinemia in normotensive patients is associated with intrauterine growth retardation. Our findings suggest that the glucose index and 2-hour plasma glucose concentration appear to be useful antepartum predictors of intrauterine growth retardation in normotensive high-risk pregnancies. There is an apparent link between selective maternal hypoglycemia, hypoinsulinemia, and being small for gestational age. A "flat" glucose tolerance test should be regarded as an abnormal pattern in normotensive pregnancies as it was associated with a twentyfold increased risk of intrauterine growth retardation in this study.

Blood Glucose↗
PubMed1982

Protective role of human milk against sudden death from infant botulism.

We examined the possibility that human milk and formula milk might differentially affect the severity of the infant botulism because they differ in immunologic composition and in influence on the normal intestinal microflora against which Clostridium botulinum must compete. A beneficial effect of human milk was suggested by the different feeding experiences of the moderate, hospitalized patients and the sudden death cases. Of patients hospitalized in California, 66% (33/50) were still being nursed at onset of illness, a percentage significantly greater than that of matched controls (P less than 0.01). In contrast, all ten California cases of sudden infant death attributable to C. botulinum infection were being fed iron-supplemented formula milk at death) unlike their controls, P less than 0.02) and had received no human milk within ten weeks of death. A beneficial effect of human milk was also observed in differences in mean age at onset; hospitalized breast-fed patients were almost twice as old (13.8 +/- 6.7 weeks) as were hospitalized formula-fed patients (7.6 +/- 2.9 weeks) (P less than 0.01). Human milk (or possibly other factors associated with breast-feeding) appeared to have moderated the severity at onset of infant botulism, allowing time for hospital admission, whereas for some infants with this illness, formula milk (or possibly other factors associated with formula feeding) was linked to sudden unexpected death.

Botulism↗
PubMed1979

Honey and other environmental risk factors for infant botulism.

Infant botulism results from the in vivo production of toxin by Clostridium botulinum after it has colonized the infant's gut. Epidemiologic and laboratory investigations of this recently recognized disease were undertaken to identify risk factors and routes by which C. botulinum spores might reach susceptible infants. Clostridium botulinum organisms, but no preformed toxin, were identified in six different honey specimens fed to three California patients with infant botulism, as well as from 10% (9/90) of honey specimens studied. By food exposure history, honey was significantly associated with type B infant botulism (P = 0.005). In California, 29.2% (12/41) of hospitalized patients had been fed honey prior to onset of constipation; worldwide, honey exposure occurred in 34.7% (28/75) of hospitalized cases. Of all food items tested, only honey contained C. botulinum organisms. On household vacuum cleaner dust specimens and five soil specimens (three from case homes, two from control homes) contained Clostridium botulinum. The known ubiquitous distribution of C. botulinum implies that exposure to its spores is universal and that host factors contribute importantly to the pathogenesis of infant botulism. However, honey is now an identified and avoidable source of C. botulinum spores, and it therefore should not be fed to infants.

Botulism↗
PubMed1978

Intestinal infection and toxin production by Clostridium botulinum as one cause of sudden infant death syndrome.

The spontaneous production of botulinum toxin in the infant gut by ingested Clostridium botulinum organisms is the underlying cause of infant botulism, recognised as an infectious disease only in late 1976. Because of the recognition of the pathophysiology of this disease and because the known potency and action of botulinum toxin can lead to rapid respiratory arrest, it appeared possible that the in-vivo production of botulinum toxin could cause the sudden death of some infants. To test this hypothesis, serum, selected tissues, and bowel contents from 280 dead infants were examined for the presence of C. botulinum toxin and/or organsisms. We found C. botulinum organisms in 10 infants, all of whom died suddenly and unexpectedly. 9 of these deaths were classified by the forensic pathologist as sudden infant death syndrome (S.I.D.S. or crib death). In 2 of these 10 sudden deaths both C. botulinum organisms and botulinum toxin were identified, and from the spleen of 1, C. botulinum organisms were isolated. Faecal specimens from 160 age-matched healthy infants who served as controls in studies of inpatient infant botulism cases were negative for both C. botulinum organisms and toxin, except for one specimen that contained only C. botulinum type A organisms. The 9 S.I.D.S. cases with evidence of C. botulinum infection comprised 4.3% of the 211 S.I.D.S. cases examined over 12 months. These findings suggest that intestinal production of botulinum toxin by C. botulinum is one cause of S.I.D.S. The strikingly similar age-distribution of 62 inpatient infant botulism cases and the 211 S.I.D.S. cases is also consistent with this concept. The possibility that in-vivo production of botulinum toxin may account for a larger proportion of S.I.D.S. cases is discussed.

Botulinum Toxins↗