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Biomedical subjects

K J Goodman

Publications and source records attributed to K J Goodman.

At least 19 recordsLinked to original sources
PubMed2001

Effect of meal size and test duration on gastric emptying and gastric myoelectrical activity as determined with simultaneous [13C]octanoate breath test and electrogastrography in normal subjects using a muffin meal.

Our purpose was to determine the effect of meal size on gastric emptying (GE) as measured by octanoate breath test (OBT), to determine the effect of the duration of breath collections on assessment of GE by OBT, and to determine the effect of meal size on gastric myoelectrical activity as measured by electrogastrography (EGG). Fourteen normal subjects underwent two modified [13C]OBTs using muffin meals of 250 or 350 kcal mixed with 100 mg [13C]sodium octanoate. T(1/2) for GE was determined for both the entire postprandial 6-hr breath collection and a truncated initial 4-hr data set. EGG was recorded for 30 min prior to the muffin meal and 4 hr postprandially. Using the 6-hr breath collection data, the T(1/2) was 177 +/- 7 (mean +/- SEM) for the 350-kcal meal compared to 153 +/- 7 min (P < 0.01) for the 250-kcal meal. Using the 4-hr data, the T(1/2) for the 350-kcal meal was 244 +/- 32 min compared to 165 +/- 12 min (P < 0.05) for the 250-kcal meal. The ratio of postprandial to fasting EGG power of the dominant frequency for the 350-kcal meal (1.9 +/- 0.4) was higher than that for the 250-kcal meal (1.3 +/- 0.6). T(1/2) for the 350-kcal meal using 4- and 6-hr data was significantly correlated with the 4-hr power ratio (r = 0.68 and 0.67; P < 0.05, respectively), but poorly correlated for the 250-kcal meal. In conclusions, GE and EGG are affected by meal size. Using the muffin-based [13C]OBT, T(1/2) for the 350-kcal meal was significantly longer than for a 250-kcal meal. Longer T(1/2) values were obtained with shorter breath sampling durations. The postprandial to fasting power ratio for the 350-kcal meal was greater than that for the 250-kcal meal.

Adult↗
PubMed2001

The role of epidemiology in understanding the health effects of Helicobacter pylori.

Helicobacter pylori infects one-half or more of the world population and causes chronic gastritis, peptic ulcer, and probably gastric cancer as well. The public-health impact of this infection is far from trivial. Chronic gastritis and peptic ulcer disease are common across populations. Gastric cancer rates have declined during this century, but this cancer remains second among causes of cancer deaths worldwide. Much has been learned about biological and clinical aspects of H. pylori, but key epidemiologic questions have not been answered. How infection results in diverse diseases, the precise modes of transmission, and a comprehensive solution to H. pylori as a public-health problem remain elusive. In this paper, we highlight methodologic challenges and outline an agenda for future research. Challenges include improving validation of detection methods and considering the limitations of these methods when interpreting epidemiologic data. The role of cofactors in H. pylori-induced diseases requires extensive exploration. Many intriguing areas of H. pylori research require the skills of epidemiologists. The discovery of an infectious etiology of common chronic diseases presents a promising opportunity for improving public health.

Chronic Disease↗
PubMed2000

Transmission of Helicobacter pylori among siblings.

BACKGROUND: Helicobacter pylori infection causes chronic digestive diseases with a major public-health impact, yet the design of prevention measures is hampered by limited knowledge of transmission pathways. We studied the effect of family composition on H. pylori prevalence among rural Colombian children aged 2-9 years. METHODS: 684 children were screened for H. pylori with the 13C-urea breath test. For each child, birth order, birth spacing, number of 2-9-year-old siblings, and number of H-pylori-positive 2-9-year-old siblings was recorded. Odds ratios were estimated by logistic regression, controlling for hygiene-related exposures, socioeconomic indicators, and the number of children in the household. FINDINGS: The odds of infection increased with the number of 2-9-year-old siblings in the household (odds ratios 1.4, 2.3, 2.6, and 4.3 for one, two, three, and four to five siblings, respectively). Compared with first-born children, odds ratios for children born second and third to ninth were 1.8 (95% CI 1.0-3.3) and 2.2 (1.0-4.3), respectively. Compared with children born 10 or more years after the next older household member, those born within 4 years were 4.1 times (CI 2.0-8.6) more likely to be infected; the age gap to the next younger household member displayed a weaker effect. The number of H-pylori-positive 2-9-year-old siblings had a particularly strong effect gradient (1.5, 3.2, 5.6, and 7.1, for one, two, three, and four positive siblings, respectively). INTERPRETATION: Among rural Andean children younger than 10 years, H. pylori infection seems to be transmitted most readily among siblings who are close in age, and most frequently from older siblings to younger ones.

Child↗
PubMed2000

Compliance with childhood immunizations in Kern County, California.

A rapid survey was conducted to describe the immunization status of the 0- to 2-year-old population in selected communities of Kern County, California, and identify reasons for noncompliance with immunization recommendations. Households were selected by two-stage cluster sampling. Among 860 children, 38% had received immunizations on schedule, while 44% had not received the recommended doses for their age. Compliance with the immunization schedule worsened dramatically after the first year of life. Among 2 year olds, the proportion that had the recommended number of vaccine doses was 81% for MMR, 82% for polio, 65% for DTP, and 47% for Hib. Parents' main reasons for noncompliance included child's illness, procrastination, and limited access to information and services. The low levels of compliance reflect lack of active follow-up in preventive health care across socioeconomic levels. The results show the importance of aiming immunization messages at parents and physicians of 12- to 18-month-old children. The rapid survey approach offers public health agencies an efficient means of assessing community health problems and targeting programs according to need.

Journal Article↗
PubMed1999

Age distribution of Helicobacter pylori seroprevalence among young children in a United States/Mexico border community: evidence for transitory infection.

Helicobacter pylori infection has been linked to a spectrum of gastroduodenal diseases of broad public health impact, yet the natural history of this frequently asymptomatic infection remains poorly understood. Evidence suggests that initial acquisition occurs primarily during childhood and may persist throughout life. The seroprevalence of H. pylori antibodies was examined in 365 primary schoolchildren aged 4-7 years in a low-income United States/Mexico border community from January to May 1996. Overall, 21% of the 365 children tested positive, with a significant monotonic decrease in seroprevalence by 1-year age intervals (36% in children aged 4 years, 24% in those aged 5 years, 20% in those aged 6 years, and 14% in those aged 7 years). The odds ratio for each 1-year age increase was 0.76 (95% confidence interval: 0.6, 1.0) after adjustment for relevant covariates. Given that H. pylori antibodies diminish after infection clears, this trend suggests that transient infection may be common in young children. In contrast, hepatitis A virus seroprevalence increased with age. There was a moderate association (odds ratio = 1.47, 95% confidence interval: 0.8, 2.9) of H. pylori with hepatitis A virus seroprevalence that weakened after adjustment for age and socioeconomic status (odds ratio = 1.26, 95% confidence interval: 0.6, 2.5). Follow-up studies are needed to clarify the natural history of Helicobacter pylori infection and identify predictors of initial acquisition, persistence, and recurrence.

Age Distribution↗
PubMed1999

Hepatitis B vaccination in high-risk infants: 10-year follow-up.

The long-term efficacy of hepatitis B vaccination among high-risk infants was determined in 805 vaccine responders, immunized at birth in Taiwan during 1981-1984 and followed to age 10 years, via life table survival and Cox multivariate analyses. At 10 years, cumulative persistence of antibody to hepatitis B surface antigen (anti-HBs) was 85%, and cumulative incidence of hepatitis B virus (HBV) infection was 15%. Three children became carriers. Twelve-month anti-HBs titer was the strongest predictor of efficacy. The higher the initial titer, the lower the risk of anti-HBs loss (relative risk [RR], 0.26 for titer of 100-999 mIU/mL; RR, 0.08 for titer >1000 mIU/mL; P<.001) and HBV infection (RR, 0.55 and 0.27; P<.05). Maternal hepatitis B e antigen positivity but not hepatitis B immunoglobulin dose or gender predicted greater antibody persistence to age 10 years. Because the level of antibody persistence remained high and few became carriers, booster revaccination within 10 years seems unnecessary.

Child↗
PubMed1998

Comparison of electron beam computed tomography scanning and conventional risk factor assessment for the prediction of angiographic coronary artery disease.

OBJECTIVE: To determine whether electron beam computed tomography (CT) adds to conventional risk factor assessment in the prediction of angiographic coronary artery disease. BACKGROUND: Electron beam CT scanning can be used to predict the severity of coronary atherosclerosis, but whether it does so independently of conventional risk factors is unclear. METHODS: Electron beam CT scans were performed and conventional risk factors were measured in 290 men and women undergoing coronary arteriography for clinical indications. The association of the electron beam CT-derived coronary artery calcium score and conventional risk factors with the presence and severity of angiographically defined coronary atherosclerosis was analyzed by logistic regression and receiver-operator characteristics analysis. RESULTS: Age, the ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol and the coronary calcium score were significantly and independently associated with the presence of any coronary disease and obstructive coronary disease. In association with any coronary disease, odds ratios for age, the ratio of total cholesterol to HDL cholesterol and calcium score, highest quartile vs. lowest quartile, were 6.01 (95% confidence interval 2.87 to 12.56), 3.14 (1.56 to 6.31) and 94.08 (21.06 to 420.12), respectively. For obstructive coronary disease, highest quartile vs. lowest quartile, the respective odds ratios for age, the ratio of total cholesterol to HDL and calcium score were 3.86 (1.86 to 8.00), 4.11 (1.98 to 8.52) and 34.12 (12.67 to 91.86). Male gender was also significantly associated with any coronary disease (odds ratio 2.19, p=0.04) and obstructive coronary disease (odds ratio 2.07, p=0.04). Cigarette smoking was significantly associated with any coronary disease (odds ratio=2.74, p=0.004), and diabetes was significantly associated with obstructive disease (odds ratio 3.16, p=0.01). After adjustment for the coronary calcium score and other risk factors, it was determined that triglycerides, family history and hypertension were not significantly associated with any disease state. A coronary calcium score >80 (Agatston method) was associated with an increased likelihood of any coronary disease regardless of the number of risk factors, and a coronary calcium score > or = 170 was associated with an increased likelihood of obstructive coronary disease regardless of the number of risk factors (p < 0.001). CONCLUSIONS: Electron beam CT scanning offers improved discrimination over conventional risk factors in the identification of persons with any angiographic coronary disease or angiographic obstructive coronary disease.

Adult↗
PubMed1998

Recycling of carbon into lipids synthesized de novo is a quantitatively important pathway of alpha-[U-13C]linolenate utilization in the developing rat brain.

Docosahexaenoate is important for normal neural development. It can be derived from alpha-linolenate, but carbon from alpha-linolenate is also recycled into de novo lipid synthesis. The objective of this study was to quantify the amount of alpha-linolenate used to produce docosahexaenoate versus lipids synthesized de novo that accumulate in the brain of the developing rat. A physiological dose of carbon-13-labeled alpha-linolenate was injected into the stomachs of mother-reared 6-day-old rat pups. Total lipids of brain, liver, and gut were extracted from rats killed 3 h to 30 days after dosing. Carbon-13 enrichment was determined by isotope ratio mass spectrometry. Carbon-13-enriched alpha-linolenate was not detected in the brain at any time point, and its levels in liver and gut exceeded detection limits at most time points, so tracer mass was quantified mainly for three end products--docosahexaenoate, palmitate, and cholesterol. Carbon-13-enriched cholesterol, palmitate, docosalphahexaenoate, and water-soluble metabolites were detected in brain, liver, and gut Enrichment (in micrograms of carbon-13 per organ) in brain cholesterol exceeded that in brain docosahexaenoate by four- to 16-fold over the duration of the study. Enrichment in brain palmitate exceeded that in brain docosahexaenoate by three- to 30-fold over the first 8 days of the study. These results indicate that carbon from alpha-linolenate is not exclusively conserved for synthesis of longer n-3 polyunsaturates but is a readily accessible carbon source for de novo lipogenesis during early brain development in the suckling rat. Owing to a high rate of beta-oxidation and carbon recycling, dependence on alpha-linolenate as the sole source of docosahexaenoate may incur a potential risk of providing insufficient docosahexaenoate for the developing brain.

Aging↗
PubMed1998

How do practicing clinicians manage Helicobacter pylori-related gastrointestinal diseases in Germany? A survey of gastroenterologists and family practitioners.

BACKGROUND: Since the bacterium H. pylori was identified in 1982, overwhelming evidence has implicated it as the causal factor in the occurrence and relapse of peptic ulcer disease. The major objective of this study was to examine the extent to which physicians recognize H. pylori as a causal agent in peptic ulcer disease or as potential cofactor in other gastrointestinal diseases, and the extent to which this knowledge has influenced diagnostic and therapeutic practices. MATERIALS AND METHODS: Using a national mail survey in Germany in September 1995, 1197 family practitioners and 1197 gastroenterologists were selected for the study. RESULTS: Of the surveyed physicians, 756 (32%) responded. Family practitioners treated almost 50% of their patients with initial presentation of suspected ulcer disease without ordering further diagnostic tests. More than 25% of the family practitioners and 14% of the gastroenterologists reported that they do not treat diagnosed H. pylori infection in the first presentation of duodenal ulcer. At the time we conducted the study, 22% of responding family practitioners and 5% of responding gastroenterologists treated the first presentation of H. pylori-positive ulcer disease with regimens determined to be ineffective according to the available literature. CONCLUSIONS: Gastroenterologists preferred to treat H. pylori infection when the associated disease was one for which a causal relationship had been more clearly established, while family practitioners showed less discrimination. In order to provide optimal therapy aimed at minimizing the course and consequences of H. pylori-related diseases, researchers in the field must ensure continuous dissemination of current knowledge.

Clinical Competence↗
PubMed1998

How do clinicians practicing in the U.S. manage Helicobacter pylori-related gastrointestinal diseases? A comparison of primary care and specialist physicians.

OBJECTIVES: We sought to examine the extent to which physicians recognize H. pylori as a causal agent in peptic ulcer disease or as a potential cofactor in other gastrointestinal diseases, and to observe how this knowledge has influenced diagnostic and therapeutic practices. METHODS: We used a national mail survey in the U.S. between February and May of 1996, querying 5994 U.S. physicians (family/general practitioners [FPs], internists [IMs], and gastroenterologists) selected at random from three different membership databases of professional associations. RESULTS: The response rate was 52%. More than 95% of physicians who treat symptoms empirically would prescribe acid suppressant therapy rather than anti-H. pylori therapy. Between 43% and 66% of physicians, varying in frequency by medical specialty, would treat the infection in H. pylori-positive patients with nonulcer dyspepsia. In confirmed peptic ulcer disease, between 88% and 100% of physicians would treat the H. pylori infection, depending on the physician group and whether or not the presentation of an ulcer was recurrent. Although 103 distinct anti-H. pylori regimens were reported, 89% of the gastroenterologists and 70% of the primary care physicians (PCPs) used combinations of antimicrobials with reported cure rates of at least 80%. CONCLUSIONS: General knowledge regarding H. pylori-associated diseases was widespread among primary care physicians and gastroenterologists. However, anti-H. pylori therapies judged ineffective were reported as the first choice regimen by 5% of gastroenterologists and 18% of primary care physicians. Gastroenterologists appear to implement the latest scientific developments in the field rapidly whereas PCPs manifest a delayed response, due to either insufficient knowledge or to other factors influencing their approach to treatment.

Gastroenterology↗
PubMed1997

Relation of coronary calcium score by electron beam computed tomography to arteriographic findings in asymptomatic and symptomatic adults.

Coronary arteriography was performed on 18 asymptomatic, apparently healthy adults with elevated coronary calcium scores. To extend the range of observation to subjects with low calcium scores, arteriograms from 18 patients with exertional dyspnea and/or valvular heart disease and low calcium scores were also analyzed; these 18 patients were considered asymptomatic from the point of view of coronary artery disease (CAD). For the comparison of symptomatic and asymptomatic persons, 3 age and sex-matched symptomatic patients were also selected for each of the original 18 asymptomatic subjects. Arteriograms were analyzed by computer-assisted quantitative coronary arteriography at a remote site without knowledge of the calcium score or any other patient characteristics. In the 18 asymptomatic subjects with elevated calcium scores, the mean calcium score was 573 +/- 504 (Agatston method) and the mean worst stenosis was 45% +/- 16%. For all 36 patients without symptoms of CAD, worst stenosis was closely correlated with the square root of the calcium score (r = 0.85, p <0.0001). Patients with symptomatic coronary disease and calcium scores < 1,000 had stenoses more severe than asymptomatic persons with similar calcium scores. Most asymptomatic adults with elevated calcium scores have nontrivial, nonobstructive CAD or preclinical obstructive CAD, and the relation between coronary calcium score and severity of stenosis is highly significant. These data indicate that electron beam tomography can be used to estimate the severity of CAD in asymptomatic persons.

Adult↗
PubMed1997

Nutritional factors and Helicobacter pylori infection in Colombian children.

BACKGROUND: Helicobacter pylori infection occurs most frequently in impoverished populations; however, little is known about specific determinants of susceptibility. This report describes the relationship between H. pylori infection and nutritional indicators among children from a rural village in the Colombian Andes, where a prevalence of 69% was observed in children from 2 to 9 years old. METHODS: In a cross-sectional study of 684 children, comprising 92% of the 2- to 9-year-old population of Aldana, Colombia, information was obtained on dietary factors by questionnaire, height and weight by direct measurement, and H. pylori status using the carbon-13 urea breath test. Multivariate logistic regression was used to estimate relative risks for nutritional indicators. RESULTS: The infection was least frequent among children who are several servings of fruits and vegetables daily, drank two or more cups of milk daily, and were in the upper quintile of height for their age. The odds of infection increased 19-fold (95% confidence interval, 4.0-91.9) among children who consumed less than two daily servings of fruits and vegetables compared with the modal intake of three to five daily servings. Children whose daily vitamin C intake from fruits and vegetables was less than 40 mg had greatly increased odds of infection (odds ratio, 7.2; 95% confidence interval, 1.5-34.1) compared to the modal intake of 80-119 mg; for beta-carotene, the odds ratio was 3.1 (95% confidence interval, 1.2-7.9) for intakes of less than 300 IU per day, compared with the modal daily intake of 900 IU or more. CONCLUSIONS: The results of this population-based study suggest that nutritional factors may play a role in determining susceptibility to H. pylori infection.

Aging↗
PubMed1996

Helicobacter pylori infection in the Colombian Andes: a population-based study of transmission pathways.

In 1992, the authors studied Helicobacter pylori infection and exposures relevant to person-to-person, waterborne, foodborne, and zoonotic transmission in a census sample of 684 2-9-year-old children in Aldana, Nariño, a rural community in the Colombian Andes. H. pylori prevalence, as determined by the 13C-urea breath test, was 69%, and prevalence increased from 53% in 2 year-olds to 87% in 9 year-olds. Beginning at 3 years of age, a higher percentage of males compared with females were infected. Odds ratios were estimated by multivariate logistic regression to control for mutual confounding by transmission-pathway proxy variables and socioeconomic indicators. Among transmission-pathway proxies, the strongest predictor of H. pylori status was the number of persons who lived in the home, with the number of children apparently being of greater importance than the number of adults. Swimming in rivers, streams, or pools increased the odds of infection, as did using streams as a drinking water source. Children who frequently consumed raw vegetables were more likely to have the infection, and children who had contact with sheep also had increased prevalence odds. Because the results did not implicate a single mode of transmission, the possibility of multiple pathways is indicated.

Age Distribution↗