Biomedical subjects

K J Roghmann

Publications and source records attributed to K J Roghmann.

At least 55 records · Page 3Linked to original sources

PubMed1990

Risk factors for nosocomial pneumonia in the elderly.

PURPOSE: Pneumonia is now the second most frequent hospital-acquired infection in acute-care facilities, and recent studies indicate that the incidence rate for nosocomial pneumonia in long-term-care facilities is of similar magnitude. The mortality rate is high, especially in the elderly. With prevention of this complication as an overall priority, this study was designed to determine the risk factors associated with nosocomial pneumonia in the elderly in both acute-care and long-term-care settings. PATIENTS AND METHODS: An epidemiologic case-control study was undertaken to compare patients or residents who developed radiographically confirmed pneumonia with control subjects who did not have and did not develop respiratory infection. Thirty-three cases were identified in the acute-care setting during the 18-week period, and 27 cases were identified in the long-term-care setting. Two matched controls were chosen for each case. Data collection involved review of the medical record and verification by medical personnel while the cases or controls were still institutionalized. Risk factor variables were analyzed using an odds ratio and 95% confidence interval calculation for matched triplets, and chi-square analysis. Selected risk factors were entered into a backward stepwise logistic regression to determine the best combination of risk factors for each setting. RESULTS: In the acute-care setting, current neurologic disease, current renal disease, deteriorating health, altered level of consciousness, disorientation, dependent bathing, dependent bowel function, dependent feeding, aspiration, difficulty with oropharyngeal secretions, and presence of a nasogastric tube were significant risk factors. In the long-term-care setting, deteriorating health, malnourishment, recent weight change, altered level of consciousness, disorientation, aspiration, difficulty with oropharyngeal secretions, suctioning, presence of a nasogastric or gastric tube, upper respiratory infection, inhalation therapy, increased confusion, and increased agitation were determined to be significant. Current pulmonary disease, previous infection, and antibiotic therapy were found not to be associated with the onset of nosocomial pneumonia. Through logistic regression, the best models for prediction of nosocomial pneumonia in the elderly were identified. In the acute-care setting, difficulty with oropharyngeal secretions and presence of a nasogastric tube were the best predictors. In the long-term-care setting, difficulty with oropharyngeal secretions, deteriorating health, and occurrence of an unusual event were the best combination of predictors. CONCLUSION: These data confirm prior findi

Aged↗

PubMed1990

Repeat adolescent pregnancy and low birth weight: methods issues.

Longitudinal studies of the relationship between birth order and birth weight suggest that mean birth weight increases with parity among women of all ages. In contrast, national birth statistics and other cross-sectional studies of these relationships suggests a decrease in mean birth weight and an increased incidence of low-weight births with parity among adolescent mothers. We examine the potential reasons for these strikingly different conclusions. Our aim is to determine whether multiparity itself is a low-birth-weight risk factor among adolescent mothers or whether it is a marker for other adolescent maternal conditions that increase the risk of a low birth weight, independent of parity.

Adolescent↗

PubMed1990

Subfecundity: a prenatal risk factor for adults but not for adolescents.

Young maternal age is associated with an increased incidence of low birth weight and prematurity; controlling for sociodemographic factors reduces the significance of this relationship. We hypothesized that this is partly because in a sociodemographically homogeneous population the adverse effects of maternal subfecundity on fetal growth confound the relationship between maternal age and infant outcome. To test this hypothesis, we studied the reproductive histories of 90 adolescent (less than 20 years old) and 35 adult lower socioeconomic, black prenatal patients. We found a strong, positive relationship between maternal age at conception and duration of unprotected intercourse prior to conception (r = 0.40; p less than 0.0001). Adults reporting 2 or more years of unprotected intercourse prior to conception were at highest risk for low birth weight (p = 0.02). Our findings demonstrate that it is important that adult controls for adolescent pregnancy studies have voluntarily postponed conception.

Adolescent↗

PubMed1990

Effect of stress and other biopsychosocial factors on primary antibody response.

There is growing evidence that life stress is associated with altered cellular immune function, but only a few studies have examined the effect of stress on humoral immune response. We immunized 89 healthy women (18-24 years) with a novel antigen, keyhole limpet hemocyanin (KLH), to study the impact of stressful events and psychosocial and biologic factors on primary antibody response to immunization. Antibodies to KLH were measured preimmunization and 3 and 8 weeks after immunization. Previously validated scales were used to measure (1) recent major stress (both "good" and "bad," as defined by the subjects) and minor stressful events, and (2) psychological status and social support. Subjects were also asked about personal medical history, sociodemographics, and side effects of immunization. Subjects with more stressful events (of any type) tended to have lower baseline and 3-week postimmunization IgG levels. Those reporting more "good" events tended to have higher IgG levels at 8 weeks postimmunization. Psychological Distress scores correlated negatively and Psychological Wellbeing scores correlated positively with each IgG level. Subjects with a recent infection (preimmunization) or a local reaction to immunization had significantly higher IgG levels at all three points compared to those without these factors. These data and exploratory analysis suggest that recent stress and psychological status (perhaps representing the cumulative effects of stress and response to stress) may influence immune response to immunization. However, predisposing biological factors must also be assessed for possible confounding in the stress-immune response relationship.

Adolescent↗

PubMed1990

Variation in severity of respiratory syncytial virus infections with subtype.

Two major subtypes of respiratory syncytial virus have been identified. This study assessed the hypothesis that A-subtype infections were more severe than B-subtype infections among the 157 infants hospitalized in two hospitals in Rochester, N.Y., during two winters. Severity was measured both by specific clinical observations and by a severity index that was derived empirically. Among all subjects, several clinical observations suggested that A-subtype infections were more severe. For example, mechanical ventilation was required in 12.6% of those with A-subtype compared with 1.6% of those with B-subtype infection (relative risk = 7.88; p = 0.01). Among high-risk infants (infants with underlying conditions or age 3 months or less at admission), carbon dioxide tension greater than 45 mm Hg was found in 37.0% of those with A-subtype compared with 12.0% of those with B-subtype infection (relative risk = 3.08; p = 0.04). In discrete multivariate (logit) analysis, effects of subtype (odds ratio = 6.59; p less than 0.01) on severity remained after adjustment for other statistically significant effects of age less than 3 months, underlying condition, and premature birth. The finding that A-subtype infections were more severe might have important implications for vaccine development, studies of the virulence of respiratory syncytial virus, clinical management (e.g., selection for antiviral therapy), and long-term prognosis.

Age Factors↗

PubMed1990

Does limited access to NICU services account for higher neonatal mortality rates among blacks?

During a 2-year period in the Finger Lakes region of upstate New York, black infants were admitted to the NICU 2.6 times as often as white infants. The relative risk of NICU admission among black low birthweight infants was 9.2 times that of normal birthweight black infants. The relative risk of NICU admission among white low birthweight infants was 16.4 times that of normal birthweight white infants. Thus, higher rates of low birthweight among blacks did not account for the increased utilization of NICU services by blacks. Within the NICU, 30% of the deaths among black normal birthweight infants could be attributed to complications of asphyxia, persistent fetal circulation, or meconium aspiration. Only 14.3% of the deaths among white normal birthweight infants were attributed to these cause. Higher black neonatal mortality rates did not appear to be due to limited access to NICU services, but more normal birthweight black babies may have died of potentially preventable causes.

Black or African American↗

PubMed1990

Prediction rules for selective radiographic assessment of extremity injuries in children and adolescents.

To assess the potential for selective use of roentgenography in evaluating extremity injuries, prediction rules were developed based on prospective observations for 617 injured children and adolescents examined in our Emergency Department (phase 1) and tested on 601 examined 1 year later (phase 2). Logit analysis produced best-fitting statistical models for phase 1 data with significant (P less than 0.05) direct effects of gross signs, point tenderness, activity not routine, swelling moderate or severe, time from injury less than 6 hours, and pain with motion for upper extremity injuries; and, for lower extremity injuries, not knee injury, activity not routine, point tenderness, and foot injury. Prediction rules developed in phase 1 performed equally well when tested on phase 2 injuries. Data from both phases were combined, therefore, in analysis that produced risk estimates. For all injury types (ie, for injuries with all possible combinations of presence or absence of these findings), risk for fracture was derived. For upper extremity injuries, with a threshold risk for fracture of 20% used to select specific injury types for roentgenography, prediction rule outcomes were 18.1% of roentgenograms avoided and 5.3% of fractures missed. For lower extremity injuries, using a threshold risk of 10% to select injury types for roentgenography, outcomes were 25.8% of roentgenograms avoided and 5.3% of fractures missed. Alternative prediction rules allowed still greater roentgenogram avoidance, although missed fractures also increased. Risk of adverse functional outcome from missed fractures appeared small. Annual national cost savings from the elimination of 18.1% of upper and 25.8% of lower extremity roentgenographic evaluations was estimated at $103 million.

Adolescent↗

PubMed1989

Wheezing at 8 and 13 years: changing importance of bronchiolitis and passive smoking.

A group of 153 children (51 with a history of bronchiolitis and 102 matched controls) were evaluated in a historical cohort study at a mean age of 8 years and again at 13 years to test the primary hypothesis that mild bronchiolitis, far more common than severe (hospitalized) bronchiolitis, predicts wheezing. A secondary hypothesis was that passive smoking also predicts wheezing. Many potentially confounding variables such as family history of asthma were controlled in analyses. Analysis at 13 years produced results that were not anticipated from previous analysis of interviews at age 8. Although mild bronchiolitis was a powerful predictor of wheezing at age 8 years, it was no longer a strong predictor of wheezing at age 13 in either bivariate or multivariate analysis. Although epidemiologic studies, by their nature, cannot prove causality, findings are consistent with the hypothesis that sequelae often follow mild bronchiolitis but diminish during childhood. Maternal smoking was a powerful predictor of wheezing at age 13 in bivariate analysis (Kendall's Tau B = 0.19, P less than 0.01) and in multivariate analysis (odds ratio = 2.67, P less than 0.01). In children at highest risk for wheezing, males with a family history of asthma, multivariate analysis suggested that maternal smoking is associated with an increase in wheezing from 36% to 60%. We conclude that passive smoking, previously identified as a risk factor in this population for both bronchiolitis in infancy and wheezing at age 8, is a risk factor for wheezing-associated morbidity throughout the childhood years.

Adolescent↗

PubMed1989

Patient satisfaction and the use of health services. Explorations in causality.

Little research exists that examines the causal relationship between patient satisfaction and the use of health services. This study of a representative sample of low income families suggests that a relationship does exist. Furthermore, results reported indicate it is bidirectional and reciprocal in nature, and that it is highly related to the provider from which patients seek care. Analysis according to the five major area clinics that were main sources of medical care for an upstate New York community (two HMOs, two hospital-affiliated teaching clinics, and one continuity-of-care clinic) revealed that, in some providers, the association between use and satisfaction is positive, in others negative. Further evidence for a "patient provider" interaction hypothesis was found, suggesting that background characteristics, including health status and race, are related to use and satisfaction in different ways in different clinics. The findings provide evidence for the existence of a causal relationship between use and satisfaction, which is dependent on the context in which medical care is given, and also suggest structural characteristics that might be responsible for these effects. A final conceptual model of satisfaction is offered, permitting reciprocal causation with use and satisfaction with emphasis on patient provider interactions, and this model provides an identification of short- and long-term processes. Progress in this area might require a shift in perspective upward toward structural and systems variables or a shift downward toward "microanalytic" processes, which detail patient-provider interactions.

Consumer Behavior↗

PubMed1988

Periorbital cellulitis. Clinical and laboratory findings in 146 episodes, including tear countercurrent immunoelectrophoresis in 89 episodes.

Medical records of 144 children hospitalized for 146 episodes of periorbital cellulitis were reviewed. During 44 episodes, systemically administered antibiotics were given before hospitalization. Bacterial pathogens were isolated in only two (5%) of 44 episodes in pretreated patients compared with 33 (32%) of 102 episodes in patients who were not pretreated. Thirty-one children who were not pretreated were bacteremic. Compared with nonbacteremic children who were not pretreated, bacteremic children were younger, more often had a history of upper respiratory tract infection and fever, had a higher white blood cell count and temperature at admission, and more often had a violaceous cellulitis. No difference between groups existed in the frequency of a history of trauma or a local lesion near the affected eye. Tear specimens from 13 of 89 children tested by countercurrent immunoelectrophoresis (CIE) to detect Haemophilus influenzae type b capsular polysaccharide were positive. Compared with positive blood culture results, tear CIE has a sensitivity of 50% and a specificity of 93%. Streptococcus pneumoniae infections were not detected by CIE.

Cellulitis↗

PubMed1987

Determination of leukocytosis in traumatic spinal tap specimens.

White and red blood cell counts from peripheral blood and from the cerebrospinal fluid of all patients who had traumatic lumbar punctures over a five-year period were studied to determine the diagnostic value of using the ratio of white blood cells to red blood cells in peripheral blood to adjust the white blood cell count found in the bloody cerebro-spinal fluid. In patients without meningitis, 55 percent of the cerebrospinal fluid specimens had more white blood cells than could be attributed to trauma. However, in only 10 percent was the actual white blood cell count more than 10 times greater than the number referable to trauma. In 38 percent, there were fewer white blood cells in the cerebrospinal fluid than the ratio predicted. Such underestimation was uncommon among patients with culture-positive meningitis: the ratio failed to detect leukocytosis in only 10 percent, and all but one of these patients had clinical reasons for the low cerebrospinal fluid count. It is concluded that true leukocytosis is rarely masked in blood-contaminated cerebrospinal fluid, and that the presence of more than 10 times the number of white blood cells than allowed by the adjustment is a sensitive and specific indicator of meningitis. However, a simple mechanical use of the formula is not justified, and all available clinical and laboratory data should be used when deciding whether to institute treatment in a patient with possible meningitis and bloody spinal fluid.

Adult↗

PubMed1987

Cord serum bromide concentration: variation and lack of association with pregnancy outcome.

Excessive maternal bromide exposure during pregnancy from drugs and occupation have been reported to have adverse effects on the fetus and newborn, including central nervous system depression at birth and possible teratogenicity. To define further fetal bromide exposure during pregnancy, we determined the cord serum bromide concentration in 1267 newborn babies born in Rochester, New York, during the 6-month period from January 1, 1984 to June 30, 1984. There was a normal distribution of the cord serum bromide concentration values (mean +/- SD = 8.6 +/- 2.6 mg/L; range 3.1 to 28.5 mg/L). The highest concentration was still significantly below the minimal bromide concentration associated with toxic effects (720 mg/L). There was no association between the cord serum bromide concentration and indices of fetal health including Apgar scores, presence of congenital malformations, and neonatal disposition. No mothers were taking significant amounts of bromide-containing drugs during pregnancy. The second highest cord serum bromide concentration (21.4 mg/L) was in a woman who was an amateur photographer and developed her own film, which required her to use chemicals containing bromide. Our results indicate that excessive fetal bromide exposure is rare and probably occurs only in the setting of maternal use of bromide-containing drugs or occupational exposure during pregnancy.

Abnormalities, Drug-Induced↗

PubMed1987

Immune response of elderly adults to pneumococcus: variation by age, sex, and functional impairment.

The immune response of 271 elderly persons to the new 23-valent pneumococcal vaccine was studied prospectively. Sera were obtained prevaccination, at 1 month post- and 12 months postvaccination. They were analyzed by radioimmunoassay for the presence of antibody Types 1, 3, 6A, 7F, 8, and 9N. The results showed differences in antibody levels by sex of the individual (p less than .01 pre and p = .04 at 1 month post), with women having lower antibody levels than men. Women responded better to vaccination than men (p = .05), but they also lost their acquired antibodies faster (p less than .01). No age effect and no effect of level of functioning were observed within this group of elderly individuals. Participants who died had high initial levels and responded well. Major differences between the six types were noticed. Type 6A exhibited the described pattern most clearly, whereas Type 3 often behaved in an opposite pattern from the other five types. We conclude that sex differences persist even among elderly adults, that high levels of antibodies are not necessarily an indicator of good health, and that much unexplained variation between antibody types exist.

Aged↗

PubMed1987

Adverse and beneficial effects of immediate treatment of Group A beta-hemolytic streptococcal pharyngitis with penicillin.

One hundred forty-two children with presumed Group A beta-hemolytic streptococcal (GABHS) pharyngitis were enrolled in a randomized double blind prospective study comparing the consequences of immediate penicillin treatment with treatment delayed for 48 to 56 hours. One hundred fourteen of the enrolled patients were culture-positive. An adverse impact of early antibiotic therapy was noted; the incidence of subsequent infections with GABHS was significantly greater in those treated at the initial office visit with penicillin. In the month following documented evaluation of GABHS, a recurrence occurred 2 times more frequently in those treated with penicillin immediately compared with those for whom treatment was delayed 48 to 56 hours. Late recurrences (beyond 1 month but in the same streptococcal season) occurred 8 times more frequently (P less than 0.035). Delay in penicillin treatment did not increase GABHS intrafamilial spread. Symptoms of both groups were assessed for 2 days following the initiation of treatment. Both placebo-treated and penicillin-treated groups used aspirin or acetaminophen ad libitum. Penicillin was shown to reduce fever and relieve sore throat, dysphagia, headache, abdominal pain, lethargy and anorexia significantly beyond that achieved with aspirin or acetaminophen alone. Penicillin had no effect on culture-negative cases.

Adolescent↗

PubMed1987

Respiratory teaching of patients: how effective is it?

In order to evaluate the effectiveness of a structured respiratory teaching programme, clients with chronic obstructive pulmonary disease who were hospitalized in a 13-month period both prior to and following the implementation of the programme were compared on several parameters to assess changes in their ability to manage their disabilities. The study demonstrated that clients who participated in the teaching sessions had fewer hospital admissions, shorter lengths of hospital stay, and longer stays in the community. A sub-group of clients who were or had been in at-risk occupations was identified as representing the 'revolving door' client with shorter hospital and community stays. The teaching programme is described as well as specific elements that can be used for a shorter teaching experience to respond to time constraints when necessary.

Adult↗

PubMed1986

Parental smoking, presence of older siblings, and family history of asthma increase risk of bronchiolitis.

Bronchiolitis is a common lower respiratory tract illness in infants and has substantial acute morbidity and sequelae. To identify risk factors for bronchiolitis, a case-control study was conducted in which 53 subjects who had bronchiolitis were matched with two controls who had no bronchiolitis in infancy. In multivariate analysis, direct effects of passive smoking and older siblings achieved statistical significance. Family history of asthma appeared to interact with older siblings. Among subjects without a family history of asthma, statistically significant predictors proved to be older siblings (odds ratio, 2.31) and passive smoking (odds ratio, 3.87). Among subjects with a family history of asthma, older siblings proved to be an even stronger predictor (odds ratio, 46.81), while the odds ratio for passive smoking did not change much (odds ratio, 4.03). The combined presence of older siblings and passive smoking yielded an odds ratio of 8.94 among subjects without a family history of asthma and 181.67 among subjects with a family history of asthma. Analysis provided risk estimates that were particularly high for certain groups. Among infants with a family history of asthma, 49% who have an older sibling may develop bronchiolitis. If they are also exposed to cigarette smoke, almost 80% may develop bronchiolitis. Among infants without a family history of asthma, bronchiolitis may develop in 46% of infants if there is both an older sibling and exposure to smoke. Exposure of infants to cigarette smoke might diminish more rapidly if clinicians and parents were aware of such high risks. Efforts to reduce morbidity from bronchiolitis in infants might best be directed at the reduction of smoking in families with previous children, particularly if there is a family history of asthma, and at methods that protect infants from respiratory virus carried by siblings.

Asthma↗

PubMed1985

Predicting clinically significant lower respiratory tract illness in childhood following mild bronchiolitis.

A historical cohort study was conducted to measure lower respiratory tract illness (LRTI) up to nine years following mild bronchiolitis and to discover attributes that predict an increased risk for LRTI in childhood. The hypothesis assessed was that the occurrence of bronchiolitis predicts LRTI following the second birthday (childhood LRTI) after adjusting for potentially confounding variables such as a family history of respiratory allergy. Fifty-three children (index subjects) who were seen for bronchiolitis at a suburban community pediatric practice were compared on the basis of childhood LRTI with a control group of 159 children. Chart review, when children were a mean of 8 years old, determined the frequency of childhood LRTI. The mean frequency of childhood LRTI was greater in index subjects than in control subjects (1.62 vs 0.98). This difference remained after adjusting for potentially confounding variables. The yearly occurrence of any LRTI was significantly more common in index subjects through the third year of life (38% vs 15%). A tendency for a more common occurrence of any LRTI was noted through the fifth year (25% vs 16%), but not thereafter. Further analysis of index subjects disclosed that only those who experienced a subsequent LRTI before the second birthday were at an increased risk for the development of childhood LRTI.

Bronchiolitis, Viral↗

PubMed1985

An analysis of waiting times in a pediatric emergency department.

Waiting times in a pediatric emergency department were studied using direct observations of patients and health providers on 14 separate days. The mean waiting time (from entry to first physician contact) of the 216 children studied was 49 minutes. Time spent in the waiting room was increased by both the nonavailability of a nurse and the nonavailability of an examining room, and was decreased by the severity of the patient's illness. Time spent in the examination room waiting for the physician was related to the availability of the physician and the number of patients concurrently registered in the emergency department as well as the severity of their complaint. Recommendations for decreasing waiting time, based on the observations, are made. Although each setting is unique, the study provides a model for the analysis of waiting patterns in similar facilities.

Child↗