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Biomedical subjects

L Epstein

Publications and source records attributed to L Epstein.

At least 37 records · Page 2Linked to original sources
PubMed1998

The contribution of multiple data sources to a clinical audit of lymphoma in a teaching hospital.

OBJECTIVE: To assess the independent contribution of data sources used for case ascertainment in a clinical audit of the outcome of lymphoma patients in our institution. DESIGN: In the absence of a unified register of lymphoma patients diagnosed and/or treated in our institution, we used an elective approach to case ascertainment. Sources included two internal databases (computerized discharge data for hospitalizations and outpatient oncology database) and one external (Israel Cancer Registry) database. Histologic diagnosis was confirmed by search of on-line pathology files or discharge summaries. Demographic, histologic and survival characteristics were compared among patients identified through each data source. Survival was assessed via record linkage with the Population Registry. SETTING: A tertiary care university teaching hospital. STUDY PARTICIPANTS: Seven hundred and twelve patients with lymphoma diagnosed between 1987 and 1992. RESULTS: All three sources contributed independently to the total, with the majority (583 or 82%) via hospitalizations. Overlap among the sources was minimal with only 73 (10.3%) of the patients being common to all three sources. Differences (P < 0.05) in the age distribution, country of birth and population groups (defined by religion) as well as histologic diagnoses among the sources were noted. In addition, survival of those ascertained via the outpatient database was higher than those ascertained from other sources (P=0.02 for Hodgkin's disease) even after controlling for age. CONCLUSIONS: The use of multiple data sources for case ascertainment in clinical audit is justified when no patient register exists. The results indicate that use of a single internal data source would have resulted both in an underestimate of the scope of lymphoma in our institution and significant bias in terms of patient characteristics and outcome.

Adolescent↗
PubMed1997

Inadequacy of qualitative implantable cardioverter defibrillator electrogram analysis to distinguish supraventricular from ventricular tachycardia due to electrogram changes during normally conducted complexes.

Stored electrograms (EGMs) recorded from ICD leads are used to evaluate the appropriateness of ICD therapies. Stored EGMs different from sinus have been interpreted as ventricular in origin. We present a patient with an ICD for VT who received multiple shocks for a tachycardia with a stored EGM different than sinus, suggesting VT. An electrophysiological study demonstrated EGMs different than sinus during atrial pacing and induced supraventricular arrhythmias. This case points out the limitations of stored EGMs and suggests complete electrophysiological study with analysis of EGMs during induced arrhythmias should be performed prior to discharge.

Cardiac Pacing, Artificial↗
PubMed1996

Interlaboratory variability in fluorescence in situ hybridization analysis. The NCI Bladder Tumor Marker Network.

Reliable interpretation of fluorescence in situ hybridization (FISH) data, especially data that have been generated in more than one laboratory, requires knowledge of the sources of variability inherent in FISH analysis. Possible sources of variation may derive from differences in sample preparation, probes used, intrasample heterogeneity, hybridization protocols, counting criteria within and between scorers, fluorescence microscopes, and filters. This study characterized the relative weight of some of these factors in order to determine the degree to which FISH results are comparable between laboratories. We used a hierarchical partitioned chi 2 analysis to measure sources of variation. We found that replicate counts varied no more than expected based on counting statistics (i.e., multinomial variation). However, with replicate hybridizations done in two separate laboratories, the variability increased significantly. Thus, care must be taken when interpreting FISH data that are derived from more than one institution. Previously agreed upon counting criteria as well as standardized FISH hybridization protocols may decrease this variability.

Chi-Square Distribution↗
PubMed1996

Exposure to missile attacks: the impact of the Persian Gulf War on physical health behaviours and psychological distress in high and low risk areas in Israel.

The purpose of this study was to compare residents of an area (Tel-Aviv), which was severely afflicted by SCUD missiles during the Persian Gulf War (high risk region), to residents of a low-risk region (Jerusalem) in terms of: (a) changes in physical health, in use of medical or psychological services, and in health behaviours during the period of the war compared to the preceding month; (b) levels of psychological distress (somatization and anxiety) during the war; (c) characteristics of persons at highest risk for psychological distress. Respondents were randomly chosen and interviewed by telephone (N = 545 in Tel-Aviv, N = 406 in Jerusalem). The respondents in both regions reported significant yet similar deterioration in physical health status, and an increase in detrimental health behaviours during the Gulf War. Tel-Aviv residents had significantly higher levels of psychological distress as compared to residents of Jerusalem: in somatization 18 vs 12% respectively (OR = 2.44, CI = 1.39-4.28), in anxiety 34 vs 26% respectively (OR = 1.62, CI = 1.1-2.42). In addition to place of residence, age, ethnicity, religiosity and self-assessed health were identified as characteristics of persons at greater risk for psychological distress.

Adaptation, Psychological↗
PubMed1996

Observer variation in the interpretation of bone scintigraphy.

To assess the reliability of bone scintigraphy, a random sample of 100 bone scans was reviewed twice by each of two physicians. Observer variation in the description and interpretation of bone scintigrams varied by diagnosis. Good to excellent k values were obtained for inter- and intraobserver variation in relation to metastasis or normal scans. For degenerative bone disease, as well as the specific agreement on major pathologies other than metastases, k values were found to be moderate. The agreement on the need for further radiographic studies was poor to moderate. The interpretation of bone metastases or normal scintigrams was found to be more reliable in a research setting than in the usual clinical framework, and the latter requires improvement. The interpretation of bone scintigraphy as consistent with degenerative changes is not reliable. The diagnosis should be evaluated by radiography.

Bone Neoplasms↗
PubMed1996

The prevalence of obesity and its changes over time in middle-aged and elderly men and women in Jerusalem.

OBJECTIVE: To study the prevalence and correlates of overweight and obesity in Jerusalem, and changes over a 15-17 year period. DESIGN: Two cross-sectional surveys in 1970 and in 1986, among residents aged 50 years and more in a defined neighbourhood. SUBJECTS: The study samples comprised 1267 individuals in 1970 and 1858 in 1986. RESULTS: In 1986, 33% of women and 16% of men were obese (BMI > or = 30.0 kg/m2). There was a decreasing trend in the prevalence of obesity with age among women, and in men there was no overall trend but the lowest prevalence was in the 75-84 age-group. Significant relationships with education and region of birth were observed in women only. Prevalence was lowest in the more educated and in women born in Europe and America. Subjects' self-appraisal and their report of physicians' diagnosis of health disorders, revealed a significantly higher prevalence of ill-health among obese people. In 1986 the mean body mass index and the prevalence of obesity were higher than in 1970, in both sexes and in almost all age groups. The prevalence rate of obesity (standardized by sex and age) was 21% in 1970 and 25% in 1986, the difference was statistically significant (p = 0.008). The age standardized prevalence rate in each sex was also higher in 1986 although statistically significant only in men (p = 0.037). CONCLUSION: A community study in Jerusalem revealed a high prevalence of overweight and obesity in 1986 in this middle-aged and elderly population; and a higher mean body mass index and an increased prevalence of obesity were found in 1986 than in 1970, in both sexes. The increased prevalence of obesity among men could not be explained by changes in the age, education and ethnic composition of the population. Among women, the possibility cannot be excluded that part of the increase in obesity was attributable to changes in the distribution of the population by region of birth.

Africa, Northern↗
PubMed1996

Human immunodeficiency virus encephalitis in SCID mice.

The human immunodeficiency virus (HIV) is neuroinvasive and commonly causes cognitive and motor deficits during the later stages of viral infection. (referred to as HIV dementia). The mechanism(s) for disease revolves around secretory products produced from immune-activated brain macrophages/microglia. Recently, we developed an animal model system for HIV dementia that contains xenografts of HIV-1-infected cells inoculated into brains of mice with severe combined immunodeficiency (SCID). This animal system was used to quantitatively evaluate HIV-induced neuropathology. Xenografts of HIV-1-infected human monocytes (placed into the putamen and cortex of SCID mice) remained viable for 5 weeks. HIV-1 p24 antigen expression in mouse brain was persistent. Progressive inflammatory responses (including astrogliosis and cytokine production), which began at 3 days, peaked at day 12. The range of astrocyte proliferative reactions exceeded the inoculation site by > 1000 microns. Brains with virus-infected monocytes showed a > or = 1.6-fold increase in glial fibrillary acidic protein (staining distribution and intensity) as compared with similarly inoculated brains with uninfected control monocytes. These findings paralleled the accumulation and activation of murine microglia (increased branching of cell processes, formation of microglial nodules, interleukin (IL)-1 beta and IL-6 expression). An inflammatory reaction of human monocytes (as defined by HLA-DR, IL-1 beta, IL-6, and tumor necrosis factor-alpha expression) and neuronal injury (apoptosis) also developed after virus-infected monocyte xenograft placement into mouse brain tissue. These data, taken together, demonstrate that this SCID mouse model of HIV-1 neuropathogenesis can reproduce key aspects of disease (virus-infected macrophages, astrocytosis, microglial activation, and neuronal damage). This model may serve as an important means for therapeutic development directed toward improving mental function in HIV-infected subjects with cognitive and motor dysfunction.

AIDS Dementia Complex↗
PubMed1996

The validity of self-reports on chronic disease: characteristics of underreporters and implications for the planning of services.

Data on the prevalence of chronic morbidity are valuable for identifying health care needs and for designing services to meet these needs. Morbidity data are frequently collected through surveys based upon self-reports of disease. However, there is evidence in the literature that people tend to underreport the presence of chronic disease. Our study identified factors related to the underreporting of chronic disease. We interviewed a proportional stratified sample of 521 sick-fund members from two typical urban primary care clinics in Israel. The respondents' self-reports were compared to the diagnoses recorded in medical sources of information. Our findings show that more than half of the respondents with chronic diseases failed to report at least one disease. By using multivariate analysis, we were able to untangle the interrelated effects of age and multiple disease. The findings indicate that "number of diseases"--a variable not taken into account in previous studies--had the greatest effect on underreporting. When controlling for number of diseases, age had an independent effect, although a much smaller one. We also found that the rate of underreporting varies by type of disease. We conclude that chronic morbidity estimates based upon self-reports may lead to the deficient planning of health care services. If possible, alternative sources should be used for collecting morbidity data, especially from patients with multiple diseases and from the elderly. Further research is needed in order to improve estimates of chronic morbidity.

Adult↗
PubMed1995

Reutilization of previously hybridized slides for fluorescence in situ hybridization.

Application of fluorescence in situ hybridization (FISH) to clinical material is sometimes limited by sample size. In addition, heterogeneity among slides prepared from a single sample may lead to variation in FISH analyses. Reutilization of material for repeated FISH analyses would help to alleviate these problems. We have developed a simple procedure for repeated FISH analyses with directly conjugated probes. Previously hybridized probes are removed by incubation in denaturing solution, and slides can then be rehybridized without residual signals remaining. Several cycles of this procedure allow a full complement of chromosomal loci to be analyzed on the same population of cells. Advantages of this protocol include gaining more cytogenetic information from small samples and eliminating the problem of intratumor variability.

Centromere↗
PubMed1995

Iraqi missile attacks on Israel. The association of mortality with a life-threatening stressor.

OBJECTIVE: The imminent deadline for the 1991 Persian Gulf War and, subsequently, the 18 missile attacks by Iraq on Israel represented an unusual, short-term, life-threatening stressor for an entire nation. We studied mortality in Israel in January and February 1991 to determine whether excess deaths were precipitated on days of missile attacks. DESIGN: A time-series mortality study. SETTING: The state of Israel. PARTICIPANTS: All Israelis aged 25 years and older. MAIN OUTCOME MEASURE: Daily mortality by sex, age, region, underlying cause, and place of death. RESULTS: On January 18, 1991, the day of the first strike on Israeli cities, a 58% increment in total mortality occurred in the Israeli population (95% confidence interval [CI], 34% to 86%; P < .0001), a 77% excess (95% CI, 40% to 120%) in women and a 41% excess (95% CI, 10% to 79%) in men. This excess mortality occurred largely in the targeted Tel Aviv-central coastal plain and Haifa regions from cardiovascular causes and mainly out of hospital, significantly more so (P < .01) in women than men. Subsequently, on 16 attack days no overall excess was noted, yet a 10% increase in out-of-hospital deaths occurred. CONCLUSIONS: Likely explanations for the initial increase in mortality include acute emotional stress coupled with breathing difficulties induced by gas masks and extended stay in sealed rooms with resultant hypoxia in susceptible individuals. Women were more vulnerable than men. The absence of elevated total mortality in the subsequent attacks suggests a rapid adaptation to the circumstances surrounding the war. The policy of an unventilated sealed room may have been detrimental.

Adult↗
PubMed1995

Psychosocial and medical factors in pregnancy outcomes: a case study of Israeli women.

Building on a body of research which confirms that psychosocial factors have an important influence on health in general and on pregnancy outcomes in particular, we carried out a prospective study of pregnant women in Israel. We hypothesized that medical pregnancy and delivery outcomes are mediated by psychosocial coping resources and risks. Resources were defined as social ties, and risks as life events self-reported as stressful. The population studied included 233 women who responded to questionnaires after the second trimester of pregnancy. Medical data on the delivery were collected from hospital archives. The questionnaire measured biomedical risks, including general medical and obstetrical history, as well as health behaviours, social ties, and perceived stress. Pregnancy outcomes were classified according to medical measures of abnormalities in mother and child at birth. Our findings show that resources such as the variety of social ties (family, friends, neighbours and colleagues) interacted significantly with biomedical risk. It was found that low scores for social ties anticipated 3.6 times higher negative medical outcome in otherwise healthy women than in those with higher scores for social ties. The findings of the study are discussed in terms of their implications for relating to social competence as a determining element in health and health behaviour.

Adult↗
PubMed1995

A peer review programme to audit the management of hypertensive patients in family practices in Israel.

We introduced and evaluated a self-audit and peer review programme for the management of hypertension in eight urban and rural family medicine practices in northern Israel between January 1991 and December 1992. Changes in the level of blood pressure control and the effect of peer review and self-audit on physicians' management of hypertension were evaluated. Participating physicians were provided with feedback throughout the course of the study. Six hundred and seventy-four hypertensive patients from a total adult population of 4445 patients (15%) were identified in eight practices and followed for two years. The percentage of uncontrolled hypertensives (blood pressure > or = to 160/95 mmHg) decreased from 46.8% at the beginning of the sstudy to 34.3% at its conclusion (P = 0.01). Data on prevalence of hypertension were analysed by participating clinics (prevalence range 8.5-24.6%) and by type of community (rural or urban). In rural communities 50% of the hypertensives were > or = to 70 years of age, compared with 39.5% in the urban practices. Differences in prescribing practices among participating physicians were discussed during peer review group meetings and changes in prescribed medications for hypertension were evaluated. We conclude that this method of self-audit and peer review is effective in improving the management of patients with hypertension in family medicine practices. It was implemented at a minimal cost, is feasible in busy practices and can be generalized to the management of other chronic diseases in the community.

Adult↗
PubMed1995

Trends in blood pressure levels over time in middle-aged and elderly Jerusalem residents.

Change in blood pressure levels over time was investigated in Jerusalem, in two cross-sectional surveys in 1970 and in 1986 among residents of a neighbourhood aged 50 years and more. The study population comprised 1397 individuals in 1970 and 1858 in the 1986. Age-adjusted mean systolic and diastolic blood pressure levels were lower in 1986 than in 1970 by 6.9 mmHg and 4.7 mmHg, respectively. The prevalence of blood pressure levels above 160 and/or 95 mmHg in 1986 was lower by 50% and there was a twofold increase in current treatment for hypertension. The reduction in blood pressure in both sexes remained evident upon control for confounding effects of age, ethnic group, education, body mass index and reported treatment for hypertension. The proportion of people who had blood pressure levels below 140/90 and did not report being under treatment, increased. The possibility of methodological problems inherent in this type of study were considered. More effective antihypertensive treatment in 1986 can explain only part of the reduction. The decrease in levels of blood pressure as revealed by this study may reflect a real reduction in the population that could explain part of the striking decline in cardiovascular mortality in Israel.

Aged↗
PubMed1995

Comparison of cephalometric analysis with ethnicity in obstructive sleep apnea syndrome.

Many studies have documented significant craniomandibular abnormalities in obstructive sleep apnea syndrome (OSAS) patients. Recent literature clearly describes the cephalometric abnormalities commonly associated with OSAS. Studies have not evaluated specific cephalometric abnormalities that may contribute to OSAS by various ethnic groups. Data were collected on 48 patients (20 Caucasian, 15 Black and 13 Hispanic) with completed cephalometric analysis and polysomnography. Cephalometric landmarks, angles and measurements [angle measured from sella to nasion to subspinale point (SNA), angle measured from sella to nasion to supramentale point (SNB), difference between SNA and SNB (ANB), perpendicular distance from gonion to gnathion to hyoid (MP-H), distance from posterior nasal spine to tip of soft palate (PNS-P) and posterior airway space (PAS)] commonly used in the evaluation of OSAS patients were recorded. Measurements were normalized by dividing the observed value by the mean value for the ethnic group. Statistically significant differences in normalized SNA and SNB appeared in the Black and Hispanic groups when compared to the Caucasian group. For both SNA and SNB, Blacks averaged approximately 3.5% above their ethnic mean, whereas Hispanics averaged 1.8-2.8% below their ethnic mean. There was a statistically significant correlation between respiratory distress index (RDI) and MP-H. These baseline cephalometric differences in the ethnic groups studied suggest that surgical intervention might be approached differently in various ethnic groups. Further studies that evaluate the surgical success achieved by various procedures among different ethnic groups may help define surgical protocol in various ethnic groups for OSAS.

Cephalometry↗
PubMed1995

Professional evacuation of persons injured in road accidents in Israel is fast but underused.

In a study of the evacuation process of injured people from motor vehicle accidents, 2,206 injured evacuees were interviewed in five emergency rooms in Israel. Of these, only 53% were evacuated professionally (by ambulance or helicopter), and only 75% arrived directly to an emergency room. In a logistic regression analysis, differences were found in relation to regions, type of road (urban vs. interurban), education, and severity of the injury. Higher education was associated with lower percentage of professional evacuation. Of those injured who arrived directly at emergency rooms, 67% did so within an hour (the "golden hour"). We found that professional evacuation was more rapid than nonprofessional evacuation.

Accidents, Traffic↗