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Biomedical subjects

M A Zielezny

Publications and source records attributed to M A Zielezny.

5 recordsLinked to original sources
PubMed1991

Relevance of major stress events as an indicator of disease activity prevalence in inflammatory bowel disease.

The impact of psychological stress in recurrence of inflammatory bowel disease (IBD) is unclear. Why some patients with ulcerative colitis (UC) or Crohn's disease (CD) have unrelenting relapses whereas other IBD patients experience long periods of quiescent disease remains an enigma. The authors examined the risk of exposure to major stress events in clinical episodes of IBD. They followed up on 124 persons in a prospective study that monitored behavioral and biological characteristics for a period of 6 months. Stress-exposed subjects demonstrated increased risk of clinical episodes of disease when compared with unexposed subjects (RR = 2.6, 95% CI: 1.3-4.9). Elevated effect measures were highest for the domain of health-related stress (RR = 3.8, 95% CI: 1.5-9.9). In the multiple regression analysis, major stress events remained the most significant indicator of disease activity in the presence of the covariables considered. Only 7% of the variation in disease activity was uniquely attributed to stress. Baseline activity was the other notable indicator of subsequent disease activity in the study sample. All variables considered together explained 52% of the variance observed and implicated factors of potential clinical importance in monitoring recurrence of the disease.

Adult↗
PubMed1991

Lag time between stress events and risk of recurrent episodes of inflammatory bowel disease.

We followed a cohort of 124 subjects with a history of inflammatory bowel disease to ascertain risk estimates for clinically active disease associated with exposure to recent stress events. We calculated risk estimates for three lag models (-1, 0, + 1 month). The data indicated a strong association between stress exposures and new clinical episodes of disease (RR = 2.9, 95% Cl: 2.0-4.1), most apparent in the immediate period (lag = 0). Risk estimates were also elevated for extended episodes of disease in subjects under stress compared with unexposed subjects. These results underscore the importance of monitoring stress exposures in prevention and treatment of recurrent disease.

Acute Disease↗
PubMed1991

Rural medicine and the closed society. Pregnancy outcomes among Amish and non-Amish women.

A rural family practitioner may be responsible for the general medical and obstetric needs of a closed population such as the Old Order Amish. Until recently, the Amish in southern New York State have preferred to receive obstetric care in the home from traditional Amish midwives. Acceptance of prenatal care and hospital deliveries by rural physicians appears to be increasingly frequent among Amish primiparas in southern New York State, while non-Amish in the area have been seeking these services for decades regardless of parity. This retrospective chart review examines first pregnancy outcomes of Amish (N = 39) and non-Amish (N = 145) women who delivered their babies at a rural hospital in southern New York State during a four-year period. Little difference was found between the two groups of women regarding the overall good health of their first babies. In the Amish population there was less variability in maternal age, season in which the birth occurred, labor duration, and birth weight of babies. The Amish had their first child an average of one year later than the non-Amish. While research on a larger sample will be necessary to fully explore Amish vs non-Amish variances, this study demonstrates the effect that traditions and customs of a closed society such as the Amish may have on obstetric practice.

Adult↗
PubMedDate not supplied

Cigarette smoking and risk of clinical relapse in patients with Crohn's disease.

Risk of clinical relapse among cigarette smokers and nonsmokers was examined in a cohort of 74 adult Crohn's disease (CD) patients who were identified and followed at monthly intervals for six months. We measured clinical activity by a weighted symptom index used previously. Relapse at any point during the study was defined by the index score exceeding 150. Approximately 50% of nonsmokers experienced clinical relapse during the study period. Current smokers experienced a relapse risk 1.6 times that of nonsmokers (P less than .01). The risk estimates correspond to mean overall clinical activity scores of 142 +/- 34 for smokers compared to 119 +/- 26 for nonsmokers. Adjustment for confounding effects did not substantially alter the association shown between cigarette use and clinical relapse. We observed no increase in the likelihood of relapse among former smokers. The statistically significant finding that current smoking increases the risk of relapse for CD patients is of clinical importance, given the high prevalence of smoking (42%) among CD patients in this sample.

Adult↗