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Biomedical subjects

M L Rosenberg

Publications and source records attributed to M L Rosenberg.

At least 19 recordsLinked to original sources
PubMed2001

Quantification of optic nerve axon loss associated with a relative afferent pupillary defect in the monkey.

OBJECTIVE: To quantify the amount of optic nerve axonal loss associated with the presence of a mild relative afferent pupillary defect (RAPD) in an experimental monkey model. METHODS: The right macula of 5 rhesus monkeys (Macaca mulatta) was treated with concentrically enlarging diode laser burns until an RAPD was detected using a transilluminator light and measured with neutral density filters. Intervals between treatments were 3 to 7 days over a period of 2 months. Pupillary responses to light stimulation were recorded with a monocular infrared television pupillometer. Two months after detection of an RAPD, 5 treated and 4 control monkeys underwent euthanasia and enucleation. Histopathologic analysis and quantification of optic nerve axon counts using an image analysis system were performed. RESULTS: No RAPD was observed despite an estimated ganglion cell loss of up to 26%. A 0.6 log unit RAPD was present in 5 monkeys when the laser scar incorporated the entire macula within the temporal vascular arcades. One eye had progressive vitreomacular traction with worsening of the RAPD to 1.8 log units without further laser treatment. Histopathologic evaluation disclosed complete loss of the normal retinal architecture within the macula. The average fiber loss for the 4 treated eyes with 0.6 log unit RAPDs compared with fellow eyes was 53.3% (95% confidence interval [CI], 45.0%-61.6%). The average difference in axon counts between untreated pairs of optic nerves was 12.8% (95% CI, 10.0%-15.6%). Optic nerve axon loss between pairs of experimental and control eyes was statistically significant (P<.001). CONCLUSION: In rhesus monkeys, an RAPD develops after an approximate unilateral loss between 25% and 50% of retinal ganglion cells. CLINICAL RELEVANCE: Owing to redundancy in the anterior visual pathways, unilateral retinal ganglion cell loss may occur prior to the observation of an RAPD. The presence of an RAPD measuring 0.6 log units implies that significant retinal ganglion cell injury has occurred.

Animals↗
PubMed2001

The effect of lid elevation on the cross-cover test.

OBJECTIVE: To discern the effect of manual lid elevation on muscle balance using the cross-cover test. MATERIALS AND METHODS: One hundred consecutive patients who were orthophoric in all fields of gaze were prospectively studied. A repeat cross-cover test was performed with the eyes looking down and to either side while pulling the lid ipsilateral to the abducting eye up and to either side. The presence and type of any phoria was noted. RESULTS: Eighty-four percent of patients and 76% of eyes developed a phoria with lifting a lid. Vertical phorias developed in 79 patients and 136 eyes, whereas horizontal phorias were seen in 51 patients and 83 eyes. In all but one case, the vertical deviation was a hyperphoria ipsilateral to the elevated lid. Horizontal deviations were esophoric in 63 eyes of 39 subjects. Induced phorias were most commonly symmetric from side to side. CONCLUSIONS: Lifting the lid produces an iatrogenic phoria that mimics a skew or IV nerve paresis. We hypothesize that stretching the lid causes traction on the levator-superior rectus complex, thereby increasing its tone. Although it makes testing more difficult, we recommend that the lids not be manipulated while performing phoria testing.

Diagnostic Techniques, Ophthalmological↗
PubMed2000

Neuro-otologic history.

Throughout medicine, the clinical history is the most important diagnostic tool. This is particularly true in vestibular disease, where pathologic confirmation of the disease process is rare. Many vestibular conditions are more appropriately called syndromes, rather than diseases, because the pathology is either variable or unknown. Knowledge of the anatomy and physiology provides the basis of understanding the control of balance and the symptoms that might occur should something go wrong. History taking should cover the elements of the balance system, including vestibular function, vision, hearing, somatosensation, and motor function.

Ear, Inner↗
PubMed2000

Building a foundation for suicide prevention: the contributions of Jack C. Smith.

Among his many other accomplishments, Jack C. Smith nurtured the early development of efforts by the Centers for Disease Control and Prevention (CDC) to address suicide as a public health problem. Smith's vision was to achieve suicide prevention through epidemiology, and his vision shaped the emergence of suicide as a public health issue. With his typical enthusiasm and inherent ability to insinuate himself into critical social networks, Smith spearheaded CDC's initial suicide surveillance activities and established strong partnerships between CDC and the National Institute of Mental Health (NIMH) and the American Association of Suicidology (AAS). These surveillance activities and relationships were the foundation on which subsequent research and programmatic activities addressing suicide as a public health problem were built at CDC. In this paper we document Smith's role in the development of the public health approach to suicide prevention. We also articulate the conceptual basis for a public health approach to suicide and discuss future directions for public health in the prevention of suicide and suicidal behavior. While Smith also made important contributions to development of CDC efforts to address homicide, his special interest was suicide; therefore, this article will emphasize his contributions to this area.

Adolescent↗
PubMed1997

Bridging prevention and practice: public health and family violence.

Public health approaches the primary prevention of family violence by focusing on surveillance, the identification of risk factors, and the development, evaluation, and dissemination of interventions. Physicians and other health care providers are crucial in this process because they are in a unique position to identify at-risk individuals and populations and to implement both broad-based and targeted preventive and intervention initiatives. Incorporating public health principles into medical education and medical practice not only can reduce the severity of this epidemic by strengthening efforts in early detection and expert intervention but also can create effective primary prevention, an important necessary step towards eradicating every disease or condition. This article discusses the role of public health professionals in preventing family and intimate violence. It notes specific findings from public health research, including the cycle of violence and the need to incorporate issues of abuse across the life span, and other factors, into medical education. Addressing family and intimate violence in a caring and sensitive manner is difficult, and incorporating public health principles into medical education and medical practice can forge an effective partnership between medical practitioners and public health professionals. This new partnership represents both an important challenge and a unique opportunity to understand family and intimate violence and thus to develop and evaluate effective short- and long-term solutions.

Attitude of Health Personnel↗
PubMed1995

Prevention of family violence.

Physicians must learn to recognize the victims of family violence among their patients and must then work to prevent such abuse. To help provide information that can help physicians understand and prevent family violence, the Centers for Disease Control and Prevention (CDC) is involved in gathering data that will enable scientists (1) to see the patterns of family violence, (2) to determine the risk factors, and (3) to evaluate interventions to prevent future violence. Then the task will be (4) to establish programs of prevention on a successful scale. The author describes several specific CDC programs designed to meet these four goals, with the ultimate goal being the drastic lowering of incidences of family violence. Medical schools can help reach that goal by using the knowledge gained by such research for curriculum development to train physicians to treat and prevent family violence.

Battered Women↗
PubMed1995

Violence in America: an integrated approach to understanding and prevention.

Violence in our country has reached epidemic proportions, especially among our youth. Of 22 industrialized nations, the United States has the highest homicide rate among young males 15 to 24 years of age. To reduce the incidence of violence, we must radically shift our approach to emphasize prevention and intervention. There are several ways of achieving violence reduction through these means. The scientific approach requires the determination of causation and risk factors to shed light on the patterns of violence and the effects on subgroups of the population. Also required is the development of targeted programs aimed at specific high-risk populations. In the area of youth violence intervention, programs must focus on young children and their parents, often children themselves, to prompt appropriate changes in knowledge, skills, and attitudes. Community-based programs can go a step further to initiate changes in the social environment that will create opportunities for adequate housing, job training or employment, or academic achievement. These efforts exemplify the notion that violence is not a factor of race, but rather is based on socioeconomic factors, particularly poverty and racism.

Adolescent↗
PubMed1994

One-year outcome for patients with a chief complaint of dizziness.

UNLABELLED: OBJECTIVE. To determine the one-year outcome for patients with a chief complaint of dizziness that had persisted at least two weeks. DESIGN: Prospective cohort study. SETTING: Federal teaching hospital. PATIENTS: 100 dizzy patients and 25 control subjects. MEASUREMENTS: The primary outcome was dizziness status (improved or not improved); the secondary outcomes were morbidity and health care utilization. RESULTS: The dizziness resolved for 18 patients, whereas the status improved for 37, stayed the same for 32, and worsened for 11, with two patients lost to follow-up. Thus, 55% of patients whose dizziness had not resolved two weeks after their initial visits improved over the subsequent 12 months. Logistic regression revealed four independent predictors of persistent dizziness at one-year follow-up: dizziness due to psychiatric causes, dysequilibrium, vertigo other than benign positional vertigo, vestibular neuronitis, or migraine (odds ratio, 6.3; 95% CI, 2.1-18.6); daily dizziness (odds ratio, 6.4; 95% CI, 2.0-21.0); dizziness worse with walking (odds ratio, 3.0; 95% CI, 1.1-9.0); and patient had initially feared a serious illness (odds ratio, 0.25; 95% CI, 0.10-0.74). These four factors could be used to classify patients as having either a high (82%), medium (47%), or low (0%) likelihood of improvement at one-year follow-up. One patient died from heart failure, and none developed a serious disease for which dizziness had been a harbinger. Dizziness was not associated with an increased number of clinic visits. CONCLUSIONS: Among patients with a chief complaint of dizziness who are still symptomatic at two-week follow-up, more than half improve within a year. Clinical factors identify patients at higher risk for persistent dizziness.

Cohort Studies↗