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Biomedical subjects

M Marcus

Publications and source records attributed to M Marcus.

At least 37 records · Page 2Linked to original sources
PubMed1999

Serum follicle-stimulating hormone and luteinizing hormone levels in women aged 35-60 in the U.S. population: the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994).

OBJECTIVE: The objective of this study was to examine age-specific population-based values for serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels in women in the U.S. population. DESIGN: Data were collected from a nationally representative cross-sectional health examination survey that included measurements of follicle-stimulating hormone and luteinizing hormone and information from a personal interview. A total of 3388 women aged 35 to 60 years were examined during the third National Health and Nutrition Examination Survey, 1988-1994. RESULTS: Among U.S. women aged 35-60 years, median FSH and LH levels began to increase for women in their late 40s and reached a plateau for women in their early 50s. This study supports the previously reported association between serum FSH and age (i.e., serum FSH and LH levels increase with age) and smoking (i.e., current smoking was associated with an increased level of serum FSH). At FSH levels of > or = 15 IU/L or > or = 20 IU/L. 70 and 73% of women, respectively, were postmenopausal. Our study also found an interaction between age and oophorectomy. In addition, the present data suggest that women with only one ovary may have higher FSH levels than women with both of their ovaries. CONCLUSIONS: NHANES III provides population-based data that support previously reported associations between serum FSH level and age, smoking, and menopausal status.

Adult↗
PubMed1999

National probability samples in studies of low-prevalence diseases. Part I: Perspectives and lessons from the HIV cost and services utilization study.

OBJECTIVE: To examine the trade-offs inherent in selecting a sample design for a national study of care for an uncommon disease, and the adaptations, opportunities and costs associated with the choice of national probability sampling in a study of HIV/AIDS. SETTING: A consortium of public and private funders, research organizations, community advocates, and local providers assembled to design and execute the study. DESIGN: Data collected by providers or collected for administrative purposes are limited by selectivity and concerns about validity. In studies based on convenience sampling, generalizability is uncertain. Multistage probability sampling through households may not produce sufficient cases of diseases that are not highly prevalent. In such cases, an attractive alternative design is multistage probability sampling through sites of care, in which all persons in the reference population have some chance of random selection through their medical providers, and in which included subjects are selected with known probability. DATA COLLECTION AND PRINCIPAL FINDINGS: Multistage national probability sampling through providers supplies uniquely valuable information, but will not represent populations not receiving medical care and may not provide sufficient cases in subpopulations of interest. Factors contributing to the substantial cost of such a design include the need to develop a sampling frame, the problems associated with recruitment of providers and subjects through medical providers, the need for buy-in from persons affected by the disease and their medical practitioners, as well as the need for a high participation rate. Broad representation from the national community of scholars with relevant expertise is desirable. Special problems are associated with organization of the research effort, with instrument development, and with data analysis and dissemination in such a consortium. CONCLUSIONS: Multistage probability sampling through providers can provide unbiased, nationally representative data on persons receiving regular medical care for uncommon diseases and can improve our ability to accurately study care and its outcomes for diseases such as HIV/AIDS. However, substantial costs and special circumstances are associated with the implementation of such efforts.

Data Collection↗
PubMed1998

Increased risk for familial ovarian cancer among Jewish women: a population-based case-control study.

Jewish women have been reported to have a higher risk for familial breast cancer than non-Jewish women and to be more likely to carry mutations in breast cancer genes such as BRCA1. Because BRCA1 mutations also increase women's risk for ovarian cancer, we asked whether Jewish women are at higher risk for familial ovarian cancer than non-Jewish women. To determine the effects of 1) Jewish religion and 2) ovarian cancer in a first-degree relative on women's risk for epithelial ovarian cancer, we used data from a population-based, case-control study conducted in 8 geographic regions in the United States from 1980 through 1982. The study group included 471 cases and 4,025 controls. Jewish women were more likely to have familial ovarian cancer than non-Jewish women [odds ratio (OR) = 8.4, 95% confidence interval (CI) = 2.6-28]. The risk of having ovarian cancer appeared to be greater in Jewish women having a first-degree relative with ovarian cancer (OR = 8.81, 95% CI = 2.02-38.23) than in non-Jewish women having a first-degree relative with ovarian cancer (OR = 3.01, 95% CI = 1.61-5.64), but differences between Jewish and non-Jewish women were not statistically significant. Jewish women with no first-degree relative with ovarian cancer had no increased risk for ovarian cancer (OR = 1.27, 95% CI = 0.74-2.91) compared to non-Jewish women. These results suggest that Jewish women may have a higher rate of familial ovarian cancer than non-Jewish women, but because the results are based on a small number of Jewish women with familial ovarian cancer, the results need to be confirmed in larger studies.

Adult↗
PubMed1998

Changing sex ratio in the United States, 1969-1995.

OBJECTIVE: To determine if the sex ratio of live births in the United States has changed during the 27 years from 1969 through 1995. DESIGN: Regression analysis of secular trends in sex ratios. SETTING: Population-based data. PATIENT(S): Liveborn infants in the United States 1969-1995. MAIN OUTCOME MEASURE(S): Sex of liveborn infant. RESULT(S): The sex ratio (number of male births divided by number of female births) declined significantly among whites during the 27 years under study. Among black newborns, the sex ratio significantly increased during the same time period. CONCLUSION(S): These secular trends could not be explained by changing maternal or paternal age, or by changing proportions of specific birth orders. Possible explanations for the observed changes in sex ratio include random fluctuations in sex ratio over time, changes in demographic characteristics of the population (other than the characteristics controlled for in this analysis), and changes in frequency or timing of intercourse. Environmental exposures are unlikely to account for the observed trends.

Black People↗
PubMed1998

A case of severe cerebral trauma in a patient under chronic treatment with cyclosporine A.

A case of severe cerebral head injury in a child, chronically treated with cyclosporine A after orthotopic liver transplantation, is presented. The initial Glasgow Coma Scale score after the motor vehicle accident was 3, and computed tomography showed multiple sites of intracerebral bleeding, an epidural hematoma, and signs of perifocal edema. Although these lesions are normally associated with a poor outcome, the child recovered unexpectedly well. In brain injury, a lucid interval can be followed by secondary neurologic deterioration due to a loss of high-energy metabolites, a release of neurotransmitters, and an increase in intracellular Ca2+. These events finally led to cell damage in the penumbra of an ischemic infarction. Among other drugs, immunosuppressants such as cyclosporine A have been shown to exhibit neuroprotective properties in experimental models if given during this time interval of secondary neurologic deterioration. Although human data on these effects are still lacking, we conclude that neuroprotective actions of cyclosporine A may have been involved in the favorable outcome in this 14-year-old boy.

Adolescent↗
PubMed1998

Concepts of quality and the provision of periodontal care: a survey.

This is a survey of various concepts of quality of care in the health care field and their application to periodontics. Definitions of quality care, measuring and improving quality, third party payment and quality of care, and the role of periodontists in managing quality are presented. The definitions of quality care include the following dimensions: access, appropriateness, technical quality, and the art of care. Examples of each of these dimensions are presented, and their implications for quality assessment are discussed. Emphasis is placed on appropriateness of care and the strengths and weaknesses of mechanisms for deriving evidence-based decision making. The use of randomized clinical trials (RCT), employing expert opinion such as consensus panels, and meta-analysis are discussed as they apply to appropriateness of periodontal treatment. Work in the area of technical quality of care (i.e., the third dimension of quality care) has resulted in the development of quality assurance guidelines. Examples of guidelines and practice parameters such as those developed by the U.S. Food and Drug Administration and by various dental specialties are presented. The fourth dimension of quality deals with the art of care. It focuses on the patient's participation in the process of care and the input of the provider in this interaction. The description of outcomes of care includes the concept of measuring clinical outcomes of treatment as well as efforts to measure the health and well-being of a patient. It deals with quality of life measures. Patient satisfaction is another outcome that is presented. Examples of these aspects of quality measurement are discussed. These concepts and measures are presented within the context of a quality assurance program. The steps used to assess and assure quality are outlined. Examples of provider and patient profiles are presented, along with a discussion on how they are used in a quality assurance system. Lastly, the role of the periodontist in quality of care is presented, emphasizing the efforts that have already been made as well as the leadership role that the periodontist has in influencing the profession of dentistry. The advent of managed care and its implications for the quality of periodontal treatment and patient management are discussed using situations obtained from dental plans.

Consensus Statements as Topic↗
PubMed1998

Calprotectin and lactoferrin levels in the gingival crevicular fluid of children.

The purpose of this study was to determine the levels of calprotectin and lactoferrin, 2 microbiostatic proteins, in the gingival crevicular fluid (GCF) of normal children. The children represented a population, primarily underprivileged, seeking care at a regional dental health care center. GCF was collected from Ramfjord teeth (or their deciduous equivalent). GCF volume was quantified by conductance. Calprotectin and lactoferrin levels were quantified by sandwich ELISA, and found to have a mean value of 70.8+/-94.2 microg/mL and 68.2+/-108.7 microg/mL, respectively. The levels of calprotectin and lactoferrin varied directly with one another and inversely with the amount of fluid obtained in a 20-second sampling period. The mean levels were at or above the minimum inhibitory concentration determined in vitro.

Adolescent↗
PubMed1998

Consistency across panels of ratings of appropriateness of dental care treatment procedures.

OBJECTIVE: To report on a study investigating the consistency across different consensus panels of ratings of appropriateness for dental procedures. RESEARCH DESIGN: The study conducted four consensus panels to determine, under various conditions, the appropriateness of five options for patients: no treatment; filling; crown; root canal with a filling or crown; extraction. The patients were categorised according to age; regular versus irregular use of dental care; degree of caries; degree of pain; degree of periodontal disease. PARTICIPANTS: The panellists were dentists enrolled in a continuing education programme on assessing the quality of dental care. The panellists were all individuals employed by various dental plans to evaluate the quality of care plans operating in California. RESULTS: The results indicate that the method does distinguish the dimensions of appropriateness used by the panellists in making their decisions, and that it is possible to substantially increase consensus among a diverse group of dentists and across separate panels on some procedures. However, it also showed that the process is sensitive to varying panels and that different variables had different outcomes in the ratings from the various panels. CONCLUSION: The consensus panel method holds some promise for determining the appropriateness of dental care. However the results of this study question whether it results in consistent ratings across different panels.

Adult↗
PubMed1997

The Union Health Center: a working model of clinical care linked to preventive occupational health services.

As health care provision in the United States shifts to primary care settings, it is vital that new models of occupational health services be developed that link clinical care to prevention. The model program described in this paper was developed at the Union Health Center (UHC), a comprehensive health care center supported by the International Ladies Garment Workers Union (now the Union of Needletrades, Industrial and Textile Employees) serving a population of approximately 50,000 primarily minority, female garment workers in New York City. The objective of this paper is to describe a model occupational medicine program in a union-based comprehensive health center linking accessible clinical care with primary and secondary disease prevention efforts. To assess the presence of symptoms suggestive of occupational disease, a health status questionnaire was administered to female workers attending the UHC for routine health maintenance. Based on the results of this survey, an occupational medicine clinic was developed that integrated direct clinical care with worker and employer education and workplace hazard abatement. To assess the success of this new approach, selected cases of sentinel health events were tracked and a chart review was conducted after 3 years of clinic operation. Prior to initiation of the occupational medicine clinic, 64% (648) of the workers surveyed reported symptoms indicative of occupational illnesses. However, only 42 (4%) reported having been told by a physician that they had an occupational illness and only 4 (.4%) reported having field a workers' compensation claim for an occupational disease. In the occupational medicine clinic established at the UHC, a health and safety specialist acts as a case manager, coordinating worker and employer education as well as workplace hazard abatement focused on disease prevention, ensuring that every case of occupational disease is treated as a potential sentinel health event. As examples of the success of this approach, index cases of rotator cuff tendonitis, lead poisoning, and formaldehyde overexposure in three patients and their preventative workplace follow-up, affecting approximately 150 workers at three worksites, are described. Work-related conditions diagnosed during the first 3 years of clinic operation included cumulative trauma disorders (141 cases), carpal tunnel syndrome (47 cases), low back disorders (33 cases), lead poisoning (20 cases), and respiratory disease (9 cases). This pilot project represents a new model for effective integration of clinical care and occupational disease prevention efforts within a primary care center. It could serve as a prototype for development of such services in other managed and primary care settings.

Ambulatory Care Facilities↗
PubMed1997

Differential effects of acute and chronic nicotine on dopamine output in the core and shell of the rat nucleus accumbens.

Like several drugs of abuse, nicotine increase dopamine (DA) release in the nucleus accumbens (NAC). In the present study, the effects of acute and chronic nicotine on DA output in two subdivisions of the NAC, the core and the shell, which are largely associated with motor control and limbic functions, respectively, were examined by means of in vivo differential normal pulse voltammetry in anesthetized, pargyline-treated rats. In the first experiment, acute administration of nicotine (25, 50 and 100 micrograms/kg, cumulative doses; i.v.) was found to increase DA levels in the NACshell to 163% of baseline, whereas DA output in the NACcore was not significantly affected. In the second experiment, animals were pretreated with twelve daily injections of saline or nicotine (0.5 mg/kg, i.p.); about 24 hours after the last injection, the animals were challenged with nicotine (50 micrograms/kg and 100 micrograms/kg, cumulative doses; i.v.). Under these conditions, nicotine increased DA output in the NACshell in saline-pretreated animals to 248% and in nicotine-pretreated rats to 180%. Also, nicotine increased DA output in the NACcore in saline-pretreated animals to 185%, whereas no significant effect was observed in nicotine-pretreated rats. The results of the present experiments indicate (i) that acutely administered nicotine or nicotine challenge in chronically pretreated animals with either saline or nicotine consistently increases DA release to a greater extent in the NACshell than in the NACcore, and (ii) that chronic nicotine pretreatment reduces the stimulatory-action of nicotine on DA output in either the shell or the core subdivision of the NAC.

Animals↗
PubMed1997

Measurement variability in upper extremity posture among VDT users.

Hand and arm posture while keying is frequently mentioned as a risk factor for upper extremity musculoskeletal disorders (UEMSDs) among video display terminal (VDT) operators. However, many epidemiologic studies have not included measures of posture of VDT operators, in part, because of the difficulty of assessing posture rapidly and reliably among large numbers of subjects. For a single measure of posture to be useful for estimating dose-response relationships between posture and risk of UEMSDs, the within-subject variability of the postural measure must be smaller than the between-subject variability of the postural measure. In addition, the measure must be stable over time. We estimate the ratio of between- to within-subject variability for manual goniometry by measuring six postural angles on six occasions among 19 subjects using VDTs. For each postural angle, between-subject variability was substantially and statistically significantly larger than within-subject variability. Stability of postural measures over time was sufficient to justify a single postural measurement in epidemiologic studies. We conclude that manual goniometry can provide useful information about upper extremity posture among VDT users for use in epidemiologic studies of UEMSDs.

Adult↗
PubMed1997

Clinical measures and treatment needs.

Clinically evaluated oral health outcome variables from the ICS-II USA data set were examined in the diverse ethnic groups, for two adult age cohorts (35-44 and 65-74 years). These measures were derived from epidemiological examinations and include the DMFT components, loss of attachment, and an indicator of treatment need--the ratio of decayed teeth over decayed and filled teeth. The ratio of decayed over decayed and filled teeth was used in multivariate analysis, since this measure represents an area where public policy could have an impact if determinants were understood. The most important independent variables were race-ethnicity, educational attainment, no fear of dental visits because of pain, and oral hygiene practices. Having a usual source of dental care and visiting the dentist within the past 12 months did not appear to be as important in predicting unmet needs as these other variables. To bridge the gap between the oral health status of majority and minority populations, health educators in minority communities need to become more accessible, have a pro-active interest in oral health, and also be cognizant of the various socio-cultural issues influencing oral health. The problems regarding Native American adults are more complex and require more careful study.

Adult↗
PubMed1997

Consumer satisfaction.

Patient satisfaction with dental care is compared across six United States groups: Whites in Baltimore and San Antonio, African-Americans in Baltimore, Hispanics in San Antonio, and Native Americans in the Southwest and the Dakotas. First, differences in patient satisfaction across ethnic groups and between two age groups (65-74 years old and 35-44 years old) are considered. Generally, people from all age and ethnic groups were satisfied with the last dental visit. Second, patient satisfaction is conceptualized as an oral health outcome influenced by characteristics of the dental service utilizer: predisposing sociodemographic characteristics, predisposing oral beliefs, enabling characteristics, oral needs, oral health behaviors, and oral health status. Multivariate analyses by age and ethnic group are used to identify characteristics that influence patient satisfaction. Sociodemographic characteristics were important among the elderly. Strong oral health beliefs influenced patient satisfaction among younger adults. Enabling characteristics were important predictors among the Native American groups. This model explained 15%-30% of the variability in patient satisfaction among the study age and ethnic groups.

Adult↗
PubMed1997

Nitrate toxicosis in beef and dairy cattle herds due to contamination of drinking water and whey.

Four cases of rarely reported nitrate toxicosis due to contamination of drinking water or whey were recorded in 2 beef and 2 dairy cattle herds. In the cases associated with water contamination, water containing ammonium nitrate as a fertilizer for irrigating orchards accidentally entered drinking water troughs for cattle through malfunctioning 1-way valves. The whey contamination in 1 instance was caused by transportation in containers which contained traces of concentrated ammonium nitrate; the 2nd case was induced by whey derived from the production of a specialty cheese produced by the incorporation of nitrate. Mortality occurred in 2 herds and abortions in the 2 other herds. Affected cows responded well to treatment, but some animals remained in a deteriorated physical condition for several months.

Animal Feed↗
PubMed1996

Upper extremity musculoskeletal symptoms among female office workers: associations with video display terminal use and occupational psychosocial stressors.

The relationships between musculoskeletal symptoms and both video display terminal (VDT) use and occupational psychosocial stress were assessed among women office workers by self-administered questionnaires. Significantly increased odds ratios for neck or shoulder symptoms were observed for subjects who had ever used a VDT, had less job security, and had more stressful work during the 2 weeks prior to completion of the questionnaire. Significantly increased odds ratios for arm and hand symptoms were observed for subjects who had used a VDT for more than 6 years, reported a very crowded workplace, or reported very stressful work during the 2 weeks prior to completion of the questionnaire. Among current non-users, those who previously used VDTs were more likely to report upper extremity musculoskeletal symptoms than those who had never used VDTs. This suggests that individuals with symptoms may be more likely to reduce their VDT usage, distorting results of cross-sectional studies.

Adult↗
PubMed1996

Methodological limitations in the study of video display terminal use and upper extremity musculoskeletal disorders.

Upper extremity musculoskeletal disorders may occur as a result of work with keyboard-equipped video display terminals. Many studies of the associations between keyboard use and upper extremity disorders have appeared in both the human factors and occupational epidemiologic literature. Methodological limitations and inconsistent results have limited conclusions that can be made from these studies, however. Although exposure conditions can be carefully controlled, human factors studies are limited by relatively small sample sizes, short exposure durations, and reliance on outcome measures with unknown relevance to chronic adverse health effects. Epidemiologic studies have been limited by poor ascertainment of both exposure and health outcome. Many have failed to control for any potential confounding. An almost exclusive reliance on cross-sectional study designs has resulted in possible bias from selective survival, exposure-effect reversal, and poor estimates of exposures occurring prior to development of the disorder. Given the inconsistency in the literature and the growing controversy surrounding this issue, prospective study of this question using objective methods for assessment of exposure and health outcome is recommended. This design allows identification of incident cases and minimizes bias from selective survival. In addition, ergonomic and psychosocial variables prior to onset of symptoms can be ascertained periodically. Given estimates for up to 100 million video display terminals to be in use in the United States by the year 2000, clarification of the health effects of their use is critical.

Arm Injuries↗