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Biomedical subjects

M R Krauss

Publications and source records attributed to M R Krauss.

At least 19 recordsLinked to original sources
PubMed2001

Weighing in on type 2 diabetes in the military: characteristics of U.S. military personnel at entry who develop type 2 diabetes.

OBJECTIVES: Current incidence trends in type 2 diabetes portend a significant public health burden and have largely been attributed to similar trends in overweight and physical inactivity. Medical surveillance of the U.S. military indicates that the incidence of all types of diabetes is similar to that in the civilian population (1.9 vs. 1.6 cases per 1,000 person-years) despite weight and fitness standards. Differences in the common determinants of diabetes have not been studied in the military population, which may provide novel clues to the increasing incidence of diabetes in the U.S. RESEARCH DESIGN AND METHODS: A case-control study, 4-to-1 matched for age, sex, entry date, time in service, and service component (e.g., Army, Navy), was used to describe the association of race/ethnicity, socioeconomic status, and BMI and blood pressure at entry into military service with the subsequent development of type 2 diabetes. RESULTS: Increased BMI (adjusted odds ratio, 3.0 for the > or =30 kg/m(2) vs. < or =20 kg/m(2) categories and 2.0 for the 25.0-29.9 kg/m(2) category, compared with the reference category), African-American (adjusted odds ratio, 2.0) and Hispanic origin (adjusted odds ratio, 1.6) compared with white race and rank (adjusted odds ratio for junior enlisted versus officers, 4.1) were all associated with type 2 diabetes. CONCLUSIONS: Individuals with type 2 diabetes in the U.S. military have risk factors similar to the general U.S. population. Because diabetes is a preventable disease, it is of concern that it is occurring in this population of younger and presumably more fit individuals. This has significant implications for the prevention of diabetes in both military and civilian populations.

Adult↗
PubMed2001

Tuberculosis infection after humanitarian assistance, Guantanamo Bay, 1995.

Upon redeployment to Fort Lewis, Washington, from Operation Sea Signal in Guantanamo Bay, Cuba, 5% of a military police unit was identified as positive for purified protein derivative (PPD). A case-control study was conducted to document the number of converters and to identify risk factors among the soldiers for PPD conversion while in Cuba. Forty-six of the soldiers (3.7% of the unit) met the criteria for PPD conversion as a result of deployment. Forty-four converters and 84 controls completed surveys. Logistic regression showed that statistically significant independent risk factors for PPD conversion included working around coughing migrants (odds ratio [OR] = 6.73, 95% confidence interval [CI] = 2.2-20.4) and birthplace outside the United States (OR = 4.89, CI = 1.3-18.5). Contact in the psychiatric hospital (OR = 0.22, CI = 0.05-0.90) and contact with migrants with known tuberculosis (OR = 0.16, CI = 0.05-0.54) appeared to be protective factors, possibly because known tuberculosis patients and hospitalized patients most likely would be on treatment and rendered noninfectious. With the U.S. military's involvement in humanitarian and refugee operations in countries highly endemic for tuberculosis, service members are at increased risk of acquiring tuberculosis infection. Detection of tuberculosis infection and appropriate treatment should become a higher priority within the U.S. military.

Case-Control Studies↗
PubMed2001

Active tuberculosis among U.S. Army personnel, 1980 to 1996.

OBJECTIVE: To describe hospitalization rates for active tuberculosis among U.S. Army personnel. METHODS: All hospitalizations for tuberculosis among Army active duty personnel from January 1, 1980, to December 31, 1996, were identified from an inpatient database. Incidence rates and trend analyses are presented for age, race, sex, and hospital location. RESULTS: A total of 936 cases of active tuberculosis required hospitalization. Hospitalization rates declined from 15.3 cases/100,000 (1980) to 5.1 cases/100,000 (1996). Significant declines in hospitalization rates occurred for white and black males but not for females. Tuberculosis rates were 3.5 times lower among soldiers compared with the general population for individuals 25 to 44 years of age. CONCLUSION: Because of medical, purified protein derivative, and human immunodeficiency virus screening, military populations represent a low-risk population for active tuberculosis. The Army's overall hospitalization rate for tuberculosis declined steadily but remained relatively high among minorities and females. Additional studies should address specific risk factors related to race and gender among healthy populations with adequate health care.

Adolescent↗
PubMed2000

Identified spouse abuse as a risk factor for child abuse.

CONTEXT: There are limited data on the extent to which spouse abuse in a family is a risk factor for child abuse. OBJECTIVE: To estimate the subsequent relative risk of child abuse in families with a report of spouse abuse compared with other families. DESIGN: Cohort study. SETTING: Analysis of a centralized US Army database PARTICIPANTS: Married couples with children with at least one spouse on active duty in the US Army during 1989-95. MAIN OUTCOME MEASURES: The US Army Family Advocacy Program's Central Database was used to identify child and spouse abuse. The exposure was an episode of identified spouse abuse and the main outcome was a substantiated episode of subsequent child abuse. RESULTS: During the study period of an estimated 2,019,949 person years, 14,270 incident child abuse cases were substantiated. Families with an incident case of spouse abuse identified during the study period were twice as likely to have a substantiated report of child abuse compaired with other military families, rate ratio, 2.0, (95% confidence interval [CI] 1.9-2.1). Young parental age had the highest rate ratio, 4.9 (95% CI 4.5-5.3) in the subgroup analysis controlling for rank. Identified spouse abuse was associated with physical abuse of a child, rate ratio 2.4 (95% CI 2.2-2.5), and with sexual abuse of a child, rate ratio 1.5 (95% CI 1.3-1.7). Identified spouse abuse was not associated with child neglect or maltreatment, rate ratio, 1.0 95% CI 0.9-1.1) CONCLUSION: An identified episode of spouse abuse in a family appears to be associated with an increased risk of subsequent child abuse and serves as an independent risk factor. Therefore. care providers should consider the potential risk to children when dealing with spouse abuse.

Adult↗
PubMed2000

Prior knee injury and risk of future hospitalization and discharge from military service.

BACKGROUND: Athletic capability is paramount for survival in military basic training and successful service. Orthopedic conditions are common reasons for hospitalization and premature discharge of military recruits. Medical fitness for military service is determined through a medical examination. Individuals medically disqualified may receive a waiver to enter the service on a case-by-case basis. This study was carried out to determine how individuals with a medical waiver for knee problems compared to recruits without a history of knee injury regarding hospitalization and military discharge. METHODS: Two hundred eighty-one enlisted recruits with a history of a waiver for a knee condition were considered high risk. The comparison group was 843 recruits without prior knee pathology. Comparisons were made using frequency and chi-square analyses, relative risk estimates, and survival analyses. RESULTS: Individuals in the high-risk group were 1.4 (CI 1.0, 2.1) times more likely to be hospitalized for any diagnoses and 8.0 (CI 2. 1, 29.9) times more likely to be hospitalized for a knee condition than those in the comparison group. Individuals with a knee waiver were 2.1 (CI 1.3, 3.5) times more likely to be prematurely discharged, and 14.0 (CI 4.6, 39.6) times more likely to be discharged for a knee-related condition than those in the comparison group. CONCLUSION: Unfavorable outcomes were more likely in recruits disqualified initially and granted a waiver than in recruits without a history of knee injury. Military service requires intense physical activity; therefore, further research should be conducted to limit knee-related morbidity, especially in those with a prior history of knee injury.

Adolescent↗
PubMed2000

The asthma accession standard: a survival analysis of military recruits, 1995 to 1997.

Asthma has a significant impact on U.S. military expenditures and readiness. Every year approximately 1,000 recruits are discharged for asthma during their first 6 months of service. This study was done to evaluate the practice of allowing some individuals with a history of asthma to enter military service (waiving). A survival analysis was performed to compare length of time until discharge and asthma-related failure for individuals waived for asthma (cases) and individuals not disqualified for asthma (controls). Cases were 587 recruit applicants initially disqualified who received waivers for asthma and accessed in the years 1995 to 1997. Controls were 1,761 matched enlisted recruits starting basic training in those years. No significant differences were found with respect to general attrition. The statistical differences for asthma-related hospitalization or discharge did not translate into practical differences. Waiving for asthma was not a significant occupational liability in terms of asthma-related hospitalization or early military attrition.

Adult↗
PubMed1999

Reducing medical attrition: the role of the Accession Medical Standards Analysis and Research Activity.

This paper illustrates how adding an epidemiologic perspective to medical accession policy development allows the Department of Defense to address unacceptably high rates of premature attrition, lost duty time, avoidable medical care costs, sick leave, disability, and various wasteful, inefficient practices. The Accession Medical Standards Analysis and Research Activity is a major new epidemiologic entity. Historically, military medical accession policy and waiver deliberations were based heavily on expert opinion. A common limitation of expert opinion is that although experience teaches much about individuals with certain conditions who develop problems, it does not teach about individuals with the same conditions who remain well. The Accession Medical Standards Analysis and Research Activity produces the analyses of epidemiologic data necessary for the joint personnel and medical flag-level Department of Defense Accessions Medical Standards Steering Committee to make evidence-based accession policy decisions.

Absenteeism↗
PubMed1995

A 'barrier-free' health care system does not ensure adequate vaccination of 2-year-old children.

OBJECTIVES: To assess vaccination status in a cohort of 2 year olds with access to health care at no cost and to delineate factors associated with failure to be fully vaccinated. DESIGN: Retrospective cross-sectional study. Children not up-to-date on vaccinations by age 2 years compared with children up-to-date by medical record review. A telephone survey was conducted for those without medical records or whose records lacked complete documentation. SETTING: Large military tertiary care hospital. PARTICIPANTS: A cohort of 844 children born between August 31, 1988, and September 1, 1989. MAIN OUTCOME MEASURES: Timeliness of vaccination, factors associated with undervaccination, number and nature of missed opportunities. RESULTS: Best estimate of coverage with entire primary vaccination series was 72% by age 2 years. Attendance at military day care was associated with full vaccination (odds ratio [OR] = 1.80, confidence interval [CI] = 1.12 to 3.24) as was completion of well-baby visits. Increasing number of other visits did not predict full vaccination. Children followed up by family practice were more likely to be up-to-date than children followed up by pediatrics (OR = 3.67, CI = 1.47 to 9.73). Seventy-two percent of children who were not up-to-date had at least one missed opportunity for vaccination. If vaccinations had been offered at all visits, 93% of children could have been fully vaccinated by age 2 years. CONCLUSIONS: Offering free vaccinations in a "barrier-free" system will not ensure vaccination levels of 90%. Health care providers should offer vaccinations during acute, non-well visits to improve coverage.

Child Health Services↗
PubMed1995

Immunization of US soldiers with a two-dose primary series of inactivated hepatitis A vaccine: early immune response, persistence of antibody, and response to a third dose at 1 year.

To study the feasibility of using inactivated hepatitis A vaccine for rapid immunization of US soldiers, 276 randomized seronegative volunteers received one of four regimens: two injections, on day 0 or one each on day 0 and 14, day 0 and 30, or day 0 and 180. A third dose was given on day 380. Among the 256 recipients of two doses, 99% responded with antibody (by ELISA) with few symptoms. A higher percentage of recipients of both doses on day 0 had antibody at day 14 (68% vs. 52% of all others, P < .03). The highest antibody concentrations (711 mIU/mL on day 240) were observed in subjects given a second dose on day 180. Recipients of the third injection developed a median 15-fold rise in antibody within 2 weeks. Virus-neutralizing antibody was detected in high titers after the third dose and neutralized strains of hepatitis A virus from several countries. Vaccines containing 1440 ELISA units of antigen may be useful for rapid immunization.

Adolescent↗
PubMed1993

An outbreak of hepatitis A during a military field training exercise.

Hepatitis A continues to pose a preventable threat to modern day military forces. We describe a food-borne outbreak of hepatitis A during a field training exercise resulting in 22 ill soldiers and over 300 lost work days. Among the population at risk, the secondary attack rate was 19.6%. Faced with epidemic disease occurrence, epidemiologic investigation of potential cases and aggressive use of post-exposure prophylaxis is recommended in a field setting. Although immune serum globulin is likely to reduce transmission, not all cases of acute hepatitis A will be prevented by this action.

Case-Control Studies↗
PubMed1992

Induction of leucine aminopeptidase by interferon-gamma. Identification by protein microsequencing after purification by preparative two-dimensional gel electrophoresis.

The protein previously called "Mr approximately 50/pI approximately 6.9," which we observed to be induced by the immunoregulatory cytokine interferon (IFN)-gamma in human fibroblasts, was purified from a total cell lysate by preparative two-dimensional gel electrophoresis and identified by partial amino-terminal sequencing as leucine aminopeptidase (LAP), a 53-kDa cytosolic exopeptidase. Induction of LAP protein by IFN-gamma, confirmed by immunoblotting with an antiserum raised against bovine lens LAP, is a consequence of induction of LAP mRNA and occurs in all four human cell lines examined: HS153 fibroblasts, ACHN renal carcinoma, A549 lung carcinoma, and A375 melanoma. Induction of LAP mRNA is a secondary response to IFN-gamma, blocked by inhibition of protein synthesis with cycloheximide.

Amino Acid Sequence↗
PubMed1992

Attendance and referral patterns in a health promotion program for soldiers.

We studied referral patterns among 505 active duty Army participants in a heath promotion program at Fort Lewis, Washington. Over one-third (35.6%) were referred to health care providers for confirmation of cholesterol or blood pressure screening results. Fifty-two (10.3%) had elevated blood pressure screening measurements, of whom 30% had been previously diagnosed as hypertensive. One hundred forty-six had cholesterol levels greater than or equal to 200 mg/dl, 22.8% of whom were already aware of hypercholesterolemia. Referral for follow-up was not associated with race, sex, or rank after controlling for age. Screening resulted in a large number of referrals for previously unrecognized abnormalities.

Adult↗
PubMed1991

Manganese superoxide dismutase is induced by IFN-gamma in multiple cell types. Synergistic induction by IFN-gamma and tumor necrosis factor or IL-1.

We have previously characterized more than 20 proteins induced by the immunoregulatory lymphokine IFN-gamma in human fibroblasts by their m.w. and isoelectric points determined in two-dimensional gels. Some of these proteins are induced uniquely by IFN-gamma, whereas others are also induced by IFN-alpha, TNF, or IL-1. Recent technologic advances have allowed us to begin to rapidly identify proteins induced by IFN-gamma and other cytokines by sequencing the induced proteins from blots of preparative two-dimensional gels of total cell lysates. In this study, we show that the approximately 21 kDa, isoelectric point greater than 7 protein induced by IFN-gamma is manganese superoxide dismutase (Mn-SOD), a mitochondrial protective enzyme encoded by a nuclear gene. Mn-SOD is induced by IFN-gamma and also by TNF in all four human cell lines examined: HS153 fibroblasts, ACHN renal carcinoma, A549 lung carcinoma, and A375 melanoma. Induction of Mn-SOD mRNA is a primary, rapid, and dose-dependent response to IFN-gamma. In ACHN renal carcinoma cells, Mn-SOD mRNA and protein are induced synergistically by IFN-gamma in combination with either TNF or IL-1, and the induced protein is enzymatically active. IFN-gamma and TNF together induce Mn-SOD mRNA by more than 100-fold relative to its level in untreated ACHN cells. The induction of Mn-SOD by IFN-gamma and its synergistic induction by IFN-gamma in combination with TNF and IL-1 should protect healthy cells from the toxicity of O2- during an immune response, and may provide a mechanism for selective killing of infected cells.

Amino Acid Sequence↗
PubMed1990

A two-dimensional acrylamide gel electrophoresis/computer software approach to decoding the human genome.

The human genome sequencing initiative is sure to be an expensive and time-consuming project. To maximize the quality of the initial thrust, it is necessary to concentrate on sequencing those genes that are actively involved in crucial biological processes, both normal and otherwise. To identify the protein products of these genes, we propose the use of two-dimensional acrylamide gel electrophoresis and powerful computer software. The two-dimensional gels can then be scaled to yield sufficient amounts of the protein for direct amino acid sequence analysis. The amino acid sequence then provides the direct link back to the gene.

Amino Acid Sequence↗
PubMed1989

Computer-analysed 2-D electrophoresis.

A service is now available for analysing 2-dimensional gels and comparing them to existing databases, broadening the number of laboratories which can study protein expression using the technique.

Computer Graphics↗
PubMed1989

Protein database development: identification of glycosylated and phosphorylated proteins in unfractionated rat fibroblast lysates.

In this paper, techniques are demonstrated for unambiguously mapping phosphoproteins and glycoproteins into a protein database of unfractionated fibroblast proteins. These methods allow for precise registration of subsets of proteins with the image of total proteins. The methods are also applicable to database mapping of antigens identified by indirect immunodetection methods and receptor molecules identified with photoaffinity ligands.

Animals↗