Alzheimer's disease in South Carolina, 1998.
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Age Distribution↗
Biomedical subjects
M Sanderson
Publications and source records attributed to M Sanderson.
Perinatal outcome and amniotic fluid index in the antepartum and intrapartum periods: A meta-analysis.
OBJECTIVE: Our purpose was to perform a meta-analysis of studies on the risks of cesarean delivery for fetal distress, 5-minute Apgar score <7, and umbilical arterial pH <7.00 in patients with antepartum or intrapartum amniotic fluid index >5.0 or <5.0 cm. STUDY DESIGN: Using a MEDLINE search, we reviewed all studies published between 1987 and 1997 that correlated antepartum or intrapartum amniotic fluid index with adverse peripartum outcomes. The inclusion criteria were studies in English that associated at least one of the selected adverse outcomes with an amniotic fluid index of </=5.0 cm versus >5.0 cm. Contingency tables were constructed for each study, and relative risks and standard errors of their logs were calculated. Fixed-effects pooled relative risks were calculated for groups of studies that were homogeneous, whereas random-effects pooled relative risks were calculated for significantly heterogeneous groups of studies. RESULTS: Eighteen reports describing 10,551 patients met our inclusion criteria. An antepartum amniotic fluid index of </=5.0 cm, in comparison with >5.0 cm, is associated with an increased risk of cesarean delivery for fetal distress (pooled relative risk, 2.2; 95% confidence interval, 1.5-3.4) and an Apgar score of <7 at 5 minutes (pooled relative risk, 5.2; 95% confidence interval, 2.4-11.3). An intrapartum amniotic fluid index of </=5.0 cm is also associated with an increased risk of cesarean delivery for fetal distress (pooled relative risk, 1.7; 95% confidence interval, 1.1-2.6) and an Apgar score <7 at 5 minutes (pooled relative risk, 1.8; 95% confidence interval, 1.2-2.7). A poor correlation between the amniotic fluid index and neonatal acidosis was noted in the only study that examined this end point. More than 23,000 patients are necessary to demonstrate that the incidence of umbilical arterial pH <7.00 is 1.5 times higher among those with oligohydramnios in labor than among those with adequate amniotic fluid index (alpha = 0.05; beta = 0.2) CONCLUSIONS: An antepartum or intrapartum amniotic fluid index of </=5.0 cm is associated with a significantly increased risk of cesarean delivery for fetal distress and a low Apgar score at 5 minutes. There are few reports linking amniotic fluid index and neonatal acidosis, the only objective assessment of fetal well-being. A multicenter study with sufficient power should be undertaken to demonstrate that a low amniotic fluid index is associated with an umbilical arterial pH <7.00.
Acidosis↗
The value of strength training for older adults.
Health in older adults can best be measured in terms of functional status. Skeletal muscle strength has been reported to be a determinant of functional status in older individuals. Two major contributors to the decline in muscle function as a person ages are disuse and physical inactivity. Declining muscle function through a loss of muscular strength may decrease functional independence and mobility and increase the risk for falls and injuries, physical frailty, and disability. Older individuals lacking an appropriate amount of muscular strength may not be able to perform various activities of daily living, which are important indicators of independence.
Activities of Daily Living↗
Validity and reliability of subject and mother reporting of perinatal factors.
The authors used data from a population-based case-control study of breast cancer in women aged < or = 44 years (cases, n = 975; controls, n = 866) conducted between 1994 and 1996 in three counties of western Washington state to assess the validity and reliability of reported perinatal factors. For a sample of participants, exposure information from self-administered questionnaires was validated with information from birth certificates (cases, n = 378; controls, n = 283). Detailed information regarding perinatal characteristics of their daughters was also collected from subjects' mothers (case mothers, n = 510; control mothers, n = 436) to assess the reliability of subjects' reporting of these events. Although reporting of birth weight by subjects (cases, r = 0.83; controls, r = 0.80) and their mothers (case mothers, r = 0.89; control mothers, r = 0.84) was highly correlated with the birth certificates, there was differential measurement error by subjects; cases reported birth weight accurately on average, but controls tended to underestimate their birth weight. Agreement between the subject and mother report was excellent for birth weight (cases, r = 0.85; controls, r = 0.87) and good for other perinatal factors, but birth order and maternal diethylstilbestrol use were underreported among cases and reported accurately among controls. Differential measurement error of birth weight by case-control status resulted in biased odds ratios for breast cancer risk.
Birth Weight↗
Maternal factors and breast cancer risk among young women.
The results from previous studies have provided evidence to support the hypothesised association between intrauterine oestrogen exposure and subsequent risk of breast cancer. Information has not been available to study this relationship for several perinatal factors thought to be related to pregnancy oestrogen levels. Data collected from the mothers of women in two population-based case-control studies of breast cancer in women under the age of 45 years (510 case mothers, 436 control mothers) who were diagnosed between 1983 and 1992 in three western Washington counties were used to investigate further the relationship between intrauterine oestrogen exposure and risk of breast cancer. A pregnancy weight gain of 25-34 pounds was associated with breast cancer risk (odds ratio [OR] = 1.5; 95% confidence interval [CI] 1.1, 2.0); however, women whose mothers gained 35 pounds or more were not at increased risk. Use of antiemetic medication in women with any nausea and vomiting (OR = 2.9; 95% CI 1.1, 8.1) and use of diethylstilboestrol (DES) (OR = 2.3; 95% CI 0.8, 6.4) appeared to be positively associated with breast cancer risk. The results from this study provide limited support for the hypothesis that in utero oestrogen exposure may be related to subsequent breast cancer risk among young women.
Adult↗
The effect of fish consumption on DDT and DDE levels in breast milk among Hispanic immigrants.
A study was conducted to (1) determine the concentration of DDT/DDE in the breast milk of mothers residing in the Yakima river basin (WA, USA), (2) assess the relative impact of fish consumption on the total DDT/DDE body burden, and (3) determine if the amount of DDT/DDE received by their breastfed infants exceeds levels that could produce deleterious effects. Results indicate that fish consumption did not significantly increase DDT/DDE breast milk concentrations. Subjects born in Mexico had elevated levels of DDT/DDE in breast milk compared to levels found in US born subjects regardless of fish consumption. Infant daily intake levels for the various subject groups were determined and compared to acceptable and tolerable daily intake levels. With benefits of breast milk well understood, breastfeeding should still be strongly recommended for these mothers.
Adult↗
1988 National Maternal and Infant Health Survey: methods and response characteristics.
OBJECTIVES: The 1988 National Maternal and Infant Health Survey (NMIHS) was conducted by the National Center for Health Statistics to study factors related to poor pregnancy outcome, such as adequacy of prenatal care; inadequate and excessive weight gain during pregnancy; maternal smoking, drinking, and drug use; and pregnancy and delivery complications. METHODS: The NMIHS is a nationally representative sample of 11,000 women who had live births, 4,000 who had late fetal deaths, and 6,000 who had infant deaths in 1988. Questionnaires were mailed to mothers based on information from certificates of live birth, reports of fetal death, and certificates of infant death. Information supplied by the mother, prenatal care providers, and hospitals of delivery was linked with the vital records to expand knowledge of maternal and infant health in the United States. RESULTS: The response rates in all three components of the NMIHS differed according to the mothers' characteristics. Mothers were more likely to respond if they were 20-39 years of age, were white, were married, had fewer than four children, entered prenatal care early, had more prenatal visits, had more years of education, or resided in the Midwest Region. The percent of respondents was lower for teenage mothers, mothers of races other than white, and mothers with four or more children, little prenatal care, or fewer years of education. Mothers whose infants weighed less than 2,500 grams were less likely to respond in the live-birth and infant-death components than mothers whose infants weighed 2,500 grams or more. CONCLUSIONS: The NMIHS will provide an invaluable tool for researchers and practitioners seeking solutions to perinatal and obstetric problems.
Adolescent↗
Aspirin reduces the incidence of second eye NAION: a retrospective study.
The objective of this study was to determine if aspirin reduces the incidence of second eye involvement after nonarteritic anterior ischemic optic neuropathy (NAION) in one eye. Records were reviewed of 131 patients who sustained unilateral NAION. Of these, the 33 patients who sustained second eye NAION were compared to those followed for a minimum of 2 years without sustaining a second eye NAION (67). Thirty-one of the 131 patients were excluded because of inadequate follow-up. Except for diabetes (relative risk [RR] 1.43, p = 0.05), the incidence of second eye NAION was independent of gender, age, cup/disk, hypertension, anemia, and migraine. The degree of visual acuity or field dysfunction in the first eye correlated poorly with the acuity (r = 0.28) and field (r = 0.33) loss in the second eye. Aspirin (65-1,300 mg) taken two or more times per week decreased the incidence (17.5% vs. 53.5%) and relative risk (RR = 0.44, p = 0.0002) of second eye AION regardless of the usual risk factors. Even after eliminating those patients who had bilateral disease when first referred, ASA still reduced the incidence of second eye involvement (35% vs. 13%, RR = 0.74, p = 0.01). Aspirin may be an effective means of reducing second eye NAION.
Aged↗
Perinatal factors and risk of breast cancer.
A high level of endogenous estrogen in utero has been hypothesized to be a possible risk factor for breast cancer. We used information from two population-based case-control studies to investigate the relation between perinatal factors and risk of invasive breast cancer among women age 21-45 years (746 cases, 960 controls) and women age 50-64 years (401 cases, 439 controls). Breast cancer cases were ascertained through a population-based cancer registry, and controls were selected by random digit dialing. After adjustment for age, menopausal status, and maternal smoking, the birthweight-breast cancer association in women age 21-45 years followed a J-shaped curve, with women whose birthweight was less than 2,500 gm [odds ratio (OR) = 1.3; 95% confidence interval (CI) = 0.9-2.0] and 4,000 gm or more (OR = 1.7; 95% CI = 1.1-2.5) at increased risk. Women age 50-64 years who were 4,000 gm or more at birth appeared to be at slightly reduced risk of breast cancer (OR = 0.6; 95% CI = 0.3-1.1). With the exception of maternal smoking, there was little effect of other perinatal factors on breast cancer risk in either group. These results support the hypothesized association between intrauterine estrogen exposure and subsequent risk of breast cancer.
Adult↗
Factors which influence the rate of receiving a routine second newborn screening test in Washington State.
This study was conducted to determine whether newborns from different ethnic and socioeconomic groups in Washington State are equally likely to have a routine second newborn screening (NBS) test and if there are identifiable factors associated with not having a second test. For many years, the standard of care for NBS in Washington has been that newborns should receive a routine second screening test at age 7-10 days. However, data collected by State Department of Health (DOH) staff for the past several years indicated that only about 80% of newborns receive a routine second NBS test. The data presented here suggest that identifiable factors (i.e., barriers) exist in accessing a routine second NBS test in Washington. Increased educational efforts targeting certain high-risk infants, their parent/caretakers, and primary care providers are apparently needed to ensure equal access to a routine second test.
Adult↗
A reexamination of the risk factors for the sudden infant death syndrome.
OBJECTIVE: To determine which risk factors are specific for the sudden infant death syndrome (SIDS) rather than characteristic of postneonatal deaths in general. STUDY POPULATION: The live births and infant death cohorts of the 1988 National Maternal and Infant Health Survey. METHODS: Information on live births, deaths from SIDS, and postneonatal deaths from other causes was abstracted from the National Maternal and Infant Health Survey. To account for oversampling of certain populations, the data were weighted to reflect national counts. Risk factors were defined as black race, birth weight less than 1500 gm, birth weight less than 2500 gm, gestational age at birth less than 37 weeks, 5-minute Apgar score less than 7, male gender, more than two previous pregnancies, maternal age less than 20 years, maternal education level less than 12 years, multiple births, and maternal smoking during pregnancy. Odds ratios (ORs) and 95% confidence intervals (Cls) were calculated to compare the SIDS with the live births cohort, infants who died of other causes with the live births cohort, and SIDS with non-SIDS deaths. The population-attributable risk percentage was computed for risk factors independently associated with SIDS when compared with other postneonatal deaths. RESULTS: For all characteristics other than a 5-minute Apgar score less than 7, the ORs comparing infants who died of SIDS with the live births cohort were significantly greater than 1.0. Similarly, ORs comparing infants who died of other causes with the live births cohort were also greater than 1.0, except for male gender. When the two infant death cohorts were compared, only maternal smoking during pregnancy and low maternal education level were significantly more common among the SIDS group. After we controlled for cigarette smoking, the adjusted OR for low maternal education level was not significantly greater than 1.0. However, even after control for low maternal education level, prenatal exposure to tobacco was significantly more common among the SIDS group than in infants dying of other causes (OR = 1.97; 95% Cl, 1.59 to 2.45). On the basis of an adjusted OR of 2.92 when the SIDS group was compared with the live births cohort, the population-attributable risk percentage for maternal smoking as a risk factor for SIDS was 30%. CONCLUSION: Among characteristics generally thought to be risk factors, only maternal smoking during pregnancy was independently associated with SIDS. Data from this nationally representative sample indicate that if women refrained from smoking while pregnant, up to 30% of SIDS might be prevented.
Apgar Score↗
The intergenerational relationship between mother's birthweight, infant birthweight and infant mortality in black and white mothers.
The relationship between the birthweight of white and black mothers and the outcomes of their infants were examined using the 1988 National Maternal and Infant Health Survey. White and black women who were low birthweight themselves were at increased risk of delivering very low birthweight (VLBW), moderately low birthweight (MLBW), extremely preterm and small size for gestational age (SGA) infants. Adjustment for the confounding effects of prepregnant weight and height reduced the risks of all these outcomes slightly, and more substantially reduced the maternal birthweight associated risk of moderately low birthweight among white mothers. There was little effect of maternal birthweight on infant birthweight-specific infant mortality in white mothers; however, black mothers who weighed less than 4 lbs at birth were at significantly increased risk of delivering a normal birthweight infant who subsequently died. Although the risks for the various outcomes associated with low maternal birthweight were not consistently higher in black mothers compared with white mothers, adjustment for prepregnant weight and height had a greater effect in white mothers than in black mothers. We suggest that interventions to reduce the risks for adverse pregnancy outcomes associated with low maternal birthweight should attempt to optimise prepregnant weight and foster child health and growth.
Adult↗
Alterations in DNA sequence and RNA transcription of the Bam HI-H fragment accompany attenuation of oncogenic Marek's disease herpesvirus.
The nucleotide sequences of the BamHI-H fragment of the HPRS16 strain of Marek's disease virus (MDV) and of its attenuated derivative HPRS16/att have been determined. The results show that in addition to the tandem expansion of a 132 bp sequence from two copies in HPRS16 virus to eight copies in HPRS16/att, nucleotide substitutions, deletions, and insertions were also noted. Several potential open reading frames (ORFs) were identified. One of these (ORF 13) encoded a deduced protein, mol wt 32 kD, which is likely to be the serotype-1 specific phosphoprotein expressed in tumours (1) and mapped to an EcoRI fragment within BamHI-H (2). Our results suggest that this ORF is unlikely to be the B antigen (3). ORF 4, which had some similarity to CD4 and immunoglobulin M heavy chain, was encoded by a transcript that originated within the first copy of the 132 bp repeat. ORF 21, which mapped entirely within UL, encoded a deduced protein at least 322 amino acids long that had some similarity to varicella zoster virus (VZV) alpha trans-inducing protein. None of these ORFs was altered significantly by attenuation, except ORF 4 and another small ORF (ORF 3), 5' of the 132 bp repeats, which would probably fail to be transcribed because of truncation of an RNA transcript.
Amino Acid Sequence↗
High-pressure injection injuries of the hand.
High pressure injection trauma to the upper extremity is a rare but potentially limb-threatening injury. The index finger on the non-dominant hand of young male workers is most commonly involved. Injected materials include paint, grease and diesel oil. Prompt recognition and initiation of treatment is necessary if a disastrous outcome is to be avoided. Primary treatment consists of surgical decompression and debridement. Amputation may be necessary. With early aggressive treatment, satisfactory results can be obtained. The use of high-pressure devices in industry has resulted in an unusual but potentially limb-threatening injury to the upper extremity known as the "high-pressure injection injury." This injury is a surgical emergency that demands prompt diagnosis and treatment if a disastrous outcome is to be avoided. The purpose of this paper is to present our recent experience and review the clinical features, evaluation and treatment principles.
Accidents, Occupational↗
Respiratory medicine: the casualties.
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Medical Staff, Hospital↗
Increasing nurses' use of feedback to promote infection-control practices in a head-injury treatment center.
This study established regular implementation of a simple feedback procedure by supervisory nurses with their assistants at a head-injury treatment center. Five nurses were trained to distribute brief written comments to their assistants about infection-control practices, including using gloves to avoid contact with body fluids. Following low rates of written feedback, nurses met with the trainer weekly to set goals for using the system, to review feedback rates, and to examine contingent letters of appreciation. Written feedback increased from 0.09 to 0.58 per day. When outcome data on glove use were subsequently added to the feedback provided to nurses, nurses' feedback on glove use increased and overall glove use by assistants increased by 36.7% for 66.7% of assistants who responded to feedback. Assistants rated feedback as highly accurate and indicated some interest in receiving future feedback. However, nurses and assistants expressed a preference for oral over written feedback.
Adult↗
Pulmonary artery leiomyosarcoma.
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Arterial Occlusive Diseases↗
Gastric juice ascorbic acid: effects of disease and implications for gastric carcinogenesis.
N-nitroso compounds (NOC) are strongly implicated in the causation of cancer of the stomach and it has been suggested that ascorbic acid might reduce the risk of gastric cancer by preventing their formation within gastric juice. However, until recently there have been no measurements of gastric juice ascorbic acid concentrations. We have measured both gastric juice ascorbic and total vitamin C (ascorbic acid and dehydroascorbic acid). Our findings suggest that ascorbic acid is secreted into the gastric lumen so that gastric juice concentrations are often greater than those in plasma. Gastric pathology affects this secretion, leading to values in gastric juice that are lower than plasma levels. Stimulation of gastric secretion does not raise vitamin C concentrations in individuals whose values are initially low. The role of ascorbic acid in preventing formation of NOC and protecting against gastric cancer is discussed in the light of these findings.
Ascorbic Acid↗