Neonatal shivering and hypothermia after intrapartum amnioinfusion.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
M Silverstein
Publications and source records attributed to M Silverstein.
Comparison of U.S. Occupational Safety and Health Administration standards and German Berufsgenossenschaften Guidelines for Preventive Occupational Health Examinations.
Thirty-three U.S. Occupational Safety and Health Administration (OSHA) standards contain mandated medical service provisions. The German Berufsgenossenschaften Guidelines for Preventive Occupational Health Examinations currently comprise 38 guidelines, which contain mandated medical service provisions. Based on a previously published method for scoring several medical program elements, the Berufsgenossenchaften guidelines were compared with the OSHA standards. Specific program elements were combined to generate and compare quality control scores, screening scores and surveillance scores. The asbestos standard/guidelines were compared in more detail (e.g., physical examination, laboratory tests, examination schedule, eligibility). The German medical requirements consistently ranked higher than their U.S. counterparts for overall scores and the scoring indices for quality control, screening, and surveillance. However, this comparison also reveals that few surveillance features have been incorporated into the medical requirements of either country, suggesting that neither country is making full use of workplace medical services for primary prevention.
Asbestos↗
Health and social precursors of later life retirement-community migration.
This study uses the developmental migration paradigm developed by Litwak and Longino (1987) as a framework to investigate the health and social determinants of late-life elderly mobility to retirement communities. Data from four waves of the Longitudinal Study of Aging are used to predict the likelihood of moving from the general community to two types of retirement communities--those with group meals and those without group meals. Multinomial logistic regression reveals that the likelihood of migrating to both types of retirement communities increases as disability advances to moderate levels, but declines as disability becomes severe. Migration to retirement communities is also more likely among elderly persons who live alone and among those whose children do not live nearby. The results suggest that retirement community migration in middle and late old age is motivated not only by social and amenity considerations, but also by the need for assisted living arising from physical frailty. Implications for developmental migration theory and long-term care policy are discussed.
Age Factors↗
Laparoscopic enterolysis and placement of an intestinal sling before radiation therapy for the treatment of prostate cancer.
We present an interesting application of laparoscopy in a man who was otherwise not a candidate for radiotherapy because of an adherent loop of small bowel in the proposed treatment field. Laparoscopic enterolysis was performed and the involved segment was displaced out of the pelvis; a synthetic mesh was placed to serve as a sling to prevent caudal migration back into the pelvis. The patient had a rapid recovery and subsequently completed a full course of radiotherapy. The experienced laparoscopist may find this a good alternative to open surgery in patients with a fixed loop of small bowel who require radiation therapy for pelvic malignancies.
Adenocarcinoma↗
Stability and change in temporal distance between the elderly and their children.
Drawing on a developmental model of late-life migration, this paper investigates how older people's health and social characteristics influence stability and change in their temporal distance from their children. Data from the Longitudinal Study of Aging are used to examine both discrete transitions and continuous change in distance over a four-year period. Decline in older parents' physical health increased the propensity of parents and children to become temporally closer to each other. Among those parent-child pairs who had become closer, the conjunction of declining health and widowhood increased both the degree of non-coresident proximity and the likelihood of transition to coresidence. The findings portray a geographically resilient family that adjusts to the changing needs of its older members.
Activities of Daily Living↗
Analysis of medical screening and surveillance in 21 Occupational Safety and Health Administration standards: support for a generic medical surveillance standard.
Twenty-one Occupational Safety and Health Act (OSHA) standards were identified which contain medical service provisions intended to help in the identification and control of harmful health effects of workplace exposures. The utility and effectiveness of these provisions have not previously been evaluated. All 21 standards were reviewed and assigned numerical scores for each of 24 potential medical program elements. Several of these elements were combined to calculate Quality Control, Screening Utility, and Surveillance Utility scores for each standard. Total scores varied greatly, suggesting a lack of consistency and uniformity which was even more obvious when the actual regulatory language was examined. The mean Quality score was only 26% of potential points. Seventeen of 21 standards received less than half the total possible Quality score. When arrayed on a two by two matrix only two standards scored above 50% for both Screening and Surveillance Utility. It was concluded that the medical service provisions in OSHA standards are lacking in consistency and coherence. Two major shortcomings are the lack of quality control elements and the absence of surveillance features which would permit medical program results to be utilized for prevention activities including the identification and control of workplace hazards. A generic occupational medical surveillance standard could address these current weaknesses. Elements of such a generic standard are proposed.
Data Collection↗
Does intergenerational social support influence the psychological well-being of older parents? The contingencies of declining health and widowhood.
This study investigates whether social support from adult children improves the psychological well-being of elderly parents. Support is studied as a direct influence on emotional distress and as a moderator of the distressing consequences of health problems and widowhood. Research questions are addressed using data from elderly parents participating in 1985 and 1988 surveys of the U.S.C., Longitudinal Study of Three Generation Families. Results from multiple regression analyses indicate that instrumental and expressive forms of social support are weakly related to 3-year change in positive and negative aspects of psychological well-being. However, both types of support moderate declines in well-being associated with poor health and widowhood. We conclude that the psychological benefits of intergenerational social support are contingent on the vulnerability of the older parent, when expectations for assistance are at their greatest. This finding has considerable implications for family theory and policy.
Adolescent↗
Neuropsychological deficit and aggressive behavior: a prospective study.
1. Failures in higher cortical executive functions and dyscontrol of aggressive impulses were hypothesized to co-occur in aggressive men. 2. The performance of a sample of violent forensic patients on selected neuropsychological measures (Judgment of Line Orientation, Stroop Color Word Test, Emotion Perception Test, Test Of Nonverbal Intelligence, Wisconsin Card Sorting Test, and Symbol Digit Modalities Test) were used to predict their overt aggressive behavior during a one-year period using the Overt Aggression Scale. 3. Whole-set correlation analyses revealed that scores on the Judgment of Line Orientation, Stroop Color Word Test, and Emotion Perception Test accounted for 57% of the variance of aggression scores. 4. Frequency of aggression, but not severity of aggression, can be predicted using these three scores.
Adult↗
Are blacks more likely than whites to receive and provide social support in middle and old age? Yes, no, and maybe so.
Differences in the social support transactions of White and Black adults were investigated using data from the 1987/88 National Survey of Families and Households. Multivariate models were estimated to identify differences between Whites and Blacks in the likelihood that they provided and received instrumental and emotional support. Most importantly, we examined, separately for men and women, variations in Black-White differences from mid-life to old age. Results indicated that, overall, Blacks were no more likely than Whites to provide and receive both types of social support. In fact, Black women were less likely than White women to provide instrumental support to others. However, in old age, Black women were more likely to receive instrumental support and about as likely as White women to provide such support. These findings suggest that when comparing the informal support activities of White and Black adults, race needs to be considered in the context of gender and stage of life.
Black or African American↗
A task-specific typology of intergenerational family structure in later life.
We tested a typology of intergenerational social support structure with data from 910 dyads of older adults and their primary child helpers. Logistic regression was used to identify variables that differentiate dyads with distinct support configurations. Household support provided to elderly parents was more sensitive to physical and social deficits and geographic distance, whereas social-emotional support was more sensitive to norms and personal affinity.
Aged↗
Choosing optimal support groups: a review and reformulation.
There is considerable empirical research on the division of supportive and caregiving services among different network members. Yet the principles that govern the configuration of social support networks are still not well understood. Cantor's (1979) and Shanas' (1979) hierarchical-compensatory model and Litwak's (1985) task-specific model are among the more prominent formulations for explaining the choice of support groups. We propose that the former model is a special case of the latter one. The major conceptual features of both models are summarized here, followed by a qualitative review of 16 key empirical studies coupled with a meta-analysis to demonstrate the broader application of the task-specific model.
Caregivers↗
Conservation therapy for invasive lobular carcinoma of the breast.
Earlier literature suggests a high incidence of multicentricity and bilaterality, with an overall poor prognosis, in patients with invasive lobular carcinoma of the breast. Consequently, there is considerable disagreement regarding appropriate local management of this disease. To determine the influence of invasive lobular histologic findings on local tumor control, disease-free survival, and overall survival, the authors reviewed 60 patients with Stage I and II invasive lobular breast carcinoma treated with local tumor excision and radiation therapy between 1981 and 1987 (mean follow-up, 5.5 years; range, 2.5 to 10 years). The 5-year actuarial risk of locoregional recurrence was 5%, with two of three failures occurring in the regional lymphatics. The mean time to locoregional failure was 28 months. The 5-year actuarial disease-free survival (84%) and overall survival (91%) were comparable to those seen in several large series of similarly treated patients with invasive ductal carcinoma. Contralateral breast cancer occurred at a rate of approximately 0.6% per year. This study and a review of the literature suggest that breast conservation, with local resection and radiation therapy, is appropriate therapy for invasive lobular breast cancer.
Adult↗
Pregnancy-associated subacute hemorrhage into a prolactinoma resulting in diabetes insipidus.
A young woman with a small pituitary tumor associated with hyperprolactinemia developed subacute intrapituitary hemorrhage during the third trimester of pregnancy and presented with central diabetes insipidus. Magnetic resonance imaging established the diagnosis. After transsphenoidal surgery, her visual findings resolved, and the patient had an uneventful spontaneous delivery.
Adult↗
Arm pain in the workplace.
Explore the source record for details and available documents.
Arm Injuries↗
Lymphocytes with a CD4+ CD8- CD3- phenotype are effectors of experimental cutaneous graft-versus-host disease.
Graft-versus-host disease (GVHD) is known to cause profound dysregulation of the immune system, although its effector mechanisms are poorly understood. We now describe an effector lymphocyte of unusual phenotype in the skin of mice with GVHD. This cell is of donor origin and expresses several T-cell surface proteins including Thy-1, CD2, and CD4 but does not express CD8, CD3, NK1.1, or macrophage antigens. Mononuclear cells of this phenotype are the predominant lymphocyte in the epidermis of mice with GVHD 3 weeks after transplant but are not detected in transplanted mice without GVHD. Isolation and transfer of these lymphocytes into secondary recipients causes epidermal damage characteristic of GVHD. These data demonstrate that CD4+ CD8- CD3- lymphocytes are an important effector population that can be amplified outside the thymus and that can mediate target organ damage of GVHD.
Animals↗
Do close parent-child relations reduce the mortality risk of older parents?
This analysis examines the association between affectional solidarity in older parent-child relationships, and the parents' length of survival over a 14-year interval. It is hypothesized that close intergenerational relations have the capacity to reduce pathogenic stress among elderly parents, thereby enhancing their ability to survive. Direct and buffering effects of affectional solidarity, as expressed by 439 elderly parents, are tested using data from the U.S.C. Longitudinal Study of Generations collected between 1971 and 1985. Buffering effects are examined in the context of social decline and social loss experienced by the older parent. Hazard regression models indicate that greater intergenerational affect increases survival time among parents who experienced a loss in their social network, particularly among those who were widowed less than five years. Neither a direct effect of affection nor a buffering effect in the presence of social decline were found. It is concluded that the mortal health risks associated with the stress of being widowed can be partially offset by affectionate relations with adult children.
Adolescent↗
Treatment of advanced transitional cell carcinoma of the bladder with irradiation and concomitant 5-fluorouracil infusion.
Twenty patients with advanced transitional cell carcinoma of the bladder were treated with radiation and concomitant continuous infusion of 5-fluorouracil with or without Mitomycin. Nineteen of 20 patients were assessed for response. Fourteen of 19 patients (74%) obtained a complete response within 3 to 6 months. An additional three patients (15%) acquired and maintained a complete response after local transurethral resection of the tumor and intravesical chemotherapy, raising the overall complete response (CR) rate to 17/19 (89%). Of the two patients with persistent disease, one is alive and well after salvage cystectomy. Eighteen of 20 patients were evaluated for survival with a median follow-up of 38 months. Seven patients remain alive and well 51 to 78 months, whereas three patients died from intercurrent disease. Eight patients died of either distant metastatic disease (7 patients) or regional disease (1 patient). An adjusted survival calculated by the Life Table Method was 53.6% at 5 years, whereas the overall survival was 39%. The combined modality therapy was well tolerated with no need for treatment interruption or reduction in dose. Late bladder complications include one patient with hemorrhagic cystitis, two patients with dysuria, and two with symptoms of irritable bladder. One patient required a colostomy for a chronic hemorrhagic proctitis. Bladder preservation was achieved in 19/20 patients.
Aged↗
Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure.
The survival and ICU length of stay of 40 ARDS patients admitted to the ICU were analyzed to determine if a management strategy of lowering the pulmonary capillary wedge pressure (Ppw) was associated with an increased survival or a decreased ICU length of stay. ARDS was defined as three or four quadrant alveolar filling roentgenographically, a PaO2 less than 80 mm Hg with an FIO2 greater than .5 and a Ppw less than 18 mm Hg. Patients were divided into two groups: group 1 included all patients in whom there was a reduction of Ppw by at least 25 percent, and group 2 included patients in whom there was no, or less than a 25 percent reduction in Ppw. Survival was statistically different between the groups with 12 of 16 group 1 patients and seven of 24 group 2 patients surviving to hospital discharge. This difference remained statistically significant after stratifying patients by age and the APACHE II severity of illness index. We conclude that this retrospective analysis supports the notion that treatment of low pressure pulmonary edema with reduction of Ppw is associated with an increased survival.
Adult↗