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M Silverstein

Publications and source records attributed to M Silverstein.

At least 37 records · Page 2Linked to original sources
PubMed1993

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↗
PubMed1993

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↗
PubMed1993

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↗
PubMed1992

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↗
PubMed1992

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↗
PubMed1991

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↗
PubMed1991

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↗
PubMed1990

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↗
PubMed1990

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↗
PubMed1989

Psychosocial outcomes of breast cancer therapies: lumpectomy versus mastectomy.

The psychological status of 50 patients who had been treated for breast cancer was assessed an average of 21 months after treatment. The patients were grouped according to major treatment modalities: mastectomy with breast reconstruction, mastectomy without breast reconstruction, or lumpectomy. Lumpectomy patients had a significantly more intact body image (p less than .008) and a greater sense of sexual desirability (p less than .009) than patients in the other groups. The patients did not differ on frequency of sexual relations or on emotional symptomatology. The results of this study generally validate those found in comparable studies showing that lumpectomy promotes a more intact body image but that no surgical procedure either produces or inhibits psychological symptomatology.

Adult↗
PubMed1988

Prospective immunologic and clinical study of a population exposed to hexamethylene diisocyanate.

We have prospectively evaluated 150 workers exposed to hexamethylene diisocyanate (HDI) and its trimer (THDI) during an 18-month period. The evaluation consisted of periodic serum antibody studies and a questionnaire that was designed to attempt to identify symptoms compatible with work-related syndromes of allergic rhinitis, allergic conjunctivitis, hypersensitivity pneumonitis, asthma, or irritant reactions. The study population was divided into seven groups on the basis of job classification. The groups differed in exposure levels but were similar in terms of age, sex, smoking history, and duration of work with isocyanates. IgE and IgG against HDI and THDI conjugated to human serum albumin (HSA) (HDI-HSA and THDI-HSA) were determined by ELISA. There were no instances of immunologically induced disease among the 21% of workers in this sample with antibody; however, there is insufficient evidence at this time to make judgments about the relationship between antibody and clinical disease. The antibody was generally low-level IgG that may be a sensitive indicator to detect exposure to certain reactive chemicals. The level of antibody was not different among job classes or between smokers and nonsmokers. Moreover, there was no correlation between antibody level and exposure duration in these workers whose exposure levels are all well below National Institute for Occupational Safety and Health recommendations. Further evaluation will extend these observations.

Antibodies↗
PubMed1988

Mortality among bearing plant workers exposed to metalworking fluids and abrasives.

Epidemiologic studies have reported associations between gastrointestinal cancer mortality and exposure to cutting fluids and abrasives in metal machining and precision grinding operations. Two previous studies found excess stomach cancer among workers exposed to water-based cutting fluids in bearing plants. This study reports similar findings in a third and larger population. Cause of death and work histories were determined for 1,766 bearing plant workers who died between Jan 1, 1950 and June 30, 1982. Mortality odds ratios (SMOR) and proportional mortality ratios (PMR) revealed significant excesses of gastrointestinal malignancies. The proportional mortality excess for stomach cancer among white men was greatest among those with more than 10 years' exposure in the major grinding group (PMR = 13/3.8 = 3.39; P less than .001). The SMOR by logistic regression for stomach cancer among white men was 2.3 (P = .02) for 25 years' grinding experience. For cancer of the pancreas among white men, there were significant associations with both machining and grinding jobs in straight oil (SMOR = 9.9 and 3.2, respectively, for 25 years duration). These findings could not be explained by confounding due to the ethnic background of the decedents. This study confirms previous evidence that grinding operations using water-based cutting fluids increase the risk for stomach cancer and provides moderate evidence that exposures to straight oil-cutting fluids increase the risk for cancer of the pancreas. There were indications, meriting further investigation, that non-malignant liver disease is associated with cutting fluid exposures and that lung cancer is associated with oil smoke from operations such as forging or heat treating.

Aluminum↗
PubMed1987

Treatment of advanced bladder carcinoma with irradiation and concomitant 5-fluorouracil infusion.

Nineteen patients with locally advanced bladder cancer were treated with irradiation and concomitant 5-fluorouracil intravenous infusion with or without bolus mitomycin. Eighteen of the 19 patients were evaluated for local response. Eleven of the 18 patients (61%) obtained a complete local response within 3 to 6 months. An additional five patients (28%) showed tumor regression to a superficial state controlled by local transurethral resection and intravesical chemotherapy making the overall local clearance rate 16/18 (89%). The remaining two patients (11%) required salvage cystectomy for persistent disease and presently show no evidence of disease. Nine patients have died. Two patients died of intercurrent disease, six patients died of metastatic disease, and one patient who died from regional disease showed no evidence of local bladder tumor at the time of death. Berkson-Gage life-table analysis yields an adjusted survival of 62.5% at 5 years. Late complications included five patients with hemorrhagic cystitis, two patients with a contracted bladder, and one patient with a hemorrhagic radiation proctitis.

Aged↗
PubMed1987

Utility of molecular genetic analysis of bcr rearrangement in the diagnosis of chronic myeloid leukemia.

Two DNA probes for the breakpoint cluster region (bcr) of chromosome # 22 have been used to determine the proportion of Philadelphia chromosome (Ph)-positive chronic myeloid leukemia (CML) cases that can be diagnosed by Southern blot analysis. Studies on 17 normal individuals and 17 patients with lymphomas and leukemias (other than CML) indicated that for the restriction enzymes chosen, only expected germ line DNA bands were obtained. In contrast, novel DNA bands interpreted as being the product of translocation within the bcr region could be demonstrated in 31 of 31 cases of Ph-positive CML. One commercially available 1.2 kb bcr probe detected most cases of CML. Because of the frequent presence of deletion of part of the bcr region, however, a probe from the 5' end of bcr is essential to detect some cases. An analysis of the bcr breakpoints occurring in CML patients suggested a difference in the location of the breakpoints for the blast crisis patients versus chronic phase patients although the difference between these two groups was not statistically significant. It is concluded that bcr analysis provides a powerful aid in the diagnosis of CML. This technique is of particular merit in cases when cytogenetic analysis is inconclusive and has considerable potential for improved speed and sensitivity of diagnosis.

Chromosome Banding↗
PubMed1986

Mortality among ferrous foundry workers.

Mortality analyses were carried out for 278 male hourly workers who were employed for at least 10 years at a gray iron foundry and who died between January 1, 1970 and December 31, 1981. Statistically significant excess proportional mortality due to non-malignant respiratory disease (SPMR = 177), lung cancer (SPMR = 148), and leukemia (SPMR = 284) was found among the 221 white males. Among nonwhite males there was a significant excess in proportional mortality due to circulatory diseases (SPMR = 143). White males in the Finishing classification experienced a significant excess of proportional mortality due to nonmalignant respiratory disease (SPMR = 279) and lung cancer (SPMR = 179). White males in the Core Room classification experienced an excess of proportional mortality due to nonmalignant respiratory disease (SPMR = 321). Case-control studies demonstrated a significant association between nonmalignant respiratory disease and the Finishing classification after controlling for the effects of age, prior occupations in coal mining or foundries, and smoking. A positive but nonsignificant association between lung cancer and Finishing was also found after controlling for age, prior work history, and smoking in case control studies.

Adult↗
PubMed1986

Predictors of outcome in schizophrenia: the process-reactive dimension.

Premorbid social-sexual competence and the process-reactive dimension, as assessed by the Phillips Scale, were investigated as predictors of posthospital adjustment in a prospective study of two samples of 141 young, early phase schizophrenics (a private hospital sample and a state hospital sample). The Phillips Scale predicted subsequent outcome at significant levels for one of the two samples of DSM-II schizophrenics (a "broad" construct of schizophrenia). It did not predict outcome as well for DSM-III schizophrenics (a "narrow" construct of schizophrenia). Mixed results emerged from separate analyses of first-admission schizophrenics only and for male schizophrenics only. The data indicated that marital status accounts for some of the positive relationship between the Phillips Scale and later outcome. A more focused measure of prehospital social adjustment successfully predicted social functioning at followup for both DSM-II and DSM-III schizophrenics (p less than .05). There were some significant and near-significant relationships, but overall results suggest that when the influence of chronicity and marital status is reduced, the relationship between the Phillips Scale and subsequent outcome is less robust than was once thought.

Adult↗