Biomedical subjects
Publications and source records attributed to Philip Weinstein.
New research developments frequently are neither adopted by providers nor utilized by patients. This dual problem of impacting the behaviors of providers and patients presents a challenge. This paper will present behavioral theories and technologies that can be utilized to impact both provider and patient behaviors.
BACKGROUND: Bushfire fighters are potentially subject to risks from bushfire smoke. Although many different protective masks and filters are available, it is not clear which is the most effective from a health and safety perspective. The effect of protective filters on the respiratory health of Western Australian urban career fire fighters under controlled simulated conditions is investigated. METHODS: Sixty-four healthy Fire and Emergency Services Authority of Western Australia (FESA) urban career fire fighters were subjected to controlled simulated bushfire smoke in an open smoke chamber for 15 min. The fire fighters were allocated one of the three types of protective filters: particulate only (P), particulate/organic vapor (POV), and a particulate/organic vapor/formaldehyde (POVF) filter using a double-blind randomized procedure. Personal air sampling inside the fire fighters' masks, spirometry, oximetry, and self-reported symptom data were collected at baseline and at two time intervals after the smoke exposure. RESULTS: A significant decline in oxygen saturation was seen immediately after exposure, however, the decline was small and no significant relationships could be established between this and the type of filter used. A significantly higher number of participants in the P and POV filter groups self-reported an increase in coughing, wheezing, and shortness of breath compared to the POVF group. Air sampling demonstrated a significantly higher level of formaldehyde and acrolein inside the masks fitted with P filters compared to POV and POVF filters. CONCLUSIONS: Testing the effectiveness of P, POV, and POVF filters under controlled conditions has demonstrated that the POVF filter provides statistically significant better protection for the fire fighters' airways in a simulated bushfire exposure chamber.
BACKGROUND: The purpose of this study was to compare the effect of a motivational interviewing (MI) counseling visit with traditional health education for mothers of young children at high risk of developing dental caries. METHODS: The authors enrolled 240 infants aged 6 to 18 months and their mothers in the study and randomly assigned them to MI or traditional health education (control) groups. Mothers in the control group received a pamphlet and watched a videotape. Those in the MI group received the pamphlet and watched the videotape, as well as received an MI counseling session and six follow-up telephone calls during the first year. There were no interventions in year 2. RESULTS: After two years, children in the MI group exhibited significantly less new caries (decayed or filled surfaces) than those in the control group (that is, a protective effect of MI) (odds ratio = 0.35, 95 percent confidence interval = 0.15 to 0.83). CONCLUSIONS: MI is a promising approach that warrants further attention in a variety of dental contexts. CLINICAL IMPLICATIONS: The results of this study show that MI has a protective effect with regard to the development of early childhood caries. One reason for this clinical effect is greater compliance with recommended fluoride varnish treatment regimens in families who received MI counseling compared with families who received traditional education.
AIMS: To predict differences in prostate cancer rates between New Zealand's major ethnic groups using community-based levels of elevated serum prostate-specific antigen (PSA). METHODS: This study was undertaken in the Wellington region of New Zealand. 1425 subjects with no clinical history of prostate cancer had serum PSA levels measured--728 New Zealand European, 353 Maori, and 344 Pacific Island men. Age-standardised elevated PSA prevalences were calculated by standardising for population proportions. Prostate cancer prevalence ratios were predicted using a previously published method. RESULTS: There was no significant difference between New Zealand's ethnic groups in the prevalence of elevated PSA (p>0.05). The overall age-standardised elevated PSA prevalence (3.9%) was lower than for all other community-based studies that were compared. Predicted cancer prevalence ratios were 1.1 across all New Zealand ethnic comparisons. CONCLUSIONS: The prevalence of elevated PSA in New Zealand men is lower than found in other community-based studies, and not significantly different between the three New Zealand ethnic groups. However, levels of elevated PSA may be useful for predicting prostate cancer incidence rates in ethnic groups. Available incidence data show New Zealand European men to have a higher prostate cancer incidence rate than both Maori and Pacific Islands men; however, this study found that prostate cancer incidence ratios between these groups are more likely to be closer to 1. Findings may indicate cultural barriers in the health system for Maori and Pacific Islands men; highlighting the need for clinicians to further consider cultural appropriateness in practice, and to target prostate health promotion for these groups.
OBJECTIVE: We retrospectively studied 20 adults who underwent C1-C2 transarticular screw (TAS) fixation utilizing frameless stereotaxy. METHODS: The study group comprised 13 men and 7 women, with a mean age of 63 years (range 12-87 years). All patients demonstrated clinical and radiographic evidence of C1-C2 instability. The cause of the instability was trauma in 11 patients, rheumatoid arthritis in 6 patients, failed prior surgery in 2 patients, and congenital malformation in 1 patient. All patients underwent stabilization with C1-C2 TASs using image-guided frameless stereotaxy. RESULTS: There were no new or worsening neurologic symptoms reported at 18-month follow-up. Motor weakness improved in seven of nine patients, myelopathy in seven of seven, and gait in three of six patients in whom these deficits were present preoperatively. Postoperative complications included one surgical site abscess, one cutaneous pressure ulcer, and one iliac crest donor site infection. Of 36 screws placed, 33 (92%) were well positioned. Normal C1-C2 alignment was achieved in 17 of 20 (85%) patients. In 4 of 20 cases, screw implant, which was thought to be anatomically difficult, if not impossible, on the basis of routine magnetic resonance or computed tomography imaging, was actually accomplished successfully using surgical navigation. CONCLUSIONS: C1-C2 TAS placement is a safe and accurate surgical technique that may improve neurologic function. Use of intraoperative navigation can facilitate achieving difficult surgical trajectories that match the patient's anatomy, thus allowing TAS implant in patients who otherwise would not be candidates for this type of internal fixation.
OBJECTIVES: The objectives of this pair of studies were to examine the internal reliability, test-retest reliability, and construct validity of the Revised Dental Beliefs Survey. METHODS: A total of 108 college students completed two questionnaires containing the Revised Dental Beliefs Survey, as well as the Revised Iowa Dental Control Index, and Desirability of Control scales. As part of another experiment, 141 study participants with dental injection phobia completed the Revised Dental Beliefs Survey and the Dental Anxiety Scale. RESULTS: Both the internal and test-retest reliabilities of the Revised Dental Beliefs Survey were high. The measure demonstrated good convergent and discriminant validities. CONCLUSION: The Revised Dental Beliefs Survey is well-suited for use with clinical and nonclinical populations, in which a stable and valid measure of perceptions of the dental situation is desired.
The revised version of the Dental Beliefs Survey (DBS-R), intended to measure three dimensions of the patient dentist relationship as perceived by the patient, namely Ethics, Communication and Control, was tested in a confirmatory factor analysis. Five different models for the internal structure of the questionnaire were tested. The final model, a 5-factor solution, basically including the 3 assumed dimensions as well as the re-introduced dimension Trust covered in the first version of the DBS plus a global factor including all items, yielded an acceptable fit. This model also omits 4 items from DBS-R, i.e. items 3, 11, 18, and 28. The reduced DBS-R is recommended for clinical use when assessing the patient's perception of the relationship to the dentist, including both trust and ethical behavior.
Surgical-site infection occurred in 6 of 42 neurospinal cases in which bone wax was used and in 1 of 72 cases in which it was not used during a 3-month period (P < .01). Increased risk of infection should be considered when using bone wax as a hemostatic agent.
OBJECTIVE: To define lower urinary tract symptoms (LUTS) and their relationship to general practitioner (GP) visits and ethnicity among men in the New Zealand (NZ) population-based Wellington Region Community Prostate Study. SUBJECTS AND METHODS: In 2001-2002 NZ European, Maori and Pacific Island participants were selected from the Wellington region of NZ. Demographic questions, the International Prostate Symptom Score and yearly GP attendance questions were completed by 862 subjects with no history of prostate cancer. RESULTS: There were no significant differences in LUTS among the ethnic groups (P = 0.80) but symptom scores were positively correlated with age only for NZ Europeans (P < 0.001, r = 0.179). Overall, NZ populations have a lower prevalence of LUTS than is evident for ethnic groups in other countries. Pacific Islanders attended the GP more often than both NZ Europeans and Maori. CONCLUSION: Ethnic differences in age-related urinary symptoms and visits to the GP are important for informing culturally appropriate clinical practice and prostate health promotion with minority groups.
BACKGROUND: Most prostate cancers are characterized by a significant rise in the production of serum prostate-specific antigen (PSA), which is used widely in screening for prostate cancer. Within New Zealand, PSA is measured on automated immunoassay analysers, including models by Abbott Laboratories (Architect i2000) and Roche Diagnostics (Elecsys 2010). These assays produce similar, but not identical, results. OBJECTIVE: To compare the measurement of PSA between the Elecsys 2010 and the Architect i2000 assay. METHODS: We measured PSA concentrations in each of 194 serum samples using both the Roche Elecsys 2010 and the Abbott Architect i2000 and compared the results using various statistical methods. RESULTS: PSA concentrations measured on the Architect i2000 system were less than those on the Elecsys 2010 system, by an average of 11%. CONCLUSION: Because the results from the two assays are different, reference intervals appropriate to the method of PSA measurement should be used.
Human health often depends on environmental variables and is generally subject to widespread and comprehensive surveillance. Compared with other available measures of ecosystem health, human disease incidence may be one of the most useful and practical bioindicators for the often elusive gauge of ecologic well-being. We argue that many subtle ecosystem disruptions are often identified only as a result of detailed epidemiologic investigations after an anomalous increase in human disease incidence detected by routine surveillance mechanisms. Incidence rates for vector-mediated diseases (e.g., arboviral illnesses) and direct zoonoses (e.g., hantaviruses) are particularly appropriate as bioindicators to identify underlying ecosystem disturbances. Outbreak data not only have the potential to act as a pivotal warning system for ecosystem disruption, but may also be used to identify interventions for the preservation of ecologic health. With this approach, appropriate ecologically based strategies for remediation can be introduced at an earlier stage than would be possible based solely on environmental monitoring, thereby reducing the level of "ecosystem distress" as well as resultant disease burden in humans. This concept is discussed using local, regional, and global examples, thereby introducing the concept of multilevel ecosystem interventions. Key words: bioindicators, disease control, disease outbreaks, ecologic management, ecosystem health, surveillance.
BACKGROUND: The authors conducted a study to compare the effect of a motivational interviewing counseling treatment with that of traditional health education on parents of young children at high risk of developing dental caries. OVERVIEW: The authors enrolled in the study parents of 240 infants aged 6 to 18 months and randomly assigned them to either a motivational interviewing, or MI, group or a traditional health education (control) group. Parents in the control group received a pamphlet and watched a video. Parents in the MI group also received the pamphlet and watched the video; in addition, they received a personalized MI counseling session and six follow-up telephone calls. RESULTS: After one year, children in the MI group had .71 new carious lesions (standard deviation, or SD, = 2.8), while those in the control group had 1.91 (SD = 4.8) new carious lesions (t[238] = 2.37, one-tailed, P < .01). CONCLUSIONS: MI is a promising approach that should receive further attention. CLINICAL IMPLICATIONS: MI may lead parents and others to better accept dental recommendations about preventing caries in their children.
AIMS: To determine whether age-adjusted levels of serum total (tPSA) and complexed (cPSA) prostate specific antigen and the ratio of free to tPSA (%fPSA) differ by ethnic group independent of symptomatic disease. METHODS: The serum levels of tPSA, cPSA, and %fPSA in relation to age, ethnicity and obstructive urinary symptoms were examined in 1405 Maori, Pacific Island and New Zealand European men in the Wellington region of New Zealand, and indicative reference range estimates produced. Participants were non-randomly selected from two study populations. RESULTS: tPSA and cPSA increased with age while %fPSA decreased with age in all ethnic groups. Maori showed higher tPSA values in the 60-69 age group than other ethnic groups. cPSA increased more rapidly with age in Maori than in New Zealand Europeans or Pacific Islanders. %fPSA differed according to age across all three ethnic groups. The median and 5th percentile Pacific Island %fPSA values were higher in comparison to the %fPSA reference ranges of all other ethnic groups and were also higher than those reported in other studies. Once adjusted for urinary symptom score, only %fPSA in Pacific Island subjects remained significantly higher than that in New Zealand Europeans (P<0.001). CONCLUSIONS: Our study indicates that %fPSA differs by ethnicity independent of symptomatic prostate disease.
New Zealand has one of the highest incidences of campylobacteriosis in the developed world, which leads a global trend of increasing notifications of Campylobacter infections over the last decade. Foodborne and waterborne transmission have been implicated as significant mechanisms in the complex ecology of the disease in New Zealand. We examined both regional and temporal variation in notification rates to gain some insight into the role of the New Zealand environments in modifying disease incidence. Firstly, there is a marked difference in the seasonality of campylobacteriosis between the North and South Islands of New Zealand. The Far North and much of the rural North Island were found to display relatively low summer incidence and small inter-seasonal variation. Secondly, there appears to be a dispersed grouping of North Island urban areas, including Auckland, Hamilton, Napier and their hinterlands as well as a few areas on the South Island that exhibit higher summer incidence and more seasonality than the first group. Thirdly, Christchurch, Dunedin, much of the South Island and the lower North Island cities of Wellington and Upper Hutt appear to experience the highest summer incidence and strongest inter-seasonal variation in New Zealand. These three broad groupings of campylobacteriosis seasonality, constructed using a principal components analysis, suggest that the importance of transmission routes may vary regionally in New Zealand. The observed variation in seasonal incidence indicates a complex ecology that is unlikely to be explained by a single dominant transmission route across these three groupings.
Converging themes from the fields of environmental health, ecology and health, and human ecology highlight opportunities for innovation and advancement in environmental health theory and practice. In this commentary we outline the role of research and applied programs that integrate biophysical and social sciences with environmental health practice in order to address deficiencies in each field when taken on its own. New opportunities for environmental health protection and promotion are outlined based on the three converging themes: integrated approaches to research and policy, methodological acknowledgment of the synergies between the social and biophysical environments, and incorporation of core ecosystem principles into research and practice. These converging themes are discussed in relation to their implications for new types of intervention to achieve health gains across different spatial and temporal scales at the interface between biophysical and social environments.
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The management of patients with intradural spinal tumors differs in many respects from approaches taken for patients with intracranial tumors. Intramedullary lesions are often completely surrounded by normal spinal cord, displacing vital functional tracts eccentrically. Extramedullary lesions can drastically compress the spinal cord and nerve roots, reducing normal tissue to a ribbon-like consistency. The small amount of normal tissue relative to tumor has implications for surgery and postoperative adjuvant therapy. In addition, operative intervention must take spinal stability into consideration. In this report, we describe the current best care practices and strategies for patients with a diagnosis of spinal astrocytoma, ependymoma, hemangioblastoma, schwannoma, and meningioma. Treatment of patients with intradural tumors of the spinal cord and adjoining structures has changed over the past 20 years. Advances in many disciplines including neuroradiology, neurosurgery, neurooncology, and neuropathology have contributed to expediting diagnosis and improving outcomes.
New Zealand's freshwater ecosystems are subject to microbial contamination from a predominantly agricultural landscape. This study examines the spatial and temporal distribution of the human pathogen Campylobacter in the lower Taieri River, South Island (New Zealand). Enumeration of thermophilic Campylobacter from river samples was performed using a most probable number (MPN) method. Seasonal variation in Campylobacter levels was evident, with higher median levels detected in summer, when human exposure through recreational water use is maximal. Campylobacter levels varied significantly among the 10 sampling sites, increasing below a major tributary entering the river and then showing a downstream decrease. These changes probably resulted from inputs from adjacent farms and instream Campylobacter losses (settling, death). Two main peaks in the flux of Campylobacter were observed, one in winter and one in summer. A decrease in notified cases of campylobacteriosis in the human population was observed when levels of Campylobacter at the main recreational bathing site on the river were low. Continuing land use change and intensification in New Zealand may lead to further increases in microbial contamination of freshwaters, and an associated increase in waterborne enteric diseases such as campylobacteriosis.