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Biomedical subjects

R C Baron

Publications and source records attributed to R C Baron.

At least 37 records · Page 2Linked to original sources
PubMed1989

Infant mortality in West Virginia. Identifying risk factors for public health intervention.

Because infant death rates vary within populations, it is important for program managers and planners to identify high-risk subgroups for whom effective interventions can be targeted. Matching infant death certificates with birth records permits us to describe infant mortality and calculate risks by a variety of maternal and infant characteristics recorded at birth. In this paper, we illustrate how several variables are associated with infant death, and show how analysis of a recent birth cohort in West Virginia can assist health officials in determining appropriate strategies for risk reduction. While efforts need to focus on reducing social and economic barriers to maternal and infant health, different strategies are required to address separately the neonatal and postneonatal components of infant mortality. Matched records can be used in a variety of ways to develop support for, and highlight the needs of, West Virginia's Maternal and Child Health programs, to monitor trends over time, to evaluate program achievements, and to modify program goals.

Cause of Death↗
PubMed1986

The cardiac pathology of sudden, unexplained nocturnal death in Southeast Asian refugees.

Sudden death during sleep has occurred among previously healthy Southeast Asian male refugees, but routine autopsies have not determined the cause of death in any of these cases. We report the first systematic attempt to define the cardiac abnormalities associated with this syndrome. Among 18 hearts examined, 14 showed slight to significant cardiomegaly, characteristic of increased cardiac work load. The reasons for the cardiomegaly remain unexplained. Conduction system anomalies were present in all but one heart. These included persistent fetal dispersion of the atrioventricular node and/or bundle of His, present in 14 hearts; accessory conduction fiber connections, found in 13 cases; and congenital heart block, observed in one case. These abnormalities were associated with variations in the structure of the cardiac base, suggesting a common aberrant developmental process. Although the functional significance of these findings has not been established, the conduction system anomalies may be the substrate for sleep-related cardiac arrhythmias and sudden death.

Adult↗
PubMed1985

A mysterious cluster of deaths and cardiopulmonary arrests in a pediatric intensive care unit.

In the period April 1981 through June 1982, there was an unusual increase in the number of deaths and cardiopulmonary arrests in the pediatric intensive care unit at a large medical center hospital in San Antonio, Texas. During this period, 34 of 42 deaths (81 per cent) occurred in the evening work shift, as compared with 36 of 106 (34 per cent) during the previous four years (P less than 0.0001). Reviews of records of patients revealed no association between death in this 15-month epidemic period and a variety of demographic, historical, medical, and admission characteristics; medical or surgical procedures; or the severity of illness. The findings of a blinded clinical consultant support the conclusion that the increase in deaths and cardiopulmonary arrests could not be explained on the basis of the clinical status of the patients, and the consultant concluded that during the epidemic period, there were more deaths and cardiopulmonary arrests that were either unexpected in timing or inconsistent with the previous clinical course. The presence of one nurse was associated with the increased numbers of deaths (relative risk, 10.7; 95 per cent confidence limits, 6.4 to 17.9), cardiopulmonary arrests (relative risk = 25.5, confidence limits = 16.8 to 38.6), and unexpected clinical events, (relative risk, infinite; confidence limits, 33.7 to infinity). Although the cause of the epidemic remains unclear, the findings illustrate that surveillance of deaths and cardiopulmonary resuscitation may allow early recognition of similar problems in other hospitals.

Child↗
PubMed1984

Serological responses among teenagers after natural exposure to Norwalk virus.

Twenty-one teenagers exposed to a contaminated water supply during an outbreak of gastroenteritis were tested for seroconversion to Norwalk virus. Serum specimens were collected within 72 hr of exposure and four weeks later. Each of the 11 individuals who developed symptoms and five of the 10 who remained well had a whole-antibody response in serum. None of the remaining five teenagers became ill or seroconverted. Neither seroconversion nor susceptibility to illness was associated with an absence of detectable antibody from acute-phase serum specimens. These findings support the view that immunity to Norwalk virus is not determined by serum antibody. Furthermore, the results are consistent with the possibility, suggested by previous studies in volunteers, that susceptibility is determined by Norwalk virus-specific intestinal receptor sites. IgM responses to the Norwalk virus were detected in only seven persons who became ill (64%) and nine who seroconverted (56%). The seroassay for the Norwalk IgM component might have proved a more sensitive diagnostic tool in this outbreak if convalescent-phase specimens had been collected sooner than four weeks after the onset of illness.

Adolescent↗
PubMed1983

Sudden death among Southeast Asian refugees. An unexplained nocturnal phenomenon.

In the period July 15, 1977, through March 30, 1982, there were at least 51 sudden, unexplained deaths in the United States among refugees from Southeast Asia. These deaths involved relatively young (median age, 33 years), previously healthy persons. All except one were male, and all died at night. Available data from studies among young adults in this country suggest that this specific phenomenon has an unusually high incidence among Laotian and Kampuchean refugees and, furthermore, has not previously been observed in the United States. Interviews with families of the decedents and a case-control study have failed to establish causal factors, but emotional stress cannot be ruled out as a contributing element. While reviews of the forensic investigations have confirmed the absence of important common pathological or toxicological findings, preliminary findings of special postmortem cardiac studies, now in progress, suggest that at least some of these deaths may be associated with developmentally abnormal conduction system pathways. Further studies are required to confirm this association, to define the apparently sleep-induced mechanism that triggers these deaths, and to explain the male preponderance in this disorder.

Adult↗
PubMed1983

Aseptic meningitis and high school football players. 1978 and 1980.

During 1978 and 1980, epidemiologists at the Centers for Disease Control investigated seven outbreaks of aseptic meningitis-like illness (AMLI) occurring in high school football players in four different states. One or more enterovirus types were isolated from affected students at all seven schools. Attack rates were highest among the varsity football teams (range, 21% to 68%), although junior varsity teams were also affected at most schools (range, 5% to 63%). Non-football athletes were relatively spared. The illness was also reported by nonathletes at all three schools where more extensive investigations were undertaken. At one school, the AMLI attack rate was higher among students who were close friends of football players than among students who were not close friends; at the other two schools, these rates were similar. Hospitalization was more likely for football players with AMLI than for affected nonfootball players. Transmission of enteroviruses among football players was probably from person to person, although there was additional evidence to implicate common vehicle transmission at two schools. We conclude that football players may or may not have been more likely to be exposed to the enteroviruses circulating in their communities, but once introduction of a virus into a team occurred, transmission potential may have been enhanced, resulting in a large number of AMLI cases in players.

Disease Outbreaks↗
PubMed1983

Ebola virus disease in southern Sudan: hospital dissemination and intrafamilial spread.

Between 31 July and 6 October 1979, 34 cases of Ebola virus disease (22 of which were fatal) occurred among five families in a rural district of southern Sudan; the disease was introduced into four of the families from a local hospital. Chains of secondary spread within the family units, accounting for 29 cases resulted from direct physical contact with an infected person. Among all persons with such contact in the family setting, those who provided nursing care had a 5.1-fold increased risk of infection, emphasizing the importance of intimate contact in the spread of this disease. The absence of illness among persons who were exposed to cases in confined spaces, but without physical contact, confirmed previous impressions that there is no risk of airborne transmission. While the ecology of Ebola virus is unknown, the presence of anti-Ebola antibodies in the sera of 18% of persons who were unassociated with the outbreak suggests that the region is an endemic focus of Ebola virus activity.

Adolescent↗
PubMed1982

Aseptic meningitis among members of a high school football team. An outbreak associated with echovirus 16 infection.

During the period Sept 1 through Oct 1, 1978, an outbreak of enteroviral illness affected 43 (70%) of the 61 members of a high school football team. Thirty-three (54%) had symptoms of aseptic meningitis, a diagnosis confirmed for each of seven players hospitalized. Echovirus 16 was recovered from a throat swab of one hospitalized player and from the CSF of another. Enteroviruses isolated from stool specimens taken after the illness from other ill players and from stool specimens of non-ill team members were also identified as echovirus 16. A survey among students not on the team showed an attack rate for enteroviral-like illness that was half that experienced by team members during the same period. Symptoms reported by nonteam members were less severe. Only 10% had an aseptic meningitis-like syndrome, and none were hospitalized. Membership on the school football team was associated with an increased attack rate of illness and a greater risk for aseptic meningitis developing.

Adolescent↗
PubMed1982

Norwalk gastrointestinal illness: an outbreak associated with swimming in a recreational lake and secondary person-to-person transmission.

An outbreak of gastrointestinal illness in which headache, low grade fever and myalgia were common symptoms occurred among persons who visited a recreational park in Macomb County, Michigan, on July 13-16, 1979. The temporal clustering of onsets of 121 persons who were the first in their households to become ill suggested an incubation period ranging from 4-77 hours. A history of swimming in the park's lake was elicited with significantly greater frequency from these persons than from park visitors who were not ill (age standardized odds ratio = 4.8; 95% confidence interval, 1.8-12.7). One hundred twenty-six park visitors who became ill were household contacts of index patients who had swum in the lake; at least 62 of these 126 cases were probably due to secondary transmission. A secondary attack rate of 19% was observed in household contacts who had not visited the park. Serologic studies identified Norwalk virus as the etiologic agent. The source of the contamination of the lake could not be determined. Although some water samples collected just before and after the epidemic period had high coliform counts, the geometric mean coliform density of all samples collected on those days was within the limits established by the Environmental Protection Agency as acceptable for recreational contact water.

Adolescent↗
PubMed1982

La Crosse virus infection and disease in western North Carolina.

Active surveillance for La Crosse infection from 1977 to 1979 revealed 12 laboratory documented cases in children from the Cherokee reservation and nearby areas of western North Carolina. The annual rate of hospitalization with La Crosse virus was isolated from two of 34 pools of male and one of 34 pools of female Aedes triseriatus mosquitoes reared from larvae collected around the residences of reservation children who had been hospitalized with encephalitis. The occurrence of the recent cases, the history of cases in 1964 and 1965, and the demonstration of antibodies to La Crosse virus in sera from second grade children collected in 1968 (2%), in 1978 (4.5%), and in high school students in 1979 (11.3%), indicate that La Crosse has persisted in the Cherokee area for at least 15 years. La Crosse infection is infrequently reported from the southeast, but this may reflect inactive surveillance. More frequent testing would reveal whether La Crosse is a significant health problem in other areas of the southeast.

Aedes↗
PubMed1982

Epidemiology of Norwalk gastroenteritis and the role of Norwalk virus in outbreaks of acute nonbacterial gastroenteritis.

Outbreaks of Norwalk gastroenteritis, which may involve persons of all ages, occur during all seasons and in various locations. Waterborne, foodborne, and person-to-person modes of transmission have been described, and secondary person-to-person transmission is common. Outbreaks generally end in about 1 week; longer outbreaks occur only when new groups of susceptible persons are introduced, usually in the setting of a persistent common source of infection. The illness is generally mild and characterized by nausea, vomiting, diarrhea, and abdominal cramps. Vomiting is the predominant symptom among children, whereas diarrhea is commoner among adults. Forty-two percent of 74 outbreaks of acute nonbacterial gastroenteritis investigated by the Centers for Disease Control from 1976 to 1980 were attributed to the Norwalk virus. The rest resembled Norwalk outbreaks clinically and epidemiologically and were probably caused by 27-nm viral agents similar to the Norwalk virus.

Acute Disease↗
PubMed1981

Changing public attitudes about the mentally ill in the community.

The public's often negative response to two decades of deinstitutionalization policies remains a substantial barrier to the integration of the mentally ill into the community. Both mental health policymakers and public education specialists must support new programs to promote public acceptance. To do this, new research on the linkages between public attitudes and public behaviors is needed. Two research agendas should be established. First, there must be more specific research on how public attitudes about the mentally ill translate into community receptivity. Second, research must determine whether collaborative approaches to attitude-behavior change--involving communities in the process of changing themselves--or structural approaches--utilizing legal and social pressures--are more effective in promoting community integration.

Attitude to Health↗
PubMed1979

Nosocomial Legionnaires' disease in Columbus, Ohio.

Three patients with severe pneumonia at a community hospital in Columbus, Ohio, were found to have Legionnaires' disease in late August 1977. A subsequent serologic survey of patients with pneumonia at this hospital identified three additional cases. Among patients with pneumonia, hospital exposure in the 2 weeks before onset of illness was significantly associated with Legionnaires' disease (P = 0.003). Serosurveys of hospital employees with a recent history of upper respiratory illness, healthy employees, and workers at the hospital construction site showed that one of 101, one of 107, and none of 114, respectively, has a single reciprocal titer of greater than or equal to 256 to the Legionnaires' disease (LD) bacterium. Serosurveys of patients with pneumonia at three control hospitals identified five additional patients with Legionnaires' disease, three of them with pneumonia that was apparently hospital acquired in a single renal transplant unit. A fourth patient from that unit without clinical illness had a fourfold rise in titer to LD bacterium.

Adult↗