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Biomedical subjects

R Finger

Publications and source records attributed to R Finger.

14 recordsLinked to original sources
PubMed1997

Results of a search for missed cases of reportable communicable diseases using hospital discharge data.

To assess how reliably hospitals report serious, uncommon communicable diseases to the Department for Public Health, we searched the 1995 hospital discharge data set (HDDS) collected by the Kentucky Health Policy Board for cases of 11 diseases. Of 17 case records found, 4 represented disease occurrences that had been reported to the Department; 6 represented coding errors in the HDDS; 4 were instances where a reportable disease had been suspected but not confirmed by subsequent workup; 1 case was a resident of another state; and 2 were cases of invasive Hemophilus influenzae infection in adults that should have been reported to the Department. The study found no evidence that hospitals failed to report vaccine-preventable diseases. There was evidence that the HDDS needs improved accuracy to maximize its usefulness for public health purposes.

Communicable Disease Control↗
PubMed1996

[Experiences and results in management of mandibular fractures with the modified Krenkel lag screw--a retrospective study].

The stable osteosynthesis of mandibular fractures with the modified lag screw (Krenkel) has proven superior to conventional lag screws in theoretical models and clinical use. Compared to osteosynthesis with plate systems, the lag screw technique is more difficult to learn for the unexperienced, but the reduction of fragments under compression with a lag screw and the stabilisation of lower jaw rotation with an additional short miniplate in our experience has proven successful in clinical use.

Adolescent↗
PubMed1995

High prevalence of multidrug-resistant Streptococcus pneumoniae among children in a rural Kentucky community.

In 1992 drug-resistant Streptococcus pneumoniae was cultured with increasing frequency from aspirates of middle ear fluid from children with acute otitis media in a rural Kentucky community. To determine the prevalence of carriage of drug-resistant S. pneumoniae in the community, we obtained nasopharyngeal swabs from 158 (70%) of 227 children attending a child daycare center and from 82 children attending the county health center. S. pneumoniae was isolated from 126 children. Among 123 isolates tested 65 (53%) were penicillin-resistant, including 41 (33%) strains that were highly resistant; 61 (50%) were multidrug-resistant. Serotypes 19F, 6B, 23F and 6A comprised 89% of the penicillin-resistant isolates. Detection of a variety of serotypes and drug resistance patterns among nasopharyngeal isolates of S. pneumoniae suggests that multidrug-resistant pneumococcal strains are endemic in this community. Surveillance for drug-resistant pneumococci with the use of respiratory secretions obtained by nasopharyngeal swab may provide useful information on the prevalence of drug-resistant strains causing invasive disease and otitis media. Such information could be used to guide empiric therapy of pneumococcal infections.

Carrier State↗
PubMed1995

Communitywide shigellosis: control of an outbreak and risk factors in child day-care centers.

OBJECTIVES: The study's objectives were to assess (1) control of a community outbreak of shigellosis through the promotion of handwashing, (2) risk factors in day-care centers, and (3) shigellosis attributable to attendance at a day-care center. METHODS: In 1991, an outbreak of Shigella sonnei infections occurred in Lexington-Fayette County, Ky; 14 licensed child day-care centers were involved. Communitywide promotion of hand washing was instituted along with diarrhea surveillance. A case-control study compared day-care centers that had confirmed cases of shigellosis with centers that had none. A family transmission study determined those cases attributable to attendance at day-care centers. RESULTS: The outbreak abated 3 weeks after the interventions' initiation. Day-care centers with outbreaks were more likely than those with no cases to have a food handler who changed diapers and to provide transportation for children from their homes to the center. These centers also had a higher toddler-to-toilet ratio than control centers (21 vs 12). In 58% of families with shigellosis, the first person with diarrhea during the outbreak was a child younger than 6 years; 92% of diarrheal illnesses among these children were attributable to day-care attendance. CONCLUSIONS: Community involvement in increasing hand washing most likely resulted in control of this shigellosis outbreak. Diarrhea prevention strategies in day-care centers could prevent substantial communitywide disease.

Case-Control Studies↗
PubMed1992

Survival of persons with AIDS in Kentucky.

Of all reported Kentucky adult/adolescent cases of AIDS (124) with diagnosis dates from July 1, 1990, through June 30, 1991, 33% died within three months of diagnosis. To discern possible reasons for these very short survival times, information was analyzed from the CDC AIDS Confidential Case Report of the 124 patients and from the hospital charts of the 29 patients who were reported as having died within the month of or the month following diagnosis. Data suggested that survival for three months appears to be less likely for blacks, for males, and for those 30 through 34 years old. In the cohort the first diagnosis of AIDS was made at 40 different hospitals and the patients presented to 77 different physicians. Of chart-reviewed patients, 16 of the 29 (55.1%) were previously known to be HIV-positive. The most commonly identified likely reason for short survival time from AIDS diagnosis to death was that the diagnosis had been previously missed (10 of the 29 patients--34%). The study showed that many known to be HIV-positive for some time had apparently received little or no care for their infection from testing until diagnosis with AIDS. Medical review of patient charts suggested that scatter of caregivers may have resulted in some errors in diagnosis and treatment decisions. Also, considerable numbers of persons with HIV infection are either not utilizing the existing HIV counseling, testing, and follow-up systems or are not receiving medical care for their infection once it is identified.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The use of analgesics in patients with acute abdominal pain.

Analgesics in patients with acute abdominal pain are often withheld for fear that they may change physical examination findings and thus may be unsafe. We conducted a randomized, prospective, placebo-controlled trial to investigate changes in physical examination following the administration of placebo, 5 mg, or 10 mg of morphine to 49 patients with acute abdominal pain. One patient was withdrawn secondary to inadequate documentation. Of the 48 patients who completed the trial, a statistically significant change in physical examination was noted in both groups receiving analgesics, but not in the placebo group. No adverse events or delays in diagnosis were attributed to the administration of analgesics. We conclude that physical examination does change after the administration of analgesics in patients with acute abdominal pain and that a larger study is needed to evaluate analgesic safety in this subpopulation of emergency department patients.

Abdominal Pain↗
PubMedDate not supplied

Age-specific incidence of chickenpox.

Because licensure of a chickenpox (varicella) vaccine is likely soon, it is important to ascertain the age-specific incidence of chickenpox. Increasing vaccine coverage and a resulting decrease in transmission may result in an accumulation of susceptible adults, followed by a shift of incidence into those older age groups in future years. Valid baseline age-specific incidence will make it possible to detect this phenomenon. Two studies were conducted in Kentucky to assess age-specific incidence of chickenpox. The first assessed chickenpox occurrence in two consecutive school-year cohorts of children from a geographically representative sample of Kentucky primary schools. The second gathered information from household members of those persons interviewed in the Behavioral Risk Factor Surveillance System telephone survey. The age-specific rates are remarkably similar between studies. Rates peak during the preschool and kindergarten years (ages 3-6). Approximately 20 percent of children remain susceptible to chickenpox after age 8 in both studies. The results from these two surveys will be valuable baselines for comparison with findings in incidence studies that will be performed after vaccine licensure.

Adolescent↗