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Biomedical subjects

S Eberly

Publications and source records attributed to S Eberly.

34 records · Page 2Linked to original sources
PubMed1996

Racial differences in Urban children's environmental exposures to lead.

OBJECTIVES: This study explored whether differences in environmental lead exposures explain the racial disparity in children's blood lead levels. METHODS: Environmental sources of lead were identified for a random sample of 172 urban children. RESULTS: Blood lead levels were significantly higher among Black children. Lead-contamination of dust was higher in Black children's homes, and the condition of floors and interior paint was generally poorer. White children were more likely to put soil in their mouths and to suck their fingers, whereas Black children were more likely to put their mouths on window sills and to use a bottle. Major contributors to blood lead were interior lead exposures for Black children and exterior lead exposures for White children. CONCLUSIONS: Differences in housing conditions and exposures to lead-contaminated house dust contribute strongly to the racial disparity in urban children's blood lead levels.

Black People↗
PubMed1996

A randomized trial of the effect of dust control on children's blood lead levels.

OBJECTIVE: Dust control is recommended as one of the cornerstones of controlling childhood lead exposure; however, the effectiveness of dust control has not been demonstrated for children who have low to mild elevations in blood lead (ie, less than 25 micrograms/dL). The objective of this study was to determine whether dust control, as performed by families, had an effect on children's blood lead levels and dust lead levels in children's homes. DESIGN: Randomized, controlled trial. SETTING: Community-based trial in Rochester, NY. PARTICIPANTS: One hundred four children, 12 to 31 months of age at baseline. INTERVENTION: Families and children were randomized to one of two groups. Families of children in the intervention group received cleaning supplies, information about cleaning areas that are often contaminated with lead, and a cleaning demonstration. Families in the control group received only a brochure about lead poisoning prevention. OUTCOME MEASURES: Baseline measurements of lead in blood, house dust, soil, water, and paint were taken from both groups. Seven months after enrollment, a second blood lead assay was obtained, and lead levels in household dust were measured. The main outcome measures were change in blood lead levels and dust lead levels by treatment group. RESULTS: The median blood lead level of children enrolled in the study was 6.7 micrograms/dL (range, 1.7 to 30.6 micrograms/dL). There was no significant difference in the change of children's blood lead levels or dust lead levels by treatment group. The median change in blood lead levels among children in the intervention group was -0.05 micrograms/dL compared with -0.60 micrograms/dL among those in the control group. There also was no significant difference in the change of dust lead by group assignment, although there was a trend toward a significant difference in the percentage of change in dust lead levels on noncarpeted floors, which was greater among houses in the intervention group. CONCLUSIONS: These data suggest that an intervention that consists only of providing cleaning supplies and a brief description of dust control is not effective at reducing blood lead levels among urban children with low to mild elevations in blood lead levels at a 7-month follow-up.

Child Welfare↗
PubMed1995

A side-by-side comparison of dust collection methods for sampling lead-contaminated house dust.

The Environmental Protection Agency is required to set a standard for lead-contaminated house dust, but whether dust lead loading (micrograms/ft2) or concentration (micrograms/g) is more predictive of children's blood lead levels, which dust collection method should be used, and which surfaces should be sampled are unknown. Using a random sample of sequential births, we enrolled 205 urban children, 12 to 30 months of age, who had lived in the same house since at least 6 months of age. Samples of dust were obtained from predetermined surfaces in each child's residence using a wipe method and two vacuum methods, the Baltimore repair and maintenance method (BRM) and the dust vacuum method (DVM). Other potential sources of environmental exposure also were analyzed for lead, including soil, water, and paint. In general, dust lead loading is more predictive of children's blood lead levels than is dust lead concentration. Dust lead loading as measured with the BRM sampler explained more of the variation in children's blood lead levels than did wipe loading and DVM loading (13.7, 10.1, and 5.9%, respectively, adjusted for other significant predictors). The partial correlation between BRM lead loading and children's blood lead was significantly different than that for DVM lead loading, but it was not significantly different than that for wipe lead loading. Of the four surfaces measured, noncarpeted floors and interior window sills or wells were significantly associated with children's blood lead levels in multiple regression models. These data indicate that dust lead loading is more predictive of children's blood lead levels than is dust lead concentration and that, to determine if a housing unit is safe for children, noncarpeted floors and interior window sills or window wells should be measured using either the BRM or wipe sampling method.

Air Pollution, Indoor↗
PubMed1994

Cigarette smoking and the age at onset of a first non-fatal myocardial infarction.

BACKGROUND: Smoking is a major risk factor for coronary heart disease. Discontinuance of smoking is associated with a reduction in the risk of coronary disease; this risk approaches the level among non-smokers after stopping smoking for periods ranging from 6 months to several years. We analyzed pertinent prospectively accumulated data from our multicenter postinfarction studies to gain further insight into the complex relationship between cigarette smoking and the premature occurrence of a first myocardial infarction. METHODS: Retrospective analysis of the relationship between the number of cigarettes smoked and the age at onset of patients experiencing their first non-fatal myocardial infarction was investigated in 2445 patients. The intensity of smoking was quantitated in terms of the average number of packs per day smoked during adult years, subcategorized in increments of a half-pack per day up to more than two packs per day. Ex-smokers were identified if they had stopped smoking 1 month before their index infarction. Analysis of variance was used to adjust for the effects of relevant confounding risk factors. RESULTS: The adjusted age for first non-fatal infarction progressively declined with increasing smoking exposure, with an average age reduction of 8.7 years (95% confidence interval; 7.2, 10.2) in those smoking more than two packs per day compared with non-smokers. The graded effect was somewhat more marked in women than in men. The number of cigarettes smoked before infarction had no effect on the severity of the acute infarction or on mortality from cardiac causes during more than 2-year post-hospital follow-up. Those who stopped smoking 1 month or longer before the infarction were significantly older at the time of first infarction than active smokers in all smoking categories. CONCLUSION: This study provides strong evidence that active smoking is associated with an earlier age at onset of first infarctions, with a striking inverse dose-response effect. Stopping smoking appears to reduce the premature occurrence of coronary events.

Age of Onset↗
PubMed1993

Routine screening of Halloween candy: helpful or hazardous?

STUDY OBJECTIVES: To determine the frequency of radiopaque items found in radiologic screening of Halloween candy and to determine the possibility of missing a small item. DESIGN: Prospective observational study on Halloween night, 1992. Data were collected from area medical centers that were screening Halloween candy. The ability to detect small sharp items was tested at five centers. SETTING: Five hospitals and three immediate care centers. PARTICIPANTS: Four hundred fifty-four bags of candy were screened. RESULTS: No unknown radiopaque items were discovered. One of five centers tested for accuracy failed to detect a small radiopaque item. Only one hospital required parents to sign a waiver of liability. The immediate care centers recorded patients' names; the other hospitals kept no record of the names of children whose bags were screened. No physicians viewed the radiographs or fluoroscopy. CONCLUSION: The routine radiologic screening of Halloween candy has an extremely low yield in detecting radiopaque items.

Candy↗
PubMed1993

One hundred autotransplants for relapsed or refractory Hodgkin's disease and lymphoma: value of pretransplant disease status for predicting outcome.

PURPOSE: One hundred autotransplants for Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL) were examined prospectively to identify variables with prognostic significance. PATIENTS AND METHODS: Ninety-six patients with relapsed or refractory HD or NHL underwent 100 autotransplants. Patients received high-dose carmustine (BCNU), etoposide, cytarabine, and cyclophosphamide (BEAC) followed by unpurged autologous stem-cell rescue. RESULTS: The 3-year actuarial event-free survival (EFS) rate for the 47 HD patients is 49%, with a median followup duration of 2 years. For the 53 NHL patients, the 3-year actuarial EFS rate is 40%, with a median follow-up duration of 19 months. By multivariate analysis, minimal disease on admission (all areas < or = 2 cm) is associated with improved EFS (HD, P = .003, NHL, P = .03). The projected EFS rate for HD patients entering with minimal disease is 70% versus 15% for patients with bulky disease (P = .0001). The projected EFS rate for NHL patients with minimal disease is 48% versus 25% for patients with bulky disease (P = .04). Posttransplant involved-field radiotherapy, administered to 26 of the last 61 patients, was associated with an improved EFS rate for NHL patients (P = .015). The BEAC regimen was well tolerated by patients who entered the study with minimal disease (mortality rate, < 5%), but caused significant toxicity in patients with bulky disease (mortality rate, 25%). CONCLUSION: Disease burden before autotransplantation is an important predictor of regimen-related toxicity and EFS. Posttransplant involved-field radiotherapy may improve outcomes in select patients with NHL. The BEAC regimen is safe and effective, particularly for patients with minimal disease.

Actuarial Analysis↗
PubMed1992

Instantaneous cardiac death in the posthospital period after acute myocardial infarction.

Sudden arrhythmic cardiac death is a major unresolved health problem, yet there is no agreement on the chronologic definition of sudden death. This retrospective study investigates the frequency distribution of the chronology of the terminal cardiac event in a large postinfarction population and identifies factors associated with instantaneous (< 1 minute) cardiac death. This study involved 229 patients enrolled in the Multicenter Diltiazem Post-infarction Trial who died during 2-year follow-up and had quantitative information on the chronology of the terminal event. Thirty-two percent of the cardiac deaths occurred instantaneously. Patients who died instantaneously were more likely (p < 0.05) to be men, to have a baseline ejection fraction < 0.40, and to have frequent (> or = 10/hour) and repetitive (> or = 3 in a row) ventricular ectopic complexes (VECs) on an ambulatory electrocardiogram than those who did not die instantaneously. Patients who died instantaneously received more digitalis and class IA antiarrhythmic agents and less beta blockers in the week before death than those dying noninstantaneously. Logistic regression analysis identified 3 independent factors that differentiated instantaneous from noninstantaneous death (relative risk; 95% confidence interval): frequent VECs (2.15; 1.11 to 4.17); digitalis (2.57; 1.31 to 5.06); and no beta blocker medication (2.90; 1.09 to 7.75). Instantaneous death (within 1 minute) was responsible for almost one third of the cardiac deaths that occurred in this postinfarction population. Frequent VECs, digitalis, and absence of beta-blocker therapy distinguished patients who died instantaneously from those who died noninstantaneously.

Adrenergic beta-Antagonists↗
PubMed1992

Interrelation of left ventricular ejection fraction, pulmonary congestion and outcome in acute myocardial infarction.

The interrelation of different grades of pulmonary congestion evaluated by chest roentgenogram in the coronary care unit, predischarge left ventricular (LV) ejection fraction (EF) and long-term prognosis was studied in 1,850 surviving patients of acute myocardial infarction (AMI). Pulmonary congestion was categorized as: none, mild or moderate, or severe; LVEF was classified as: greater than or equal to 40%, 25 to 39%, or less than 25%. The majority of patients (1,060; 57%) had an LVEF greater than or equal to 40% and no signs of pulmonary congestion. Severe pulmonary congestion was noted in 63 patients (3.4%), 17 with LVEF less than 25% and 16 with LVEF greater than or equal to 40%. One hundred twenty-five patients (6.8%) had an LVEF less than 25%, 49 of whom had no signs of pulmonary congestion. During a mean 2-year follow-up, cardiac mortality occurred in 212 patients (11.5%). The cardiac mortality rate was related to both predischarge LVEF impairment and severity of pulmonary congestion. Cardiac mortality hazard ratios (95% confidence intervals [CI]) for LVEF less than 25%, and 25 to 39% were 5.32 (CI 3.49, 8.13; p less than 0.0001) and 2.91 (CI 2.10, 4.02; p less than 0.0001), respectively, where a referent hazard ratio of 1 was assigned to patients with LVEF greater than or equal to 40% and to those with no pulmonary congestion. Development of pulmonary congestion during AMI significantly increased the cardiac mortality risk derived from LVEF, with a marked mortality effect in patients with severe pulmonary congestion; (hazard ratio 4.20; 95% CI 2.67, 6.62; p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Effects of diltiazem on long-term outcome after acute myocardial infarction in patients with and without a history of systemic hypertension. The Multicenter Diltiazem Postinfarction Trial Research Group.

The effect of diltiazem on long-term outcome in patients with acute myocardial infarction with and without a history of systemic hypertension was investigated in 2,466 patients using the Multicenter Diltiazem Postinfarction Trial data-base. The baseline variables were comparable in the diltiazem and placebo-treated patients within the groups with and without hypertension. The initial 60-mg dose of diltiazem was associated with a significant (p less than 0.001) but modest (3%) reduction in blood pressure and heart rate in both groups with and without hypertension. Univariate and multivariate analyses revealed a meaningful overall reduction in first recurrent cardiac events (cardiac death or nonfatal reinfarction, whichever occurred first) and cardiac death in patients with hypertension treated with diltiazem compared with results in those treated with placebo. Similar effects were not observed in patients without a history of hypertension. When first recurrent cardiac events were used as the end point, the diltiazem:placebo hazard ratio (95% confidence limits) was 0.77 (0.58, 1.01) for the total hypertension group, and 0.67 (0.47, 0.96) and 1.32 (0.83, 2.10) for patients with hypertension with and without pulmonary congestion during the acute infarction, respectively. Similar results were observed using cardiac death as the end point. Beta blockers had a negligible effect on the hypertension-diltiazem relation. These findings suggest that diltiazem may exert a long-term beneficial effect in most patients with hypertension who do not have pulmonary congestion during an acute infarction, and a detrimental effect in the minority who have pulmonary congestion.

Adult↗
PubMed1969

An end to cavities.

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Comprehensive Health Care↗
PubMedDate not supplied

Living alone after myocardial infarction. Impact on prognosis.

OBJECTIVE: To determine if the presence of a disrupted marriage or living alone would be an independent prognostic risk factor for a subsequent major cardiac event following an initial myocardial infarction. DESIGN: Prospective evaluation in the placebo wing of a randomized, double-blind drug trial in patients with an enzyme-documented acute myocardial infarction who were admitted to a coronary care facility. Data for living alone and/or a marital disruption were entered into a Cox proportional hazards model constructed from important physiologic and nonphysiologic factors in the same database. SETTING: Multicenter trial in a mixture of community and academic hospitals in the United States and Canada. PATIENTS: All consenting patients who were 25 to 75 years of age and without other serious diseases were enrolled (placebo, N = 1234) within 3 to 15 days of the index infarction and followed for a period of 1 to 4 years (mean, 2.1 years). Nine hundred sixty-seven patients were followed for 1.1 years and 530 for 2.2 years. PRIMARY OUTCOME MEASURE: Recurrent major cardiac event (either recurrent nonfatal infarction or cardiac death). RESULTS: Living alone was an independent risk factor, with a hazard ratio of 1.54 (95% confidence interval, 1.04 to 2.29; P less than .03). Using the Kaplan-Meier statistical method for calculation, the recurrent cardiac event rate at 6 months was 15.8% in the group living alone vs 8.8% in the group not living alone. Risk remained significant throughout the follow-up period (P = .001). A disrupted marriage was not an independent risk factor. CONCLUSION: Living alone but not a disrupted marriage is an independent risk factor for prognosis after myocardial infarction when compared with all other known risk factors.

Adult↗