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Biomedical subjects

S Tepper

Publications and source records attributed to S Tepper.

At least 19 recordsLinked to original sources
PubMed2004

Randomized, placebo-controlled trial of rofecoxib in the acute treatment of migraine.

OBJECTIVE: To investigate the clinical profile of rofecoxib, a long-acting (approximately 17-hour half-life) selective cyclo-oxygenase-2 inhibitor, for the acute treatment of migraine. METHODS: A randomized, double-blind, placebo-controlled, parallel-group study was conducted. Patients age > or =18 treated a moderate or severe migraine headache with placebo (n = 182), rofecoxib 25 mg (n = 183), or rofecoxib 50 mg (n = 192). The primary efficacy measure was headache relief (mild or no pain) 2 hours after dose. RESULTS: The proportions of patients with migraine headache relief at 2 hours after dose were 34.3% for placebo, 54.0% for rofecoxib 25 mg (p < 0.001 vs placebo), and 56.7% for rofecoxib 50 mg (p < 0.001 vs placebo). Rofecoxib 25 and 50 mg were superior to placebo in providing pain freedom at 2 hours, 24-hour sustained headache relief, and 24-hour sustained pain freedom; in reducing photophobia, phonophobia, nausea (50 mg only), and functional disability at 2 hours after dose; and in improving some quality-of-life scores over 24 hours. More patients on rofecoxib 50 mg reported adverse events (39.6%) than patients on rofecoxib 25 mg (26.8%) or placebo (23.6%) regardless of drug relatedness; however, the incidences of drug-related adverse events were similar between treatment groups. These adverse events were generally mild or moderate in severity. The most commonly reported adverse events were dry mouth, dizziness, somnolence, nausea, dyspepsia, paresthesia, and asthenia, with similar incidences between treatment groups. CONCLUSION: Rofecoxib 25 and 50 mg were effective and generally well tolerated for the acute treatment of migraine attacks.

Acute Disease↗
PubMed2004

Seroepidemiology of varicella-zoster virus antibodies among health-care workers and day-care-centre workers.

Inclusion of live varicella vaccine in the routine occupational health vaccination schedule requires knowledge of the natural immunity to varicella zoster virus (VZV) among high-risk occupations. This study aims were to evaluate VZV antibody positivity among health-care workers (HCWs) and day-care-centre workers (DCWs) and to assess its association with potential risk factors. Three groups of workers were tested for VZV antibody positivity: hospitals and community clinic HCWs (n = 335), DCWs (n = 117) and blue-collar workers as controls (n = 121). The total VZV antibody positivity was 94.4%. There was no significant difference in VZV antibody positivity among study groups. DCWs had the lowest VZV seroprevalence (90.9%, 95% CI 85.7-96.1) and controls the highest (96.6%, 95% CI 93.2-99.9). This high VZV antibody positivity suggests that no special occupational measures are indicated in health-care or day-care occupational settings in Israel. On-going monitoring of the natural immunity to VZV is necessary to detect trends over time.

Adult↗
PubMed2003

A six-item short-form survey for measuring headache impact: the HIT-6.

BACKGROUND: Migraine and other severe headaches can cause suffering and reduce functioning and productivity. Patients are the best source of information about such impact. OBJECTIVE: To develop a new short form (HIT-6) for assessing the impact of headaches that has broad content coverage but is brief as well as reliable and valid enough to use in screening and monitoring patients in clinical research and practice. METHODS: HIT-6 items were selected from an existing item pool of 54 items and from 35 items suggested by clinicians. Items were selected and modified based on content validity, item response theory (IRT) information functions, item internal consistency, distributions of scores, clinical validity, and linguistic analyses. The HIT-6 was evaluated in an Internet-based survey of headache sufferers (n = 1103) who were members of America Online (AOL). After 14 days, 540 participated in a follow-up survey. RESULTS: HIT-6 covers six content categories represented in widely used surveys of headache impact. Internal consistency, alternate forms, and test-retest reliability estimates of HIT-6 were 0.89, 0.90, and 0.80, respectively. Individual patient score confidence intervals (95%) of app. +/-5 were observed for 88% of all respondents. In tests of validity in discriminating across diagnostic and headache severity groups, relative validity (RV) coefficients of 0.82 and 1.00 were observed for HIT-6, in comparison with the Total Score. Patient-level classifications based in HIT-6 were accurate 88.7% of the time at the recommended cut-off score for a probability of migraine diagnosis. HIT-6 was responsive to self-reported changes in headache impact. CONCLUSIONS: The IRT model estimated for a 'pool' of items from widely used measures of headache impact was useful in constructing an efficient, reliable, and valid 'static' short form (HIT-6) for use in screening and monitoring patient outcomes.

Adult↗
PubMed2001

Efficacy of gabapentin in migraine prophylaxis.

OBJECTIVE: To compare gabapentin with placebo for use as a prophylactic agent in patients with migraine (with or without aura). STUDY DESIGN AND TREATMENT: After screening, a 4-week, single-blind, placebo baseline period was followed by a 12-week, double-blind, treatment period. The 12-week treatment period consisted of a 4-week titration phase and an 8-week stable-dosing phase. During the 4-week titration phase, patients were started on one 300-mg capsule of gabapentin or matching placebo. Patients were titrated weekly from 900 mg/day (end of week 1) to 2400 mg/day (end of week 4) and had to be receiving a stable dose of study medication by the end of the titration period. Study medication was to be given on a three-times-a-day dosing regimen. METHODS: The study hypothesis was defined a priori as a lower 4-week migraine rate during the second stabilization period for the gabapentin-treated patients as compared with the placebo-treated patients. The analyses were performed with the 4-week migraine rate at baseline as a covariate and center as a blocking factor. RESULTS: At seven participating centers, 143 patients with migraine were randomized in a 2:1 ratio and received either gabapentin (n = 98) or matching placebo (n = 45). Thirty-three patients (24.1%) discontinued prematurely from the study, including 24 (24.5%) of 98 gabapentin-treated patients and 9 (20.0%) of 45 placebo-treated patients; the majority of patients discontinued due to adverse events (16 [16.3%] of 98 gabapentin-treated patients; 4 [8.9%] of 45 placebo-treated patients). Patients included in the analysis were evenly balanced for age, sex, race, weight, and height. The majority of these patients were white (80 [92.0%] of 87) and women (72 [82.8%] of 87), with a mean age of approximately 39.4 years and a history of migraine episodes for a mean of about 21 years. At the end of the 12-week treatment phase, the median 4-week migraine rate was 2.7 for the gabapentin-treated patients maintained on a stable dose of 2400 mg/day and 3.5 for the placebo-treated patients (P =.006), compared with 4.2 and 4.1, respectively, during the baseline period. Additionally, 26 (46.4%) of 56 patients receiving a stable dose of 2400 mg/day gabapentin and 5 (16.1%) of 31 patients receiving placebo showed at least a 50% reduction in the 4-week migraine rate (P =.008). The average number of days per 4 weeks with migraine was also statistically significant and favored gabapentin (P =.006) during stabilization period 2. The median change in 4-week headache rate was statistically significant as well (P =.013). The most frequently reported adverse events for both treatment groups were asthenia, dizziness, somnolence, and infection. Adverse events determined by the investigator to be associated with study drug resulted in patient withdrawal in 13 (13.3%) of 98 gabapentin-treated patients and 3 (6.7%) of 45 placebo-treated patients. Somnolence and dizziness accounted for many of the premature withdrawals among those taking gabapentin. CONCLUSION: Gabapentin is an effective prophylactic agent for patients with migraine. In addition, gabapentin appears generally well tolerated with mild to moderate somnolence and dizziness.

Acetates↗
PubMed1998

Personal assistance for people with physical disabilities: consumer-direction and satisfaction with services.

OBJECTIVE: To determine whether people who receive consumer-directed personal assistance services (PAS) are more satisfied with the services they receive than those receiving PAS that are not consumer-directed. DESIGN: A quasi-experimental survey comparison of long-term outcomes among people receiving consumer-directed PAS in Virginia and persons on the waiting list to receive those services. Surveys were conducted by mail and telephone. SETTING: The general community in Virginia. PARTICIPANTS: Ninety-two Virginia residents with physical disabilities living in the community. Sixty individuals were receiving consumer-directed PAS, and 32 were on the waiting list for consumer-directed PAS and were receiving paid personal assistance that was not consumer-directed. MAIN OUTCOMES MEASURES: The Personal Assistance Satisfaction Index (PASI); chi2 and t tests were conducted. RESULTS: People receiving consumer-directed PAS scored significantly higher on the PASI than the waiting-list control group and were consistently more likely to report high levels of satisfaction on the majority of individual PASI items. CONCLUSION: Consumer-directed PAS are associated with high levels of satisfaction relative to PAS that are not consumer-directed. Individual PASI items related to control over PAS and flexibility of services showed the greatest differences in satisfaction.

Activities of Daily Living↗
PubMed1998

Daily sumatriptan for detoxification from rebound.

Medications which provide symptomatic relief from headache can transform episodic migraine into chronic daily headache by propagating the daily headache, causing "rebound." It is possible to restore the episodic migraine pattern by using an inpatient course of intravenous dihydroergotamine. This study was undertaken to explore whether it was possible to use oral sumatriptan in the outpatient setting as a bridge to detoxification for patients with chronic daily headache due to medication overuse. All patients had previously met International Headache Society (IHS) criteria for episodic migraine and currently had greater than 15 days of headache per month for greater than 1 month. These patients were advised to take 25 mg sumatriptan by mouth three times a day for 10 days or until they were headache-free for 24 hours. Results reveal that of the 26 patients who started the protocol, 58% had reverted to an episodic migraine pattern at 1 month, and 69% were no longer having chronic daily headache at 6 months. This study demonstrates that it is possible to detoxify patients with rebound headaches using oral sumatriptan during the withdrawal period in an outpatient setting.

Administration, Oral↗
PubMed1997

Alternative definitions of disability: relationship to health-care expenditures.

The purpose of this study is to investigate the relationship between different definitions of disability and health-care expenditures in the working aged population in the United States using the 1987 National Medical Expenditure Survey (NMES). Five different definitions of disability were identified and the health-care expenditures for each group were compared using descriptive analyses. Results reveal that estimates of the prevalence of disability vary dramatically by the definition of disability. A more than three-fold difference in average total health-care expenditures is observed using different specifications of disability. These results suggest that estimates of health-care expenditures should be interpreted cautiously, since the definition influences the magnitude of estimates. Researchers and policy-makers should consider the standardization of the term 'disability'.

Activities of Daily Living↗
PubMed1996

Outcomes in traumatic brain injury: self-report versus report of significant others.

This paper examines the inter-rater reliability of 148 persons with traumatic brain injury (PwTBI) and their significant others (SO) on the Functional Independence Measure (FIM), and the Community Integration Questionnaire (CIQ). Results reveal that agreement differs across instruments and subscales, with greatest response comparability on the productivity CIQ subscale, followed by the motor FIM, social integration CIQ, cognitive FIM, and home integration CIQ. These findings have important implications for the future of TBI outcomes studies.

Activities of Daily Living↗
PubMed1996

Functional decline in older adults: expanding methods of ascertainment.

BACKGROUND: There is substantial interest in the prevention of physical disability associated with aging. However, little is known about how to screen for declining function at sufficiently early stages to prevent frank disability. This work provides an initial description and assessment of a new self-report method for measuring function in older adults which complements standard methods and may be sensitive to subtler degrees of disablement than currently employed methods. We operationalize the method and demonstrate that it identifies a meaningful number of people as potentially disabled who are not identified by standard methods; also, we evaluate the method's reliability and validity for identifying subtle functional decline relative to existing methods. METHODS: This is a cross-sectional, observational study of a volunteer population of 231 adults 59 years and older, evaluated in a multidisciplinary laboratory. Self-reported difficulty and dependency in each of 27 tasks of daily life were assessed as the measure of disability. Those without difficulty were evaluated for other functional change, by self-report, defined as either: (a) modification of method, or (b) decreased frequency of task performance, when due to health rather than change in social circumstances. Prevalence, test-retest reliability, construct, and criterion validity were evaluated. RESULTS: In a study population in which from 1% to 50% of participants reported difficulty with each of 27 tasks, from 2% to 33% reported modification of task performance while not having difficulty. Few participants reported decreased frequency without modification. Persons with task modifications, particularly in mobility tasks, showed intermediate levels of performance on objectively measured tests and an intermediate number of chronic diseases, compared to those reporting difficulty and those reporting neither difficulty nor modification. CONCLUSIONS: Cross-sectional evidence supports the ability of the proposed method to identify meaningful numbers of people with functional decline who were not identified by standard self-report methods. In some cases, these were individuals with functional losses comparable to those who did report difficulty. In other cases, these may have been individuals with earlier functional loss, perhaps representing a preclinical stage of disability. Prospective evaluation will identify whether this method predicts the onset of difficulty or disability, and whether it predicts decline with sufficient precision to identify at-risk individuals in a clinical setting.

Activities of Daily Living↗
PubMed1996

Linking data from national trauma and rehabilitation registries.

OBJECTIVE: To evaluate te feasibility of retrospectively creating a data base useful in trauma systems evaluations. MATERIALS AND METHODS: Records for 375 patients in both the Major Trauma Outcome Study and the Uniform Data System for Medical Rehabilitation were linked to create an injury-through-rehabilitation data base, including patients from four impairment groups: traumatic brain injury (TBI); spinal cord injury --paraplegic complete (SCI-PARA) and quadriplegic complete (SCI-QUAD); and hip fracture (HIP-FX). MEASUREMENTS AND MAIN RESULTS: The average ages (25.1 years SCI-QUAD, 72.6 years HIP-FX); Injury Severity Score (10.2 HIP-FX, 31.7 SCI-PARA); Revised Trauma Score (5.9 TBI, 7.8 HIP-FX); and acute care lengths of stay (13.3 days HIP-FX, 24.2 days TBI) varied substantially over the four groups. On average, patients spent from approximately 20 days (HIP-FX) to nearly 100 days (SCI-QUAD) in rehabilitation. Functional gains during rehabilitation were primarily in motor skills, but TBI patients also made substantial cognitive gains. Nearly 90% of TBI and SCI patients were discharged to their homes; the percentage of HIP-FX patients discharged to their homes, however, was lower (74%). Across all impairment groups, more patients lived with their relatives after rather than before injury. The correlation between a summary Major Trauma Outcome Study-Functional Independence Measure assessed at acute care discharge and the complete Uniform Data System for Medical Rehabilitation-Functional Independence Measure assessed on admission to rehabilitation was significant for all study patients and for each impairment group except SCI_PARA. CONCLUSIONS: Linking records to create the study data base was arduous and could not be practically accomplished on a large scale or on a continuing basis. Because of the growing emphases on trauma system evaluations and outcomes beyond survival at acute care discharge, we recommend the routine inclusion of rehabilitation data in hospital-based trauma registries.

Activities of Daily Living↗
PubMed1995

Criteria for selection of a payment method for inpatient medical rehabilitation.

This article presents the results of a 3-stage Delphi survey designed to identify the policy criteria that should govern the evaluation of alternative payment methods and guide the selection of a payment method for inpatient medical rehabilitation. The Delphi survey (n = 85) included four groups of participants: consumers (n = 8), providers (n = 35), payers (n = 15), and health services researchers (n = 27). The Delphi survey uncovered 16 evaluation criteria. Delphi participants evaluated each criterion on a 10-point scale (1 = not important; 10 = greatest importance). Respondents value maximize patient/family outcome, maximize access, and maximize efficiency as the three most important criteria. Respondents report that minimize financial risk is the least important criterion. The results from both stage 2 and stage 3 (response rate = 85%) indicate a high level of consensus across the four respondent groups.

Delphi Technique↗
PubMed1994

Knee range of motion in isolated femoral lengthening.

Twenty-five patients underwent isolated Ilizarov femoral lengthenings (mean lengthening, 6 cm). A retrospective review of the charts showed the specific changes in knee range of motion (ROM) during lengthening, after removal of the frame, and at the final follow-up examination. A decrease in ROM was seen during lengthening to an average minimum of 37 degrees +/- 15 degrees. Toward the end of the consolidation phase, improvement to 69 degrees +/- 28 degrees was noted. A progressive increase in ROM was seen after frame removal. Mean preoperative flexion was 127 degrees +/- 16 degrees, and at follow-up flexion was 122 degrees +/- 23 degrees (p = 0.191). Of the five patients who did not achieve 120 degrees flexion at the final follow-up examination, three had a diminished ROM (average, 107 degrees) at the outset. Two patients lost more than 15% of their preoperative flexion. There was no correlation noted between worst ROM (during lengthening) and final ROM at the last follow-up examination.

Adolescent↗
PubMed1993

Factors associated with hip osteoarthritis: data from the First National Health and Nutrition Examination Survey (NHANES-I).

Factors associated with hip osteoarthritis were studied in 2,490 subjects aged 55-74 years using data from the First National Health and Nutrition Examination Survey (NHANES-I). Pelvic radiographs were read for hip osteoarthritis using Kellgren-Lawrence scales; cases were defined by grade > or = 2 changes. Subjects with missing radiographs and other data and those with grade 1 radiographic changes (n = 132) were excluded from analyses. Crude and adjusted odds ratios and 95% confidence intervals (CIs) were estimated from logistic regression analyses. Overall, the crude prevalence of hip osteoarthritis was 3.1% (73 of 2,358); 42 cases were unilateral, and 31 cases were bilateral. Age was significantly associated with hip osteoarthritis (adjusted odds ratios = 1.30 (95% CI 0.60-2.81), 1.69 (95% CI 0.83-3.44), and 2.38 (95% CI 1.15-4.92) for ages 60-64, 65-69, and 70-74, respectively). Other sociodemographic factors, obesity, and fat distribution were not associated with hip osteoarthritis. Age and hip trauma were strongly associated with hip osteoarthritis among men; however, among women, no factors were significantly associated with hip osteoarthritis. Hip trauma was significantly associated with unilateral but not bilateral hip osteoarthritis, while obesity was associated with bilateral but not unilateral hip osteoarthritis. These data suggest that etiologic factors associated with hip osteoarthritis may differ for males and females and for unilateral and bilateral hip osteoarthritis.

Age Factors↗
PubMed1992

Psychopathology and attrition in the epidemiologic catchment area surveys.

This analysis shows the effect of sociodemographic variables and psychopathology on attrition in a 1-year follow-up of 10,167 household-residing respondents, aged 18-64 years, from four sites of the National Institute of Mental Health Epidemiologic Catchment Area Program. Attrition is defined in two ways: failure to locate (n = 1,035) and refusal to participate (n = 1,010). As compared with 8,122 respondents successfully interviewed after 1 year, those who are not located are more likely to be male, Hispanic, young, and unmarried. Refusers are older and more likely to be married and to have lower educational attainment than those successfully reinterviewed. After adjusting for sociodemographic variables, psychopathology had a small to moderate effect on attrition. Panic and depression were associated with failure to locate, but no diagnoses, or selected symptoms, were strongly or significantly associated with refusal to participate in the second wave.

Adolescent↗
PubMed1985

The clinicopathological spectrum of non-tuberculous mycobacterial osteoarticular infections.

We studied the clinicopathological features of eight patients in whom a non-tuberculous mycobacterium was unexpectedly isolated from osteoarticular material obtained at operation. Three distinct types of infection with non-tuberculous mycobacteria were found: tenosynovitis, synovitis, and osteomyelitis. Tissue specimens from these sites showed a spectrum of pathological findings, including (1) virtually no inflammation, (2) mild to severe non-specific chronic inflammation, (3) granulomas without necrosis, and (4) caseating epithelioid granulomas that were indistinguishable from those of tuberculosis. In six patients the infection responded well to adequate surgical excision alone. In the remaining two the infection responded to surgical intervention and antituberculous therapy.

Adolescent↗
PubMed1982

The spectrum of pathology of nontuberculous mycobacterial infections in open-lung biopsy specimens.

The diagnosis of pulmonary nontuberculous mycobacterial (NTM) infection may be difficult to establish unless open-lung biopsy is performed. Mycobacteria were present in resected lung tissues from forty patients at the Mount Sinai Hospital during the period 1969-1980. M. avium-intracellulare was cultured in 24 patients, M. tuberculosis in six, M. gordonae in three, and M. fortuitum in two. In five instances, mycobacteria were seen in smears of lung tissues but failed to grow in culture. Three distinct clinicopathologic groups of patients with NTM were recognized. (1) Eighteen patients had solitary pulmonary nodules resected with the clinical diagnosis of lung cancer. Histologically, they exhibited granulomas with varying degrees of necrosis. Mediastinal lymph nodes had no granulomas, except in one case. (2) Seven patients presented with roentgenologic evidence of bilateral, diffuse interstitial infiltration. M. avium-intracellulare or M. gordonae were isolated from lung tissue which histologically showed interstitial fibrosis and organizing pneumonia. In only one instance a few non-caseating epitheloid cell granulomas were found. Three of these patients had underlying malignancies treated with chemotherapy and one other had arthritis. The other three had no underlying diseases. (3) Three patients had multiple discrete infiltrates on chest roentgenograms. M. avium-intracellulare was isolated from their lung tissues. One of these patients exhibited necrotizing granulomatous vasculitis indistinguishable from Wegener's granulomatosis. It is apparent that classical "tuberculosis-like" granulomatous reaction is the most common histologic pattern but should not be expected in all patients with NTM infections.

Biopsy↗
PubMedDate not supplied

Changes in health status for persons with wrist or hand impairments receiving occupational therapy or physical therapy.

OBJECTIVE: The purpose of this study was to describe changes of health status as perceived by clients with hand or wrist impairments who received rehabilitation in acute, orthopedic outpatient facilities from occupational therapy or physical therapy personnel. METHOD: One thousand three hundred ninety-nine adults with wrist (n = 692) or hand (n = 707) impairments who were treated between July 1996 and June 1997 were selected from the Focus On Therapeutic Outcomes, Inc. (FOTO) national rehabilitation database. Each client completed a health status questionnaire on intake and discharge. Data consisted of number of outpatient visits, duration of treatment episode, and health status scores for six functional scales. Measures of intensity, global health status, global utilization, and client satisfaction were calculated. Outcomes were evaluated across occupational therapists and physical therapists. RESULTS: Clients perceived improvement (p < .05) in their health status over the course of therapy. Number of visits and measures of health status and client satisfaction were similar across type of therapist. Episode duration was longer (p < .05) and intensity was less (p < .05) for clients seen by occupational therapists. CONCLUSION: Clients receiving rehabilitation in acute orthopedic outpatient centers perceived improvement in their functional abilities and health and well-being (global health status and individual functional scales) over the time during which treatment was provided. Results confirm the responsiveness of the outcomes instrument to clinical change in the clients' perception of their health status over the course of therapy and support the use of health status as a measure of clinical outcome.

Activities of Daily Living↗