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Biomedical subjects

A L Klatsky

Publications and source records attributed to A L Klatsky.

At least 19 recordsLinked to original sources
PubMed2003

Distinguishing intracerebral hemorrhages caused by arteriovenous malformations.

BACKGROUND: There is a shortage of data addressing the clinical characteristics of patients with arteriovenous malformations (AVMs) who present with intracerebral hemorrhages (ICH). METHODS: A retrospective cohort study of members of a large, pre-paid health care program was conducted to identify factors that distinguish ICH secondary to cerebral AVMs from all other causes. Univariate and multivariate analysis was performed using Student's t test, Wilcoxon rank-sum test, and logistic regression. RESULTS: Patients with an underlying AVM were younger and more likely to be female, non-smokers with lower blood pressures, lower cholesterol, and lower white blood cell counts on presentation. CONCLUSIONS: These clinical characteristics may be useful in defining potential risk factors in future prospective studies as well as targeting candidates for additional imaging studies after ICH with no apparent etiology.

Adult↗
PubMed2001

Utilization of health services among patients referred to an alcohol treatment program.

This study assessed utilization of health services among 1,317 adults referred to an outpatient Psychiatry Department alcohol treatment program from July, 1988 through December, 1989. The mean number of visits/year for 1 year before and 4 years after treatment referral were compared for all outpatient clinics combined and 4 clinic subgroups; the mean number of hospitalizations and number of days hospitalized were also analyzed. Overall, utilization was higher before treatment than after, except for Psychiatry Department visits. Amount of treatment received had little effect on utilization. These results suggest that alcoholism treatment contributes to a reduction in higher cost health services utilization.

Adult↗
PubMed2001

Exposure to environmental tobacco smoke: association with personal characteristics and self reported health conditions.

STUDY OBJECTIVE: To examine the association between exposure to environmental tobacco smoke (ETS) and demographic, lifestyle, occupational characteristics and self reported health conditions. DESIGN: Cross sectional study, using data from multiphasic health checkups between 1979 and 1985. SETTING: Large health plan in Northern California, USA. PARTICIPANTS: 16 524 men aged 15-89 years and 26 197 women aged 15-105 years who never smoked. RESULTS: Sixty eight per cent of men and 64 per cent of women reported any current ETS exposure (at home, in small spaces other than home or in large indoor areas). The exposure time from all three sources of ETS exposure correlated negatively with age. Men and women reporting high level ETS exposure were more likely to be black and never married or separated/divorced, to have no college or partial college education, to consume three alcoholic drink/day or more and to report exposure to several occupational hazards. Consistent independent relations across sexes were found between any current exposure to ETS and a positive history of hay fever/asthma (odds ratio (OR)=1.22 in men, 1.14 in women), hearing loss (OR=1.30 in men, 1.27 in women), severe headache (OR=1.22 in men, 1.17 in women), and cold/flu symptoms (OR=1.52 in men, 1.57 in women). Any current ETS exposure was also associated with chronic cough (OR=1.22) in men and with heart disease (OR=1.10) in women. Self reported stroke was inversely associated with any current ETS exposure in men (OR=0.27). No associations were noted for cancer or tumour and for migraine. CONCLUSION: ETS exposure correlated with several personal characteristics potentially associated with adverse health outcomes. Although the study design precluded causal inference, ETS exposure was associated with several self reported acute and chronic medical conditions.

Adolescent↗
PubMed2000

Risk of pulmonary embolism and/or deep venous thrombosis in Asian-Americans.

Several reports from Asian countries suggest a low prevalence of pulmonary embolism (PE) and deep venous thrombosis (DVT) in Asians, and sparse US data show that a slightly higher prevalence of PE/DVT in "nonwhites" than in whites is evident in all geographic regions except the Pacific region (California, Oregon, and Washington) where "nonwhites" include a larger proportion of Asians and Hispanics than in other US locations. We prospectively studied PE/DVT hospitalizations in 128,934 persons in relation to traits determined at health examinations in 1978 to 1985. Through 1994, 337 persons were subsequently hospitalized for PE and/or DVT (for PE first, n = 206). Cox proportional-hazards models with 9 covariates were used. In multivariate models, the following RRs (95% confidence intervals) were found for PE/DVT combined: black/white = 1.1 (0.4 to 1.4); Hispanic/white = 0.7 (0.3 to 1.5); and Asian/white = 0.2 (0.1 to 0. 5; p = 0.002). The lower risk of Asians was present in each sex and for persons first hospitalized for either PE or DVT. Covariates with significant positive relations to risk were age, male sex, body mass index, and a composite coronary disease risk/symptom variable; covariates not significantly related were education, marital status, smoking, and alcohol. These data suggest that Asians have very low risk of PE/DVT, which may account for US geographic variations in white/non-white risk differences. Possible explanations include the absence of hazardous mutations or unspecified PE/DVT protective traits in Asians.

Adult↗
PubMed1999

Moderate drinking and reduced risk of heart disease.

Although heavier drinkers are at increased risk for some heart diseases, moderate drinkers are at lower risk for the most common form of heart disease, coronary artery disease (CAD) than are either heavier drinkers or abstainers. This association has been demonstrated in large-scale epidemiological studies from many countries. Abstainers may share traits potentially related to CAD risk, such as psychological characteristics, dietary habits, and physical exercise patterns. However, evidence supports a direct protective effect of alcohol, even after data have been adjusted for the presence of these factors. The alcohol-CAD relationship is also independent of the hypothetically increased risk status among abstainers who stopped drinking for medical reasons. All alcoholic beverages protect against CAD, although some additional protection may be attributable to personal traits or drinking patterns among people who share some beverage preferences or to nonalcohol ingredients in specific beverages. Alcohol's protective effect may result from favorable alterations in blood chemistry and the prevention of clot formation in arteries that deliver blood to the heart muscle. Because CAD accounts for a large proportion of total mortality, the risk of death from all causes is slightly lower among moderate drinkers than among abstainers, but heavier drinkers are at considerably higher total mortality risk.

Alcohol Drinking↗
PubMed1998

Alcohol consumption and utilization of health services in a health maintenance organization.

OBJECTIVES: This study examined the relation between alcohol use and utilization of health services during a 3-year period in a sample of 4,264 adult respondents to a member health survey in a health maintenance organization. METHODS: Respondents were categorized as abstainers (no drinks in the past year, n = 1,139), lighter drinkers (less than seven drinks/week, n = 2,330), moderate drinkers (seven to 13 drinks/week, n = 498), and heavier drinkers (> or =14 drinks/week, n = 297). Each drinker group was compared with abstainers on outpatient visits, hospital days, and number of hospitalizations controlling for age, race, and health plan membership. RESULTS: The mean number of outpatient visits was inversely related to the amount of alcohol consumed. Significant differences also were found for mean number of hospitalizations and mean days hospitalized per year. Compared with the three drinker groups, abstainers were significantly higher on both inpatient measures. CONCLUSIONS: These results might be explained by the inclusion in the abstainer group of exdrinkers who quit because of illness, inattention to health problems by heavier drinkers, or lower rates of illness among drinkers. The findings underscore the importance of replicating our study in other cohorts in which problem drinkers can be identified and compared with non-problem drinkers and in which lifelong abstainers can be separated from exdrinkers in the analysis.

Adult↗
PubMed1998

Alcohol and cardiovascular diseases: a historical overview.

Evident disparities in relationships make it desirable to consider several disorders separately. (1) Alcoholic cardiomyopathy was perceived 150 years ago, but understanding was clouded by recognition of beriberi and of synergistic toxicity from alcohol with arsenic or cobalt. (2) A report of a link between heavy drinking and hypertension in WWI French soldiers was apparently ignored for > 50 years. Epidemiological and intervention studies have now firmly established this association, but a mechanism remains elusive. (3) The 'holiday heart syndrome', an increased risk of supraventricular tachyarrhythmias in alcoholics, has been widely known to clinicians for 25 years; data remain sparse about the total role of heavier drinking in cardiac rhythm disturbances. (4) Failure of earlier studies to distinguish types of stroke impeded understanding; it now seems probable that alcohol drinking increases risk of haemorrhagic stroke but lowers risk of ischaemic stroke. (5) Heberden reported angina relief by alcohol in 1786, and an inverse alcohol-atherosclerosis association was observed by pathologists early in this century. Recent population studies and plausible mechanisms support a protective effect of alcohol against coronary disease. International comparisons dating back to 1819 suggest beverage choice as a factor, but this issue (the 'French Paradox') remains unresolved.

Alcohol Drinking↗
PubMed1997

Red wine, white wine, liquor, beer, and risk for coronary artery disease hospitalization.

International comparison data suggest that wine may be more protective against coronary artery disease than beer or liquor. There are potentially protective antioxidants in wine, especially red wine. However, prospective population studies suggest that each beverage type may reduce coronary risk. The role of alcoholic beverage choice in coronary risk remains unresolved. We performed a prospective study of coronary disease hospitalizations among 128,934 adult members of a Northern California prepaid comprehensive health care program. Alcohol data were supplied at health examinations. Using Cox proportional-hazards models with 9 covariates, analyses were performed of the roles of each major beverage type (wine, beer, and liquor) and of drinking only table wine (red, white, or both). Generally, coronary risk traits were most favorable for wine drinkers and least favorable for liquor drinkers. Among 3,931 persons hospitalized for coronary disease, total alcohol drinking was inversely related to risk in both sexes. Uncontrolled for total alcohol, each beverage type showed evidence for coronary protection, weakest for liquor and strongest for beer in men and wine in women. Controlled for total alcohol, these relations were much reduced, and lost statistical significance except for beer in men and both red and white wine (combined) in all persons. We conclude that (1) drinking ethyl alcohol apparently protects against coronary disease, and (2) there may be minor additional benefits associated with drinking both beer and wine, but not especially red wine.

Adult↗
PubMed1997

Alcoholic liver cirrhosis after the advent of hepatitis C virus: some reflections on its epidemiology and on the concept of attributable risk. Collaborative GESIA and AISF Groups. Gruppo Epidemiologico della Società Italiana di Alcologia and Associazione Italiana per lo Studio del Fegato.

The recent availability of hepatitis C virus (HCV) infection markers has led to the hypothesis that the prevalence of alcoholic liver cirrhosis (ALC) may be far lower than has hitherto been believed. On the other hand difficulties in obtaining a reliable patient history of alcohol consumption and of making a differential diagnosis on the basis of histology suggest that the aetiology role of alcohol may be underestimated. Furthermore, epidemiological data strongly suggest that an individual susceptibility of alcoholic liver damage exists. The interaction between alcohol consumption and acquired factors, in particular hepatitis B and C viruses and nutrition, can be studied using an epidemiological approach. The concept of attributable risk, which depends on the strength of the aetiological factors and on their diffusion in the target population, is helpful in this context. Preliminary estimates suggest that alcohol is at least as important as HCV infection in causing liver cirrhosis in Italy. A nationwide study (SIDE-CIR Project) is currently being conducted in order to clarify this issue.

Alcohol Drinking↗
PubMed1996

Alcohol and hypertension.

Epidemiologic studies in the past two decades have firmly established a relationship between regular, heavier alcohol consumption and hypertension. This association has been demonstrated in both cross-sectional and prospective studies. It is found in both sexes and several races and is independent of the type of alcoholic beverage, adiposity, education, smoking, salt intake, and several other traits. Clinical experiments show that blood pressure falls in days to weeks with abstinence from alcohol and that it rises again within days after resuming drinking. No mechanism has been demonstrated for this alcohol/blood pressure effect. Alcohol withdrawal symptoms have not been seen in the clinical experiments; thus, this is not likely to be the major explanation. Studies of the role of alcohol in hypertension sequelae, such as coronary heart disease and stroke, have been difficult because of the effects of alcohol, independent of blood pressure, in these conditions. Overall, it is likely that this alcohol-hypertension relation is causal. Restriction of intake by heavier drinkers lowers blood pressure in some, and heavy alcohol ingestion should always be considered by clinicians as a possible hypertension risk factor.

Alcohol Drinking↗
PubMed1996

Myocardial infarction in users of low-dose oral contraceptives.

OBJECTIVE: To determine the relationship between the use of low-dose (less than 50 micrograms estrogen) oral contraceptives (OC) and myocardial infarction. METHODS: In this population-based case-control study, all incident myocardial infarctions in women, ages 15-44 years who were members of the Kaiser Permanente Medical Care Program, Northern and Southern California regions were ascertained during a 39-month period from 1991 through 1994. For each woman with myocardial infarction, up to three age- and facility-matched controls were chosen at random from female members. Information about OC use (predominantly low-dose preparations) was obtained in face-to-face interviews. RESULTS: There were 187 incident cases of myocardial infarction during 3.6 million woman-years of observation (incidence rate, 5.2 per 100,000 woman-years). The prevalence of several risk factors for myocardial infarction was lower in controls who were current users of OCs than in controls who were noncurrent (past and never) users. The odds ratio for myocardial infarction in current OC users compared with noncurrent users was 1.65 (95% confidence interval 0.45, 6.06) after adjustment for major risk factors and for race and ethnicity, corresponding to an excess risk of less than one case per 100,000 woman-years. The study had 80% power to detect a relative risk of 2.3 (one-sided test, alpha = .05). The odds ratio of myocardial infarction in past OC users was not elevated. CONCLUSION: With respect to myocardial infarction, low-dose oral contraceptives can be used safely by women who lack risk factors for coronary heart disease.

Adolescent↗