PubMed Health⌕ Search

Biomedical subjects

A R Assaf

Publications and source records attributed to A R Assaf.

At least 19 recordsLinked to original sources
PubMed2000

Coronary heart disease surveillance: field application of an epidemiologic algorithm.

This report describes the performance of a surveillance system and computerized algorithm for the assignment of definite or probable hospitalized cardiac events for large epidemiologic studies. The algorithm, developed by the Coordinating Committee for Community Demonstration Studies (CCCDS), evolved from the Gillum criteria, and included selected ICD-9-CM codes including codes 410 through 414 for discharge record screening, plus creatine kinase. For the small percentage of cases in which enzyme analysis was inconclusive (8%), presence of pain and/or Minnesota-coded electrocardiograms were included to define the outcome. All data items were easily obtained from medical records by trained lay record abstractors and required no interpretation. From January 1980 through December 1991, 21,183 medical records were screened for ICD-9-CM codes 410 through 414. Of all 410 to 411 ICD-9-CM codes (n = 9026), 36.9% (n = 3220) were classified as definite cardiac events and 10.6% (n = 1057) as probable events. Of all 412 through 414 codes (n = 9070), only 1.8% (n = 227) were classified as definite cardiac events and 5.4% (n = 716) as probable events. The epidemiologic diagnostic algorithm presented in this article used computerized data to assign diagnoses in a standard, objective manner, and was a lower cost alternative to classification of cardiac events on the basis of clinical review and/or more complex record abstraction approaches.

Abstracting and Indexing↗
PubMed1995

Measuring cardiovascular disease risk factor levels: international comparisons between Bremen-north/west (Germany) and two southeastern New England (USA) cities.

Cardiovascular disease risk factor comparisons were made on study populations from communities in two different countries with similar ongoing intervention programs. Baseline survey data from the intervention and comparison communities of the Pawtucket Heart Health Program in Pawtucket, Rhode Island, and from the intervention Region of Bremen-North/West of the German Cardiovascular Prevention Study were compared with respect to these cardiovascular disease risk factors: smoking, overweight, physical inactivity, hypertension, and hypercholesterolemia. The relationship between these variables and social class was also examined in an attempt to partially explain some of the cross cultural differences in risk factors and predicted CHD and CVD mortality. Results indicated statistically significant differences in amount of cigarettes smoked, exercise frequency, diet, body mass index, total cholesterol, HDL, and blood pressure. These risk factors were generally higher in the German population than in the American population as were the predicted CHD and CVD mortality. For the study populations of both countries, however, the lower the social class, the more prevalent the smoking, excess weight, and lack of physical activity.

Adult↗
PubMed1995

The association between perceived risk and actual cardiovascular disease.

We examined the association between self-rated risk of stroke or myocardial infarction and actual morbidity and mortality by gender among participants of the Pawtucket Heart Health Program Health Survey in a nested case-control study. We defined cases (N = 191) as survey participants who later had a cardiac event registered in the Pawtucket Heart Health Program cardiovascular disease morbidity and mortality surveillance system. We matched controls (N = 573) on age, sex, date of survey, and city of residence. Women reporting a high perceived risk of stroke or myocardial infarction were four times as likely as women who indicated low perceived risk to have a future cardiovascular event [adjusted odds ratio = 4.0; 95% confidence interval (CI) = 1.5-10.3]. Men who perceived their risk as average were twice as likely as those who rated their risk as low to have a future myocardial infarction or stroke (adjusted odds ratio = 1.9; 95% CI = 1.0-3.6), whereas those who perceived their risk as high were at only slightly higher risk of morbid or mortal events (adjusted odds ratio = 1.8; 95% CI = 0.9-3.9).

Cerebrovascular Disorders↗
PubMed1995

The Pawtucket Heart Health Program: community changes in cardiovascular risk factors and projected disease risk.

OBJECTIVES: Whether community-wide education changed cardiovascular risk factors and disease risk in Pawtucket, RI, relative to a comparison community was assessed. METHODS: Random-sample, cross-sectional surveys were done of people aged 18 through 64 years at baseline, during, and after education. Baseline cohorts were reexamined. Pawtucket citizens of all ages participated in multilevel education, screening, and counseling programs. RESULTS: The downward trend in smoking was slightly greater in the comparison city. Small, insignificant differences favored Pawtucket in blood cholesterol and blood pressure. In the cross-sectional surveys, body mass index increased significantly in the comparison community; a similar change was not seen in cohort surveys. Projected cardiovascular disease rates were significantly (16%) less in Pawtucket during the education program. This difference lessened to 8% posteducation. CONCLUSIONS: The hypothesis that projected cardiovascular disease risk can be altered by community-based education gains limited support from these data. Achieving cardiovascular risk reduction at the community level was feasible, but maintaining statistically significant differences between cities was not. Accelerating risk factor changes will likely require a sustained community effort with reinforcement from state, regional, and national policies and programs.

Adolescent↗
PubMed1995

Physical activity, physical fitness, and coronary heart disease risk factors.

The relationships between physical activity, physical fitness, and coronary heart disease risk factors measured in a large community sample were evaluated. Self-reported physical activity using a single question, maximal oxygen consumption estimates derived from the Pawtucket Heart Health Step Test, blood pressure, nonfasting lipids, and body mass index were cross-sectionally evaluated in 381 men and 556 women. The correlation of estimated maximal oxygen consumption and self-reported physical activity was modest but statistically significant (r = 0.13 in men and r = 0.19 in women). Blood pressure, body mass index, and HDL cholesterol were correlated with physical fitness (r = 0.24-0.65) and correlated to self-reported physical activity (r = 0.09-0.14). Evaluation of coronary heart disease risk factors using both physical activity and physical fitness revealed a complex relationship that generally showed a stronger relationship with measures of physical fitness than with physical activity. This study suggests that simultaneous measurement of physical activity and physical fitness may be useful in epidemiologic studies of habitual physical activity and chronic disease.

Adolescent↗
PubMed1995

Sedentary lifestyle and risk of coronary heart disease in women.

Relatively few studies have assessed the prospective relationship of sedentary lifestyle and coronary heart disease (CHD) in women. We performed a nested case-control study, identifying 50 cases of acute CHD in women and 150 age-matched controls. Risk factors including sedentary lifestyle, cigarette smoking, hypertension, diabetes mellitus, total, and HDL cholesterol levels had been previously determined in this cohort using household survey techniques. The odds ratio (OR) of CHD in sedentary women was 2.1 (95% CI 1.0-4.3, P = 0.046). The odds ratio was similar (OR = 2.3, 95% CI 1.0-5.7, P = 0.051) after adjusting for potential confounders of hypertension, cigarette smoking, low HDL cholesterol, diabetes mellitus, and being U.S. born. This study suggests that sedentary lifestyle may be an independent risk factor for CHD in women, but its results are open to several contradictory interpretations. Further studies to investigate the prospective relationship of sedentary lifestyle and the risk of CHD in women are needed.

Case-Control Studies↗
PubMed1994

Program evaluation strategies for community-based health promotion programs: perspectives from the cardiovascular disease community research and demonstration studies.

Community-based programs are being widely adopted in the struggle to prevent chronic disease. Program evaluation of community-based programs involves a particular set of problems stemming from the variety of activities being undertaken simultaneously, the multiple intermediate goals of the programs and the rapidity with which the programs evolve. An analysis of the experience of four large community-based cardiovascular disease research and demonstration studies (Stanford Five-City Project, Minnesota Heart Health Program, Pawtucket Heart Health Program and the German Cardiovascular Prevention Project) provides valuable models, methodologies and strategies for planning and conducting evaluations of public health programs or community studies. By comparing and combining their experiences, the four programs have identified eight categories of evaluation for community studies, including formative evaluation, quality assurance, assessment of delivered dose, assessment of received dose, component program impact, intermediate outcomes, community impact and cost analysis. This paper presents information on the strategies by which each of the four programs addressed these evaluation categories.

Cardiovascular Diseases↗
PubMed1994

Prevalence of hypertension, dyslipidemia, and dyslipidemic hypertension.

BACKGROUND: It has been proposed that dyslipidemic hypertension is part of a distinct metabolic syndrome related to insulin resistance. This paper describes the prevalence and cross-sectional relations of dyslipidemic hypertension in a population-based sample of men and women. METHODS: In two southeastern New England communities, 11,199 randomly selected participants were evaluated as part of a cross-sectional surveillance program of coronary heart disease risk factors between 1981 and 1990. RESULTS: The frequency of dyslipidemia was 38% and of hypertension was 26.5%; the conjoint frequency (dyslipidemic hypertension) was 15.0%, which is 1.49 times the expected value if the two diseases were independent P < .05). Using a discrete multivariate model, dyslipidemia and hypertension were associated with sex, obesity, and diabetes mellitus. The excess association of dyslipidemic hypertension, compared with individual effects of dyslipidemia and hypertension, was not related to these factors. CONCLUSIONS: This study suggests that dyslipidemic hypertension is common but may not be a unique entity associated with a distinct metabolic syndrome.

Adolescent↗
PubMed1993

Possible influence of the prospective payment system on the assignment of discharge diagnoses for coronary heart disease.

BACKGROUND: The prospective payment system, under which diagnosis-related groups (DRGs) are used to reimburse hospitals for the care of Medicare patients, replaced the fee-for-service method of payment in Rhode Island in 1983 and in Massachusetts in 1985. Changes in financial incentives resulting from the use of the DRG system may have influenced the assignment of discharge diagnostic codes away from those with lower reimbursement toward codes with higher reimbursement. METHODS: We collected data from the hospital records of patients 35 through 74 years of age who were discharged with codes 410 through 414 (representing various categories of coronary heart disease) of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). The patients were discharged from seven hospitals in two New England communities (one in Rhode Island and one in Massachusetts) between 1980 and 1988. The rates of diagnosis of various forms of coronary heart disease were determined by studying ICD-9-CM hospital discharge codes (codes 410 and 411 for acute forms of coronary heart disease and codes 412, 413, and 414 for chronic forms) and by using a computerized diagnostic algorithm designed to detect definite myocardial infarction and fatal coronary heart disease. RESULTS: The rates of definite coronary events diagnosed by the algorithm and by the study of ICD-9-CM codes 410 through 414 were constant or increased slightly during the study period. However, the frequency of assignment of codes for the acute forms of coronary heart disease (which entail higher reimbursement) rose from 35.2 percent to 48.4 percent among discharged patients with cardiac disease after the institution of DRGs. The majority of this increase was associated with the code for unstable angina pectoris. The frequency of assignment of codes for the chronic forms of coronary heart disease (which entail lower reimbursement) decreased reciprocally, from 64.8 percent to 51.6 percent (P < 0.001). CONCLUSIONS: Our data are consistent with the hypothesis that the prospective reimbursement system has influenced the assignment of hospital discharge codes in a way that would increase payment to hospitals. However, the data do not permit us to distinguish whether hospitals began to assign more precise diagnoses with the advent of the DRG system, or whether they began to favor diagnoses of acute conditions solely for financial reasons.

Acute Disease↗
PubMed1993

Prevalence and descriptors of aspirin use as an antiplatelet agent in two New England communities.

OBJECTIVE: To determine the overall prevalence of aspirin use as an antiplatelet agent in a population-based sample of respondents between the ages of 18 and 64 years, and to describe their sociodemographic characteristics. DESIGN: Data were derived from five biennial cross-sectional household surveys conducted between 1981 and 1990 in two southeastern New England communities by the Pawtucket Heart Health Program. Individuals reporting aspirin use as an antiplatelet agent were identified using data from a structured medication interview. RESULTS: The prevalence of aspirin use per 1000 population was 2.5 (95 percent confidence interval [CI] 0.5, 4.4), 5.0 (95 percent CI 2.4, 7.6), 7.8 (95 percent CI 4.6, 11.0), 7.5 (95 percent CI 4.3, 10.6), and 11.8 (95 percent CI 7.1, 16.5) in the first through the fifth survey periods, respectively (p = 0.0002). The prevalence of aspirin use per 1000 men increased from 4.9 (95 percent CI 0.6, 9.1), 8.7 (95 percent CI 3.3, 14.1), 12.3 (95 percent CI 6.1, 18.5), 8.5 (95 percent CI 3.5, 13.5) to 23.2 (95 percent CI 13.4, 32.9) for the first through the fifth survey periods, respectively. The corresponding prevalence rates of aspirin use per 1000 women were 0.7 (95 percent CI 0, 2.1), 2.43 (95 percent CI 0.05, 4.80), 4.6 (95 percent CI 1.4, 7.8), 6.6 (95 percent CI 2.7, 10.6), and 2.7 (95 percent CI 0, 5.7). Both a gender trend (p = 0.0002) and a survey trend (p = 0.0001) were detected. A gender-survey interaction was not found. CONCLUSIONS: In this population, aspirin use was reported primarily by middle-aged men who had coexisting cardiovascular disease as indicated by concurrent medications. Aspirin use as antiplatelet therapy increased in the population-based samples of two New England communities over the past nine years, with slightly more than one percent of the respondents reporting its use in the fifth cross-sectional survey conducted in 1989-1990. This finding may reflect the publication of important clinical trials near the time the survey was performed and subsequent dissemination of the findings both in the professional and lay press.

Adolescent↗
PubMed1991

Daytime hypertension in obstructive sleep apnea. Prevalence and contributing risk factors.

We examined the prevalence of daytime hypertension in a modern sample of patients with obstructive sleep apnea (OSA) and assessed the relative risk factors contributing to the development of hypertension in this disorder. Daytime hypertension was present in 92 (45 percent) of 206 male and female patients with OSA. Stepwise logistic regression revealed that only age and body mass index (BMI) were predictors of hypertension in this population. A subsample of 152 male patients with OSA was then compared to 904 men identified from a geographically and ethnically similar general population. When one controlled for age and BMI, the prevalence of hypertension in the two groups was the same except for those aged 25 to 44 years who were markedly obese (BMI greater than 31 kg/m2). In this group, 47 percent of the patients with OSA were hypertensive vs 26 percent of control subjects (p less than 0.05). Our data suggest that the high prevalence of hypertension in OSA is primarily related to age and the excess obesity seen in these patients. In morbidly obese young patients with OSA, factors directly related to OSA may also be contributing to the development of hypertension. With increasing age, other competitive risks may obscure any independent effect that OSA may exert.

Adult↗
PubMed1990

Information-seeking about health in a community sample of adults: correlates and associations with other health-related practices.

Action by individuals to acquire information about their health has been an element incorporated throughout theory, research, and programs related to health promotion. This report describes an attempt to determine if an information-seeking dimension could be empirically identified in a general community-resident sample, and if so, to examine some of its characteristics. A total of 281 adults aged 18-75 were contacted by telephone using random digit dialing and were interviewed about a variety of personal health practices. Factor analysis identified a five-item cluster representing a tendency to seek out information about health. Women were more likely than men to report seeking information. In addition, more frequent information-seeking was associated with favorable responses to several other health-related practices. Formal health service use was the only type of health practice not associated with information-seeking, perhaps because regularity of contact is influenced strongly by health professionals (e.g., reminder cards and having staff call to schedule annual exams). Overall, results of the investigation support the importance of information-seeking as a component of a personal health practice repertoire. Additional attention might be directed toward elaborating its role as a "process" variable in health education programs and social marketing efforts, particularly in areas such as response to recruitment messages, dropout vs. maintenance, and differential gains on outcome measures of program effectiveness.

Adolescent↗
PubMed1990

Pawtucket Heart Health Program point-of-purchase nutrition education program in supermarkets.

Point-of-purchase nutrition education in supermarkets is one intervention strategy of the Pawtucket Heart Health Program, a community cardiovascular disease prevention program in Pawtucket, Rhode Island. Using consumer intercept interviews, awareness of shelf labels and their effect on purchase behavior have been continuously evaluated. Between 1984 and 1988, the percent of shoppers who could identify correct labels increased from 11 percent to 24 percent (95% confidence intervals of difference: 7.17). The percent who reported they were encouraged to purchase the identified foods increased from 36 percent to 54 percent (95% CI of difference: 5.41).

Adult↗
PubMed1989

A new approach to surveillance for acute myocardial infarction: reproducibility and cost efficiency.

A new approach to surveillance of myocardial infarction, the major cardiovascular endpoint is described using an algorithm which depends primarily on enzyme data, using evidence of chest pain and positive electrocardiogram findings as supplemental information only. This approach is evaluated with respect to reproducibility by minimally trained abstractors, cost, and robustness with respect to different hospital systems as well as changes in diagnostic techniques and/or labelling over time. Two pilot studies demonstrate that, in comparison to more traditional approaches, the new surveillance system provides at least a 50% reduction in cost, is highly reproducible over different hospital systems, and potentially, is resilient to changes in diagnostic procedures or coding. The more general applicability of such an innovative surveillance approach to other disease endpoints, in which one reliable procedure contains most of the diagnostic information, is discussed with particular reference to cancer.

Algorithms↗
PubMed1988

Pawtucket Heart Health Program: the process of stimulating community change.

The Pawtucket Heart Health Program (PHHP) is a community-based research and demonstration project in cardiovascular disease (CVD) prevention located in the United States. Targeted risk factors include high blood pressure, elevated blood cholesterol, cigarette smoking, obesity and sedentary living. Evaluation methods included biennial household risk factor surveys in the education and comparison communities, morbidity and mortality surveillance in hospitals serving each community, and both formative evaluation and process tracking. Intervention methods are theoretically derived from social learning theory and seek to motivate, enable and maintain individual behavior change; modify social networks; and introduce environmental change in organizations and normative shifts in the community in ways that reduce the prevalence of CVD risk factors. The intervention strategy began as an organization-based model, and has evolved into a community-wide effort in which marketing research tools and techniques are employed. In the past 4 years, over 40,000 individual contacts have been made with PHHP programs, including 1,260 persons who have volunteered their time to deliver risk factor programs.

Cardiovascular Diseases↗