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Biomedical subjects

Charles J Everett

Publications and source records attributed to Charles J Everett.

At least 19 recordsLinked to original sources
PubMed2006

Association of a polychlorinated dibenzo-p-dioxin, a polychlorinated biphenyl, and DDT with diabetes in the 1999-2002 National Health and Nutrition Examination Survey.

The association of a polychlorinated dibenzo-p-dioxin, a polychlorinated biphenyl, and p,p'-DDT with diabetes was evaluated using the 1999-2002 National Health and Nutrition Examination Survey. Persons 20 years old and older were included. Relationships with diagnosed diabetes, undiagnosed diabetes (glycohemoglobin (HbA1c) >6.1%), and total diabetes (diagnosed plus undiagnosed) were tested. When all three chemicals were evaluated together for total diabetes, the unweighted number of participants was 1830. All three compounds were significantly associated with diagnosed diabetes. PCB 126 and p,p'-DDT were significantly associated with undiagnosed diabetes. 1,2,3,6,7,8-hexachlorodibenzo-p-dioxin (HxCDD) was not associated with undiagnosed diabetes. When the three chemicals were included in a combined model for total diabetes, PCB 126>83.8pg/g lipid adjusted had an odds ratio of 2.57 (95% CI 1.33-4.95) compared to PCB 126 < or = 31.2pg/g lipid adjusted. Also significant in a combined model for total diabetes was p,p'-DDT 20.8-26.6ng/g lipid adjusted with an odds ratio of 2.52 (95% CI 1.26-5.02) and p,p'-DDT >26.6ng/g lipid adjusted with an odds ratio of 2.74 (95% CI 1.44-5.23) both compared to p,p'-DDT < or = 20.7ng/g lipid adjusted. HxCDD was not associated with total diabetes in a combined model. When participants with poor liver function and poor kidney function were removed from the analysis, the combined model for total diabetes produced similar results with PCB 126 and p,p'-DDT having been significantly associated, and HxCDD not having been associated. These findings add to the list of chemicals found to be associated with diabetes in the 1999-2002 National Health and Nutrition Examination Survey.

Adult↗
PubMed2006

Long-term prognostic value of resting heart rate in subjects with prehypertension.

BACKGROUND: Increased resting heart rate increases cardiovascular risk in individuals with hypertension. The extent to which such risk extends to people with prehypertension is not known. The purpose of this study was to determine whether elevated resting heart rate contributes to increased coronary heart disease (CHD) risk in people with prehypertension. METHODS: The cohort for the current study consisted of 3275 persons from the Atherosclerosis Risk in Communities (ARIC) study, 45 to 64 years old in 1986 to 1989, with a mean follow-up of 10.1 years. The primary outcomes were CHD and all-cause mortality. RESULTS: Individuals with prehypertension and elevated resting heart rate had 50% higher all-cause mortality than people with prehypertension and lower resting heart rate (hazard ratio [HR] 1.50, 95% confidence interval [CI] 1.0-2.15), which was essentially unchanged after controlling for age, ethnicity, gender, diabetes, smoking status, LDL-cholesterol, exercise, and use of antilipemic agents (P < .01). Similarly, in unadjusted analyses, CHD risk was 49% higher for people with increased heart rate (HR 1.49, 95% CI 1.03-2.14). In adjusted analyses, elevated resting heart rate remained a factor in increased risk of CHD in women (adjusted HR 2.18, 95% CI 1.08-4.42), but not in men. CONCLUSIONS: Resting heart rate is an easily accessible tool that may be helpful for stratifying CHD and mortality risk in people with prehypertension.

Coronary Disease↗
PubMed2006

Ambulatory antibiotic prescribing for acute bronchitis and cough and hospital admissions for respiratory infections: time trends analysis.

OBJECTIVES: To examine the relationship between ambulatory antibiotic prescribing for acute bronchitis and cough with hospital admissions for respiratory infections in the USA between 1996 and 2003. DESIGN: Analysis of data on antibiotic prescribing for episodes of acute bronchitis/cough illness in ambulatory care and hospitalization for respiratory infections for adults between 1996 and 2003 in the USA. SETTING: USA: ambulatory prescribing behaviour was derived from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey while hospitalizations in acute care hospitals were assessed in the National Hospital Discharge Survey. PARTICIPANTS: Adults 18-64 years old. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Proportion of visits for acute bronchitis/cough receiving a prescription for antibiotics and hospitalization for respiratory infections. RESULTS: Ambulatory antibiotic prescribing practices for acute bronchitis/cough and hospitalizations for respiratory infections exhibited non-linear patterns over the 8 year period. However, antibiotic prescribing practices for acute bronchitis/cough and hospitalizations for respiratory infections had a weak/moderate negative association. For three of the seven yearly changes in prescribing and hospitalizations as one increased the other decreased (P<0.01). CONCLUSIONS: Ambulatory antibiotic prescribing for respiratory tract infections was inversely associated with hospital admissions for respiratory tract infections.

Acute Disease↗
PubMed2006

Diabetes management in the USA and England: comparative analysis of national surveys.

OBJECTIVES: To compare diabetes management in adults between England and the United States, particularly focusing on the impact of a universal access health insurance system. DESIGN: Analysis of the nationally-representative surveys Health Survey of England, 2003 (unweighted n =14 057) and the National Health and Nutrition Examination Survey, 2001-2002 (unweighted n =5411). SETTING AND PARTICIPANTS: Adults 20-64 years of age; individuals >65. MAIN OUTCOME MEASURES: Glycaemic, lipid and blood pressure control and medication use among individuals with previously diagnosed diabetes. RESULTS: Among those aged 20-64 the prevalence of diagnosed diabetes was lower in England (2.7%) than in the USA (5.0%). The proportion with diabetes receiving treatment was similar for the two countries. However, the mean HbA1c in England was 7.6%: in the USA it was 7.5% for those with insurance and 8.6% for those without insurance. The proportion of individuals on ACE inhibitors in England was 39%: in USA it was 39% for those with insurance, and 14% for those without. CONCLUSIONS: Individuals in a healthcare system providing universal access have better managed diabetes than those in a market based system once one accounts for insurance.

Adult↗
PubMed2006

Practice patterns in sildenafil prescribing.

BACKGROUND: This study explores the incorporation of sildenafil into treatment of the common conditions of psychosexual and erectile dysfunction (ED). METHODS: The 2002 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey were analyzed for visits in which sildenafil was prescribed. Patient, visit, and provider characteristics for visits in which sildenafil was prescribed were compared between visits that documented a presenting complaint or diagnosis consistent with ED and those without documentation consistent with ED. RESULTS: Of visits by men 30 years or older receiving sildenafil, 50% had no documented presenting complaint or diagnosis consistent with ED. No significant differences were found between those prescribed sildenafil with or without a reason for visit or diagnosis of ED based on age, race, or payment type. Individuals with more visits in the last 12 months were significantly less likely to have a recorded diagnosis consistent with ED. Urologists documented ED significantly more often than family medicine, internal medicine, and other physicians. CONCLUSIONS: Sildenafil is being prescribed at a significant number of visits without documentation of a reason for visit or diagnosis consistent with psychosexual or erectile dysfunction.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2006

Multiple lipid scoring system for prediction of coronary heart disease risk: application to African Americans.

BACKGROUND: Clinicians often obtain a panel of lipids but then only use low-density-lipoprotein (LDL) cholesterol to make clinical decisions. We previously described the multiple lipid measure, a strategy that integrates information about seven lipid measures. Our current inquiry uses the multiple lipid measure to create a scoring system and validates that system in a second cohort. METHODS AND RESULTS: A scoring system that uses total cholesterol, high-density lipoprotein (HDL) cholesterol, LDL cholesterol and triglycerides was developed and tested. African-American participants of the Atherosclerosis Risk in Communities (ARIC) Study were used to validate the multiple lipid measure score. For nonsmokers, scores > or = 2 had a hazard ratio of 4.25 (95% CI 1.92-9.40) compared to reference scores of < or = -3 in adjusted survival analysis predicting incident coronary heart disease risk in the ARIC. The best conventional single lipid measure for nonsmokers was LDL cholesterol. Compared to LDL cholesterol <100 mg/dl, those with LDL cholesterol > or = 160 mg/dl had a hazard ratio of 2.31 (95% CI 1.13-4.75). For current smokers, the best conventional lipid measure was the total cholesterol/HDL cholesterol ratio, which was similar in predictive ability to the multiple lipid measure score. However, the multiple lipid measure score predicted an additional 10% of the cohort at risk compared to the total cholesterol/HDL cholesterol ratio. CONCLUSIONS: The use of the multiple lipid scoring system improves the assessment of incident coronary heart disease risk and may have utility for clinicians in integrating lipid values.

Black or African American↗
PubMed2005

Iron, lipids, and risk of cancer in the Framingham Offspring cohort.

Iron and lipids combine to create oxidative stress, and oxidative stress has a role in the development of cancer. The objective was to determine the risk of cancer among persons who had both elevated iron and lipids. The authors conducted an analysis of the cohort available in the Framingham Offspring Study. Adults aged 30 or more years at baseline had serum iron and high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol, and very low density lipoprotein cholesterol (VLDL-C) assessed in 1979-1982 and were followed for development of cancer until 1996-1997 (n = 3,278). Cox regression models were computed while controlling for age, gender, smoking status, and body mass index. In adjusted models, both elevated iron (hazard ratio (HR) = 1.66, 95% confidence interval (CI): 1.11, 2.46; 29 cases) and VLDL-C (HR = 1.54, 95% CI: 1.04, 2.28; 93 cases) had significant independent risks for development of cancer. When elevated iron was combined with elevated VLDL-C, the adjusted relative risk of cancer increased (HR = 2.68, 95% CI: 1.49, 4.83; 18 cases). Elevated iron and low HDL-C also had a significant adjusted relative risk of cancer (HR = 2.82, 95% CI: 1.50, 5.28; 14 cases). The results suggest that elevated serum iron levels coupled with either high VLDL-C or low HDL-C appear to interact to increase cancer risk in this cohort.

Adult↗
PubMed2005

Predicting coronary heart disease risk using multiple lipid measures.

Principal component analysis was used to summarize variations among 7 lipid measures included in the Framingham Offspring Study (n = 2,694). An overall measure combining information from the 7 lipids was compared with conventional lipid measures in adjusted survival analyses and was found to be a superior predictor of coronary heart disease risk.

Adult↗
PubMed2005

The association between weight fluctuation and mortality: results from a population-based cohort study.

Previous studies evaluating the association between weight fluctuation and mortality are limited and have conflicting results. This study will further evaluate the association between weight fluctuation and mortality in a nationally representative cohort by performing survival analysis of NHANES I and NHANES I Epidemiologic Follow-up Study (n = 8479; weighted sample = 68,200,905). This cohort was followed from 1971 to 1992 and categorized using weight change over five time points into stable non-obese, stable obese, weight gain, weight loss and weight fluctuation groups. All-cause mortality (ACM) and cardiovascular mortality (CM) were evaluated. Respondents with weight fluctuation had higher ACM (HR: 1.83, 95% CI: 1.25-2.69) and CM hazards ratios (HR: 1.86, 95% CI: 1.10-3.15) than the stable non-obese group, even after controlling for pre-existing disease, initial BMI and excluding those in poor health or incapacitated. Increased mortality was also seen in the weight loss group (ACM HR: 3.36, 95% CI: 2.47-4.55), (CM HR 4.22, 95% CI: 2.60-6.84). The stable obese group did not have increased ACM, but did have increased CM prior to the exclusion of those in poor health or incapacitated. (HR: 2.17, 95% CI: 1.10-4.28). Weight fluctuation is associated with a higher risk of all-cause and cardiovascular disease mortality in the US population, even after adjustment for pre-existing disease, initial BMI and the exclusion of those in poor health or incapacitated. Thus, health care providers should promote a commitment to maintaining weight loss to avoid weight fluctuation and consider patients' weight histories when assessing their risk status.

Adult↗
PubMed2005

Association between dietary arginine and C-reactive protein.

OBJECTIVE: We investigated whether a dietary intake of arginine is associated with risk for cardiovascular disease as determined by levels of C-reactive protein (CRP). METHODS: We analyzed the Third National Health Nutrition and Examination Survey, a national public-use dataset collected between 1988 and 1994. Arginine intake was calculated from the 24-h dietary recall using the nutrient composition database of the University of Minnesota Nutrition Coordinating Center. A logistic regression model was used to evaluate the relation between arginine intake and serum levels of CRP while controlling for age, sex, race, exercise, total caloric intake, body mass index, smoking status, diabetes, hypertension, and fiber intake. RESULTS: In the unadjusted model, the likelihoods of having a high level of CRP (>3.0 mg/L), from the lowest to the highest level of arginine intake, were 34.8%, 31.0%, 27.7%, and 18.4% respectively. Arginine intake below the median range was associated with higher levels of CRP (P < 0.05), and arginine intake above the median range was associated with lower levels of CRP (P < 0.05). In the adjusted regression, subjects in the highest level (90th percentile) of arginine intake were 30% less likely to have a CRP above 3.0 mg/L than were subjects with a median arginine intake (odds ratio= 0.70, 95% confidence interval = 0.56 to 0.88). CONCLUSIONS: The results of this study show a relation between arginine intake and CRP level that persisted after controlling for factors associated with CRP. Individuals may be able to lower their risk for cardiovascular disease by consuming more arginine-rich foods such as nuts and fish.

Adult↗
PubMed2005

Nonprescribed antimicrobial drugs in Latino community, South Carolina.

We investigated in a sample of Latinos the practices of antimicrobial drug importation and use of nonprescribed antimicrobial drugs. In interviews conducted with 219 adults, we assessed health beliefs and past and present behaviors consistent with acquiring antimicrobial drugs without a prescription in the United States. Many (30.6%) believed that antimicrobial drugs should be available in the United States without a prescription. Furthermore, 16.4% had transported nonprescribed antimicrobial drugs into the United States, and 19.2% had acquired antimicrobial agents in the United States without a prescription. A stepwise logistic regression analysis showed that the best predictors of having acquired nonprescribed antimicrobial drugs in the United States were beliefs and behavior consistent with limited regulations on such drugs. Many persons within the Latino community self-medicate with antimicrobial drugs obtained without a prescription both inside and outside the United States, which adds to the reservoir of antimicrobial drugs in the United States.

Adult↗
PubMed2005

Cholesterol, transferrin saturation, and the development of dementia and Alzheimer's disease: results from an 18-year population-based cohort.

BACKGROUND AND OBJECTIVES: Oxidative stress plays a role in Alzheimer's disease (AD), and iron and cholesterol together have been linked to oxidative stress. This study examined the relationship between transferrin saturation (TS) and cholesterol to see if both are necessary to increase the risk for the subsequent development of AD. METHODS: We analyzed data from US adults (ages 40-74 years at baseline) followed from baseline in 1971-1974 to 1992 (n=6,558) in the cohort study, the National Health and Nutrition Examination Survey I Epidemiologic Followup Study (NHEFS). RESULTS: The unadjusted relative risk of developing AD when both TS and cholesterol were at the 75th percentile was 3.19 (95% CI, 1.31-7.75). In adjusted models when only one marker was elevated, there was no significant increased risk for AD. The risk of AD increased as both markers increased. Even at the 85th percentile, individuals had no significant risk of AD when only having elevated cholesterol (>280 mg/dl) but not elevated TS (39.6%). Findings were similar for individuals with elevated TS but not elevated cholesterol. CONCLUSIONS: In this population-based cohort, the risk of developing AD when one has both elevated cholesterol and elevated TS is much larger than the risk associated with elevation of either of these factors alone.

Adult↗
PubMed2004

Prehypertension and mortality in a nationally representative cohort.

The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 7 recommendations include early identification of prehypertension (120 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic). Although prehypertension is a risk factor for hypertension, little is known of prehypertension's independent risk for mortality. We conducted an analysis of a nationally representative cohort in the second National Health and Nutrition Examination Survey 1976 to 1980 (NHANES II) and the NHANES II Mortality Study, 1992. The cohort included 9,087 patients aged 30 to 74 years at baseline, who represented nearly 95 million Americans. Cox proportional-hazards models were conducted for both cardiovascular disease (CVD) and all-cause mortality. The unadjusted relative risk of both all-cause (hazard ratio [HR] 1.27, 95% confidence interval [CI] 1.02 to 1.58) and CVD (HR 1.66, 95% CI 1.21 to 2.26) mortality is increased for patients with prehypertension over patients with normal blood pressure (BP). Almost all patients with hypertension (93%), prehypertension (90%), and normal BP (85%) have other CVD risk factors. When the presence of any CVD risk factor is adjusted for in the survival analysis, the adjusted relative risk of both all-cause (HR 0.82, 95% CI 0.64 to 1.04) and CVD (HR 1.00, 95% CI 0.72 to 1.39) mortality is no longer increased for patients with prehypertension. Similarly, in analyses of patients aged >/=55 years, there is no significant independent mortality risk for prehypertension. Lifestyle interventions targeting multiple risk factors including BP may be the most effective prevention strategy.

Adult↗
PubMed2004

Association of ferritin and lipids with C-reactive protein.

C-reactive protein (CRP) and lipids (e.g., low-density lipoprotein [LDL]) are both markers of cardiovascular disease risk, yet they are not highly correlated. Oxidative stress of lipids induced by iron may play a role in vascular inflammation, as indicated by CRP. The purpose of this study was to examine, in a representative sample of United States adults, the relation between ferritin, lipids, and CRP. We analyzed data on adults (aged > or =25 years) in the National Health and Nutrition Examination Survey III, a national public-use data set collected between 1988 and 1994. Ferritin, total cholesterol, LDL, high-density lipoprotein, and ferritin-lipid combinations were analyzed in relation to CRP in age-, gender-, and race-adjusted models as well as models with other potential confounding variables. In adjusted models, neither elevated ferritin (odds ratio [OR] 1.11, 95% confidence interval [CI] 0.94 to 1.32) nor elevated LDL was significantly associated with elevated CRP (OR 1.03, 95% CI 0.79 to 1.33). Patients with elevated ferritin and elevated LDL were more likely to have elevated CRP (OR 1.68; 95% CI 1.06 to 2.68). Patients with elevated ferritin and low high-density lipoprotein were also more likely to have elevated CRP (OR 1.71; 95% CI 1.28 to 2.27). These results suggest that both iron and lipids induce inflammation. Future research needs to focus on preventive medicine to decrease iron in patients with elevated lipids.

Adult↗
PubMedDate not supplied

Acculturation and diabetes among Hispanics: evidence from the 1999-2002 National Health and Nutrition Examination Survey.

OBJECTIVE: Hispanic individuals in the United States have a greater prevalence of diabetes mellitus than non-Hispanic white individuals; however, it is unclear whether Hispanics' risk of diabetes differs based on their level of acculturation. The purpose of our research was to examine acculturation among Hispanic Americans with respect to prevalence and control of diabetes. METHODS: We conducted an analysis of the National Health and Nutrition Examination Survey (NHANES), 1999-2002, a nationally representative sample of the noninstitutionalized U.S. population. We evaluated data on Hispanic adults (> or = 18 years of age, unweighted n=2,696), analyzing diagnosed diabetes, glycemic blood pressure and lipid control, and diabetes complications according to acculturation as measured by language and birth outside the United States. RESULTS: Hispanics with low acculturation were more likely to be without a routine place for health care, have no health insurance, and have low levels of education. In adjusted analyses, individuals with low acculturation, measured by language, were more likely to have diabetes (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.02, 3.54). Among individuals with diagnosed diabetes, no significant association was yielded between acculturation and diabetes control. However, individuals with low language acculturation were more likely to have the diabetes complication of peripheral neuropathy (OR 4.01, 95% CI 1.40, 11.48). CONCLUSIONS: Acculturation as measured through language is associated with diabetes and complications among Hispanics even after controlling for a variety of demographic characteristics including health insurance and education. The findings suggest that even within a "single" minority ethnic group, there are differences in disease prevalence and complications and access to health care.

Acculturation↗
PubMedDate not supplied

Transferrin saturation, dietary iron intake, and risk of cancer.

PURPOSE: Transferrin saturation of more than 60% has been identified as a cancer risk factor. It is unclear whether dietary iron intake increases the risk of cancer among individuals with transferrin saturation of less than 60%. The purpose of this study was to examine the association of dietary iron intake and the risk of cancer among adults with increased transferrin saturation. METHODS: Analysis of a cohort study, the National Health and Nutrition Examination Survey I Epidemiologic Follow-Up Study, was performed. US adults (aged 25 to 74 years at baseline) were followed up from baseline in 1971-1974 to 1992 (N = 6,309). RESULTS: A total of 7.3% of the US population had a serum transferrin saturation of more than 45% at baseline. Intake of dietary iron was essentially uncorrelated with transferrin saturation (r = 0.04). Compared with individuals who had normal serum transferrin saturation and low dietary iron intake, individuals whose serum transferrin saturation was more than 45% and who had high dietary iron intake also had an increased adjusted relative risk of cancer (2.24; 95% confidence interval [CI], 1.02-4.89). Increased risk was not found for individuals with a transferrin saturation of more than 45% but a normal dietary iron intake (hazard ratio, 1.02; 95% CI, 0.69-1.49). Transferrin saturation levels could be set as low as 41%, and the individuals with high transferrin saturation and high dietary iron intake would still have an increased adjusted relative risk of cancer (hazard ratio, 2.00; 95% CI, 1.04-3.82). CONCLUSIONS: Among persons with increased transferrin saturation, a daily intake of dietary iron more than 18 mg is associated with an increased risk of cancer. Future research might focus on the benefits of dietary changes in those individuals with increased serum transferrin saturation.

Adult↗