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D L Hahn

Publications and source records attributed to D L Hahn.

17 recordsLinked to original sources
PubMed1992

Smoking is a potential confounder of the Chlamydia pneumoniae-coronary artery disease association.

Two recent studies, which did not adequately control for smoking status, found associations between Chlamydia pneumoniae serological titers and various manifestations of coronary artery disease (CAD). The validity of C. pneumoniae-CAD associations found in case-control studies has been criticized on the basis that smoking, known to be associated with CAD and hypothesized to be associated with C. pneumoniae seroreactivity via an increased prevalence of respiratory infection in smokers, could be an uncontrolled confounder in these studies. We investigated associations between current smoking status and C. pneumoniae serological titers in a cohort of 365 outpatients (mean age, 34 years) with respiratory illness. Current smokers were significantly (p = 0.04) more likely than nonsmokers to have C. pneumoniae titers greater than or equal to 1:128, and there was a significant (p less than 0.05) "dose-response" association between titer category and smoking, which persisted after controlling for age and sex in a logistic-regression model. These results support the hypothesis that smoking may be a confounder of the association of C. pneumoniae antibody titer and smoking-associated diseases such as CAD. Future studies into these associations should control for cigarette use.

Adult↗
PubMed1991

Association of Chlamydia pneumoniae (strain TWAR) infection with wheezing, asthmatic bronchitis, and adult-onset asthma.

UNLABELLED: OBJECTIVE--To study the clinical characteristics of respiratory tract illness caused by Chlamydia pneumoniae. DESIGN: -Prospective clinical, bacteriologic, and serologic study. Secondarily, a matched comparison of patients with and without evidence of C pneumoniae infection (serologic titers greater than or equal to 1:64 and less than 1:16, respectively). SETTING: --Four primary care (family practice) clinics in Madison, Wis, and nearby towns. PATIENTS: --The study included 365 white males and females (mean age, 34.2 years). MAIN OUTCOME MEASURES: --Association of acute C pneumoniae infection with signs and symptoms of respiratory illness and the relationship of C pneumoniae antibody titer with wheezing at the time of enrollment in the study, and with the diagnosis of asthmatic bronchitis. RESULTS: --Nine (47%) of 19 patients with acute C pneumoniae infection had bronchospasm during respiratory illness, and there was a strong quantitative association of C pneumoniae titer with wheezing at the time of enrollment in the study (P = .01). In the matched study, C pneumoniae antibody was significantly associated with asthmatic bronchitis after, but not before, respiratory illness (odds ratio, 7.2; 95% confidence interval, 2.2 to 23.4). Four infected patients had newly diagnosed asthma after illness, and four others had exacerbation of previously diagnosed asthma. There was no serologic evidence of coexisting Mycoplasma pneumoniae, Chlamydia trachomatis, or respiratory viral infection in 96% of patients with asthmatic bronchitis and asthma. CONCLUSIONS: --Some C pneumoniae antibody titers, although not diagnostic of chlamydial infection by present criteria, probably represent acute reinfection or ongoing chronic infection. Repeated or prolonged exposure to C pneumoniae may have a causal association with wheezing, asthmatic bronchitis, and asthma.

Adolescent↗
PubMed1991

Efficient diagnosis.

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Cross-Cultural Comparison↗
PubMed1990

Implementation of a systematic health maintenance protocol in a private practice.

The impact of a policy to introduce a simple health maintenance protocol systematically to all patients belonging to a private practice is reported. Results after 18 months' experience in over 1400 patients indicate that (1) physician compliance was excellent (97% of eligible patients were included, and physician time taken to introduce the protocol at the index visit took less than 4 minutes), and (2) patient acceptance (which varied from procedure to procedure) was good to excellent (minimum acceptance: 77% for sigmoidoscopy; maximum acceptance: 97% for cholesterol screening). For patients seen once, acceptance rates for procedures were generally comparable to prior published performance rates for highly selected patient populations. Integration of a simple health maintenance protocol into routine office care of unselected primary care patients was feasible, effective, and acceptable to patients. Patient refusal was a minor barrier to performance of health maintenance.

Adult↗
PubMed1990

Sex and race are risk factors for colorectal cancer within reach of the sigmoidoscope.

There is controversy about the efficacy and feasibility of flexible fiberoptic sigmoidoscopy (FFS) as a screening test for colorectal cancer in asymptomatic adults aged 50 years and over. Some authorities recommend periodic FFS screening for all such adults, whereas other authorities do not recommend screening FFS at all. There is evidence that some physicians have adopted a policy of "selective screening" by emphasizing screening FFS for adults with ancillary risk factors such as a personal history of colon polyps or previous colorectal cancer, or a family history of colon, female genital, or breast cancer. Results of this study of the subsite distribution of colorectal cancer show that both male sex and Oriental race are risk factors for colorectal cancer within reach of FFS, and that the risk of being male and Oriental (relative risk [RR] = 1.9) is of the same magnitude as that for other ancillary risk factors known for the general population (excluding specific rare disorders). Knowledge that sex and race are risk factors for colorectal cancer detectable by screening FFS may be important to those physicians who choose the selective screening approach. Further research is necessary to determine whether selective screening for colorectal cancer is efficacious, or whether the race and sex differences noted in this study are important in the etiology of colorectal cancer.

Adult↗
PubMedDate not supplied

Mammography.

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Breast Neoplasms↗
PubMedDate not supplied

Mammography.

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Family Practice↗
PubMedDate not supplied

Feasibility of sigmoidoscopic screening for bowel cancer in a primary care setting.

Sigmoidoscopic screening for bowel cancer is controversial because of its debatable efficacy, lack of patient and physician acceptance of the procedure, and uncertainty about its practicality with the large numbers of patients in primary care settings. This study addressed patient acceptance and practicality. During an 18-month period, 75 percent of all patients aged 50 years and greater who were seen for health maintenance accepted sigmoidoscopy. The procedure was integrated into office routines without disrupting other patient care. While compliance with fecal occult blood testing was high (88 percent), sensitivity of this test for neoplastic polyps within reach of the proctosigmoidoscope was low (11 percent). These results suggest that acceptance of sigmoidoscopy by patients seen in family physicians' offices could be greater than has been anticipated.

Aged↗