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Biomedical subjects

D R Labarthe

Publications and source records attributed to D R Labarthe.

At least 37 records · Page 2Linked to original sources
PubMed1997

Quality control for blood pressure measurement in population studies: Shibata Children's Heart Study.

To investigate the relation between observer performance for blood pressure measurement in a training process and in field conditions, measurement values were studied under training and field conditions among 21 blood pressure observers of 1434 subjects aged 6-15 years in Japan. The observers received training by a videotape, which included six audiovisual presentations of a falling mercury column in a standard sphygmomanometer with Korotkoff sounds. Observer bias was measured for each trainee as the mean difference between the observed and the standard values for each blood pressure reading, including systolic (SBP), fourth-phase diastolic (K4), and fifth-phase diastolic (K5) values. In multiple linear regression analyses, each 1 mmHg increment in observer bias was equivalent to 1.27, 0.88, and 1.25 mmHg difference in actual readings of SBP, K4, and K5, respectively, in the field. This finding indicates that observer performance in videotape training is predictive of measurement behavior in the field.

Adolescent↗
PubMed1997

Sex and ethnic differences in use of myocardial revascularization procedures in Mexican Americans and non-Hispanic whites: the Corpus Christi Heart Project.

Age-adjusted rates of percutaneous transluminal coronary angioplasty (PTCA) and aortocoronary bypass surgery (ACBS) were determined for Mexican American (MA) and non-Hispanic white (NHW) patients hospitalized for coronary heart disease. Hypotheses of equal receipt of procedures between gender and ethnic groups were tested. Following myocardial infarction (MI), women were less likely than men to receive either procedure (22 versus 32%, p < 0.01), and MA were less likely than NHW to receive PTCA (13 versus 23%, p < 0.01) but not ACBS. After adjustment for extent of disease and other potential confounders, ethnic groups differed marginally in receipt of PTCA but not ACBS, while gender differences were not significant. Although women received revascularization procedures less frequently than men, this difference did not persist after controlling for extent of coronary artery disease by angiography: therefore, these observed differences in delivery of health care services may be appropriate. Mexican Americans received PTCA, but not ACBS, less frequently than NHW. This selective ethnic difference in receipt of PTCA does not appear to be associated with the extent of disease or other medical characteristics, and may represent inappropriate bias in delivery of health care services.

Adult↗
PubMed1996

Women and Mexican Americans receive fewer cardiovascular drugs following myocardial infarction than men and non-Hispanic whites: the Corpus Christi Heart Project, 1988-1990.

Mortality following myocardial infarction (MI) is greater among women than men and among Mexican Americans than non-Hispanic whites. Because therapy can affect mortality following MI, we examined differences in discharge therapy among these groups. Data regarding discharge therapy of 982 patients in the Corpus Christi Heart Project showed that women received fewer cardiovascular drugs than men, and Mexican Americans received fewer cardiovascular drugs than non-Hispanic whites. In multivariate analysis adjusting for age, cigarettes smoking, diabetes, hypertension, congestive heart failure, and serum cholesterol, the odds ratio for receipt of cardiovascular medications was 0.51 (95% CI: 0.28-0.93) for women versus men and 0.62 (0.3-1.15) for Mexican Americans versus non-Hispanic whites. Beta-blockers were prescribed rarely. Thus, treatment differences between ethnic and gender groups were observed following MI. Further research is needed to determine both the reasons for these differences and the extent to which these differences contribute to the observed survival patterns following MI.

Adult↗
PubMed1996

Higher levels of social support predict greater survival following acute myocardial infarction: the Corpus Christi Heart Project.

Although low levels of social support have been related to mortality from coronary heart disease, little is known about the role of social support among Mexican Americans. The authors therefore examined the relationship between social support and long-term survival in the Corpus Christi Heart Project. They developed a social support scale that used data collected during in-hospital interviews of 292 Mexican Americans and 304 non-Hispanic Whites who survived a myocardial infarction for more than 28 days. The scale incorporated three measures: marital status; if not married, whether living alone; and whether advised to seek help. During an average follow-up period of 43 months, 115 participants died. Survival following myocardial infarction was greater for those with high or medium social support than for those with low social support. With age, gender, ethnicity, education, employment, smoking, diabetes, hypertension, and hypercholesterolemia included in a proportional hazards regression model, the relative risk of mortality was 1.89 (95% CI, 1.20-2.97) for those with low social support. But when the two ethnic groups were analyzed separately, low social support was no longer a significant predictor of mortality for non-Hispanic Whites, whereas for Mexican Americans, the relative risk of mortality was 3.38 (95% CI, 1.73-6.62) for those with low social support.

Adult↗
PubMed1996

An assessment of the validity of ICD Code 410 to identify hospital admissions for myocardial infarction: The Corpus Christi Heart Project.

BACKGROUND: The identification of myocardial infarction (MI) is typically based on finding events designated by a nosologist with the appropriate International Classification of Diseases (ICD) code, currently code 410. These codes are applied based on review of medical records or death certificates. However, other factors, including reimbursement considerations, may influence the coding process, especially for hospitalizations. Thus, the validity of using ICD code 410 to identify MI must be assessed. METHODS: The Corpus Christi Heart Project (CCHP) is a population-based surveillance programme for hospitalized MI. Patients were identified using concurrent ascertainment in coronary care units and retrospective review of medical records. Events were validated as definite or possible MI using data regarding chest pain, electrocardiographic changes and cardiac enzymes. The validity of using ICD code 410 to identify cases of MI was assessed by calculating the sensitivity, specificity, predictive values and efficiency of ICD code 410 versus the CCHP 'gold standard'. RESULTS: Use of ICD code 410 identified 80.9% (401/496) of definite MI, but only 19.0% (243/1280) of possible MI. Only 12.3% (90/734) of discharges with an ICD 410 code received a 'no MI' designation based on the 'gold standard'. The efficiency of ICD code 410 for identifying MI was 92.0% for definite MI and 77.1% for definite and possible MI. CONCLUSIONS: The use of ICD code 410 to identify hospitalized cases of MI results in a modestly biased overestimate of the number of definite MI hospitalizations; however, this approach warrants consideration due to the expense of validation procedures.

Adult↗
PubMed1996

Changes in cardiovascular disease risk factors in three Japanese national surveys 1971-1990.

Trends of cardiovascular disease risk factors were evaluated through comparison of three national surveys in Japan, 1971-1990. Data from three Japanese national surveys on circulatory disorders, conducted in 1971, 1980, and 1990, were analyzed. Variables common to the three national surveys were selected for analysis. Serum total cholesterol was also but was examined only in 1980 and 1990. Age- and sex-specific mean values, standard deviations, median values, and proportions in extreme categories were determined for all continuous variables and proportions in categories interest for all discrete variables. Trends from 1971-1990 and 1980-1990 were estimated by linear regression analysis for continuous variables, and logistic regression analysis for binary variables. Systolic blood pressure was decreasing constantly during three surveys in both men and women (beta = -0.22 in men and -0.34 in women, p < 0.01 in both). Total cholesterol was increasing rapidly in both men and women between 1980 and 1990 (beta = 1.27 in men and 1.41 in women, p < 0.01 in both). For other risk factors, the results were less consistent among age- or sex-specific groups. Continued monitoring of risk factor trends in Japan will be important for predicting and explaining future trends in the occurrence of coronary heart disease and stroke in this population.

Adult↗
PubMed1996

Recruitment and enrollment for Project HeartBeat! Achieving the goals of minority inclusion.

OBJECTIVE: The inclusion of women and minorities in health research supported by the National Institutes of Health (NIH) has received increasing attention since the adoption of related guidelines by NIH in 1990. Investigators in population-based and clinical research may need to identify and recruit research participants from community settings in which little is known by investigators of the dynamics and day-to-day needs of the community. This was the case at the start of Project HeartBeat!, an intensive longitudinal study of the development of cardiovascular risk factors against the background of growth and maturation. This paper identifies those elements found essential when recruiting and enrolling minority participants for Project HeartBeat! METHODS: No prior experience had existed in the community from which the majority of Black participants were recruited to the Project. Therefore, recruitment methods were based on previous experience of the investigators as well as on the published reports of others. RESULTS: Immediate costs were substantially greater than projected, and the recruitment period was two years rather than one-a circumstance with longer-term implications as well. However, with the support of a community-based advisory committee, the school district, and a local recruitment staff, the recruitment goal was obtained. CONCLUSIONS: Recruitment and enrollment of minority participants can be especially challenging; however, many of those challenges are common to any target population. Elements that need to be adequately addressed include the researchers' involvement with the community in which the participants live, a tracking system to assess recruitment efforts, flexibility in the methods of recruitment, and adequate resources in time, money and personnel.

Adolescent↗
PubMed1995

A population-based assessment of the use and effectiveness of thrombolytic therapy. The Corpus Christi Heart Project.

Little is known regarding the use and effectiveness of thrombolytic therapy in community settings, especially regarding the receipt of therapy by Mexican Americans. Thus, we examined the factors associated with receipt of thrombolysis and the survival experience of recipients and nonrecipients in the Corpus Christi Heart Project. The Corpus Christi Heart Project is a population-based surveillance program for hospitalized myocardial infarction among Mexican-American and non-Hispanic white women and men residing in Corpus Christi, Texas. Multivariate regression analyses were used to identify factors associated with receipt of thrombolytic therapy and to assess the association between receipt of thrombolytic therapy and mortality. During a 2-year period, 1199 patients hospitalized for myocardial infarction were identified; 159 (13.3%) received thrombolysis. Among "ideal" candidates for thrombolytic therapy, 74 (35.1%) of 211 received such therapy. Women were less likely to receive thrombolysis than men, and Mexican Americans were less likely to received thrombolysis than non-Hispanic whites. Patients for whom there was a delay of more than 4 hours between onset of symptoms and arrival at the hospital were also less likely to receive thrombolysis. Recipients of thrombolytic therapy experienced lower mortality over 56 months following myocardial infarction than did nonrecipients (20.5 versus 33.2%, P < 0.01). Use of thrombolytic therapy was less frequent among women and Mexican Americans than among men and non-Hispanic whites, and was limited by delay between onset of symptoms and arrival at the hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

A case-control study of ulcerative colitis with relation to smoking habits and alcohol consumption in Japan.

Epidemiologic studies of ulcerative colitis in western countries have shown that former smokers are at greater risk than those who never smoked, but current smoking and alcohol drinking habits appear to be inversely associated with the development of this disease. The present case-control study examines whether these relations are found among Japanese people, after adjustment for the separate effects of smoking and alcohol consumption. The subjects were 384 patients with ulcerative colitis who first received financial aid for treatment of this disease within the 2-year period from April 1988 to March 1990. From the same public health centers, age- and sex-matched paired controls were selected randomly from rosters of persons attending health checkup programs. Information on smoking behavior and alcohol use was obtained by self-administered questionnaires. Compared with nonsmokers, former smokers were at increased risk of suffering from this disease (odds ratio (OR) = 1.67, 95% confidence interval (CI) 0.97-2.88); current smokers were at decreased risk (OR = 0.30, 95% CI 0.18-0.50); and usual consumption of alcohol reduced the risk compared with less frequent use (OR = 0.57, 95% CI 0.37-0.86). Significant dose-response relations were observed between these two factors and the disease. In conclusion, the relations between both smoking and alcohol consumption and ulcerative colitis among Japanese people exist independently and are consistent with those reported in several previous studies outside Japan.

Adult↗
PubMed1994

Greater case-fatality after myocardial infarction among Mexican Americans and women than among non-Hispanic whites and men. The Corpus Christi Heart Project.

Age-adjusted 28-day case-fatality rates were higher among Mexican Americans than among non-Hispanic whites and higher among women than among men hospitalized for definite or possible myocardial infarction in Corpus Christi, Nueces County, Texas, from May 1, 1988, through April 30, 1990. The authors therefore examined whether these higher case-fatality rates were associated with greater prevalence of previously diagnosed coronary heart disease or diabetes; with greater age, frequency of definite myocardial infarction, or congestive heart failure; with higher values of indicators of severity of infarction, including peak creatine phosphokinase levels and scales prognostic of early mortality after myocardial infarction; and with differences in receipt of in-hospital therapy. The overall 28-day case-fatality rate among 1,228 patients hospitalized for myocardial infarction during a 24-month period was 7.3%. After adjustment for age; diabetes; myocardial infarction class (definite vs. possible); congestive heart failure; the Norris and Peel severity indices; peak total creatine phosphokinase; and receipt of thrombolytic therapy, aspirin, calcium channel blockers, beta-blockers, anticoagulants, angioplasty, and bypass surgery, the risk of 28-day case-fatality for Mexican Americans in relation to non-Hispanic whites was 1.49 (95% confidence interval 0.92-2.40). The corresponding risk for women in relation to men was 1.80 (95% confidence interval 1.12-2.89). These findings should alert clinicians to the high-risk status of these groups of patients.

Adult↗
PubMed1994

Secular trends in mortality from asthma in Japan, 1979-1988: comparison with the United States.

To determine whether mortality from asthma in Japan has increased, and to examine the age-, sex-, and race-specific mortality rates from this disease and their secular trends in both Japan and the US, vital statistics from 1979 through 1988 were studied. Overall, rates were highest among Japanese and decreased from 1979 to 1988, while rates in the US were lower and increased somewhat, especially among Blacks (whose rates were intermediate, in general, between Japanese and US Whites). Age-specific rates showed the greater asthma mortality in Japan to be due to deaths at ages greater than 50 or 60 years. The downward trend in the Japanese, unlike US Blacks and Whites, was due specifically to decreasing rates among the youngest and the oldest age group between the earlier and later years of the period, 1979-1988.

Adolescent↗
PubMed1994

Rise of blood pressure with age. New evidence of population differences.

Epstein and Eckoff in 1967 devised a scheme to summarize population differences in the rise of mean values of systolic blood pressure by age in accordance with their slopes and levels. For the first time, the validity of this scheme can be examined with data from a single study, INTERSALT. This study included 52 populations in 32 countries. On the basis of these data, collected in an exceptionally well-standardized mode under a common protocol, the diversity of populations in the slopes of age differences in median values of systolic blood pressure has been strongly reconfirmed. Populations with no increase in median systolic blood pressure were again observed and remained exceptional. The analyses of these data also indicate a positive relation between the slope of rising systolic blood pressure with age and urinary sodium, urinary sodium-potassium ratio, and reported alcohol consumption as well as a negative association between urinary potassium excretion and blood pressure slope. The present analyses therefore add to the previous knowledge and results published by the INTERSALT investigators in the following three respects: (1) they relate INTERSALT results to the postulated biological gradient of variation among populations as presented by Epstein and Eckoff, including explanatory variables; (2) they demonstrate strong correlation between ranks of median blood pressure at 40 to 49 years and values at 20 to 29 years; and (3) they therefore support the original Epstein and Eckoff concept of population variation, link this with blood pressure risk factors, and call attention to the large degree of population differences already evident among populations at 20 to 29 years of age.

Adult↗
PubMed1994

The relation of diabetes to the severity of acute myocardial infarction and post-myocardial infarction survival in Mexican-Americans and non-Hispanic whites. The Corpus Christi Heart Project.

The effect of diabetes on survival after myocardial infarction (MI) was examined in a prospective population-based study of individuals hospitalized with MI in a bi-ethnic community of Mexican-Americans and non-Hispanic whites. Among Mexican-Americans, 54% (331 of 610) had diabetes compared with 33% (192 of 589) of non-Hispanic whites (P < 0.001). Among those with diabetes, the prevalence of a history of a cardiac event before the index admission was significantly higher (odds ratio = 1.4, 95% confidence interval [CI] 1.1-1.8) than among nondiabetic subjects. During the index hospitalization, diabetic subjects received cardiac catheterization less frequently than did nondiabetic subjects (45.1 vs. 51.5%, P = 0.03). Diabetic subjects had lower estimated ejection fractions, and the number of coronary arteries with significant obstruction (> 75%) was higher (P < 0.001). The peak creatine phosphokinase and creatine phosphokinase myocardial isoenzyme (CK-MB) levels were similar in diabetic and nondiabetic subjects. Despite a similar infarct size, diabetic subjects had a higher incidence of congestive heart failure (relative ratio = 2.2, 95% CI 1.7-2.8), more adverse indexes of short-term and long-term prognosis, and a longer average hospital stay (12.1 vs. 8.9 days, P < 0.01). After adjustment for age, sex, and ethnicity, the cumulative risk for total mortality, over 44 months of follow-up, was 37.4% among diabetic compared with 23.3% among nondiabetic subjects (P < 0.001). Diabetic subjects had a higher 28-day case-fatality rate post-MI as well as higher long-term mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Hospitalization rates for myocardial infarction among Mexican-Americans and non-Hispanic whites. The Corpus Christi Heart Project.

The rate of hospitalization for myocardial infarction was examined in the Corpus Christi Heart Project (CCHP), a prospective population-based surveillance program in a biethnic community of Mexican-Americans and non-Hispanic whites. During 12 months of ascertainment, a total of 740 patients hospitalized with definite (217) or possible (523) myocardial infarction were identified. Of the 740 subjects, 334 were Mexican-Americans (150 females and 184 males), 348 were non-Hispanic whites (138 females and 210 males), and 58 were of other ethnic backgrounds. The 1-year age-adjusted rates of hospitalization per 100,000 population were 427.4 and 276.9 among Mexican-American and non-Hispanic white females, respectively, and 721.4 and 502.6 among Mexican-American and non-Hispanic white males, respectively. The age-adjusted hospitalization rate ratios for Mexican-Americans in relation to non-Hispanic whites were 1.55 (95% confidence interval [CI]: 1.23 to 1.95) and 1.40 (95% CI: 1.15 to 1.70) for females and males, respectively. These results suggest that Mexican-Americans may have a greater burden of coronary disease than non-Hispanic whites.

Adult↗
PubMed1993

Factors associated with serum cholesterol level in a pediatric practice. Cholesterol screening in a pediatric practice.

The associations between age, sex, height, Quetelet index, blood pressure, and serum cholesterol level were examined among 1406 routinely screened children, aged 4 to 19 years, in a pediatric practice. After adjustment for sex and age, height and Quetelet index were associated with serum cholesterol levels. Quetelet index was shown by multiple linear regression to be positively related to cholesterol levels (b = 0.780, P < 0.01), but the predictive value of screening based on an elevated Quetelet index was marginal. Clustering of elevated serum cholesterol level, Quetelet index, and systolic blood pressure was observed. Familial aggregation of cholesterol levels was demonstrated using analysis of variance for 742 children from 342 families included in the regression analysis (F341,400 = 1.56, P < 0.0001). The intraclass correlation coefficient, a measure of familial aggregation, was 0.205 (P < 0.0001). Age, sex, height, Quetelet index, and familial aggregation accounted for 10.6% of the variance in serum cholesterol levels. Siblings of children with high cholesterol levels are a high-yield group in cholesterol screening.

Adolescent↗
PubMed1993

Parental response to identification of elevated blood pressure or cholesterol following school-based screening.

The objective of this study was to identify factors that influenced compliance with a recommendation for reevaluation of an elevated cholesterol or blood pressure level following a school-based screening examination. A questionnaire was developed and mailed to parents of 103 5th- through 8th-grade students who had received such a recommendation. A total of 72 usable questionnaires were returned. There were no significant physiologic, health, or demographic differences between the respondents and the nonrespondents. Of the respondents, 38 (53%) had their child's cholesterol or blood pressure level reevaluated. There were no differences in mean levels of total cholesterol or blood pressure between those reevaluated and those who were not. The factor most often associated with compliance was parents' reported concern about their children's health. Of note was the apparent lack of action by many physicians when presented with blood pressure and cholesterol values above recommended levels. Further study is needed to determine appropriate interventions to enhance compliance.

Attitude to Health↗