Biomedical subjects

Deborah L Wingard

Publications and source records attributed to Deborah L Wingard.

15 recordsLinked to original sources

PubMed2006

Breastfeeding, infant formula supplementation, and Autistic Disorder: the results of a parent survey.

BACKGROUND: Although Autistic Disorder is associated with several congenital conditions, the cause for most cases is unknown. The present study was undertaken to determine whether breastfeeding or the use of infant formula supplemented with docosahexaenoic acid and arachidonic acid is associated with Autistic Disorder. The hypothesis is that breastfeeding and use of infant formula supplemented with docosahexaenoic acid/arachidonic acid are protective for Autistic Disorder. METHODS: This is a case-control study using data from the Autism Internet Research Survey, an online parental survey conducted from February to April 2005 with results for 861 children with Autistic Disorder and 123 control children. The analyses were performed using logistic regression. RESULTS: Absence of breastfeeding when compared to breastfeeding for more than six months was significantly associated with an increase in the odds of having autistic disorder when all cases were considered (OR 2.48, 95% CI 1.42, 4.35) and after limiting cases to children with regression in development (OR 1.95, 95% CI 1.01, 3.78). Use of infant formula without docosahexaenoic acid and arachidonic acid supplementation versus exclusive breastfeeding was associated with a significant increase in the odds of autistic disorder when all cases were considered (OR 4.41, 95% CI 1.24, 15.7) and after limiting cases to children with regression in development (OR 12.96, 95% CI 1.27, 132). CONCLUSION: The results of this preliminary study indicate that children who were not breastfed or were fed infant formula without docosahexaenoic acid/arachidonic acid supplementation were significantly more likely to have autistic disorder.

Journal Article↗

PubMed2006

Electron beam computed tomography screening and heart disease risk factor modification.

The authors examined the effect of electron beam computed tomography screening on perceived risk, behavior change, and medical intervention among community-dwelling adults with no history of heart disease. Participants were 184 men and 180 women aged 55 years and older who had electron beam computed tomography scans in 2000-2001 and responded to a questionnaire 6 months later. They were classified as low-, medium-, or high-risk based on coronary artery calcification score, an indicator of coronary artery plaque burden. Overall, only 5% of participants were alarmed or quite worried about developing heart disease. Compared with those with lower risk, high-risk participants were more likely to discuss scan results with a physician, undergo further cardiac testing, have a cholesterol test (all p < 0.001), and begin cholesterol-lowering medication (p < 0.001), aspirin (p = 0.009), and multivitamins (p = 0.018). The authors conclude that electron beam computed tomography screening motivates initiation of measures to prevent clinical heart disease without causing undue alarm among older men and women.

Aged↗

PubMed2006

Does coffee consumption reduce the risk of type 2 diabetes in individuals with impaired glucose?

OBJECTIVE: The purpose of this study was to investigate the association between coffee intake and incident diabetes based on an oral glucose tolerance test (OGTT) and examine coffee habits in those with impaired glucose separately from those with normal glucose at baseline. RESEARCH DESIGN AND METHODS: In this prospective study, 910 adults aged >/=50 years without diabetes at baseline in 1984-1987 were followed to 1992-1996, an average of 8 years after assessment of coffee intake. Logistic regression models were adjusted for sex, age, physical activity, BMI, smoking, alcohol, hypertension, and baseline fasting plasma glucose. RESULTS: Past and current coffee drinkers had a reduced risk of incident diabetes (odds ratio 0.38 [95% CI 0.17-0.87] and 0.36 [0.19-0.68], respectively) compared with those who never drank coffee. The 317 participants with baseline impaired glucose who were past or current coffee drinkers were also at reduced risk for incident diabetes (0.31 [0.11-0.87] and 0.36 [0.16-0.83], respectively). CONCLUSIONS: This study confirms a striking protective effect of caffeinated coffee against incident diabetes and extends these findings to incident diabetes based on OGTT independent of multiple plausible confounders.

Aged↗

PubMed2006

Improving the retention of underrepresented minority faculty in academic medicine.

BACKGROUND: Although several studies have outlined the need for and benefits of diversity in academia, the number of underrepresented minority (URM) faculty in academic health centers remains low, and minority faculty are primarily concentrated at the rank of assistant professor. In order to increase the diversity of the faculty of the University of California, San Diego (UCSD) School of Medicine, the UCSD National Center for Leadership in Academic Medicine, in collaboration with the UCSD Hispanic Center of Excellence, implemented a junior faculty development program designed in part to overcome the differential disadvantage of minority faculty and to increase the academic success rate of all faculty. METHODS: Junior faculty received counseling in career and research objectives; assistance with academic file preparation, introduction to the institutional culture; workshops on pedagogy and grant writing; and instrumental, proactive mentoring by senior faculty. RESULTS: After implementation of the program, the retention rate of URM junior faculty in the school of medicine increased from 58% to 80% and retention in academic medicine increased from 75% to 90%. CONCLUSION: A junior faculty development program that integrates professional skill development and focused academic career advising with instrumental mentoring is associated with an increase in the retention of URM faculty in a school of medicine.

Academic Medical Centers↗

PubMed2005

Hyperglycemia and type 2 diabetes among Filipino women in the Philippines, Hawaii, and San Diego.

BACKGROUND: Diabetes risk increases as immigrant populations adopt western lifestyles. We compared the prevalence of fasting hyperglycemia among Filipino women aged 40-79 years in the Philippines, Hawaii, and San Diego. METHODS: Data were obtained from the (1) Philippine National Nutrition Survey (1998), (2) Native Hawaiian Health Research Project (1997-2001), and (3) University of California San Diego Filipino Women's Health Study (1995-1999). Fasting glucose after an 8h fast, blood pressure, and body mass index (BMI) were measured in all three regions; a 75 g oral glucose tolerance test was performed in San Diego and Hawaii. RESULTS: The proportion of Filipinas with BMI > or = 30 kg/m2 was higher in Hawaii (20%) compared to women in San Diego (9.3%) or the Philippines (5.2%, p<0.001). Fasting hyperglycemia prevalence (fasting plasma glucose > or = 126 mg/dl or fasting whole blood glucose > or = 110 mg/dl) did not differ among Filipinas in the Philippines (11.8%), San Diego (14.1%), and Hawaii (14.7%, p = 0.323). Type 2 diabetes prevalence was similar among Filipinas in San Diego (31.6%) and Hawaii (24.9%, p = 0.79). CONCLUSIONS: Despite regional differences in obesity, fasting hyperglycemia was similar among Filipinas in the Philippines, San Diego, and Hawaii and type 2 diabetes prevalence was similar among Filipinas in San Diego and Hawaii.

Adult↗

PubMed2004

Facilitating faculty success: outcomes and cost benefit of the UCSD National Center of Leadership in Academic Medicine.

PROBLEM AND BACKGROUND: In 1998, the University of California San Diego (UCSD) was selected as one of four National Centers of Leadership in Academic Medicine (NCLAM) to develop a structured mentoring program for junior faculty. METHOD: Participants were surveyed at the beginning and end of the seven-month program, and one-four years after. The institution provided financial information. Four primary outcomes associated with participation in NCLAM were assessed: whether participants stayed at UCSD, whether they stayed in academic medicine, improved confidence in skills, and cost-effectiveness. RESULTS: Among 67 participants, 85% remained at UCSD and 93% in academic medicine. Their confidence in skills needed for academic success improved: 53% personal leadership, 19% research, 33% teaching, and 76% administration. Given improved retention rates, savings in recruitment was greater than cost of the program. CONCLUSIONS: Structured mentoring can be a cost-effective way to improve skills needed for academic success and retention in academic medicine.

Academic Medical Centers↗

PubMed2003

Sarcopenia in elderly men and women: the Rancho Bernardo study.

BACKGROUND: Sarcopenia risk factors are poorly understood. METHODS: This study examines sarcopenia prevalence and risk factors in community-dwelling men (694) and women (1006) aged 55-98 years (mean=73) who attended a 1988-1992 Rancho Bernardo Study clinic visit. Height, weight, muscle strength, fat-free mass (FFM), fat mass by bioelectric impedance analysis, and grip strength were measured; alcohol and medication use, smoking, and physical activity were ascertained. RESULTS: Mean FFM was 43.5 kg for women and 61.7 kg for men. Sarcopenia, defined as FFM of > or =2.0 standard deviations below the gender-specific mean of a young reference population, was present in 6.0% overall. Prevalence increased dramatically from 4% of men and 3% of women aged 70-75 to 16% of men and 13% of women aged 85 and older. Both men and women with sarcopenia had a significantly lower fat mass and body mass index than those without sarcopenia. Men with sarcopenia were twice as likely to have fallen in the past year compared with those without sarcopenia. Grip strength, but not quadriceps strength, was lower in men and women with sarcopenia. Physically active women were about half as likely to have sarcopenia, but no association was found in men. Few men and women were current smokers, but they were more likely to have sarcopenia. Comorbidities (heart disease, diabetes, pulmonary disease, arthritis, cancer) and medications (thyroid hormones, corticosteroids, and hormone replacement therapy) were not associated with sarcopenia. CONCLUSIONS: Sarcopenia increases with age. This study also identified lack of physical activity and current smoking as reversible risk factors for sarcopenia.

Aged↗

PubMed2003

Bone mineral density in postmenopausal Caucasian, Filipina, and Hispanic women.

BACKGROUND: Previous bone mineral density (BMD) studies have suggested Asian women have lower BMD and Hispanic women have similar or higher BMD compared with Caucasian women, partially explained by ethnic differences in body size. This study compared the effect of different variables representing body size on BMD in postmenopausal women aged 50-69 years from three ethnic groups in San Diego County, CA: 354 Caucasians, 285 Filipinas, and 164 Hispanics. METHODS: In all three groups, BMD was measured by DXA (Hologic 2000) at the hip, lumbar spine, and total body. Lifestyle variables and anthropometric measures were assessed by standard methodology; medication and supplement use were validated by a nurse. RESULTS: Regardless of the variables used to represent body size in the regression modelling, either body mass index or lean and fat tissue mass, ethnic differences were minimal across the three groups. The only significant differences observed using the two fully adjusted models (age, height, body mass index or lean and fat tissue mass, smoking, alcohol, exercise, current oestrogen and calcium supplement use, and osteoarthritis) were at the total body BMD site where Filipinas had significantly higher BMD than the Caucasians or Hispanics, whose total body BMD was similar to one another. The independent variables in the fully adjusted models explained approximately 20-40% of the variation in BMD at each of the four sites. Income or occupation did not help explain BMD differences, but a pattern of increased BMD among those with some college education in all three groups was observed. CONCLUSIONS: Accounting for body size using either body mass index or fat and lean tissue mass along with height and other lifestyle variables minimizes ethnic differences and explains a considerable amount of variation in mean BMD among older ethnic minority and Caucasian women.

Adult↗

PubMed2002

Mortality associated with sleep duration and insomnia.

BACKGROUND: Patients often complain about insufficient sleep or chronic insomnia in the belief that they need 8 hours of sleep. Treatment strategies may be guided by what sleep durations predict optimal survival and whether insomnia might signal mortality risks. METHODS: In 1982, the Cancer Prevention Study II of the American Cancer Society asked participants about their sleep duration and frequency of insomnia. Cox proportional hazards survival models were computed to determine whether sleep duration or frequency of insomnia was associated with excess mortality up to 1988, controlling simultaneously for demographics, habits, health factors, and use of various medications. RESULTS: Participants were more than 1.1 million men and women from 30 to 102 years of age. The best survival was found among those who slept 7 hours per night. Participants who reported sleeping 8 hours or more experienced significantly increased mortality hazard, as did those who slept 6 hours or less. The increased risk exceeded 15% for those reporting more than 8.5 hours sleep or less than 3.5 or 4.5 hours. In contrast, reports of "insomnia" were not associated with excess mortality hazard. As previously described, prescription sleeping pill use was associated with significantly increased mortality after control for reported sleep durations and insomnia. CONCLUSIONS: Patients can be reassured that short sleep and insomnia seem associated with little risk distinct from comorbidities. Slight risks associated with 8 or more hours of sleep and sleeping pill use need further study. Causality is unproven.

Adult↗

PubMed2002

The relationship between weight loss and all-cause mortality in older men and women with and without diabetes mellitus: the Rancho Bernardo study.

OBJECTIVES: To examine the relationship between measured weight change over an approximate 10-year time period on all-cause mortality over the following 12 years in 1,801 community-dwelling men and women (mean age 71 at the beginning of mortality follow-up) with and without diabetes mellitus. DESIGN: A longitudinal cohort study. SETTING: A geographically defined community in southern California. PARTICIPANTS: One thousand eight hundred one older men and women with and without diabetes mellitus. MEASUREMENTS: Weight, body mass index (BMI), blood pressure, and fasting plasma glucose were measured in 1972-74 (Visit 1) when participants were aged 40 to 79 and again in 1984-87 (Visit 2). Lifetime weight history and dieting for weight control were ascertained in 1985 using a mailed questionnaire. Vital status was determined for the next 12 years, from Visit 2 (1984-87) through 1996. The Cox proportional hazards model was used to assess the age- and multiply adjusted effect of weight change on mortality. RESULTS: At Visit 1, diabetic men (n = 140) and women (n = 90) were more overweight than nondiabetic men (n = 633) and women (n = 938). Weight gain between Visits 1 and 2 was not a significant predictor of mortality in this cohort. Men and women losing 10 or more pounds between visits had higher age-adjusted death rates during the following 12 years than those with stable weight or weight gain. Weight loss was associated with an increased hazard ratio (HR) for all-cause mortality in nondiabetic men (HR = 1.38, 95% confidence interval (CI) = 1.06-1.80) and women (HR = 1.76, 95% CI = 1.33-2.34) and diabetic men (HR = 3.66, 95% CI = 2.15-6.24) and women (HR = 1.65, 95% CI = 0.70-3.87) after adjustment for age, smoking, and sedentary lifestyle. Significant associations persisted in analyses excluding cigarette smokers and those with depressed mood and low baseline BMI. After excluding those who died within 5 years of the weight loss, the increased HR was statistically significant in men and women with and without diabetes mellitus. Stratified analyses comparing those who reported dieting for weight control with those not dieting showed similar trends, with a higher mortality risk for weight loss in those who lost weight without dieting. CONCLUSION: In this population of older individuals, weight loss predicted increased all-cause mortality risk not explained by covariates.

Adult↗

PubMed2002

The National DES Education Program: effectiveness of the California Health Provider Intervention.

BACKGROUND: Diethylstilbestrol (DES), a synthetic estrogen prescribed during pregnancy between 1938 and 1971, was later shown to have serious health effects, including higher risks of cancer in daughters and mothers. The authors report results of an intervention to increase health care providers' awareness of preventive care for women exposed to DES before birth. METHODS: A controlled trial enrolled 20 to 25 health care providers in each of three communities to test the effectiveness of an academic detailing intervention. Outcomes (knowledge, routine screening) were assessed by provider questionnaires and patient surveys. RESULTS: DES knowledge, familiarity with national guidelines, and screening for exposure increased significantly in the intervention communities but not in the control communities. The intervention effect for DES screening was significant (p = 0.01). Patient surveys confirmed provider self-report. CONCLUSION: Academic detailing can increase DES knowledge and history taking among primary care providers. This intervention could be disseminated to increase knowledge of DES preventive care.

California↗

PubMed2002

Hysterectomy status and life satisfaction in older women.

OBJECTIVES: This cross-sectional, population-based study examines the long-term effect of hysterectomy on life satisfaction in 1177 women aged 55-94 years. METHODS: A 1992 mailed survey obtained information on menopausal history, including hysterectomy and oophorectomy status, and estrogen use. Two standardized measures ascertained general life satisfaction: the Life Satisfaction Index-Z (LSI-Z) and the Satisfaction with Life Scale (SWLS). A separate question asked participants to rate life satisfaction (better, the same, or worse) after menopause or hysterectomy compared with before. RESULTS: Twenty-three percent of the women reported hysterectomy with bilateral oophorectomy an average of 24 years earlier, and 26% reported hysterectomy with ovarian conservation an average of 28 years earlier. Women who were 20 or more years posthysterectomy or postmenopause were significantly more likely to rate their life satisfaction as better than were women 5 or fewer years posthysterectomy or postmenopause (p < 0.01). Among women with a hysterectomy, 53% with oophorectomy and 60% with ovarian conservation rated life satisfaction better after hysterectomy. Only 42.2% of women without a hysterectomy rated life satisfaction as better after menopause (p < 0.001). Differences persisted after adjustment for age and other covariates: p < 0.01 for hysterectomy with ovarian conservation and p < 0.001 for hysterectomy with bilateral oophorectomy vs. no hysterectomy. Even among women who had never used estrogen, a significantly greater proportion of those who had a hysterectomy with ovarian conservation rated their life satisfaction as better compared with women who did not have a hysterectomy (p < 0.05). There were no differences in standard life satisfaction scores (LSI-Z or SWLS) by hysterectomy status. CONCLUSIONS: There are no long-term adverse effects of hysterectomy on life satisfaction. When queried specifically, women report increased life satisfaction following hysterectomy. Relief from symptoms necessitating hysterectomy may be responsible for this increase. This difference may be specific to hysterectomy because there were no differences in general life satisfaction as assessed with standardized measures.

Adaptation, Psychological↗

PubMed2002

Endogenous sex hormones and the development of type 2 diabetes in older men and women: the Rancho Bernardo study.

OBJECTIVE: To determine the prospective association between endogenous sex hormones and the development of type 2 diabetes in older men and women. RESEARCH DESIGN AND METHODS: A standardized medical history was obtained, an oral glucose tolerance test was performed, and plasma samples for sex hormones and covariates were collected from ambulatory, community-dwelling men and women at baseline from 1984 to 1987. Approximately 8 years later (1992-1996), another medical history was obtained, an oral glucose tolerance test was performed, fasting and 2-h insulin levels were measured, and the homeostasis model assessment for insulin resistance (HOMA-IR) was evaluated. This report is based on the 294 men and 233 women, aged 55-89 years, who completed both visits and who did not have diabetes as determined by history or glucose tolerance test at baseline, as well as women who were postmenopausal and not taking replacement estrogen. RESULTS: In age-adjusted correlation analyses, total testosterone was inversely and significantly related to subsequent levels of fasting and postchallenge glucose and insulin in men, whereas bioavailable testosterone and bioavailable estradiol were positively and significantly related to fasting and postchallenge glucose and insulin in women (all P <0.05). There was similar significant association with insulin resistance (HOMA-IR) in unadjusted and multiply adjusted analyses (P <0.05). There were 26 men and 17 women with new (incident) diabetes. The odds for new diabetes were 2.7 (95% CI 1.1-6.6) for men in the lowest quartile of total testosterone and 2.9 (1.1-8.4) for women in the highest quartile of bioavailable testosterone. CONCLUSIONS: Low testosterone levels in men and high testosterone levels in women predict insulin resistance and incident type 2 diabetes in older adults.

Aged↗

PubMed2002

Type 2 diabetes and metabolic syndrome in Filipina-American women : a high-risk nonobese population.

OBJECTIVE: To compare the prevalence of type 2 diabetes and features of the metabolic syndrome among Filipina and Caucasian women in San Diego County, California. RESEARCH DESIGN AND METHODS: Data on several chronic diseases were collected between 1992 and 1999 from community-dwelling Filipina (n=294) and Caucasian (n=379) women aged 50-69 years. RESULTS: Filipina and Caucasian women did not differ in mean age (59.7 vs. 60 years, respectively), BMI (25.6 vs. 25.4 kg/m(2)), percentage of body fat (33.5 vs. 34.2%), or waist-to-hip ratio (0.84 vs. 0.83), although Filipinas had larger waist circumferences and higher percentages of truncal fat. Compared with Caucasians, Filipinas were less likely to be obese (BMI > or = 30 kg/m(2), 8.8 vs. 14%, P=0.04) and less likely to smoke, consume alcohol, or take postmenopausal estrogen; Filipinas also had lower levels of HDL cholesterol. Compared with Caucasians, Filipinas had higher prevalence of type 2 diabetes by oral glucose tolerance test criteria (36 vs. 9%) and the metabolic syndrome (34 vs. 13%). These differences persisted after adjusting for age, body size, fat distribution, percentage of body fat, smoking, alcohol consumption, exercise, and estrogen therapy. CONCLUSIONS: A total of 10% of Filipinas with diabetes were obese, compared with one third of Caucasians with diabetes. The finding of a high prevalence of diabetes in an unstudied nonobese ethnic group reinforces the importance of expanding the study of diabetes to diverse populations. The high prevalence of diabetes in populations who are not of Northern European ancestry may be missed when they are not obese by Western standards.

Aged↗

PubMedDate not supplied

Children's visits to providers of complementary and alternative medicine in San Diego.

OBJECTIVE: Increased attention has been focused on the growing use of complementary and alternative medicine (CAM); however, few studies have included children in the general US population. The present study investigated children's visits to CAM providers and factors associated with these visits. METHODS: Analysis of cross-sectional data from the 2001 United Way Outcomes and Community Impact Program telephone survey, a representative sample of households in San Diego County, California. We selected households with children younger than 19 years of age (N = 1104). Parents reported on children's CAM visits in the past year. RESULTS: Approximately 23% of parents reported that their child saw a CAM provider in the past 12 months. CAM care was sought for sick and routine care. Children of white parents had greater odds of having a CAM visit in the past year compared with children whose parents were Hispanic (adjusted odds ratio 1.71, 95% confidence interval [95% CI] 1.11-2.63). Children whose parents were college graduates had a greater likelihood of seeing a CAM provider than children of parents with high school education (adjusted odds ratio = 1.82, 95% CI 1.19-2.79). Children who were insured were also more likely to have CAM visits than uninsured children (adjusted odds ratio = 2.32, 95% CI 1.04-5.21). CONCLUSIONS: Visits to CAM providers were much more common among children in the general San Diego population compared with 1996 national estimates. Pediatric health care providers should remain aware that their patients may be using CAM so they can provide coordinated care.

Adolescent↗