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Biomedical subjects

G E Dever

Publications and source records attributed to G E Dever.

At least 19 recordsLinked to original sources
PubMed2001

Obesity is associated with reduced self-rated general health status: evidence from a representative sample of white, black, and Hispanic Americans.

BACKGROUND: Although the evidence linking obesity with many chronic diseases is well established, the relationship with self-rated health is not clear. Self-rating of health is a broad summary measure of different domains of health that include psychosocial domain. The aims of this study were to examine the relationship between obesity and self-rated health and the degree of agreement between patients' self-rated health status and physicians' impression of patients' health in a representative sample of healthy noninstitutionalized American adults. METHODS: Data (n = 10, 298) used for this analysis were obtained from the Third National Health and Nutrition Examination Survey. Normal weight was defined as BMI 18.5-24.9 kg/m(2) and preobesity was defined as BMI 25-29.9 kg/m(2). Moderate (class I) obesity was defined as BMI 30-34.9 kg/m(2) and severe (class II) obesity as BMI > or =35 kg/m(2). Self-rated health conditions were categorized as excellent, very good, good, fair, or poor. Agreement between physicians' impression and self-rated health and a linear relationship between obesity and individual perceived health were quantified using kappa and gamma statistics, respectively. Using the logistic regression analysis, odds of reporting reduced health in preobese, class I obese, and class II obese individuals were compared with those for normal-weight individuals, adjusting for age, current smoking, and alcohol intake. The contribution of obesity to ethnic differences in reduced self-rated health was determined by comparing blacks with whites and Hispanics with whites fitted in multiple logistic regression models. RESULTS: Among both men and women, there was a statistically significant linear association between obesity and self-rated health (P < 0.05). The proportion of subjects reporting excellent health tended to decrease with increasing level of obesity in the three ethnic groups. In the three ethnic groups, the degrees of concordance between self-rated health and physicians' impressions were poor and decreased with increasing obesity level. In each ethnic group, class II obesity was associated with approximately twofold increased odds of reporting reduced health compared with normal-weight individuals. Compared to whites, black and Hispanic races/ethnicities were respectively associated with 23 and 175% increased odds of reduced self-rated health among men. The corresponding values for women were 45 and 177%, respectively. CONCLUSION: The results of this study provide evidence that obesity has a negative impact on self-rated health among adults, even in the absence of chronic disease conditions. The results of this investigation also underscore the need to craft national preventive strategies to curb obesity in these at-risk population groups.

Black or African American↗
PubMed2001

Hypertension and type 2 diabetes comorbidity in adults in the United States: risk of overall and regional adiposity.

OBJECTIVE: To evaluate the impact of generalized, abdominal, and truncal fat deposits on the risk of hypertension and/or diabetes and to determine whether ethnic differences in these fat patterns are independently associated with increased risk for the hypertension-diabetes comorbidity (HDC). RESEARCH METHODS AND PROCEDURES: Data (n = 7075) from the Third U.S. National Health and Nutrition Examination Survey were used for this investigation. To assess risks of hypertension and/or diabetes that were due to different fat patterns, odds ratios of men and women with various cut-points of adiposities were compared with normal subjects in logistic regression models, adjusting for age, smoking, and alcohol intake. To evaluate the contribution of ethnic differences in obesity to the risks of HDC, we compared blacks and Hispanics with whites. RESULTS: Generalized and abdominal obesities were independently associated with increased risk of hypertension, diabetes and HDC in white, black, and Hispanic men and women. The risk of HDC due to generalized, truncal, and abdominal obesities tended to be higher in whites than blacks and Hispanics. In men, the contribution of black and Hispanic ethnicities to the increased risk of HDC due to the various obesity phenotypes was approximately 73% and approximately 61%, respectively. The corresponding values for black and Hispanic women were approximately 115% and approximately 125%, respectively. CONCLUSIONS: In addition to advocating behavioral lifestyles to curb the epidemic of obesity among at-risk populations in the United States, there is also the need for primary health care practitioners to craft their advice to the degree and type of obesity in these at-risk groups.

Adipose Tissue↗
PubMed2001

Abdominal obesity defined as a larger than expected waist girth is associated with racial/ethnic differences in risk of hypertension.

OBJECTIVE: Waist circumference (WC) cut-points of > or =102 cm and > or =88 cm for men and women, respectively, representing abdominal obesity have been recommended for determining obesity related co-morbidities. However, these cut-points carry the component of generalised obesity estimated by body mass index (BMI). The aim of this investigation was to determine whether abdominal obesity free of the influence of overall heaviness is associated with increased risk of hypertension in a representative sample of white and black Americans. METHODS: Data (n = 11114) from the Third US National Health and Nutrition Examination Survey were used in this investigation. Standardised residual values from the linear regression of WC on BMI were used to define abdominal obesity status. The risk of hypertension associated with abdominal obesity was estimated from the logistic regression model, adjusting for age, smoking and alcohol. We also estimated the public health consequences of abdominal obesity from the population attributable fraction of hypertension. RESULTS: Relative to white, black race/ethnicity was associated with approximately 1.8 and approximately 2.7 greater risk of hypertension in men and women, respectively, adjusting for abdominal obesity, age, smoking and alcohol consumption. Having larger than expected waist girths were associated with 1.58 and 1.39 increased risk of hypertension in black men and black women, respectively, adjusting for confounders. Population attributable risks of hypertension due to abdominal obesity were approximately 24.9% and 15.9%, in black men and black women, respectively. CONCLUSIONS: In Americans, hypertension is a public health problem that is closely linked to abdominal adiposity. An important research challenge therefore is to determine the best way to regulate body weight under conditions of food abundance. There is a need to clarify how lifestyle habits promote large waist sizes leading to abdominal adiposity and associated cardiovascular disease in the US, particularly among black Americans.

Abdomen↗
PubMed2001

Apolipoprotein B, ratio of total cholesterol to HDL-C, and blood pressure in abdominally obese white and black American women.

OBJECTIVE: To compare the association of apolipoprotein B (ApoB) and total cholesterol to high-density lipoprotein cholesterol (TC/HDL) with blood pressure in abdominally obese white and black American women. We also sought to determine if there are ethnic differences in blood pressure values that could be explained by differences in mean values of ApoB and TC/HDL. METHODS: Data (n = 1844) from the Third US National Health and Nutrition Examination Survey were used in this study. Abdominal obesity was defined as waist circumference (WC) of > or =88cm or having WC greater than what was expected as predicted from residuals obtained from linear regression of WC on BMI. Bi-variate Pearson's correlation analysis was used to quantify the degree of association of ApoB and TC/HDL with blood pressure and other lipids. Multiple linear regression analysis was used to assess the independent contribution of ApoB and TC/HDL to blood pressure, adjusting for age, total cholesterol, alcohol intake, and smoking. To determine ethnic differences in blood pressure values associated with ApoB or TC/HDL, dummy variables were used to compare blacks with whites fitted in multiple regression models, while adjusting for age, total cholesterol, alcohol intake and smoking. RESULTS: Elevated ApoB was positively associated with diastolic and systolic blood pressure (DBP/SBP) in blacks and whites, independent of age, total cholesterol, alcohol intake and smoking (P < 0.01). Elevated TC/HDL was also positively associated with increased DBP and SBP in whites (P < 0.05). For the same value of ApoB and TC/HDL whites had higher values of DBP and SBP than blacks, adjusting for confounding variables. CONCLUSIONS: Compared with TC/HDL, ApoB was more strongly associated with DBP and SBP in both abdominally obese white and black women. Since ApoB is associated with hypertension, the combination of elevated ApoB and hypertension may identify a group of patients with more marked risk of vascular disease, thus, warranting further investigation.

Abdomen↗
PubMed2001

Verbal autopsy: a necessary solution for the paucity of mortality data in the less-developed countries.

Although global disease burden can best be described using accurate and reliable mortality data, many investigators rely solely on death certificates, despite the fact that many of the less-developed countries (LDCs) do not have mandated death certifications. In many of these LDCs, particularly in remote areas, verbal autopsy (VA) may be a surrogate for death certificates in ascertaining causes of death. The main benefit of using VA stems from the fact that it is based on laypersons' observations of the diseased, and therefore does not require medical training. Because of human and economic resource constraints in many LDCs, investments in infrastructures for collecting mortality data needed for the planning, monitoring, and evaluation of health are unlikely in the immediate future. Investment in rural health workers who are trained in VA may prove useful in increasing the quality and availability of mortality data from many LDCs. Rural health workers are essentially 'foot doctors' in many of these countries, whose familiarity with nooks and crannies of villages would be beneficial in the collection of needed mortality data. There is a need for international development agencies, such as the World Health Organization, to devote resources for training rural health workers in order to increase the availability of mortality data for describing worldwide disease burdens.

Cause of Death↗
PubMed2000

Impact of birth weight on ethnic variations in subcutaneous and central adiposity in American children aged 5-11 years. A study from the Third National Health and Nutrition Examination Survey.

OBJECTIVE: To determine the types of subcutaneous adiposity represented by different measurements of skinfold thickness that are associated with birth weight in white (n=759), Black (n=916) and Hispanic (n=813) American children aged 5-11 y. We also determined the contribution of birth weight to ethnic differences in subcutaneous and central adiposity. DESIGN AND METHODS: Data for this analysis were from the Third US National Health and Nutrition Examination Survey. The outcome measures were triceps, subscapular, suprailiac and thigh skinfold thicknesses at 5-11 y of age. Central adiposity was defined as ratios of subscapular to triceps (STR) and central-peripheral (CPR) (subscapular+suprailiac)/(triceps+thigh) skinfolds. Partial correlation analyses were used to determine the association between birth weight and measures of subcutaneous fatness, while multiple linear regression analyses were used to determine the independent contribution of birth weight to ethnicity variations in subcutaneous and central adiposity adjusting for sex, age and BMI. RESULTS: Overall, birth weight was negatively associated with subscapular skinfold and central adiposity in White, Black and Hispanic American children (P < 0.05). Birth weight was also negatively associated with suprailliac skinfold in both Blacks and Hispanics (P < 0.01) and with sum of the four skinfolds in Blacks (P < 0.05). Compared with White, Black ethnicity was negatively associated with triceps, suprailliac thigh and sum of skinfold thicknesses controlling for birth weight, sex, age and BMI (P < 0.01). Compared with White, Hispanic ethnicity was negatively associated with triceps, thigh and sum of skinfold thicknesses (P < 0.01). Both Black and Hispanic ethnicity was positively associated with STR and CPR (P < 0.01). CONCLUSIONS: In this population of American children, the association of birth weights with subcutaneous and central fat accumulation may be due to fetal programming. Since the impact of fetal conditions is likely to be modified by life course, defining the interaction between factors that are present at birth and subsequent exposures is one of the essential challenges for future research.

Adipose Tissue↗
PubMed2000

Abdominal adiposity values associated with established body mass indexes in white, black and hispanic Americans. A study from the Third National Health and Nutrition Examination Survey.

PURPOSE: To determine whether white, black and hispanic young (17-39y) and middle-aged (40-59y) adults, and elderly (60-90y) Americans have the same values of abdominal adiposity (estimated from waist circumference (WC) at the established levels of overweight (body mass index, BMI 25-29.9 kg/m2) and obesity (BMI > or = 30 kg/m2). METHODS: Data (n=16,120) from the US Third National Health and Nutrition Survey were utilized. Age-adjusted linear regression analyses were used to estimate gender- and ethnic-specific WC values corresponding to overweight and obesity. Receiver operating characteristic (ROC) curves were also employed to determine the choices of WC values corresponding to the established BMI cut-off points. With ROC, gender- and ethnic-specific cut-off points producing the best combination of sensitivity and specificity were selected as optimal thresholds for WC values corresponding to the established BMI cut-off points. RESULTS: WC values associated with the established BMI were lower in blacks and hispanics compared with whites. In men, the WC values that corresponded to overweight ranged from 89 to 106 cm, from 84 to 95 cm, and from 87 to 97 cm in whites, blacks and hispanics, respectively. The corresponding values for obesity ranged from 99 to 110 cm, from 96 to 107 cm, and from 97 to 108 cm. The WC values that corresponded to overweight in women ranged from 82 to 91 cm, from 81 in to 90 cm, and from 83 to 92 cm in whites, blacks and hispanics, respectively. The analogous values for obesity ranged from 94 to 101 cm, from 93 to 100cm, and from 94 to 101 cm. CONCLUSIONS: The lack of higher WC values in blacks (particularly women) and hispanics at the same levels of BMI for whites challenges previously held assumptions regarding the role of abdominal adiposity in cardiovascular disease experienced by non-whites. Defining the anthropometric variables that satisfactorily describe reasons for ethnic differences in cardiovascular disease is one of the challenges for future research.

Abdomen↗
PubMed1998

Analysis of health service areas: another piece of the psychiatric workforce puzzle.

Planning for development of a national or regional psychiatrist workforce that is the appropriate size must consider numerous issues. They include the dynamics of workforce distribution, effects of managed care, reduction in potential residency slots, participation of international medical graduates, apathy toward the field of psychiatry, service area variations, and increased interest in allied mental health professions, along with the burgeoning global burden of psychiatric illness. This paper examines the application of two benchmark standards for the number of psychiatrists needed per 100,000 population--the standard developed by the Graduate Medical Education National Advisory Committee and the Average Requirement Benchmark--to the supply of psychiatrists in Georgia in 1996 by county and by health service regions, which are geographical units based on health care utilization patterns of Medicare and Medicaid recipients. Areas with a surplus or deficit of psychiatrists are identified. The findings provide contextual evidence of a surplus of psychiatric physicians in the most populous areas of the state, given a substantial presence of health maintenance organizations. The state's less populated rural areas may potentially benefit from a redistribution of the psychiatrist workforce. The authors recommend continued refinement of models to estimate psychiatric workforce needs and suggest development of a comprehensive model that uses needs-based, demand-based, and benchmarking approaches.

Benchmarking↗
PubMed1997

Clinical, motor, and biological correlates of depressive disorders after focal subcortical lesions.

The authors studied depression after focal subcortical lesions (SCLs) in 45 highly selected subjects. Secondary major depression (secondary MD) occurred in 20.0%, depressive disorder NOS (secondary DDNOS) in 4.4%, and secondary dysthymia in 0.0%. secondary MD after SCLs was associated with pallidal lesions (88.9%) and dystonia without geste antagonistique; subjects with secondary DDNOS had nigrotegmental lesions and parkinsonism. Depressive severity after SCLs correlated positively with severity of parkinsonism and dystonia. Pallidal lesions disrupting neurotransmitter systems and pallidothalamic and parietal input to the frontal lobe may lead to secondary MD, whereas nigrotegmental lesions may predispose to secondary MD forme fruste (secondary DDNOS) through disruption of mesocortical frontal or nigrostriatal dopamine tracts. Patients should be closely followed over several years for depression after such lesions, especially when accompanied by parkinsonism or dystonia without geste antagonistique.

Brain Diseases↗
PubMed1997

Major depression after left posterior globus pallidus lesions.

We studied subjects with focal subcortical lesions (SCLs) and investigated the frequency of pallidal lesions in secondary major depression (secondary MD) presenting after but not before lesion onset. Forty-five subjects were selected for focal subcortical lesions (SCLs) from 10,000 hospital magnetic resonance imaging (MRI) films. SCLs were ascertained by neuroradiologic criteria. Major depression was ascertained by DSM-III, -III-R, and -IV criteria. We compared subjects with secondary MD to SCL subjects lacking life histories of mood disorders and investigated the lesion distribution among pallidal subregions evident on MRI. We further tested an association between pallidal lesions and secondary MD. Pallidal lesions were present in eight (89%) of nine subjects with secondary MD and 13 (59%) of 22 controls. Left posterior pallidal lesions occurred in four (44%) of the nine subjects with secondary MD and two (9%) of the 22 controls (one-tailed Fisher's exact test p = 0.043). Demographic and other factors did not differ between subjects with secondary MD and controls (using Fisher's exact test or Mann-Whitney U test as statistically appropriate). These data, of small sample size and requiring confirmation, suggest the possibility that abnormal pallidal function may contribute to depressive pathophysiology, perhaps by influencing basal ganglia-thalamocortical mood circuits. Left-lateralized circuits in the posterior pallidum may be of particular relevance. The left pallidal association is compatible with previous findings in poststroke depression. Patients with left pallidal lesions may deserve close monitoring for secondary MD after subcortical lesions.

Aged↗
PubMed1989

Physician supply and distribution in Georgia.

Physician supply in Georgia must be considered an urgent issue. Several important points must be recognized and addressed. The lowest physicians rates are in the more rural county population groupings. The only county population grouping with a surplus of physicians is in the over 150,000 population. The majority of physicians are concentrated in the metropolitan counties. Sixteen percent of all physicians practice in the 134 counties having less than 50,000 population. The majority of physicians are in primary care specialties. Family practice is the most dominant specialty in rural areas. By the year 2000, Georgia can expect to add 5,600 physicians due to growth. By the year 2000, Georgia can expect to lose 2,600 physicians due to retirement. Family practitioners are the most uniformly distributed of the specialties examined. They are also the specialty most needed. The average age of Georgia physicians is 46. General surgeons are in the oldest average age group (50), whereas internists are in the youngest (44). Older physicians are concentrated in the more rural areas. A significant number of all physicians are over age 55. The majority of these will be retired by the year 2000. Physicians over age 65 represent 9.2% of all physicians from the survey. In Georgia, 13.6% of all physicians were Foreign Medical School Graduates. They tend to locate their practices in medically underserved areas. The specialty choices most frequently favored by FMGs are: pediatrics, internal medicine, family practice, and obstetrics/gynecology. A total of 71.2% of all physicians accept Medicare patients; 83.8% accept Medicare patients. Ninety-two percent of all obstetricians accept obstetric patients, but this participation is threatened by problems with malpractice insurance.

Adult↗