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Biomedical subjects

G R Cutter

Publications and source records attributed to G R Cutter.

At least 91 records · Page 5Linked to original sources
PubMed1988

CARDIA: study design, recruitment, and some characteristics of the examined subjects.

In 1984, a prospective cohort study, Coronary Artery Risk Development in Young Adults (CARDIA) was initiated to investigate life-style and other factors that influence, favorably and unfavorably, the evolution of coronary heart disease risk factors during young adulthood. After a year of planning and protocol development, 5,116 black and white women and men, age 18-30 years, were recruited and examined in four urban areas: Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota, and Oakland, California. The initial examination included carefully standardized measurements of major risk factors as well as assessments of psychosocial, dietary, and exercise-related characteristics that might influence them, or that might be independent risk factors. This report presents the recruitment and examination methods as well as the mean levels of blood pressure, total plasma cholesterol, height, weight and body mass index, and the prevalence of cigarette smoking by age, sex, race and educational level. Compared to recent national samples, smoking is less prevalent in CARDIA participants, and weight tends to be greater. Cholesterol levels are representative and somewhat lower blood pressures in CARDIA are probably, at least in part, due to differences in measurement methods. Especially noteworthy among several differences in risk factor levels by demographic subgroup, were a higher body mass index among black than white women and much higher prevalence of cigarette smoking among persons with no more than a high school education than among those with more education.

Adult↗
PubMed1988

Plasmid-containing strains of Streptococcus mutans cluster within family and racial cohorts: implications for natural transmission.

The transmission of mutans streptococci is thought to occur along familial lines based on investigations which have shown common strains within family units by using phenotypic typing methods, such as bacteriocin production and immunity profiles and serotyping. Difficulties in implementing these typing methods, coupled with conflicting interpretations of results between laboratories, led us to study the conservation of Streptococcus mutans strains within a mother-child cohort by using a genotypic marker, plasmid DNA. Plasmids (all 5.6 kilobases in size) were observed at an overall frequency of 3.3%, with a significantly different frequency in whites (1.5%) compared with blacks (6.6%). Plasmid-containing strains were significantly clustered in mother-child pairs compared with nonrelated individuals (58 versus 3.3%; P less than 0.001). Moreover, the different plasmid groups (I and II) were highly conserved within racial boundaries (P = 0.007). In those instances in which we were able to characterize distinct strains by either biotype or plasmid profile, we found that mothers harbored a more heterogeneous population of mutans streptococci than did their children. This suggested, among other possibilities, that children acquire additional strains as they approach adulthood. Alternatively, we may have been unable to detect more heterogeneity of strains in children because of quantitative differences of strains in saliva. We present collective data which show that strains of S. mutans are highly conserved within not only mothers and their children but also racial groups, suggesting vertical transmission of this organism within human populations. Moreover, we show that levels of S. mutans found in the saliva of the mother correlated with levels found in her child, demonstrating a quantitative relationship within mother-child pairs.

Family↗
PubMed1987

Fetal deaths in Alabama, 1974-1983: a birth weight-specific analysis.

Birth weight-specific fetal death rates were evaluated for Alabama for the years 1974-1983. The fetal death rate for the total low birth weight group improved less than 20% during the decade, whereas the fetal death rate for the 2500-3999-g birth weight group improved 40%, and the fetal death rate for the group of 4000 g or more improved 71%. By 1983, 76% of all stillbirths weighed less than 2500 g, compared with 66% in 1974. In contrast, in both years, only about 7% of live births weighed less than 2500 g. This study suggests that increased reporting of stillbirths of less than 500 g has contributed to the recent apparent lack of improvement in stillbirth rates in Alabama.

Alabama↗
PubMed1985

Low birth weight, intrauterine growth retardation, and preterm delivery.

The relationship between low birth weight, intrauterine growth retardation, and preterm delivery in infants born at a perinatal center is described. Between 20% and 30% of infants born weighing 500 to 2000 gm and nearly 50% of infants born weighing 2001 to 2750 gm had intrauterine growth retardation. For infants within the same low-birth weight group, infants with intrauterine growth retardation had one half to one sixth of the neonatal mortality rate of non-growth-retarded infants. However, only in the 501 to 1000 gm group did the difference in mortality between infants with and without intrauterine growth retardation substantially influence the composition of the group of survivors.

Birth Weight↗
PubMed1985

Dietary therapy slows the return of hypertension after stopping prolonged medication.

This study asks whether prolonged antihypertensive therapy will "cure" a substantial percent of rigorously treated hypertensive patients and whether nutritional change will add an antihypertensive effect and reduce the relapse rate. Of 584 eligible patients normotensive while receiving therapy, 496 were randomized into control and discontinued-medication groups with and without dietary intervention. At 56 weeks, 50% of those who were no longer receiving medication remained normotensive by study criteria. Randomization either to weight-loss group (mean loss of 4.5 kg [10 lb]) or to sodium-restriction group (mean reduction of 40 mEq/day) increased the likelihood of remaining without drug therapy, with an adjusted odds ratio of 2.17 for the sodium group and 3.43 for the weight group. Highest success rates were in the nonoverweight mild hypertensives with sodium restriction (78%) and the overweight mild hypertensives who were reducing their weight (72%). These data demonstrate that weight loss or sodium restriction, in hypertensives controlled for five years, more than doubles success in withdrawal of drug therapy.

Clinical Trials as Topic↗
PubMed1985

The risk of bladder calculi in patients with spinal cord injuries.

A nonconcurrent prospective study of bladder calculi included 500 persons treated at the University of Alabama in Birmingham Spinal Cord Injury Care System between 1973 and 1981. Risk factors suspected of contributing to the development of bladder calculi were identified. Logistic regression analysis was used to estimate each risk factor's adjusted odds ratio and to develop a predictive model for bladder stone formation. Bladder calculi were most likely to develop within one year of injury. Patients developing bladder calculi prior to first definitive discharge were most likely to be white and have neurologically complete lesions and Klebsiella infections at admission. Patients developing bladder stones within two years of hospital discharge were most likely to be young and white and have indwelling urethral catheters and either Proteus or multiple-organism infections at discharge. The predictive model was 82% sensitive and 83% specific when applied to a validation sample of patients.

Adult↗
PubMed1985

Late results of surgical and medical therapy for patients with coronary artery disease and depressed left ventricular function.

Late survival and freedom from myocardial infarction were determined for 192 patients with coronary artery disease and depressed left ventricular ejection fraction at rest (less than or equal to 35%) determined by biplane angiography who were evaluated between 1970 and 1977. Seventy-seven patients had coronary artery bypass grafting and 115 patients were treated medically and were considered surgical candidates. The medical and surgical groups were comparable in all baseline characteristics examined except frequency of three vessel disease and angina pectoris, which occurred in a significantly greater percent of the surgically treated patients (p less than 0.01). Only three medically treated patients (2.6%) underwent coronary bypass grafting in the follow-up period. Seven year actuarial survival was 63% in the surgical and 34% in the medical group (p less than 0.001). Ninety-three percent of patients in the surgical group and 81% of those in the medical group were free of nonfatal myocardial infarction (p = 0.01), and 62 and 33%, respectively, were alive and free of myocardial infarction (p less than 0.001) at 7 years. Significant differences in survival favoring surgical treatment were observed for the subsets of patients with an ejection fraction of 25% or less (p = 0.0002) and 26 to 35% (p = 0.01), and for the subsets with three vessel coronary disease (p less than 0.001), normal left ventricular end-diastolic volume (less than or equal to 100 ml/m2) (p = 0.005) and elevated end-diastolic volume (greater than 100 ml/m2)(p = 0.001). After adjustment for other important prognostic variables, the type of treatment remained significant in predicting the relative risk (medical to surgical) of mortality at 5 and 7 years (2.58 and 2.12, respectively). These data corroborate the trends observed in several randomized trials of medical and surgical therapy in patients with abnormal left ventricular function. If hospital mortality for coronary artery bypass grafting is less than 5%, substantial benefit can be anticipated for the majority of patients with depressed ventricular function.

Cardiac Volume↗
PubMed1984

The risk of renal calculi in spinal cord injury patients.

A retrospective epidemiologic study of renal calculi was conducted on 5,915 patients from the National Spinal Cord Injury Data Research Center data base. Various risk factors suspected of contributing to the development of renal calculi were identified. Logistic regression analyses were conducted to estimate the adjusted odds ratio for the formation of renal calculi for each risk factor. Life-table techniques were used to assess the interval of highest renal stone risk after injury. Spinal cord injury patients in whom renal calculi developed were more likely to be male patients with neurologically complete lesions and histories of bladder stones. Renal stones were most likely to develop within 3 months after injury. The estimated cumulative proportion of patients free of renal stones 8 years after injury was 92 per cent. Although it appears that patients at high risk for renal calculi can be identified with a relatively small set of predictor variables, more definitive urological information is needed to improve predictive accuracy before final construction of mathematical predictive models that can be considered appropriate for use in a clinical environment.

Adult↗
PubMed1984

Return of hypertension after withdrawal of prolonged antihypertensive therapy, effect of weight loss, sodium reduction, and baseline factors.

The effect of dietary modification on continued blood pressure control after discontinuation of antihypertensive therapy has been studied. Participants who had been treated for 5 years in the Hypertension Detection and Follow-up Program were enrolled and randomly assigned to continue medication, discontinue medication with no dietary intervention, discontinue medication and reduce weight, discontinue medication and reduce sodium groups. Relapse of hypertension was slow, even without dietary modification. Both weight loss and sodium restriction slowed relapse. The severity of the hypertension and the number of drugs required for hypertension control had a marked effect on the rate of relapse. Relapse was slowest in the participants who had attained the lowest blood pressure on therapy.

Adult↗
PubMed1984

Effect of dietary change on the return of hypertension after withdrawal of prolonged antihypertensive therapy (DISH). Dietary Intervention Study of Hypertension.

The possibility exists that dietary modification may increase the number of patients who remain normotensive after drug withdrawal. In an effort to resolve this question, former Hypertension Detection and Follow-up Program Stepped Care participants (n = 496) were randomized into four major groups at the end of the programme (greater than 5 years antihypertensive therapy): controls (continue medication); discontinue medication, no dietary intervention; discontinue medication and weight loss; discontinue medication and reduce sodium. Groups 1, 2 and 4 were further divided into obese (greater than or equal to 120% ideal weight, and non-obese groups). The weight reduction group (greater than or equal to 120% ideal weight) lost 10.1 +/- 11 lbs without changing dietary sodium (n = 87). The sodium restriction group reduced urine sodium excretion from 145 to 97 mEq per day (n = 169). Sixty per cent of the weight loss group were normotensive at 56 weeks compared to 35% withdrawn from medication without dietary intervention. The highest 56 weeks success rates were in the mild non-overweight hypertensives on sodium restriction (78%), and the mild overweight hypertensives on weight reduction (72%). Randomization to either weight loss group or sodium restriction group increased the likelihood of remaining off drugs (adjusted odds ratio of 3.43 for the weight group and 2.17 for the sodium group (P less than 0.05). Age, severe hypertension greater than 5 years previous to entry into Dietary Intervention Study of Hypertension (DISH) or need for several drugs increased the chance of failure.

Adult↗
PubMed1983

An assessment of the Environmental Protection Agency's asbestos hazard evaluation algorithm.

We performed an exploratory evaluation of the Environmental Protection Agency's algorithm for assessment of risk of exposure to asbestos in buildings. Observers scored five sites using the algorithm. One group (N = 23) conducted their assessments relying only on written instructions, while another (N = 20) was trained in the use of the algorithm. Five professional industrial hygienists, experienced in risk assessment, also used the algorithm on the same sites. A wide range of highly variable results, for both untrained and trained observers coupled with poor comparability with expert's scores raise concern as to the reliability of this assessment tool. The development of a valid and reliable "lay" index of risk is still needed.

Adult↗
PubMed1982

Validation of a risk function to predict mortality in a VA population with coronary artery disease.

A multivariate risk function based on the Cox model was developed in the VA Study of Coronary Artery Bypass Surgery to predict the survival of patients with stable angina pectoris. The methods used in developing and evaluating the performance of the risk function (validation) are described. Performance was evaluated internally by the methods of resubstitution, half-sample replication, and jackknifing, and externally by use of an independent patient population.

Actuarial Analysis↗
PubMed1982

Epidemiologic study of candidates for coronary artery bypass surgery.

Simplified estimates of the potential patients eligible for coronary artery bypass surgery are presented. Various means of identification are discussed, as well as effects of two levels of stenosis. Although ultimate operability is not directly considered, the results demonstrate a substantial and growing pool of eligible patients. Data from the National Center for Health Statistics characterizes the trend toward more arteriograms and bypass procedures and more procedures being performed in smaller hospitals. Unexplained patterns exist with regard to racial and geographic differences. Factors that contribute to the increase of bypass procedures include more catheterizations being performed, declining mortality, the aging of the U.S. population, less reluctance to perform surgery, repeat operations, and increased availability of surgical teams and facilities. Factors discouraging an increase in the number of procedures include cost, equivocal results relative to increased survival in certain stages of disease, and improved alternative therapies.

Angina Pectoris↗
PubMed1981

Increasing utilization of a rural cervical cancer detection program.

The Alabama Department of Public Health established, in 1973, a Cancer Screening Program (CSP). Although 66,000 women have been screened, many rural females had never used the program. After a community health organization education effort was introduced into a target rural county, an examination of CSP new user data for two intervention quarters revealed 345 and 150 per cent increases, respectively, in the pattern of use.

Age Factors↗