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Biomedical subjects

J M Sprafka

Publications and source records attributed to J M Sprafka.

At least 73 records · Page 4Linked to original sources
PubMed1990

Prevalence of undiagnosed eye disease in high-risk diabetic individuals.

A total of 533 diabetic individuals using the Marshall, Minn, medical care system were identified as potential subjects for a study of unrecognized eye disease. Of these, 172 (32%) stated they had never had an ophthalmologic eye examination and subsequently were defined as being at high risk for unrecognized diabetic eye disease. Ophthalmic examination was performed on 145 (84%) of these high-risk individuals and revealed that 61% had clinical characteristics consistent with diabetic retinopathy, glaucoma, cataract, or other eye abnormalities. Twenty-five (17%) of these subjects presented with eye disease that required immediate treatment, referral, or accelerated follow-up. Of those indicating they had an ophthalmologist, approximately 35% reported a time since last visit of 2 years or greater. These findings indicate a high prevalence of ocular morbidity among diabetic individuals who are not under routine ophthalmic surveillance and suggest that improvements in patient and professional compliance with recommended guidelines for eye care are warranted.

Adult↗
PubMed1989

Hypercholesterolemia prevalence, awareness, and treatment in blacks and whites: the Minnesota Heart Survey.

Two cross-sectional population-based surveys were conducted in 1985 and 1986 to describe cardiovascular risk factors in blacks and whites in the Twin Cities. A total of 1,254 blacks and 2,934 whites ages 35-74 years participated. The surveys consisted of a home interview followed by survey center visit during which nonfasting serum total cholesterol level was measured and medication use during the past year was reviewed. Age-adjusted mean values for serum total cholesterol were significantly higher among white than black participants for both men (207 vs 193 mg/dl, P less than 0.001) and women (206 vs 202 mg/dl, P less than 0.05). Blacks had significantly higher serum HDL cholesterol levels than whites (men, 49 vs 41 mg/dl, P less than 0.001; women, 56 vs 54 mg/dl, P less than 0.01). The age-adjusted prevalence of hypercholesterolemia (serum total cholesterol greater than or equal to 240 mg/dl on the day of survey and/or current use of cholesterol lowering medication) was significantly higher among white than black men (18.3% vs 12.2%, P less than 0.01). No significant race differences were noted for women (whites, 19.7% vs blacks, 16.6%). Among hypercholesterolemic men, 66% of whites current use of cholesterol lowering medication) was significantly higher among white than black men (18.3% vs 12.2%, P less than 0.01). No significant race differences were noted for women (whites, 19.7% vs blacks, 16.6%). Among hypercholesterolemic men, 66% of whites current use of cholesterol lowering medication) was significantly higher among white than black men (18.3% vs 12.2%, P less than 0.01). No significant race differences were noted for women (whites, 19.7% vs blacks, 16.6%). Among hypercholesterolemic men, 66% of whites and 80% of blacks were unaware of their condition; among women, 72% of whites and 79% of blacks were unaware. Among individuals told by a physician they had "high blood fats," 2.9% of whites and no blacks were using medication for elevated blood cholesterol levels, while 70% of whites and 63% of blacks reported being advised to follow a low-fat-low-cholesterol diet. These data emphasize the need for education programs for physicians and patients regarding detection and control of hypercholesterolemia.

Adult↗
PubMed1989

Is early natural menopause a biologic marker of health and aging?

The relation between age at natural menopause and all-cause mortality was investigated in a sample of 5,287 White women, ages 55 to 100 years, naturally-postmenopausal, Seventh-day Adventists who had completed mailed questionnaires in 1976. The age-adjusted odds ratio of death during 1976-82 in women with natural menopause before age 40 was 1.95 (95% confidence interval = 1.24, 3.07), compared to the reference group of women reporting natural menopause at ages 50 to 54. Corresponding odds ratios of death were 1.39 (95% CI = 1.06, 1.81) for natural menopause at ages 40 to 44, and 1.03 (95% CI = 0.84, 1.25) for natural menopause at ages 45 to 49. Among 3,166 White, 55- to 100-year-old, surgically-postmenopausal, Adventist women, there was no relation between age at surgical menopause and mortality. Logistic regression analyses indicated that findings from this study were apparently not due to confounding by smoking, over- or underweight, reproductive history, or replacement estrogen use.

Adult↗
PubMed1989

Mechanical restraints on the medical wards: are protective devices safe?

We prospectively identified 102 mechanically restrained hospital patients and determined their hospital course. The cohort was elderly, cognitively impaired with multiple chronic diseases. The in-hospital mortality was 21 percent. Nosocomial infection developed in 12 percent and new pressure sores in 22 percent. Prolonged use of restraints (greater than 4 days) was the strongest independent predictor of nosocomial infection (relative risk 1.8, 95% CI = 1.2, 2.8) and new pressure sores (RR 1.4, 95% CI = 1.1, 1.8) as determined by multiple logistic regression analysis. Patients placed in mechanical restraints for longer than four days experience frequent morbid events and should be monitored carefully.

Aged↗
PubMed1989

Trends in CHD mortality, morbidity and risk factor levels from 1960 to 1986: the Minnesota Heart Survey.

The Minnesota Heart Survey (MHS) assessed population trends in coronary heart disease (CHD) mortality, morbidity and risk factor levels in the Twin Cities metropolitan area to explain the decline in CHD deaths. Age-adjusted CHD mortality rates declined in Twin Cities residents aged 30 to 74 from 1968 to 1986 by 52% in men and 58% in women. Much of the decline in CHD mortality was attributable to decreased out-of-hospital deaths. Attack rates based on hospitalized definite myocardial infarction (MI) did not change from 1970 to 1985, and hospital case-fatality rates declined consistently from 1970 to 1985 (from 21% to 11% in men, from 27% to 17% in women). Dramatic increases were noted in the percentage of patients undergoing cardiac procedures (coronary artery bypass, angioplasty, and thrombolytic agents). Trends in CHD rates were associated with improved population levels of risk factors. Average serum total cholesterol levels decreased by 8 mg/dl and 11 mg/dl between 1973 and 1987 in men and women, respectively. Cigarette smoking prevalence declined from approximately 40% to 30%. Average systolic blood pressure apparently declined about 1 mm Hg and diastolic blood pressure by 2 mm Hg from 1973 to 1987. Body mass index (wt/ht2) increased by 1 unit in men and 1.7 units in women from 1973 to 1987. These data suggest that a combination of primary prevention and improved medical care of acute CHD contributed to the decline in CHD mortality.

Adult↗
PubMed1988

Use of aspirin for prevention of cardiovascular disease--1981-82 to 1985-86: the Minnesota Heart Survey.

The efficacy of aspirin to prevent ischemic cardiovascular disease has received considerable attention recently. To determine the prevalence of aspirin use for cardiovascular disease prevention, the Minnesota Heart Survey examined population-based samples of Twin Cities' adults in 1981 to 82 and 1985 to 86. Over the 4-year period, reported use of aspirin for cardiovascular disease prophylaxis increased from 0.6% to 2.4% in women (p less than 0.05) and from 1.7% to 3.3% in men (p = 0.10). Prophylactic aspirin use was more common in older than in younger adults, in whites than in blacks, in those with a history of cardiovascular disease or hypercholesterolemia, and in health professionals and nonsmokers. Some individuals were apparently taking aspirin for "primary" prevention, although it has not yet been approved for that reason. Use of aspirin for cardiovascular disease prevention has been increasing and is likely to increase more rapidly over the next few years. This could favorably impact on mortality rates of cardiovascular disease, but untoward side effects of aspirin may be expected to increase as well.

Adult↗
PubMed1988

Prevalence of coronary heart disease risk factors in an urban black population: the Minnesota Heart Survey, 1985.

A cross-sectional study of a sample of Minnesota black urban residents was conducted in 1985 to develop cardiovascular risk profiles. Participants were evaluated during a home interview (N = 1,254, 78% participation) and a survey center visit (N = 1,052, 65% participation). Black men had significantly higher mean systolic and diastolic blood pressure than Black women (129.7/80.9 vs 124.8/77.3, respectively). Age-specific values for systolic and diastolic blood pressure were greater in men than women for all age categories. Men were more likely to have uncontrolled hypertension or to be unaware of their hypertension than women in all age categories. Women had significantly higher mean total and high-density lipoprotein cholesterol values than men (202.1 and 56.1 mg/dl vs 193.2 and 48.7 mg/dl, respectively). Age-specific values for total and high-density lipoprotein cholesterol values were greater in women than men for all age categories except the 35-44 age group. Men were significantly more likely to be current cigarette smokers (43.3% vs 33.2%) and to have higher cigarette consumption per day (17 vs 14) than women. The major risk factors for cardiovascular disease (with the exception of smoking) were lower in the Minnesota study in 1985 than in the National Health and Nutrition Examination Survey in 1976-1980. These lower levels may also be a component in the decline of cardiovascular disease mortality rates among Blacks.

Adult↗
PubMed1988

Prevalence of cardiovascular disease risk factors in blacks and whites: the Minnesota Heart Survey.

Two cross-sectional surveys were conducted in 1985 and 1986 to measure the prevalence of coronary heart disease (CHD) risk factors in Blacks and Whites. A home interview was followed by a survey center visit. Participation rates were 78 per cent and 90 per cent for the home interview and 65 per cent and 68 per cent for the survey center visit. Adjusted for age and education, systolic and diastolic blood pressure was 3 to 4 mmHg higher in Blacks. Hypertension was more prevalent in Blacks than Whites (44 per cent vs 28 per cent); serum total cholesterol was approximately 0.4 mmol/l lower in Black than White men and 0.08 mmol/l lower in Black than White women. Among men, more Blacks than Whites were current cigarette smokers (44 per cent vs 30 per cent); however, White smokers smoked more cigarettes per day (26 vs 17). Similar differences were noted for women, although the prevalence and quantity of cigarette consumption was less than men. The excess prevalence of these CHD risk factors in Blacks, especially among women, may explain their elevated CHD and stroke mortality rates in the Twin Cities.

Adult↗
PubMed1988

Usefulness of comprehensive feasibility studies in environmental epidemiology investigations: a case study in Minnesota.

Episodes of public water supply contamination with industrial or agricultural chemicals frequently give rise to public concerns about adverse health effects. These concerns may precipitate epidemiologic or clinical investigations requiring large expenditures of state and federal resources regardless of whether such investigations are justified by scientific criteria. An alternative is a comprehensive feasibility study, utilizing all available information to determine whether large-scale studies are warranted or feasible. At a relatively modest cost, a feasibility study allows health officials to identify information needs and deficiencies, outline potential study options and costs, clearly establish the rationale for a proposed study or, conversely, prevent unwarranted expenditures of public resources. Furthermore, a feasibility study may in itself resolve many community and scientific concerns. This article provides a case study of the usefulness of a formal feasibility study in a situation involving an elevated cancer rate and contaminated municipal water supply wells surrounding a federal superfund site.

Costs and Cost Analysis↗
PubMed1988

Prevalence of hypertension and associated risk factors among diabetic individuals. The Three-City Study.

A cross-sectional study was conducted from 1979 through 1982 in three rural Minnesota cities to describe the natural history of diabetes mellitus. Detailed abstracts of the medical records of physician-defined diabetic individuals were used to construct medical profiles. As part of the effort, the date of physician-defined hypertension was identified and used to calculate hypertension prevalence. The crude hypertension prevalence was 56.8% for women and 33.99% for men, with an overall crude prevalence of 47.2%. No hypertensive patients were identified among diabetic patients less than 15 yr old, and most hypertensive diabetic patients were greater than 70 yr old. Hypertension prevalence in diabetic individuals demonstrated a highly significant trend with age (P less than .01). Compared with the general population, diabetic individuals had a significantly higher prevalence of hypertension (P less than .01), largely explained by the higher prevalence in women. Variables known to be associated with hypertension risk in the general population were also significantly associated with hypertension among diabetic individuals. Older age, being female, and increased body mass index were strongly associated with hypertension in this study population. Diabetic individuals with hypertension were six times more likely to have renal disease than those without hypertension. The level of blood glucose control, diabetes treatment (i.e., insulin or oral hypoglycemics versus diet), and diabetes duration were not associated with hypertension.

Adolescent↗
PubMed1987

Trends in cardiovascular risk factors in an urban black population, 1973-74 to 1985: the Minnesota Heart Survey.

Cardiovascular disease mortality rates have fallen dramatically in blacks in the United States. To determine whether this may be due to a decline in cardiovascular risk factors, we compared risk factors in a 1985 urban black population, ages 35 to 69, with those obtained in blacks of the same area in 1973-74. Age-adjusted mean body mass and the prevalence of overweight increased significantly over the 12-year period in both men and women. Mean systolic blood pressures declined significantly in both sexes, diastolic blood pressure declined significantly in men, and the proportion of men and women hypertensives on medication and under control increased. The overall prevalence of cigarette smoking changed very little, but the proportion of heavy smokers decreased significantly in men. No significant changes occurred in resting heart rate. Concurrently with these risk factor trends, age-adjusted heart disease mortality rates in area blacks fell 27% between 1968-73 and 1979-84, and stroke mortality fell 58%. Changing risk factors may be contributing to declining cardiovascular mortality rates in blacks. However, overweight seems to be a worsening problem.

Adult↗
PubMed1987

Prevalence and accuracy of home sphygmomanometers in an urban population.

The prevalence of ownership (7.5 per cent) and the accuracy of home sphygmomanometers were determined in a population-based survey in the Minneapolis-St. Paul metropolitan area. Sixty-four per cent of home sphygmomanometers were accurate within +/- 2 mm Hg of a calibrating sphygmomanometer; another 26 per cent were within +/- 3-6 mm Hg. These results suggest that although many home sphygmomanometers are accurate, some are very inaccurate. Health care providers should advise regular calibration when home sphygmomanometers are used for therapeutic self-management of hypertension.

Adult↗
PubMedDate not supplied

Survey of health and use characterization of pesticide appliers in Minnesota.

We surveyed 1,000 randomly selected state-licensed pesticide appliers to improve our understanding of pesticide use and its potential health effects. Participants were stratified by pesticide class (herbicides, insecticides, fungicides, fumigants) to determine potential differences in health characteristics among different pesticide groups. A subset of 60 applicators, divided by pesticide class used, were studied for exposure-related cholinesterase (ChE) depression. ChE depression in excess of 20% was most frequent in fumigant applicators who did enclosed-space application, in addition to other pesticide application procedures (p < .05). Survey data demonstrated that the prevalence of all common chronic diseases considered together was significantly increased (p = .015) in fumigant appliers, compared with all other pesticide use groups. The frequency of chronic lung disease was also significantly increased in the fumigant applier group (p = .027). Curiously, two cases of a rare hematopoietic neoplasm--hairy cell leukemia--were identified in our study group (annual incidence 0.67/100,000 in Minnesota). Whether there is an association between this unique tumor and agricultural work is uncertain, and further study is needed in this regard.

Adult↗
PubMedDate not supplied

Mortality among type 2 diabetic individuals and associated risk factors: the Three City Study.

The 10 year mortality experience was determined in a population-based cohort of 540 Type 2 diabetic individuals. The association between potential risk factors and all causes mortality was examined. Diabetes was not mentioned anywhere on the death certificate in 46% of 274 decedents. Diseases of the circulatory system (ICD9-390-459) accounted for the majority (62%) of deaths in this cohort. Ten-year survival was poorer than expected for both men and women compared to the age- and sex-matched Minnesota population. Standardized mortality ratios for selected causes of death indicated excess for cardiovascular disease (ICD9-390-459), coronary heart disease (ICD9 410-414) and cerebrovascular disease. Baseline variables associated with all causes of mortality included age and a history of macrovascular disease. These findings indicate that mortality data significantly underestimate the magnitude of diabetes and that individuals with diabetes have poorer survival than non-diabetic individuals.

Age Factors↗
PubMedDate not supplied

Trends in diabetes prevalence among stroke patients and the effect of diabetes on stroke survival: the Minnesota Heart Survey.

This study documented trends in the prevalence of diabetes among men and women hospitalized for acute stroke and determined the effect of diabetes on short- and long-term survival following stroke. These issues were investigated in the Minnesota Heart Survey, a population-based surveillance system that has monitored trends in stroke morbidity and mortality in the Minneapolis-St Paul metropolitan area since 1970. Clinical data were obtained from the hospital records of 50% samples of residents ages 30 to 74 years who were discharged with a diagnosis of acute stroke in 1970, 1980, and 1985. Between 1970 and 1985, the prevalence of diabetes as listed on the discharge diagnoses among stroke patients increased significantly in men (22.4% vs 10.5%; p = 0.006) and non-significantly in women (24.7% vs 15.9%; p = 0.3). During this time period, both in-hospital and 28-day case fatality rates declined in non-diabetic stroke patients but remained unchanged in stroke patients with diabetes. After controlling for the effects of age, sex, survey year, and level of consciousness, diabetes status had little effect on short-term (28-day) mortality of stroke patients, but the odds of 5-year mortality among those surviving to 1 year was 2.0 (95% Cl (1.3, 3.2)) times higher in diabetic compared to non-diabetic individuals. These findings suggest that the prevalence of diabetes has been increasing among stroke patients, and that the diabetic condition is a significant predictor of poorer long-term but not short-term survival following stroke.

Adult↗