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Jan M H Risser

Publications and source records attributed to Jan M H Risser.

12 recordsLinked to original sources
PubMed2006

Ethnic differences in stroke recurrence.

OBJECTIVE: To determine whether stroke recurrence and the effect of recurrence on mortality differ by ethnicity. METHODS: Using methods from the Brain Attack Surveillance in Corpus Christi project, we prospectively identified first-ever ischemic strokes from emergency department logs and hospital admissions (January 2000 to December 2004). Recurrent strokes and deaths were identified for the same period. Cumulative probability of stroke recurrence was estimated. Cox proportional hazards models were used to examine ethnic differences in recurrence and to examine the relation among ethnicity, recurrence, and mortality. RESULTS: During the time interval, 1,345 first-ever ischemic strokes were validated. Median age of patients was 72 years; 53% were Mexican American (MA). There were 126 recurrent strokes. Cumulative risk for recurrence at 30 days and 1 year was 2.6 and 7.5%, respectively. MAs had higher risk for stroke recurrence (risk ratio, 1.57; 95% confidence interval, 1.05-2.34) compared with non-Hispanic white patients, adjusted for demographics, stroke risk factors, and stroke severity. Stroke recurrence was related to mortality to a similar extent across ethnic groups (non-Hispanic white patients: risk ratio, 3.32; 95% confidence interval, 2.07-5.32; MAs: risk ratio, 2.35; 95% confidence interval, 1.42-3.88). INTERPRETATION: MAs had higher stroke recurrence risk compared with non-Hispanic white patients. Stroke recurrence had an important impact on mortality. Efforts to reduce stroke recurrence in MAs are needed.

Age Factors↗
PubMed2006

Recruiting injection drug users: a three-site comparison of results and experiences with respondent-driven and targeted sampling procedures.

Several recent studies have utilized respondent-driven sampling (RDS) methods to survey hidden populations such as commercial sex-workers, men who have sex with men (MSM) and injection drug users (IDU). Few studies, however, have provided a direct comparison between RDS and other more traditional sampling methods such as venue-based, targeted or time/space sampling. The current study sampled injection drug users in three U.S. cities using RDS and targeted sampling (TS) methods and compared their effectiveness in terms of recruitment efficiency, logistics, and sample demographics. Both methods performed satisfactorily. The targeted method required more staff time per-recruited respondent and had a lower proportion of screened respondents who were eligible than RDS, while RDS respondents were offered higher incentives for participation.

Adolescent↗
PubMed2005

Stroke burden in Mexican Americans: the impact of mortality following stroke.

PURPOSE: To estimate ethnic-specific all-cause mortality risk following ischemic stroke and to compare mortality risk by ethnicity. METHODS: DATA from the Brain Attack Surveillance in Corpus Christi Project, a population-based stroke surveillance study, were used. Stroke cases between January 1, 2000 and December 31, 2002 were identified from emergency department (ED) and hospital sources (n = 1,234). Deaths for the same period were identified from the surveillance of stroke cases, the Texas Department of Health, the coroner, and the Social Security Death Index. Ethnic-specific all-cause cumulative mortality risk was estimated at 28 days and 36 months using Kaplan Meier analysis. Cox proportional hazards regression was used to compare mortality risk by ethnicity. RESULTS: Cumulative 28-day all-cause mortality risk for Mexican Americans (MAs) was 7.8% and for non-Hispanic whites (NHWs) was 13.5%. Cumulative 36-month all-cause mortality risk was 31.3% in MAs and 47.2% in NHWs. MAs had lower 28-day (RR = 0.58; 95% CI: 0.41, 0.84) and 36-month all-cause mortality risk (RR = 0.79, 95% CI: 0.64, 0.98) compared with NHWs, adjusted for confounders. CONCLUSIONS: Better survival after stroke in MAs is surprising considering their similar stroke subtype and severity compared with NHWs. Social or psychological factors, which may explain this difference, should be explored.

Aged↗
PubMed2005

The epidemiology of sexually transmitted infections in adolescents.

This article addresses the epidemiology of several common sexually transmitted infections (STIs) in adolescents. Chlamydia is a common occurrence in adolescents, more so than is gonorrhea, but both are of particular concern because they may cause pelvic inflammatory disease. Many experts recommend screening for chlamydia in sexually active adolescents, particularly females. Trichomonas vaginalis is significant as a marker for risk of contracting other STIs and because of its association with pregnancy complications and with increased risk of transmission of HIV. Genital herpes simplex virus (HSV) infection, which usually has been caused by HSV-2, is a common finding in adolescents, and it now is caused also by HSV-1 in some populations. Human papillomavirus (HPV), though widespread in adolescents, usually is a self-limited infection, and malignancy resulting from HPV is a rare occurrence in this age group. The least common of the diseases discussed below is syphilis, but a recent sharp increase in incidence has occurred in men who have sex with men.

Adolescent↗
PubMed2004

Excess stroke in Mexican Americans compared with non-Hispanic Whites: the Brain Attack Surveillance in Corpus Christi Project.

Mexican Americans are the largest subgroup of Hispanics, the largest minority population in the United States. Stroke is the leading cause of disability and third leading cause of death. The authors compared stroke incidence among Mexican Americans and non-Hispanic Whites in a population-based study. Stroke cases were ascertained in Nueces County, Texas, utilizing concomitant active and passive surveillance. Cases were validated on the basis of source documentation by board-certified neurologists masked to subjects' ethnicity. From January 2000 to December 2002, 2,350 cerebrovascular events occurred. Of the completed strokes, 53% were in Mexican Americans. The crude cumulative incidence was 168/10,000 in Mexican Americans and 136/10,000 in non-Hispanic Whites. Mexican Americans had a higher cumulative incidence for ischemic stroke (ages 45-59 years: risk ratio = 2.04, 95% confidence interval: 1.55, 2.69; ages 60-74 years: risk ratio = 1.58, 95% confidence interval: 1.31, 1.91; ages >or=75 years: risk ratio = 1.12, 95% confidence interval: 0.94, 1.32). Intracerebral hemorrhage was more common in Mexican Americans (age-adjusted risk ratio = 1.63, 95% confidence interval: 1.24, 2.16). The subarachnoid hemorrhage age-adjusted risk ratio was 1.57 (95% confidence interval: 0.86, 2.89). Mexican Americans experience a substantially greater ischemic stroke and intracerebral hemorrhage incidence compared with non-Hispanic Whites. As the Mexican-American population grows and ages, measures to target this population for stroke prevention are critical.

Age Distribution↗
PubMed2004

Stroke risk after transient ischemic attack in a population-based setting.

BACKGROUND AND PURPOSE: Stroke risk after transient ischemic attack (TIA) has not been examined in an ethnically diverse population-based community setting. The purpose of this study was to identify stroke risk among TIA patients in a population-based cerebrovascular disease surveillance project. METHODS: The Brain Attack Surveillance in Corpus Christi (BASIC) Project prospectively ascertains stroke and TIA cases in a geographically isolated Southeast Texas County. The community is approximately half Mexican American and half nonHispanic white. Cases are validated by board-certified neurologists using source documentation. Cumulative risk for stroke after TIA was determined using Kaplan-Meier estimates. Cox proportional hazards regression was used to test for associations between stroke risk after TIA and demographics, symptoms, risk factors, and history of stroke/TIA. RESULTS: BASIC identified 612 TIA cases between January 1, 2000, and December 31, 2002; 60.9% were female and 48.0% were Mexican American. Median age was 73.8 years. Stroke risk within 2 days, 7 days, 30 days, 90 days, and 12 months was 1.64%, 1.97%, 3.15%, 4.03%, and 7.27%, respectively. Stroke risk was not influenced by ethnicity, symptoms, or risk factors. CONCLUSIONS: Using a population-based design, we found that early stroke risk after TIA was less than previously reported in this bi-ethnic population of Mexican Americans and nonHispanic whites. Approximately half of the 90-day stroke risk after TIA occurred within 2 days.

Aged↗
PubMed2004

Self-assessment of circumcision status by adolescents.

In epidemiologic studies of the relation between circumcision and sexually transmitted infections, it is necessary to rely on self-report of circumcision status. The purpose of this 2002 study in Houston, Texas, was to determine whether adolescent males could make correct self-reports. During physical examinations, adolescents were asked whether they were circumcised. The authors then examined the adolescents' genitalia. Circumcision status was recorded as complete (glans penis fully exposed), partial (glans partly covered), or uncircumcised (glans completely covered). The mean age of the 1,508 subjects was 15.0 (standard deviation, 1.63) years; 64% were Black, 29% Hispanic, and 7% White. Forty-nine percent had full, 1% partial, and 50% no circumcision. Of the 738 fully circumcised subjects, 512 (69%) considered themselves circumcised, 54 (7%) considered themselves uncircumcised, and 172 (23%) did not know. Of the 751 uncircumcised youth, 491 (65%) described themselves as uncircumcised, 27 (4%) reported being circumcised, and 233 (31%) did not know. The sensitivity of self-report among those who thought they knew their status was 90.5%, and the specificity was 94.8%; 27% did not know their status. In this population, self-report of circumcision status did not result in accurate information mainly because many adolescents were unsure of their status.

Adolescent↗
PubMed2004

Designing multi-ethnic stroke studies: the Brain Attack Surveillance in Corpus Christi (BASIC) project.

The Brain Attack Surveillance in Corpus Christi (BASIC) project is a population-based stroke study comparing Mexican Americans and non-Hispanic whites. Extensive effort is made to detect all patients regardless of ethnicity and ensure equal participation in the interview among both groups. We describe here the study's design and process evaluation with a focus on reducing bias in case ascertainment and participation. During the first 28 months of the project, 11,829 subjects were screened. Availability of neuroimaging did not differ by ethnicity (P=0.22), nor did confidence in the validated diagnosis of stroke (P=0.10). Participation rate in the interview also did not differ by ethnicity (P=0.92). There was excellent agreement of ethnic classification between chart abstraction and self-report (kappa=0.94, P<0.001). We conclude that multi-ethnic stroke comparison studies are feasible. Utilizing epidemiologic principles to design, recruit and analyze data are critical. Process evaluation to examine for sources of bias is important to study conduct.

Aged↗
PubMed2003

Access to care, acculturation, and risk factors for stroke in Mexican Americans: the Brain Attack Surveillance in Corpus Christi (BASIC) project.

BACKGROUND AND PURPOSE: Mexican Americans are the largest subgroup of Hispanic Americans, now the most numerous US minority population. We compared access to care, acculturation, and biological risk factors among Mexican American and non-Hispanic white stroke patients and the general population. METHODS: The Brain Attack Surveillance in Corpus Christi project is a population-based stroke surveillance study conducted in southeast Texas. All stroke cases were ascertained through active and passive surveillance from January 2000 through April 2002 and compared with population estimates from a random-digit telephone survey. RESULTS: Compared with non-Hispanic white stroke patients (n=405), Mexican American stroke patients (n=403) were less likely to have graduated from high school (odds ratio [OR], 15.4; 95% confidence interval [CI], 10.6 to 22.4) and more likely to earn less than 20 000 dollars per year (OR, 6.5; 95% CI, 4.5 to 9.4). Mexican American stroke patients were more likely to have diabetes (OR, 2.7; 95% CI, 2.0 to 3.7) and less likely to have atrial fibrillation (OR, 0.5; 95% CI, 0.4 to 0.8). Compared with population estimates (n=719), stroke was associated with diabetes (Mexican Americans: OR, 3.6; 95% CI, 2.2 to 5.8; non-Hispanic whites: OR, 3.0; 95% CI, 1.7 to 5.5), hypertension (Mexican Americans: OR, 2.8; 95% CI, 1.8 to 4.3; non-Hispanic whites: OR, 3.3; 95% CI, 2.2 to 5.0), lower incomes (Mexican Americans: OR, 3.4; 95% CI, 2.1 to 5.4; non-Hispanic whites: OR, 3.0; 95% CI, 1.7 to 5.2), and lower educational attainment (Mexican Americans: OR, 5.1; 95% CI, 3.2 to 8.1; non-Hispanic whites: OR, 4.5; 95% CI, 2.2 to 9.3). CONCLUSIONS: Biological and social variables are associated with stroke to a similar extent in both Mexican Americans and non-Hispanic whites. Health behavior interventions for both populations may follow from this work. Stroke disparities between these populations may be explained only partially by differences in the prevalence of currently identified biological and social factors.

Acculturation↗
PubMed2002

Prevalence and incidence of pelvic inflammatory disease in incarcerated adolescents.

BACKGROUND: Few recent studies have determined the prevalence and incidence of pelvic inflammatory disease (PID) among adolescents. GOAL: The goal of this study was to determine these parameters among incarcerated youths. STUDY DESIGN: Both on admission and during incarceration, consecutive adolescents entering the Harris County, Texas, Juvenile Detention Center were evaluated for symptoms of PID. One of two experienced clinicians examined adolescents with possible PID. For the diagnosis of PID, we used the minimal criteria of the CDC. RESULTS: In sexually active heterosexual or bisexual adolescents (N = 313), the prevalence of PID at admission was 4.5%; during the first 31 days of incarceration, the incidence density of PID was 3.3 cases/100 person-months, and the cumulative incidence was 2.2%. The prevalence among these youths of chlamydial and/or gonorrheal infection, as determined by urine or cervical testing, was 24.9%. CONCLUSION: The high prevalence and incidence of PID underscore the need for effective programs to eradicate chlamydial and gonorrheal infections in high-risk youths.

Adolescent↗
PubMed2002

Pelvic inflammatory disease in adolescents: a review.

Pelvic inflammatory disease is relatively common in sexually active adolescents. Most cases are only mildly symptomatic, and criteria for diagnosis should not be stringent. Although chlamydial or gonorrheal infections or both are common in pelvic inflammatory disease, other aerobic and anaerobic organisms are often also present and may be the only causative agents. Commonly used initial therapy, e.g., ceftriaxone and doxycycline, treats some but not all of these organisms. Patients should be seen within 48 to 72 hours after initiating therapy; lack of improvement suggests noncompliance with antibiotic therapy, the need for broader-spectrum antibiotic coverage, a tubo-ovarian abscess, or a mistake in diagnosis. Important preventive measures include screening of sexually active, asymptomatic adolescents for gonorrheal and chlamydial infections, not only in clinics for sexually transmitted diseases and family planning but also in primary care settings. Urine tests that amplify chlamydial and gonococcal nucleic acid are noninvasive and very accurate.

Adolescent↗