Biomedical subjects

Janet B Croft

Publications and source records attributed to Janet B Croft.

45 records · Page 3Linked to original sources

PubMed2002

Adverse childhood experiences and risk of paternity in teen pregnancy.

OBJECTIVE: Few studies have investigated risk factors that predispose males to be involved in teen pregnancies. To provide new information on such factors, we examined the relationships of eight common adverse childhood experiences to a male's risk of impregnating a teenager. METHODS: We conducted a retrospective cohort study using questionnaire responses from 7399 men who visited a primary care clinic of a large health maintenance organization in California. Data included age of the youngest female ever impregnated; the man's own age at the time; his history of childhood emotional, physical, or sexual abuse; having a battered mother; parental separation or divorce; and having household members who were substance abusers, mentally ill, or criminals. Odds ratios (ORs) for the risk of involvement in a teen pregnancy were adjusted for age, race, and education. RESULTS: At least one adverse childhood experience was reported by 63% of participants, and 34% had at least two adverse childhood experiences; 19% of men had been involved in a teen pregnancy. Each adverse childhood experience was positively associated with impregnating a teenager, with ORs ranging from 1.2 (sexual abuse) to 1.8 (criminal in home). We found strong graded relationships (P <.001) between the number of adverse childhood experiences and the risk of involvement in a teen pregnancy for each of four birth cohorts during the last century. Compared with males with no adverse childhood experiences, a male with at least five adverse childhood experiences had an OR of 2.6 (95% confidence interval [CI] 2.0, 3.4) for impregnating a teenager. The magnitude of the ORs for the adverse childhood experiences was reduced 64-100% by adjustment for potential intermediate variables (age at first intercourse, number of sexual partners, having a sexually transmitted disease, and alcohol or drug abuse) that also exhibited a strong graded relationship to adverse childhood experiences. CONCLUSION: Adverse childhood experiences have an important relationship to male involvement in teen pregnancy. This relationship has persisted throughout four successive birth cohorts dating back to 1900-1929, suggesting that the effects of adverse childhood experiences transcend changing sexual mores and contraceptive methods. Efforts to prevent teen pregnancy will likely benefit from preventing adverse childhood experiences and their associated effects on male behaviors that might mediate the increased risk of teen pregnancy.

Adolescent↗

PubMed2002

The heart, kidney, and brain as target organs in hypertension.

The heart, kidney, brain, and arterial blood vessels are prime targets of hypertensive damage. Uncontrolled hypertension accelerates the damage to these organs and results in eventual organ failure and cardiovascular death and disability. Current guidelines for the appropriate treatment and control of hypertension requires an assessment of the presence of target organ damage. When present, evidence of target organ damage determines the urgency and intensity of drug treatment and may also dictate the choice of initial antihypertensive drug class. Thus, evaluation of persons with suspected or established hypertension must include a meticulous search for evidence of target organ damage. Fortunately, treatment with all antihypertensive medications that results in significant BP reductions also reduces fatal and nonfatal hypertensive complications and significantly slows down the progression to organ failure. Because of the important role that adverse activation of the renin-angiotensin-aldosterone system plays in target organ damage, drugs that antagonize this system have provided consistent and compelling proof of organ protection in both primary and secondary prevention of adverse outcomes. The challenge now is to use these and all other antihypertensive agents effectively to control BP to target levels in patients with hypertension. Continued emphasis on the adoption of lifestyle changes for prevention of hypertension in the first place or as adjunctive therapy in hypertensive patients is essential.

Adult↗

PubMed2002

Familial aggregation of early-onset myocardial infarction.

Although ischemic heart disease tends to cluster in families, previous studies have reported a modest (2-fold increased risk) to strong (10-fold increased risk) contribution of family history to the explanation of disease occurrence. The authors assessed the familial aggregation of early-onset myocardial infarction in 11,307 adults aged <65 years who participated in the Third National Health and Nutrition Examination Survey. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). A parental history was more common in those with (n = 237) than in those without (n = 11,070) a myocardial infarction (19.8 vs. 7.9%, p < or = 0.01). Adults with a parental history were also more likely to have multiple risk factors for cardiovascular disease (OR for four or five risk factors compared with none: 2.9, 95% CI: 1.4, 6.3). After multivariate adjustment, the likelihood of myocardial infarction was more than three times greater among adults with a parental history than among those without (95% CI: 1.7, 6.7). A maternal history of myocardial infarction was strongly associated (OR = 6.1, 95% CI: 2.1, 17.4) with an increased likelihood of myocardial infarction, and a paternal history was associated with a 3-fold (95% CI: 1.5, 6.3) increased likelihood of myocardial infarction after adjustment for cardiovascular disease risk factors. These results suggest a familial aggregation of early-onset myocardial infarction and show that family history is strongly associated with cardiovascular disease risk factors.

Journal Article↗

PubMed2002

Sex differences in US mortality rates for stroke and stroke subtypes by race/ethnicity and age, 1995-1998.

BACKGROUND AND PURPOSE: Ischemic stroke accounts for 70% to 80% of all strokes, but intracerebral and subarachnoid hemorrhagic strokes have greater fatality. Age-standardized death rates from overall stroke are higher among men than women, but little is known about sex differences in stroke subtype mortality by race/ethnicity. METHODS: We analyzed 1995 to 1998 national death certificate data to compare sex-specific age-standardized death rates (per 100 000) for ischemic stroke (n=507 256), intracerebral hemorrhagic stroke (n=98 709), and subarachnoid hemorrhagic stroke (n=27 334) among whites, blacks, American Indians/Alaska Natives, Asians/Pacific Islanders, and Hispanics. We calculated rate ratios and 95% CIs comparing women with men within age and racial/ethnic groups. RESULTS: Age-specific rates of ischemic and intracerebral hemorrhagic stroke deaths were lower for women than for men aged 25 to 44 and 45 to 64 years but were higher for ischemic stroke among older women, aged > or =65 years. Only among whites did women have higher age-standardized rates of ischemic stroke. Age-standardized death rates for intracerebral hemorrhagic stroke among women were lower than or similar to those among men in all racial/ethnic groups. Women had higher risk of death from subarachnoid hemorrhagic; this sex differential increased with age. CONCLUSIONS: The female-to-male mortality ratio differs for stroke subtypes by race/ethnicity and age. A primary public health effort should focus on increasing the awareness of stroke symptoms, particularly among people at high risk, to decrease delay in early detection and effective stroke treatment.

Adult↗

PubMed2002

Physician advice, patient actions, and health-related quality of life in secondary prevention of stroke through diet and exercise.

BACKGROUND AND PURPOSE: Healthy diet and exercise are recommended for secondary prevention in stroke patients. We examined the prevalence of persons with stroke who received physician advice for, and engaged in, dietary change and exercise, and we also sought to determine whether engaging in these actions was associated with differences in health-related quality of life (HRQOL). METHODS: Data are from 51 193 participants in the 1999 Behavioral Risk Factor Surveillance System, a state-based telephone survey. The participants noted whether they were advised to eat fewer high fat/high cholesterol foods and to exercise more and whether they engaged in these activities. HRQOL measures were the reported number of the preceding 30 days when physical health was not good, mental health was not good, usual activities were limited, and both physical and mental health were good (healthy days). RESULTS: Overall, 2.4% of the participants reported a history of stroke. Sixty-one percent of those who reported a history of stroke had been advised to eat fewer high fat/high cholesterol foods, and 85.4% of those who had received such advice reported a dietary change compared with 56.0% of those who did not receive such advice. Almost 64% of those who reported a stroke had been advised to exercise more, and 76.5% of those who received such advice reported exercising more versus 38.5% of those who did not receive such advice. Persons with stroke who reported exercising had fewer limited activity days and days when physical health was not good and more healthy days than did persons who did not exercise. Dietary actions were not associated with differences in HRQOL. CONCLUSIONS: Results highlight the importance of provider advice for secondary prevention among persons with stroke.

Adolescent↗

PubMed2002

Apolipoproteins A-1 and B and the likelihood of non-fatal stroke and myocardial infarction -- data from The Third National Health and Nutrition Examination Survey.

BACKGROUND: The measurement of plasma apolipoproteins (APO) has been proposed for predicting the risk of cardiovascular diseases. However, the association between APOs and stroke is not well defined. MATERIAL/METHODS: We evaluated the association between plasma concentrations of APO A-1 and APO B with a physician diagnosis of stroke (n=153), and electrocardiogram evidence or physician diagnosis of myocardial infarction (n=379), in a nationally representative sample of 3,696 US adults aged >40 years who participated in the Third National Health and Nutrition Examination Survey. Multivariate logistic regression analyses were used to investigate these relationships. RESULTS: After adjusting for differences in age, gender, race/ethnicity, education, hypertension, cholesterol, body mass index, and cigarette smoking, the upper quartile of APO A-1 (> or = 161 mg/dl) when compared with the lowest quartile (<126 mg/dL) was inversely associated with the likelihood of myocardial infarction (Odds Ratio [OR], 0.6; 95% Confidence Interval [CI] 0.4-0.9) but not stroke. APO B concentrations were not associated with either myocardial infarction or stroke. However, an APO A-1 to B ratio > or = 1.59 when compared with a ratio < or = 1.04 was associated with a decreased likelihood of myocardial infarction (OR, 0.3; 95% CI, 0.2-0.6); and stroke (OR 0.4, 95% CI, 0.2-1.0). CONCLUSIONS: Higher APO A-1 concentrations were associated with a decreased likelihood for myocardial infarction but not for stroke. The APO A-1 to B ratio was inversely associated with both myocardial infarction and stroke and may be an important protective clinical marker for atherosclerosis.

Adult↗

PubMed2002

Associations of hyperinsulinemia and hypertension independent of body mass among white, black, and Mexican-American adults without diabetes.

OBJECTIVE: In a cross-sectional study, we examined the association between hyperinsulinemia and hypertension, independent of body mass, among White non-Hispanic, Black non-Hispanic, and Mexican-American adults without diabetes. METHODS: Data are from 8,004 adults, aged > or = 20 years from the Third National Health and Nutrition Examination Survey, 1988-1994. Univariate differences in C-peptide levels (fasting) were examined in normotensives and hypertensives by racial or ethnic group. Multivariate logistic regression models were used to estimate the likelihood of hypertension across race-specific tertiles of C-peptide levels. Adjustments were made for age, sex, education, body mass index, and waist-to-hip ratio. RESULTS: The prevalence of hypertension was 21.1% among non-Hispanic Whites, 24.6% among non-Hispanic Blacks, and 10.9% among Mexican Americans. The prevalence of hypertension increased significantly with C-peptide level for each racial or ethnic group. Mexican Americans with a C-peptide level in the upper tertile were 3.3 times (95% confidence interval [CI]=2.2-4.8) more likely to have hypertension than those with a C-peptide level in the lower tertile, after adjustment for age, sex, education, and BMI. Further adjustment for WHR resulted in a slightly lower odds ratio (OR=3.1; 95% CI=2.0-4.6). Among non-Hispanic Whites and Blacks, respectively, persons with a C-peptide level in the upper tertile were 1.6 times (95% CI=1.2-2.2) and 1.7 times (95% CI=1.1-2.6) more likely to have hypertension than those with a C-peptide level in the lower tertile, after multivariate (including WHR) adjustment. CONCLUSIONS: These data suggest that high C-peptide levels, reflecting endogenous insulin secretion, are associated with hypertension, independent of body mass index and diabetes. This association was strongest among Mexican Americans. Our results also suggest that adjustment for waist-to-hip ratio as a confounding factor may be important in evaluation of the relationship between C-peptide level and hypertension.

Black or African American↗

PubMedDate not supplied

Adverse childhood experiences and personal alcohol abuse as an adult.

Adult alcohol abuse has been linked to childhood abuse and family dysfunction. However, little information is available about the contribution of multiple adverse childhood experiences (ACEs) in combination with parental alcohol abuse, to the risk of later alcohol abuse. A questionnaire about childhood abuse, parental alcoholism and family dysfunction while growing up was completed by adult HMO members in order to retrospectively assess the independent relationship of eight ACEs to the risk of adult alcohol abuse. The number of ACEs was used in stratified logistic regression models to assess their impact on several adult alcohol problems in the presence or absence of parental alcoholism. Each of the eight individual ACEs was associated with a higher risk alcohol abuse as an adult. Compared to persons with no ACEs, the risk of heavy drinking, self-reported alcoholism, and marrying an alcoholic were increased twofold to fourfold by the presence of multiple ACEs, regardless of parental alcoholism. Prevention of ACEs and treatment of persons affected by them may reduce the occurrence of adult alcohol problems.

Alcoholism↗

PubMedDate not supplied

Treatment of chronic heart failure in a managed care setting. Baseline results from the Achieving Cardiac Excellence Project.

BACKGROUND: Effective therapy for chronic heart failure (CHF) is underutilized despite a broad consensus regarding treatment recommendations. METHODS: As a quality improvement project designed to reduce preventable hospitalizations associated with CHF, we examined use of angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and beta-adrenergic receptor blockers (BB) in a population of patients enrolled in a managed care plan. Medicare and commercial enrollees were included. Patients with CHF were identified using claims data (International Classification of Disease 9th Clinical Modification code 428) covering January 1, 1998 through December 31, 1998. Drug utilization data were obtained from the plan's pharmacy benefits database. Data were available for 1220 patients. RESULTS: The mean age (+/- SD) was 71 +/- 12 years, 53% were female, and 84% were Medicare enrollees. Prescriptions for ACEI, ARB and BB were filled by 52%, 9% and 25% of patients, respectively. Prescriptions for diuretics, digitalis preparations, and calcium channel blockers (CCB) were filled by 69%, 34%, and 32%, respectively. Therefore, almost half of patients with CHF were not receiving ACEI therapy, even though it had been proven to reduce morbidity and mortality related to CHF. Furthermore, three-quarters of patients were not receiving BB therapy, a similarly effective therapy. In contrast, CCB and digitalis have not been convincingly shown to reduce mortality in patients with CHF broadly defined. Utilization of CCB and digitalis exceeded that of BB. CONCLUSIONS: Managed care organizations should develop, test, and implement network-level strategies designed to optimize the appropriate utilization of effective drug therapies for patients with CHF.

Adrenergic beta-Antagonists↗