Biomedical subjects

M Espeland

Publications and source records attributed to M Espeland.

At least 19 recordsLinked to original sources

PubMed2000

Multidisciplinary Women's health research: the national centers of excellence in women's health.

Contemporary research increasingly needs to consider the value of a multidisciplinary approach in answering critical health questions. The current article outlines the need for multidisciplinary investigations specifically in reference to women's health, and addresses issues related to generating and sustaining interest in such an approach. In addition, the importance of resources and environment for facilitating multidisciplinary research and advocacy efforts for obtaining funding for this approach are discussed. Methodological issues pertinent to the operationalization of multidisciplinary research in women's health are also addressed, and lessons learned from the National Centers of Excellence in initiating multidisciplinary research in women's health are reviewed.

Female↗

PubMed1999

Low fibrinogen level: A predisposing factor for venous thromboembolic events with hormone replacement therapy.

Several studies have reported an association between hormone replacement therapy (HRT) in postmenopausal women and increased risk of idiopathic venous thromboembolic events (VTEs). Given the widespread use of HRT, it is important to identify factors that may predispose women on HRT to VTEs. To address this concern, we examined potential risk factors for VTEs in women assigned to HRT in the Postmenopausal Estrogen/Progestin Interventions (PEPI) study, a three-year, double-blinded, placebo-controlled trial of 875 postmenopausal women designed to assess the effects of HRT on heart disease risk factors (HDL cholesterol, fibrinogen, blood pressure, and insulin). Women with a history of estrogen-associated VTEs were excluded from the trial. Ten women, all assigned to HRT, had a VTE during PEPI. Only baseline fibrinogen varied significantly between those who did (mean = 249.0 mg/dl) and did not (mean = 280.8 mg/dl) have a VTE while assigned to HRT (P < 0.03). Adjusting for covariates including age, smoking, body mass index, lipid levels, blood pressure, alcohol, exercise, and prior HRT or oral contraceptive use did not affect this finding. The significantly lower fibrinogen levels seen among women subsequently reporting VTEs may be a marker for a specific, but as yet undefined, coagulopathy that is magnified in the presence of exogenous hormones. However, larger studies are needed to confirm this finding.

Afibrinogenemia↗

PubMed1997

The Postmenopausal Estrogen/Progestin Interventions Study: primary outcomes in adherent women.

OBJECTIVE: To assess the efficacy of unopposed estrogen, and three estrogen/progestin regimens on selected heart disease risk factors among adherent women and to contrast those results with efficacy among all women in the PEPI study. DESIGN: A 3-year, multicenter, randomized, double-blinded, placebo-controlled clinical trial. PARTICIPANTS: A total of 847 healthy postmenopausal women aged 45 to 64 years of age with no known contraindication to hormone therapy, who attended their 36 month clinical visit. INTERVENTION: Participants were randomized in equal numbers to one of the following treatments: (1) placebo; (2) conjugated equine estrogen (CEE) 0.625 mg daily; (3) CEE 0.625 daily plus medroxyprogesterone acetate (MPA) 10 mg, days 1-12; (4) CEE 0.625 daily plus MPA 2.5 mg daily; or (5) CEE 0.625 daily plus micronized progesterone (MP) 200 mg, days 1-12. ANALYSIS: Analyses are based on adherent women, where adherence is defined as taking at least 80% of pills at each 6-month visit. RESULTS: Adherence rates were high in all groups except women with a uterus assigned to unopposed CEE. The difference in HDL-C levels resulting from the CEE vs. CEE+MP was approximately three times larger than in the intent-to-treat analyses, reaching statistical significance (P < 0.05). In each active treatment, LDL-C decreased 10-15%. Triglycerides increased 15-20% in each opposed CEE arm and over 25% in the CEE only arm; this difference was not statistically significant. Fibrinogen increased by 7% among placebo adherers, but decreased or remained fairly stable among the active arm adherers. Systolic blood pressure increased 3-5% in all treatment arms. Women adherent to the CEE+MPA arms had twice the increase of 2 h glucose levels as women adherent to CEE only, or CEE+MP (8-9% vs. 3-4%). Two-hour insulin levels decreased 3-12% for all arms. The patterns of change for fibrinogen, SBP, 2 h glucose and insulin were similar to those from the intent-to-treat analyses. CONCLUSIONS: In analyses limited to adherent women, all active treatments, compared to placebo, continued to have similar and favorable effects on LDL-cholesterol and fibrinogen and no significant effects on blood pressure or insulin levels. Given the overall high adherence rates in PEPI, the results are similar to the intent-to-treat analyses, as expected. Only the trend of HDL-C to have a larger increase in the CEE only arm (in the intent-to-treat analyses) gained statistical significance in analyses restricted to adherers.

Blood Glucose↗

PubMed1996

Pregnancy in sickle cell disease: experience of the Cooperative Study of Sickle Cell Disease.

OBJECTIVE: To determine the maternal and fetal outcomes of pregnancy in women with sickle cell disease. METHODS: The subjects were part of a cohort recruited from 19 centers for a prospective study of the clinical course of sickle cell disease. Each participant was evaluated using a structured protocol in which steady-state data and information on both sickle- and non-sickle-related events were collected. The rates of antepartum and intrapartum complications were tallied for pregnancies carried to delivery. Fetal outcome was assessed according to gestational age, birth weight, and Apgar score. Differences among genotypes in event rates were assessed using Fisher exact test. Differences in gestational age and birth weight, and predictors of these outcomes, were assessed using analyses of covariance. RESULTS: Two hundred eighty-six of the 445 reported pregnancies proceeded to delivery. Non-sickle-related antepartum and intrapartum complication rates were comparable with those of African-American women who did not have sickle cell disease. One of the two deaths observed during this study was directly related to the presence of sickle cell disease. Rates of maternal morbidity from sickle cell disease were the same during pregnancy as during the nonpregnant state. Ninety-nine percent of those pregnancies carried to delivery resulted in a live birth. Twenty-one percent of the infants born to women of the SS genotype were small for gestational age (SGA). Preeclampsia and acute anemic events were identified as risk factors for SGA infants. CONCLUSIONS: Those caring for women with sickle cell disease should support them if they desire to have children.

Adult↗

PubMed1996

A study of the characteristics of the dementia patients and caregivers in dementia-nonspecific adult day care programs.

OBJECTIVE: To determine if basic differences exist between the patients and caregivers of a representative group of dementia-nonspecific medical versus social adult day care centers with specific programs for dementia patients. DESIGN: A telephone interview questionnaire survey. SETTING: North Central North Carolina. PARTICIPANTS: A total of 242 adult day care dementia patients and caregivers from three medical and three social nondementia-specific adult day care centers. MEASUREMENTS: Dementia patient variables: Day care subtype (medical or social); length of stay; number of days attended; age; sex; race; educational level; marital status; religious affiliation; income; living status; number of medical conditions; number of prescription medications; function; ADL status (walking, eating, bathing, dressing, grooming, toileting); continence status; number and type of abnormal behaviors; formal help status (hospitalization during day care, part or full-time nursing home attendance, or home healthcare assistance); transportation; and financial assistance. Caregiver variables: day care subtype; age; sex; race; educational level; marital status; religious affiliation; income; number of medical conditions; number of prescription medications; informal help (family friends or other non-paid help); paid help (friend, other, home health, or nursing home); relationship to patient; employment status; and level of caregiver burden. MAIN RESULTS: There were 144 medical and 62 social adult day care dementia patients and caregivers who agreed to participate. The average age of the patient was 77.9 years (SD +/- 8.4), and that of the caregiver was 57.7 years (SD +/- 13.9); 68.4% of the patients and 75.4% of the caregivers were females. Dementia patients in the medical subtype day care had a shorter length of stay than social day care patients; this did not reach statistical significance. There were significantly more white patients and caregivers in the medical than in the social subtype day care, 83.1% versus 50% and 83.3% versus 50.8%, respectively. Dementia patients of the medical subtype also had significantly more education, income, less function, and more symptoms of depression than dementia patients in the social subtype. Dementia patients of the medical subtype also had more abnormal psychological behaviors than their social subtype counterparts, with borderline significance (P = .071). There were more married caregivers in the medical subtype than in the social subtype day care. Caregivers of dementia patients in the medical subtype had significantly more paid help and caregiver burden than did caregivers of dementia patients in the social subtype. CONCLUSIONS: In this study, there appear to be key differences between the dementia patients and caregivers of medical versus social adult day care centers as to demographic and health-related variables. The differences in demographic variables appear to be associated with socioeconomic factors, whereas the decreased function and greater number of depressive symptoms of the medical dementia patients may reflect poorer health as reflected by the greater amount of paid help and increased caregiver burden experienced by the caregivers of medical dementia patients. These findings should be verified in prospective studies.

Adult↗

PubMed1995

Trial of Nonpharmacologic Intervention in the Elderly (TONE). Design and rationale of a blood pressure control trial.

National and international policy-making organizations advocate nonpharmacologic therapies to reduce blood pressure (BP). However, data to support such recommendations in older persons are virtually nonexistent. The Trials of Nonpharmacologic Intervention in the Elderly (TONE) is a randomized, controlled trial that will test whether weight loss or a reduced sodium (Na) intake or both can maintain satisfactory BP control, without unacceptable side effects, after withdrawal of antihypertensive drug therapy. Medication-treated hypertensives (aged 60 to 80 years) with a systolic BP less than 145 mm Hg and a diastolic BP less than 85 mm Hg who are taking one antihypertensive medication are randomly assigned to one of four groups: (1) weight loss alone, (2) reduced Na intake alone, (3) combined weight loss and reduced Na intake, or (4) usual life-style (control group). Overweight participants are randomized to one of these four groups, while nonoverweight individuals are assigned to either the reduced Na intake or the usual life-style group. The interventions, tailored to the needs of older persons, use behavioral approaches to accomplish intervention-specific goals (weight loss > or = 10 lb, daily Na intake < or = 80 mEqa). Three months after the start of intervention, antihypertensive drug therapy is withdrawn. The primary trial end point is a BP of 150/90 mm Hg or higher, resumption of antihypertensive drug therapy, or the occurrence of a BP-related clinical complication during 2 to 3 years of follow-up. It is anticipated that TONE findings may identify an effective and acceptable nonpharmacologic approach to control hypertension in the increasingly large number of older persons treated with antihypertensive drug therapy.

Aged↗

PubMed1995

The heart in sickle cell anemia. The Cooperative Study of Sickle Cell Disease (CSSCD).

The objective of this study was to obtain representative echocardiographic measurements of cardiac size and function in stable patients with sickle cell disease. This prospective, multicenter study utilized central reading of echocardiograms by an investigator blinded to other patient data. Stable outpatients from a balance of inner city and rural settings with SS phenotype and a broad age range were selected, because conflicting results from earlier studies were believed to be due to these patient selection criteria. Right and left ventricular dimensions and wall thickness, left atrial and aortic root dimensions, and systolic time intervals were measured. Body surface area indexed chamber dimensions and septal thickness were significantly increased from normal. Except for the right ventricle, chamber dimensions and wall thickness were inversely correlated with hemoglobin. The relationship between left ventricular dimension and hemoglobin was significantly dependent on age. Systolic time interval ratios were normal though left ventricular ejection time was prolonged. Shortening fraction was normal but velocity of circumferential fiber shortening was abnormally low. Stable patients with sickle cell disease have dilated chambers, septal hypertrophy, and normal contractility. Though left ventricular dilatation was inversely related to hemoglobin, age (duration of illness) was an important factor in that relationship. No specific cardiomyopathy was associated with sickle cell anemia.

Adolescent↗

PubMed1993

Developmental screening in young children with sickle cell disease. Results of a cooperative study.

PURPOSE: The goal of the study was to assess development in young children with sickle cell disease as part of the Cooperative Study of Sickle Cell Disease (CSSCD). PATIENTS AND METHODS: The Denver Developmental Screening Test (DDST) was administered to children younger than 6 years at 12 participating institutions of the CSSCD. Trained examiners administered tests to 344 children. RESULTS: Tests were scored as normal in 90.4%, questionable in 6.4%, and abnormal in 1.5%; 1.7% of children were considered untestable. There was no relationship between DDST results and sickle cell genotype. Questionable and abnormal (Q/A) scores were more common in children ages 3-5 years than in younger children (12.6% versus 3.8%; P = 0.002). CONCLUSIONS: Because the DDST is a screening test, it should be interpreted cautiously. However, the more numerous Q/A scores in our "older" group agree with the findings of recent reports of neuropsychological impairment in school-age children with sickle cell disease. Our data suggest that development is relatively normal before age 3 years; deficits seen in older children may reflect subsequent ischemic insults.

Age Factors↗

PubMed1991

Comparison of hospital and neighborhood controls in a study of coronary artery disease.

Case-control studies of risk factors for coronary artery disease (CAD) have almost invariably employed hospital controls, with minimal or no coronary artery stenosis. Although there is an important advantage in knowing the CAD status of controls, such groups are subject to bias related to hospitalization. To evaluate the generalizability of results obtained from studies using hospital controls, we compared risk factors in 342 hospital controls free of angiographic evidence for CAD, 168 neighborhood controls without symptoms of CAD, and 450 CAD patients. Coronary artery disease in cases and hospital controls was established arteriographically. No significant differences were found between the male control groups for total and low density lipoprotein (LDL) cholesterol, LDL apo-B, pack-years of smoking, body mass index, proportion with hypertension, diabetes and family history of coronary heart disease. Compared with neighborhood controls, male hospital controls had significantly lower high density lipoprotein (HDL) cholesterol, higher triglycerides and uric acid and scored higher on the Framingham Type A behavior pattern scale. Among women, the hospital control group had significantly lower LDL cholesterol and fewer pack-years of smoking, and a greater prevalence of hypertension than the neighborhood group. A greater proportion of both male and female hospital controls had left ventricular hypertrophy, and there were more current smokers among the neighborhood controls in both sexes. Age adjustment did not change these comparisons. While very few neighborhood controls were treated with beta-blockers, 32.7% of male and 41.4% of female hospital controls were so medicated. Control for beta-blocker use eliminated the difference in HDL cholesterol and triglycerides between the two male control groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Case-Control Studies↗

PubMed1991

Cell populations and episodic periodontal attachment loss in humans.

The purpose of the present study was to assess possible associations between episodic probing attachment loss and cell populations in the supracrestal connective tissue in humans. 10 systemically healthy adult patients with untreated advanced periodontitis were monitored during a period of 10 months. At baseline and every month thereafter, probing attachment levels were measured at 6 sites of every tooth using an electronic pressure sensitive probe and flexible stents. Corresponding contralateral sites were identified where 1 site had lost 2 mm or more attachment within the previous month (P), and the other site had not (C). Supracrestal soft tissue biopsies were taken from these sites, processed and cut into 1 micron sections. Cell populations were identified in superficial and deep connective tissue areas by counting fibroblasts, macrophages, plasma cells, mast cells, granulocytes, lymphocytes, endothelial cells and the total number of inflammatory cells. Analysis of variance assessed differences in cell populations between P- and C-sites. There were statistically significantly higher numbers of fibroblasts in the standard areas of C-sites (p less than 0.0001). In P-sites, the numbers of macrophages, plasma cells, mast cells, lymphocytes and total inflammatory cells were significantly higher as compared to C-sites (p = 0.05-0.0001). There were no differences in cell populations between superficial and deep connective tissue areas within P- and C-sites (p greater than 0.2). Clinically assessed episodes of periodontal disease progression may be associated with site-specific shifts in inflammatory cell populations.

Adult↗

PubMed1990

Characteristics of stroke victims associated with early cardiovascular mortality in their children.

We assessed the relationship between characteristics of stroke victims and the risk of early death from coronary or cerebrovascular disease (CCVD) among their children. For each of 55 stroke patients selected from a registry which enrolled patients between 1969 and 1973, an index of their progeny's survival was calculated using the age in 1987 of 197 surviving children, and the age at and cause of death for 55 deceased children. Increased risk of CCVD death within families was significantly related to parental age at the time of first stroke, and with the parental history of diabetes mellitus. No significant relationship was found between the children's risk of CCVD death and the stroke patient/parent's sex, race, history of hypertension or cardiac disease, stroke diagnosis (infarction vs hemorrhage), or severity upon admission. These results suggest that family histories of cerebrovascular disease may impart differential risks, depending upon a family history of diabetes, and perhaps, the ages at which ancestral strokes first occurred.

Adolescent↗

PubMed1990

Episodic probing attachment loss in humans: histologic associations.

Marginal periodontitis in humans is characterized by episodes of probing attachment loss followed by periods of quiescence. The purpose of the present study was to assess characteristics of the inflammatory infiltrate in periodontal lesions where episodic probing attachment loss had occurred within the previous month. In 10 systemically healthy adult human subjects with untreated advanced periodontitis, probing attachment levels were measured at baseline and every 30 days thereafter for 10 months. Measurements were made at six sites of every tooth using an acrylic onlay as a reference point and a pressure sensitive probe. Sites where double measurements confirmed that probing attachment loss of 2 mm or more had occurred within the previous month were identified (P-sites), as were corresponding contralateral non-progressing sites (C-sites). Biopsies of the supracrestal tissues were taken from these sites, processed, and cut in 1 mu sections for histologic evaluation. Counts of inflammatory cells in standard areas of the sections were compared between P and C sites. The results indicated that 5.04% of 1566 sites under investigation lost probing attachment during the 10-month observation period. Inflammatory cell counts were higher in P-sites as compared to C-sites. P-sites with more than 2 mm attachment loss (P greater than 2 sites) had significantly more inflammatory cells within standard areas at the apical end of the junctional epithelium than non-progressing C-sites (P less than 0.02). There was no significant difference in counts between P-sites progressing 2 mm (P-2 sites) and corresponding C-sites.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

Correcting umbilical artery flow velocity waveforms for fetal heart rate is unnecessary.

We prospectively examined 55 normal pregnant women between 32 and 41 (means = 37) weeks' gestation. Five measurements of the umbilical artery peak-systolic/end-diastolic frequency ratio were obtained from each patient during one examination. Comparison of the fetal heart rate and the umbilical artery peak-systolic/end-diastolic frequency ratios between pregnancies less than 37 and greater than 37 weeks' gestation revealed no difference. Subsequently a total of 256 measurements were analyzed as one group. Plotting the individual peak-systolic/end-diastolic frequency ratios against the corresponding fetal heart rates revealed a moderate negative linear correlation: y = 4.15-0.012x, r = -0.36 and p less than 0.04. When only heart rates between 120 to 160 beats/min were plotted against peak-systolic/end-diastolic frequency ratios, a weaker correlation was found (r = -0.33, p = 0.15). The difference (mean +/- SD) between the obtained and the corrected peak-systolic/end-diastolic frequency ratios was 4.4% +/- 3.2%. The 95th percentile of the obtained peak-systolic/end-diastolic frequency ratio was 3.35 and the corrected ratio was 3.27. Averaging of the five measurements obtained from each patient for all 55 patients decreased the 95th percentile value to 3.09 whereas the same procedure for the corrected peak-systolic/end-diastolic frequency ratios decreased it to 3.07. We conclude that although there is a statistically significant negative linear correlation between the fetal heart rate and the umbilical artery peak-systolic/end-diastolic frequency ratio, this relationship is not clinically significant.

Arteries↗

PubMed1989

Effects of personal oral hygiene and subgingival scaling on bleeding interdental gingiva.

The aim of this study was to determine the effects of personal oral hygiene and subgingival scaling on bleeding interdental gingiva. The Eastman Interdental Bleeding Index (EIBI) was used to clinically evaluate interdental gingival status. Forty-seven bleeding interdental sites in 47 patients were divided into three groups. Sites in Group I bled on stimulation with wooden interdental cleaners. Groups II and III initially bled but were converted to nonbleeding with oral hygiene alone or oral hygiene combined with subgingival scaling, respectively. Interdental gingival biopsies were obtained and subjected to morphometric analysis to compare the three groups. The findings from this study indicated that: (A) personal oral hygiene reduced the magnitude and extent of the interdental inflammatory lesion; (B) subgingival scaling plus oral hygiene decreased the interdental inflammatory lesion to a greater extent than oral hygiene alone; (C) significant repair of the interdental lesion occurred within four weeks; and (D) the EIBI was an effective method for monitoring the effects of therapy directed towards resolution of the interdental inflammatory lesion.

Adult↗

PubMed1988

Cell populations associated with conversion from bleeding to nonbleeding gingiva.

The purpose of this study was to observe changes in cell populations of the interdental gingival tissue, which accompanied the conversion of a bleeding to a nonbleeding state induced by scaling and improved oral hygiene. Fifteen bleeding and 18 stopped-bleeding interproximal gingival biopsies were obtained from 33 patients and processed for light microscopic evaluation. The morphometric analysis of eight connective tissue components revealed that the percentage volume density of all inflammatory cells decreased, and the percentage of fibroblasts and collagen increased, when the gingiva changed from a bleeding to a nonbleeding state. Furthermore, the inflammatory cell infiltrate in bleeding and stopped-bleeding specimens was dominated by mononuclear cells of the lymphocyte/macrophage/monocyte group, while plasma cells and polymorphonuclear leukocytes comprised only a small fraction of the inflammatory cells present. Significant repair of gingival connective tissue had occurred in the stopped-bleeding specimens.

Adult↗

PubMed1988

Associations between bleeding and visual signs of interdental gingival inflammation.

Interdental gingival tissues are designated inflamed on the basis of their color and bleeding after stimulation. Gingival bleeding was previously shown in histological studies to indicate the presence of inflammatory lesions. The present study was undertaken to determine associations between bleeding and visual signs of interdental gingival inflammation. Each interdental site in 82 males, aged 18 to 30, was evaluated for the presence or absence of visual signs of inflammation. The interdental sites on one side of the mouth were evaluated for bleeding tendency using the Papilla Bleeding Index (PBI), while the other half was evaluated using the Eastman Interdental Bleeding Index (EIBI). The percentage of inflamed areas detected with the EIBI and visual method was similar and significantly higher than with the PBI. When the visually noninflamed sites were examined, 38.5% of these areas bled, indicating that interdental inflammatory lesions existed in the absence of visual signs of inflammation. Of the sites that bled but were visually noninflamed, 33.1% were detected using the PBI, while 66.9% were detected using the EIBI. The Eastman Interdental Bleeding Index was a more reliable clinical indicator for detecting interdental inflammatory lesions than the Papilla Bleeding Index.

Adolescent↗

PubMed1988

Effect of personal oral hygiene on bleeding interdental gingiva. Histologic changes.

A previous study demonstrated that the combination of subgingival scaling and improved oral hygiene resulted in a reduction of clinical and histological signs of interdental gingival inflammation, changes that were associated with a cessation of interdental gingival bleeding. The present study compared, histologically, the interdental tissues of bleeding sites with sites that initially bled but had been converted to nonbleeding by an oral hygiene program alone. Morphometric analysis of interdental gingiva demonstrated that conversion from bleeding to nonbleeding was associated with a significant reduction in the inflamed connective tissue component. This study showed that an oral hygiene program consisting of toothbrushing and interdental cleaning could significantly reduce interdental inflammation, and that bleeding determinations monitored the effects of this therapy.

Adult↗

PubMed1987

Retention of sealants over carious and sound tooth surfaces.

Bacteriologic and clinical studies suggest that sealants can be used therapeutically on incipient caries of the enamel. The present study was designed to explore this approach further by determining whether there is a difference in retention rates on sound or carious tooth surfaces sealed for the first time as well as resealed surfaces. A total of 1766 teeth were sealed for subjects 12-14 yr of age of which 120 were judged to be carious. Mouths were divided sagittally on a random basis and an ultraviolet light activated resin with a filler or an autopolymerizing resin without a filler was placed on contralateral surfaces of all molar and premolar teeth. The effects of sealant type, caries status, arch and tooth type on retention over a 2-yr period were tested using Mantel-Haenszel statistics. At the end of 1 yr, 88% of the teeth sealed with the autopolymerizing resin were judged to be completely intact compared to 82% of the teeth filled with the ultraviolet light resin. At the end of the second year the retention rates were 84% and 75% respectively. The retention rates for carious and sound teeth at the end of both years were almost identical. Overall, premolars had a 15% more favorable retention rate than molars. There were minimal differences between arches although maxillary premolars had approximately a 5% higher retention rate than mandibular premolars. The reverse was true for molar teeth. Retention of sealants at the end of the second year (resealed after 1 yr) was 4% less than comparable teeth sealed initially.

Adolescent↗