Factor V Leiden, prothrombin 20210 gene variant, and risk of myocardial infarction.
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Factor V↗
Biomedical subjects
R C Grimson
Publications and source records attributed to R C Grimson.
Hypertension in nursing home patients.
There have been few studies of hypertension in nursing home patients. To assess the prevalence, demographic characteristics, comorbidity and drug therapy in hypertensive nursing home patients compared with those who are normotensive, we reviewed all medical charts of patients in three nursing home facilities. Of the 804 patients, 355 (44.2%) have hypertension. Calcium channel blockers were the most frequently prescribed anti-hypertensive (30.3%) and together with diuretics (28.4%) and ACE inhibitors (27.7%) account for more than 85%. Hypertensive patients take more cardiac, hypoglycaemic, and analgesic drugs (P = <0.001, <0.001, and 0.004, respectively) than those who are normotensive. Overall patients take an average of 8.68 medications daily. In hypertensive patients, the average number of comorbid conditions (excluding hypertension) is 5.02 compared with 3.23 in normotensive patients. Hypertension is significantly associated with diabetes, heart disease, cerebrovascular disease, neoplasms, endocrine disorders, gastrointestinal diseases, psychiatric disorders, dementia, other central nervous system diseases, skin problems, blood diseases and inversely with hip fracture. Blood pressure control (<140/90 mm Hg) is achieved in 88.8%, is not related to age and is significantly more frequent in males than females (91.8% vs 82.6% P = 0.025). The problem of hypertension in nursing home patients is complex and has received insufficient study. Since studies demonstrating benefit from anti-hypertensive therapy in the elderly excluded the very elderly and those with significant comorbid conditions, additional research is needed.
Aged↗
Disease clusters, exact distributions of maxima, and P-values.
This paper presents combinatorial (exact) methods that are useful in the analysis of disease cluster data obtained from small environments, such as buildings and neighbourhoods. Maxwell-Boltzmann and Fermi-Dirac occupancy models are compared in terms of appropriateness of representation of disease incidence patterns (space and/or time) in these environments. The methods are illustrated by a statistical analysis of the incidence pattern of bone fractures in a setting wherein fracture clustering was alleged to be occurring. One of the methodological results derived in this paper is the exact distribution of the maximum cell frequency in occupancy models.
Accidental Falls↗
Clustering in sparse data and an analysis of rhabdomyosarcoma incidence.
Time series of epidemiologic events often contain periods of atypically low or high frequency. Correspondingly, for quite rate diseases there occur instances of long vacuous durations interrupted noticeably by periods of some disease activity. A recent community-based observation of the incidence of rhabdomyosarcoma (RMS), and an investigation of it, yielded sparse data of this general description. We introduce a combinatorial test for patchy time series and apply it to the RMS data. We comment on the prevalent practice of post hoc data analysis of alleged clusters, and on scale effects.
Adolescent↗
Pediatric myocardial protection in the United States: a survey of current clinical practice.
A nationwide survey of institutions in the United States that perform congenital heart disease surgery was conducted to obtain an overview of the current use of myocardial protection in pediatric patients (aged 0-16 years). One hundred and one (55%) of 183 institutions responded, completing a 4-page questionnaire about pediatric cases in 1989. A total of 12,072 cases were represented. Caseloads ranged from 7 to 498 at these institutions (mean 124, median 30). Cardioplegia was used by 100 institutions (44 blood, 45 crystalloid, 11 both). Administration was guided by formulas alone in 69 and by clinical criteria alone in 32. A wide variety of compositions of cardioplegic solutions was found with no preference for any particular type. No correlation between caseloads and cardioplegic solutions was found. Hypothermia was used by all institutions, with a mean of 25.8 +/- 3.5 degrees C for a simple ventricular septal defect closure. Deep hypothermia and circulatory arrest were used in 3048 cases (25.2%). A clear trend indicated that circulatory arrest was used more frequently in larger institutions (p less than 0.0001). Fibrillation as a strategy was used in 45 institutions. Twenty-five institutions changed cardioplegia technique during 1989. The findings suggest that, even though no consensus exists about its ideal composition, cardioplegia in conjunction with hypothermia is currently the strategy most often used for pediatric myocardial protection.
Adolescent↗
Inguinal herniorrhaphy. Reduced morbidity by service standardization.
To ascertain if service specialization and procedure standardization would improve the complication rate of inguinal herniorrhaphy, the results of all inguinal herniorrhaphies performed during a 3-year period by board-certified general surgeons who also performed a variety of other procedures common to the field of general surgery, assisted by general surgical residents (group B, 390 patients), were compared in the same institution with the results of inguinal herniorrhaphy when performed during 3 years under protocol by a Hernia Service directed by a senior faculty member assisted by junior surgical residents (group C, 442 patients). Group B patients had essentially no follow-up until they reappeared for care at the Hernia Service, whereas patients in group C achieved an 82% 7-year follow-up. The infection and recurrence rates of group C patients (0.45% and 0.9%, respectively) were significantly better than those of group B patients (5.9% and 4.6%, respectively). These results suggest that in our institution, the concentration of patients with hernias in a hernia service, manned by a specialized surgeon, produced better short- and long-term results than those obtained by general surgeons not dedicated to the field of hernia repair. Further studies will be necessary to confirm these findings.
Follow-Up Studies↗
Follow-up of a cohort of alcoholic patients through 12 months of comprehensive biobehavioral treatment.
One hundred and eleven socially stable alcoholic patients were subjected to a comprehensive diagnostic and treatment protocol based on a biobehavioral model of alcoholism. Physical pathology, malnutrition, and toxicity were prevalent throughout the sample. After a period of inpatient care, subjects were treated for a period of 12 months with a combination of medical, nutritional, behavioral, and psychological support and care. At the end of the study period, 91 subjects (81.9%) remained in treatment contact. Sixty seven subjects (60.4%) were abstinent and physically stable at the 12-month date. Elevations of three scales of the MMPI were significantly predictive of treatment outcome.
Adult↗
A versatile test for clustering and a proximity analysis of neurons.
A test for nonrandom patterns in populations of "cells" of binary attributes is formulated for applications in settings where it is impossible or impractical to completely specify the adjacency matrix, as in circumstances involving enormous numbers of cells and/or censored data. Applications are made to problems concerning spatial distributions of specially labeled cells in nervous system research.
Animals↗
Apportionment of risk among environmental exposures: application to asbestos exposure and cigarette smoking.
A new method for assessing the attribution of risk for each of two exposures is developed. In one instance it generalizes a method now used to evaluate compensation for smokers who have been exposed to asbestos and it extends the notion of attributable risk. This method of apportioning risk is applicable in occupational settings where risk assessment and/or compensation is required and an application is presented.
Asbestos↗
Pituitary tumors following fallout radiation exposure.
Two pituitary tumors were diagnosed in a small population of Marshallese accidentally exposed to radioactive fallout in 1954.
Adenoma↗
The Edgecombe County High Blood Pressure Control Program: I. Correlates of uncontrolled hypertension at baseline.
To guide the planning of a multifacetted hypertension control program in Edgecombe County, North Carolina, a baseline survey of a stratified (by township) random sample of 1,000 households was conducted. All adults (greater than or equal to 18 years) were interviewed and had their blood pressures (BP) measured. Five hundred thirty-nine individuals, 27 per cent of the survey population, had diastolic BP greater than or equal to 90 mm Hg or were receiving anti-hypertensive drug therapy. The 539 hypertensives were divided into seven subgroups reflecting successive stages in the control of hypertension based on the awareness, treatment, and control of their hypertension. Unaware hypertensives were further subdivided into three groups according to the recency of their last BP check, and those aware but untreated were subdivided by whether they had previously received treatment. The seven subgroups of hypertensives were compared, separately for women and men, with respect to sociodemographic characteristics, health behaviors, and health status. In general, the progression from undetected hypertension to treatment and control appeared to be associated with being older, female, and White. This progression was further associated with greater educational levels and higher family incomes among women and increasing self-reported morbidity among men. The implications for intervention of these and other described associations are discussed.
Adolescent↗
Evaluation of the effects of the North Carolina Improved Pregnancy Outcome Project: implications for state-level decision-making.
This study was designed to assess the effects of the North Carolina Improved Pregnancy Outcome (IPO) Project on use of prenatal care and incidence of low birthweight among its primarily Black registrants . Weighted least squares and stratified analysis procedures were used to scrutinize vital statistics data for subpopulation effects. IPO services were received by 51.7 per cent of Black women in the counties served by the project. For all Black registrants , the risk of receiving less than adequate prenatal care was 55.1 per cent of that of the comparison group. For Black teenage registrants , the risk was even less: 37.2 per cent of that of the comparison group. Nevertheless, no corresponding effects on the incidence of low birthweight could be detected. The evaluation methods used in this study can be applied to programs for mothers and infants in other locales to generate useful and practical information for state-level decision-making.
Adolescent↗
Statistical procedures for assignments of upper bounds for radiation doses to an unbadged individual in a group for which some individuals are badged.
Consider a group of individuals exposed to radiation for an interval of time, such as units of military personnel during nuclear weapons tests three and four decades ago. Often, dosimetry information is known for several, but not all, individuals of that group. A nonparametric procedure is described that gives probability-based, upper-bound estimates of doses for an unbadged individual (within the group) for whom dose information is required; such information is useful in litigation. The method is illustrated by an application to a Navy unit.
Humans↗
Prevalence of self-reported depressive symptoms in young adolescents.
To investigate the significance and measurement of depressive symptoms in young adolescents, 624 junior high school students were asked to complete the Center for Epidemiologic Studies Depression Scale (CES-D) during home interviews. In 384 usable symptom scales, item-scale correlations (most were above .50), inter-item correlations, coefficient alpha (.85), and patterns of reported symptoms were reasonable. Persistent symptoms were reported more often by Blacks, especially Black males. Prevalence of persistent symptoms in Whites was quite close to reported figures for adults, ranging from 1 per cent to 15 per cent in adolescent males and 2 per cent to 13 per cent in adolescent females. Adolescents reported persistent vegetative symptoms less often and psychosocial symptoms more often. Reports of symptoms without regard to duration were much more frequent in the adolescents, ranging from 18 per cent to 76 per cent in White males, 34 per cent to 76 per cent in White and Black females, and 41 per cent to 85 per cent in Black males. The results support the feasibility of using a self-report symptom scale to measure depressive symptoms in young adolescents. Transient symptoms reported by adolescents probably reflect their stage of development, but persistent symptoms are likely to have social psychiatric importance.
Adolescent↗
Clustering of rare events.
The clustering of cases of a rare disease is considered. The number of events observed for each unit is assumed to have a Poisson distribution, the mean of which depends upon the population size and the cluster membership of that unit. Here a cluster consists of those units that are homogeneous in their rate of occurrence of the rare events under study. A sample of units is modeled by a mixture of Poisson distributions, one for each cluster, the mixing parameters being the proportions of all units represented by the components of the mixture. Maximum likelihood and Bayes approaches are employed to determine criteria for separating a sample into groups of units with homogeneous rates. A likelihood ratio test for the significance of a two-component mixture is presented as an example. The performance of the criteria is illustrated with data on the spatial occurrence of sudden infant deaths (SIDs) in North Carolina counties over a four-year period. The results suggest that the practice of dividing the counties into high- and low-risk categories on the basis of the ordered rates alone should be questioned. Tests based upon combinatorial methods are also presented to examine the significance of the number of contiguous counties among those with high rates.
Biometry↗
An epidemiologic study of tracheoesophageal fistula and esophageal atresia in North Carolina.
Two hundred and eighty-five cases of TEF/EA occurring in North Carolina from 1952-1978 were reviewed. Except for a greater incidence of low-birth-weight infants and hydramnios during pregnancy, the cases appeared to be representative of the population. Clustering of cases over time was statistically confirmed. The cyclic variation suggested an association with an infectious agent. The variation of reported infectious hepatitis cases during the period of this study resembled the variation of TEF/EA cases that had no other documented congenital malformations.
Epidemiologic Methods↗
Use of a symptom scale to study the prevalence of a depressive syndrome in young adolescents.
The entire student enrollment (n = 624) in a public junior high school in Raleigh, North Carolina were visited in their homes between October 1978 and February 1979. Eleven (2.9%) of 384 students completing the Center for Epidemiologic Studies self-report depression scale reported symptoms patterns consistent with the Research Diagnostic Criteria for major depressive disorder. These 11 subjects were concentrated in the top 12% of the distribution of symptom scores and had symptom prevalences exceeding those in the overall study population by a factor of three or more. Black males from low income households predominated. A self-report questionnaire may be usable to detect a depressive "syndrome" in young adolescents. The prevalence of such a syndrome is similar to prevalence estimates for adults and young adolescents, but considerably lower than estimates derived from total scale scores and cutoff points. A syndrome-oriented analytic approach for symptom scales should be explored as an alternative to the use of cutoff scores for epidemiologic studies of psychiatric disorders.
Adolescent↗
Endometrial cancer and detection bias.
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Aged↗