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Biomedical subjects

Richelle J Koopman

Publications and source records attributed to Richelle J Koopman.

At least 19 recordsLinked to original sources
PubMed2006

Association of a polychlorinated dibenzo-p-dioxin, a polychlorinated biphenyl, and DDT with diabetes in the 1999-2002 National Health and Nutrition Examination Survey.

The association of a polychlorinated dibenzo-p-dioxin, a polychlorinated biphenyl, and p,p'-DDT with diabetes was evaluated using the 1999-2002 National Health and Nutrition Examination Survey. Persons 20 years old and older were included. Relationships with diagnosed diabetes, undiagnosed diabetes (glycohemoglobin (HbA1c) >6.1%), and total diabetes (diagnosed plus undiagnosed) were tested. When all three chemicals were evaluated together for total diabetes, the unweighted number of participants was 1830. All three compounds were significantly associated with diagnosed diabetes. PCB 126 and p,p'-DDT were significantly associated with undiagnosed diabetes. 1,2,3,6,7,8-hexachlorodibenzo-p-dioxin (HxCDD) was not associated with undiagnosed diabetes. When the three chemicals were included in a combined model for total diabetes, PCB 126>83.8pg/g lipid adjusted had an odds ratio of 2.57 (95% CI 1.33-4.95) compared to PCB 126 < or = 31.2pg/g lipid adjusted. Also significant in a combined model for total diabetes was p,p'-DDT 20.8-26.6ng/g lipid adjusted with an odds ratio of 2.52 (95% CI 1.26-5.02) and p,p'-DDT >26.6ng/g lipid adjusted with an odds ratio of 2.74 (95% CI 1.44-5.23) both compared to p,p'-DDT < or = 20.7ng/g lipid adjusted. HxCDD was not associated with total diabetes in a combined model. When participants with poor liver function and poor kidney function were removed from the analysis, the combined model for total diabetes produced similar results with PCB 126 and p,p'-DDT having been significantly associated, and HxCDD not having been associated. These findings add to the list of chemicals found to be associated with diabetes in the 1999-2002 National Health and Nutrition Examination Survey.

Adult↗
PubMed2006

Rural residence and Hispanic ethnicity: doubly disadvantaged for diabetes?

CONTEXT: Hispanics are at increased risk for diabetes, while rural residents have historically had decreased access to care. PURPOSE: To determine whether living in a rural area and being Hispanic confers special risks for diagnosis and control of diabetes. METHODS: We analyzed the Third National Health and Nutrition Examination Survey (1988-1994). Hispanics and non-Hispanic white adults were classified according to rural/urban residence to create 4 ethnicity-residence groups. Investigated outcomes were previously diagnosed and undiagnosed diabetes. Among those with diagnosed diabetes, we investigated control of glucose, hypertension, and lipids. FINDINGS: The prevalence of diagnosed diabetes was greatest for rural residents, especially for rural Hispanics (8.2%) versus that for urban whites (4.6%), rural whites (6.5%), or urban Hispanics (4.5%), (P < .01). However, urban Hispanics were most likely to have undiagnosed diabetes at 3.7%, versus 2.3% of rural whites, 2.8% of urban whites, and 2.7% of rural Hispanics (P = .04). Among people with diagnosed diabetes, there was no difference in glycemic control between the 4 groups. Rural Hispanics with diagnosed diabetes had the greatest prevalence of elevated systolic blood pressure at 45%, compared to 37% of urban whites, 29% of rural whites, 28% of urban Hispanics (P = .01). In regression models controlling for potential confounders, there were no differences among urban and rural whites and Hispanics in the likelihood of undiagnosed diabetes or in glycemic control for those with diagnosed diabetes. CONCLUSIONS: Initiatives that target Hispanic health, and especially diabetes, should acknowledge rural/urban Hispanic health differences.

Adult↗
PubMed2006

Diabetes management in the USA and England: comparative analysis of national surveys.

OBJECTIVES: To compare diabetes management in adults between England and the United States, particularly focusing on the impact of a universal access health insurance system. DESIGN: Analysis of the nationally-representative surveys Health Survey of England, 2003 (unweighted n =14 057) and the National Health and Nutrition Examination Survey, 2001-2002 (unweighted n =5411). SETTING AND PARTICIPANTS: Adults 20-64 years of age; individuals >65. MAIN OUTCOME MEASURES: Glycaemic, lipid and blood pressure control and medication use among individuals with previously diagnosed diabetes. RESULTS: Among those aged 20-64 the prevalence of diagnosed diabetes was lower in England (2.7%) than in the USA (5.0%). The proportion with diabetes receiving treatment was similar for the two countries. However, the mean HbA1c in England was 7.6%: in the USA it was 7.5% for those with insurance and 8.6% for those without insurance. The proportion of individuals on ACE inhibitors in England was 39%: in USA it was 39% for those with insurance, and 14% for those without. CONCLUSIONS: Individuals in a healthcare system providing universal access have better managed diabetes than those in a market based system once one accounts for insurance.

Adult↗
PubMed2006

Multiple lipid scoring system for prediction of coronary heart disease risk: application to African Americans.

BACKGROUND: Clinicians often obtain a panel of lipids but then only use low-density-lipoprotein (LDL) cholesterol to make clinical decisions. We previously described the multiple lipid measure, a strategy that integrates information about seven lipid measures. Our current inquiry uses the multiple lipid measure to create a scoring system and validates that system in a second cohort. METHODS AND RESULTS: A scoring system that uses total cholesterol, high-density lipoprotein (HDL) cholesterol, LDL cholesterol and triglycerides was developed and tested. African-American participants of the Atherosclerosis Risk in Communities (ARIC) Study were used to validate the multiple lipid measure score. For nonsmokers, scores > or = 2 had a hazard ratio of 4.25 (95% CI 1.92-9.40) compared to reference scores of < or = -3 in adjusted survival analysis predicting incident coronary heart disease risk in the ARIC. The best conventional single lipid measure for nonsmokers was LDL cholesterol. Compared to LDL cholesterol <100 mg/dl, those with LDL cholesterol > or = 160 mg/dl had a hazard ratio of 2.31 (95% CI 1.13-4.75). For current smokers, the best conventional lipid measure was the total cholesterol/HDL cholesterol ratio, which was similar in predictive ability to the multiple lipid measure score. However, the multiple lipid measure score predicted an additional 10% of the cohort at risk compared to the total cholesterol/HDL cholesterol ratio. CONCLUSIONS: The use of the multiple lipid scoring system improves the assessment of incident coronary heart disease risk and may have utility for clinicians in integrating lipid values.

Black or African American↗
PubMed2005

Iron, lipids, and risk of cancer in the Framingham Offspring cohort.

Iron and lipids combine to create oxidative stress, and oxidative stress has a role in the development of cancer. The objective was to determine the risk of cancer among persons who had both elevated iron and lipids. The authors conducted an analysis of the cohort available in the Framingham Offspring Study. Adults aged 30 or more years at baseline had serum iron and high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol, and very low density lipoprotein cholesterol (VLDL-C) assessed in 1979-1982 and were followed for development of cancer until 1996-1997 (n = 3,278). Cox regression models were computed while controlling for age, gender, smoking status, and body mass index. In adjusted models, both elevated iron (hazard ratio (HR) = 1.66, 95% confidence interval (CI): 1.11, 2.46; 29 cases) and VLDL-C (HR = 1.54, 95% CI: 1.04, 2.28; 93 cases) had significant independent risks for development of cancer. When elevated iron was combined with elevated VLDL-C, the adjusted relative risk of cancer increased (HR = 2.68, 95% CI: 1.49, 4.83; 18 cases). Elevated iron and low HDL-C also had a significant adjusted relative risk of cancer (HR = 2.82, 95% CI: 1.50, 5.28; 14 cases). The results suggest that elevated serum iron levels coupled with either high VLDL-C or low HDL-C appear to interact to increase cancer risk in this cohort.

Adult↗
PubMed2005

Predicting coronary heart disease risk using multiple lipid measures.

Principal component analysis was used to summarize variations among 7 lipid measures included in the Framingham Offspring Study (n = 2,694). An overall measure combining information from the 7 lipids was compared with conventional lipid measures in adjusted survival analyses and was found to be a superior predictor of coronary heart disease risk.

Adult↗
PubMed2005

Race and diet in the overweight: association with cardiovascular risk in a nationally representative sample.

OBJECTIVE: Because dietary differences may account for much of the racial and ethnic disparities in cardiovascular risk status, we evaluate the effect of race on cardiovascular risk after adjustment for dietary factors. METHODS: Prevalence of healthy diets in overweight U.S. adults (body mass index > or = 25 kg/m(2), age > or = 18 y) by race or ethnicity was determined by using 24-h dietary recalls from the National Health and Nutrition Examination Survey of 1999 to 2000. Dietary recalls included daily total calories, percentage of calories obtained from saturated fat, cholesterol, dietary fiber, and sodium and potassium intakes. Logistic regressions were used to evaluate the association between race/ethnicity, dietary factors, and cardiovascular risk markers (high levels of total cholesterol, C-reactive protein, systolic blood pressure, and diastolic blood pressure and low levels of high-density lipoprotein). RESULTS: The percentage of respondents who met healthy diet parameters ranged from 11.2 to 63.3. Non-Hispanic whites without diagnosed disease were less likely to have healthy diets than were African Americans or Hispanics, except with regard to cholesterol and fiber intake. After controlling for dietary factors, African American ethnicity was associated with a lower risk of hypercholesterolemia (odds ratio 0.587, 95% confidence interval 0.403 to 0.855), lower level of high-density lipoprotein (odds 0.440, 95% confidence interval 0.236 to 0.763), and a greater risk of high systolic blood pressure (odds ratio 2.383, 95% confidence interval 1.043 to 5.442) compared to whites. CONCLUSIONS: Differences in adherence to healthy diet parameters by race/ethnicity exist. However, after adjustment for diet and other modifiable factors, African Americans have a decreased risk of hypercholesterolemia and low level of high-density lipoprotein but an increased risk of systolic hypertension. Further research into the genetic basis for these differences is suggested.

Adult↗
PubMed2005

Views of family medicine department Chairs about mentoring junior faculty.

Mentoring can be a key component contributing to the success of faculty. We investigated the attitudes of family medicine department Chairs toward mentoring, with emphasis on mentoring female and minority faculty. This qualitative inquiry used semi-structured interviews with 13 Chairs of US departments of family medicine. Although most Chairs felt that mentoring had value, a minority of our sample had formal mentoring programs. Multiple mentors were suggested for female and minority faculty to meet both their personal career and content needs. Availability of senior faculty is a key resource. Until more senior women and minority faculty are available, cross-gender and cross-ethnicity mentoring will need to be utilized.

Administrative Personnel↗
PubMed2004

Relationship between continuity of care and diabetes control: evidence from the Third National Health and Nutrition Examination Survey.

OBJECTIVES: We examined the relationship between continuity of care and diabetes control. METHODS: We analyzed data on 1400 adults with diabetes who took part in the Third National Health and Nutrition Examination Survey. We examined the relationship of continuity of care with glycemic, blood pressure, and lipid control. RESULTS: Continuity of care was associated with both acceptable and optimal levels of glycemic control. Continuity was not associated with blood pressure or lipid control. There was no difference between having a usual site but no usual provider and having a usual provider in any of the investigated outcomes. CONCLUSIONS: Continuity of care is associated with better glycemic control among people with diabetes. Our results do not support a benefit of having a usual provider above having a usual site of care.

Adolescent↗
PubMed2004

Specialist management and coordination of "out-of-domain care".

BACKGROUND AND OBJECTIVES: Fifteen percent of Medicare patients receive care only from specialists. This has led to the supposition that there might be a "hidden system of primary care," where specialists provide comprehensive care to their patients, including care traditionally outside their specialty domain. This study explores the perspectives of specialists at an academic medical center on their decisions to provide "out-of-domain" care and how it is coordinated. METHODS: We used grounded theory methodology and a constant comparative process with 13 specialist interviews. RESULTS: Patient requests drive the provision of out-of-domain care. Specialist comfort with this care and desire to perform it are involved with their decision to provide out-of-domain care. Coordination of out-of-domain care performed by specialists can be difficult and time consuming but is important and is facilitated by electronic medical records. CONCLUSIONS: The results suggest that there is no hidden system of primary care. Coordination among all providers of medical care for a patient is needed to prevent medical errors, especially when specialists provide out-of-domain care.

Academic Medical Centers↗
PubMed2004

A suggested fourth-year curriculum for medical students planning on entering family medicine.

BACKGROUND: Students interested in a family medicine residency often seek advice about what electives to take in their final year of medical school. This study sought to develop a consensus about what rotations to recommend and what essential skills students should possess before starting their family medicine residency. METHODS: We conducted Delphi studies with panels of experienced community- and university-based family medicine residency directors and predoctoral educators in departments of family medicine at US medical schools. Each group participated in a three-phase Delphi process that asked each member to identify potential rotations and skills and then narrowed the list to those of the highest priority. RESULTS: Both the residency directors and predoctoral educators recommended that students participate in an ambulatory family medicine month in their fourth year of medical school, along with electives in emergency medicine, dermatology, obstetrics, and an acting internship (subinternship) in internal medicine. While there was some divergence in the panel's opinions, both panels felt that superior interviewing skills, the ability to manage undifferentiated problems, and the interpretation of common imaging studies were essential skills that students should have before entering a family medicine residency. CONCLUSIONS: Experienced family medicine educators appear to agree that students benefit most from a few specific rotations during the final year of medical school. This information may be useful to faculty members who advise students during medical school.

Clinical Clerkship↗
PubMed2004

Undiagnosed obesity: implications for undiagnosed hypertension, diabetes, and hypercholesterolemia.

BACKGROUND AND OBJECTIVES: Since obesity is a risk factor for hypertension, diabetes, and hypercholesterolemia, health care providers should screen obese individuals for these common diseases. It is possible that obese adults are not receiving appropriate screening for these diseases. This study's objective was to describe the prevalence of undiagnosed obesity, diabetes, hypertension, and hypercholesterolemia, in a nationally representative sample of obese US adults, by patients' recollection of whether they had received such a diagnosis. METHODS: The prevalence of undiagnosed disease was obtained by identifying respondents in the 1999-2000 National Health and Nutrition Examination Survey (NHANES) who had findings consistent with a condition but who did not report being told they had that condition by a health care provider. RESULTS: The prevalence of undiagnosed obesity, diabetes, hypertension, and hypercholesterolemia in currently obese US adults is 22.9%, 11.3%, 16.1%, and 37.7%, respectively. Significant predictors of undiagnosed obesity include black race and younger age. In addition, obese adults with excellent self-reported general health condition and lower body mass index are less likely to have diagnosed obesity. CONCLUSIONS: Health care providers are missing valuable opportunities to address obesity and diagnose diabetes, hypercholesterolemia, and hypertension in obese adults. An emphasis on screening obese individuals for these diseases is needed to improve health promotion.

Adult↗
PubMed2003

Continuity of care and recognition of diabetes, hypertension, and hypercholesterolemia.

BACKGROUND: Continuity of care has been shown to have a variety of health benefits, but the effect of continuity of care on recognition of common chronic diseases has been underinvestigated. OBJECTIVE: To examine the relationship between continuity of care and the recognition of 3 prevalent chronic diseases: diabetes, hypertension, and hypercholesterolemia. METHODS: We analyzed data from the third National Health and Nutrition Examination Survey, a nationally representative sample of 18 162 adult noninstitutionalized residents of the United States collected from 1988 through 1994. We examined the proportion of unrecognized disease among all individuals with diabetes, hypertension, and hypercholesterolemia according to self-reported level of continuity of care. We used logistic regression to control for possible confounders, including number of disease risk factors. RESULTS: Among persons with diabetes, in adjusted models, those with a usual provider of care had a lower likelihood of having unrecognized disease (odds ratio, 0.30; 95% confidence interval, 0.10-0.95) than those with no usual site or provider of care. Unrecognized hypertension had an unadjusted relationship with level of continuity of care, but continuity of care was not a significant predictor after possible confounders were adjusted for. Unrecognized hypercholesterolemia was not predicted by level of continuity of care. CONCLUSIONS: Continuity of care has some benefits in terms of recognizing chronic disease, although benefits appear to be disease specific. More research needs to be conducted to elucidate the complex relationship between continuity and disease recognition.

Adolescent↗
PubMedDate not supplied

Acculturation and diabetes among Hispanics: evidence from the 1999-2002 National Health and Nutrition Examination Survey.

OBJECTIVE: Hispanic individuals in the United States have a greater prevalence of diabetes mellitus than non-Hispanic white individuals; however, it is unclear whether Hispanics' risk of diabetes differs based on their level of acculturation. The purpose of our research was to examine acculturation among Hispanic Americans with respect to prevalence and control of diabetes. METHODS: We conducted an analysis of the National Health and Nutrition Examination Survey (NHANES), 1999-2002, a nationally representative sample of the noninstitutionalized U.S. population. We evaluated data on Hispanic adults (> or = 18 years of age, unweighted n=2,696), analyzing diagnosed diabetes, glycemic blood pressure and lipid control, and diabetes complications according to acculturation as measured by language and birth outside the United States. RESULTS: Hispanics with low acculturation were more likely to be without a routine place for health care, have no health insurance, and have low levels of education. In adjusted analyses, individuals with low acculturation, measured by language, were more likely to have diabetes (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.02, 3.54). Among individuals with diagnosed diabetes, no significant association was yielded between acculturation and diabetes control. However, individuals with low language acculturation were more likely to have the diabetes complication of peripheral neuropathy (OR 4.01, 95% CI 1.40, 11.48). CONCLUSIONS: Acculturation as measured through language is associated with diabetes and complications among Hispanics even after controlling for a variety of demographic characteristics including health insurance and education. The findings suggest that even within a "single" minority ethnic group, there are differences in disease prevalence and complications and access to health care.

Acculturation↗
PubMedDate not supplied

Changes in age at diagnosis of type 2 diabetes mellitus in the United States, 1988 to 2000.

PURPOSE: The prevalence of diabetes in the United States is increasing. There is also concern that diabetes may be occurring at a greater frequency in youth and in young adults. We describe US population trends in self-reported age at diagnosis of type 2 diabetes mellitus. METHODS: We undertook a secondary analysis of data from the National Health and Nutrition Examination Survey (NHANES) 1999-2000 and NHANES III (1988-1994). Both surveys are stratified, multistage probability samples targeting the civilian, noninstitutionalized US population, which allow calculation of population estimates. We included adults aged 20 years and older. We compared self-reported age at diagnosis of type 2 diabetes between the 2 survey periods. RESULTS: The mean age at diagnosis decreased from 52.0 to 46.0 years (P <.05). Racial and ethnic differences in age at diagnosis found in 1988 to 1994 are no longer found in 1999 to 2000. CONCLUSIONS: The age at diagnosis of type 2 diabetes mellitus has decreased with time. This finding likely represents a combination of changing diagnostic criteria, improved physician recognition of diabetes, and increased public awareness. Younger age at diagnosis may also reflect a true population trend of earlier onset of type 2 diabetes.

Age Factors↗
PubMedDate not supplied

Evidence of nephropathy and peripheral neuropathy in US adults with undiagnosed diabetes.

PURPOSE: Nearly one third of diabetes cases in the United States is undiagnosed, with mounting evidence that complications accrue even before clinical diagnosis. We wanted to determine whether persons with undiagnosed diabetes have signs of nephropathy and peripheral neuropathy. METHODS: We examined the prevalence of positive screening tests for nephropathy and peripheral neuropathy in adults aged > or = 40 years with undiagnosed diabetes using secondary analysis of survey and examination data from the population-based United States National Health and Nutrition Examination Survey 1999-2002. We defined a positive screening test for nephropathy as a spot urine albumin-creatinine ratio > 30.0 mg/g, representing at least microalbuminuria. We defined > or = 1 insensate area on Semmes-Weinstein monofilament testing as a positive finding for neuropathy. Undiagnosed diabetes was defined as a combination of no history of diagnosed diabetes and a measured fasting glucose > or = 126 mg/dL. We used SUDAAN for chi2 and regression analyses. RESULTS: The prevalence of a positive test when screening for nephropathy among those with undiagnosed diabetes was 26.5% compared with 7.1% in those with no diabetes (chi2, P <.01). After adjusting for age and diagnosed or undiagnosed hypertension, the association of undiagnosed diabetes with nephropathy persisted (odds ratio = 2.35; 95% confidence interval, 1.38-4.01). For peripheral neuropathy, 21.5% with undiagnosed diabetes had positive screening tests compared with 10.1% with no diabetes (chi2, P <.01); however, this effect was not significant after adjustment for age. There was no significant difference in positive screening tests for nephropathy or neuropathy when comparing those with undiagnosed and diagnosed diabetes. CONCLUSIONS: A significant proportion of adults with undiagnosed diabetes have signs of nephropathy and peripheral neuropathy. These findings may influence policies about early screening for diabetes.

Adult↗