Biomedical subjects

Robert T Greenlee

Publications and source records attributed to Robert T Greenlee.

11 recordsLinked to original sources

PubMed2006

Acute health events in adult patients with genetic disorders: the Marshfield Epidemiologic Study Area.

PURPOSE: We ascertained and reviewed acute health events occurring in 2003 among patients age 18 and greater with well-defined single gene, chromosomal, and selected multifactorial conditions within the Marshfield Epidemiologic Study Area. METHODS: Of 47,077 adult Marshfield Epidemiologic Study Area Central cohort members, 1,831 (3.9%) had been given at least one of 71 ICD-9 codes appropriate for genetic diagnoses of interest. Physician review narrowed this to 591 (1.3%) validated patients for the study. Of the 591, 527 (89.2%) patients registered 6,849 visits, which were manually reviewed to delineate acute, relevant health events in the urgent care and primary care provider setting. RESULTS: A total of 244 acute relevant health events among 126 patients corresponding to 58 different genetic conditions were observed. Acute relevant health events corresponded to 3.4% of the total health events in patients identified with genetic problems. Categories of genetic conditions with the highest frequencies of acute relevant health events included chromosomal and microdeletion syndromes (21.3%), hematologic disorders (11.5%), muscular dystrophies (8.6%), and connective tissue disorders (10.2%). CONCLUSIONS: These data have multiple applications and implications in addressing the natural history, long-term medical needs and financial impact of adult patients with genetic conditions.

Acute Disease↗

PubMed2006

Characteristics of diagnosed polymorphous light eruption.

BACKGROUND: The characteristics of polymorphous light eruption (PMLE) have been described in patients evaluated and diagnosed at specialized photodermatology centers. Our goal was to describe the characteristics of PMLE diagnosed in a general clinic setting. METHODS: We used electronic medical records to identify patients diagnosed with PMLE from 2000 to 2002 within a large group practice. We then collected additional information from medical records about patient demographics, lesion morphology, diagnostic testing, and therapies for the selected patients. RESULTS: We identified 142 patients with diagnosed PMLE. After manual chart review, we excluded 18 patients with other forms of photosensitivity, eczema, or collagen vascular disease. Eighty-percent of the remaining 124 patients were diagnosed by a dermatologist during the study period. Females predominated in our patient series and the mean age of PMLE onset was 37.8 years. Lesions were commonly described as papular, edematous papulare, papulo-vesicular, eczematous, and plaque-like. Few skin biopsies were performed, and no patient had phototesting or photopatch testing. Topical corticosteroids and antihistamines were the most commonly prescribed therapies. Only four patients were treated with phototherapy. CONCLUSIONS: Patient demographics and lesion morphology in our cohort were similar to other reports, but patterns of diagnostic testing and treatment were somewhat different than those observed in photodermatology clinics.

Adrenal Cortex Hormones↗

PubMed2005

Recent progress in the epidemiology of atrial fibrillation.

PURPOSE OF REVIEW: Atrial fibrillation is a common arrhythmia with serious health consequences. This review explores contributions to the characterization and control of atrial fibrillation made by recent epidemiologic efforts. RECENT FINDINGS: Topics included in this review include the classification and clinical progression of atrial fibrillation, the burden atrial fibrillation places on the individual and on the health care delivery system, temporal trends in the occurrence and effect of atrial fibrillation, and novel predictors and risk factors. In light of the clinically relevant classification system used in the 2001 American College of Cardiology/American Heart Association/European Society of Cardiology Practice Guidelines for atrial fibrillation, recent estimates of pattern-specific recurrence and progression rates are described, along with insights into the incidence and prognosis of primary and secondary atrial fibrillation. Important new studies from North America and Europe quantifying the alarming health care burden and economic effect of atrial fibrillation are summarized. A discussion of several novel risk factors recently found to be associated with the development of atrial fibrillation is also included. SUMMARY: Better characterization of the predictors, natural history, and clinical course of atrial fibrillation should ultimately support improvements in prevention, clinical decision making, and patient communication. A fuller comprehension of the current and future impact of atrial fibrillation can assist in planning health care delivery from the local facility to the international arena. Finally, there is a growing recognition that unraveling the complex interplay between atrial fibrillation and other associated diseases and their common risk factors may hold promise of deep insights into the fundamental nature of cardiovascular diseases.

Atrial Fibrillation↗

PubMed2005

Rate control versus rhythm control.

PURPOSE OF REVIEW: The results of five randomized clinical trials comparing rate control with rhythm control in the management of atrial fibrillation have been published recently. The purpose of this report is to review their main results and selected subanalyses and other related data to offer practical recommendations regarding the treatment of patients with this common arrhythmia. RECENT FINDINGS: In the aggregate, the five trials enrolled a total of 5175 subjects and accumulated 16,186 patient-years of follow-up. All these trials have had similar results in that each of them failed to demonstrate a clear advantage of the rhythm control approach over that of rate control. The largest of the studies, the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study, enrolled 79% of all the cases in the five trials and accounts for 88% of the cumulative follow-up experience and for 92% of all deaths. Among AFFIRM participants, antiarrhythmic drug use did not improve survival, stroke risk, quality of life, or functional capacity but was associated with increased resource use. In several of the trials, however, the presence of sinus rhythm was associated with improved outcomes. SUMMARY: The evidence is now overwhelming that for most patients with atrial fibrillation, rhythm control using currently available antiarrhythmic drugs is more expensive but not more effective than the rate control strategy in the prevention of major adverse events. Further research is needed to determine whether maintaining sinus rhythm by other means can improve outcomes.

Anti-Arrhythmia Agents↗

PubMed2003

Eczematous skin disease and recall of past diagnoses: implications for smallpox vaccination.

BACKGROUND: Persons with atopic dermatitis or eczema, regardless of disease severity or activity, may develop eczema vaccinatum if they or their close contacts receive the smallpox vaccine. According to current recommendations, a preexposure vaccination program should identify these persons and exclude them from participating. OBJECTIVE: To determine the prevalence of diagnosed atopic dermatitis and eczema in a defined population and assess the sensitivity of screening questions to identify patients who have received these diagnoses. DESIGN: Population-based prevalence survey and telephone interview. SETTING: 14 ZIP code regions in Wisconsin. PATIENTS: Persons given a diagnosis of atopic dermatitis or eczema in 2000 and 2001 were identified from a population-based cohort. Persons with a history of atopic dermatitis diagnosed since 1979 were eligible for the telephone survey. MEASUREMENTS: Prevalence of diagnosed atopic dermatitis or eczema; proportions of respondents able to recall a past diagnosis of atopic dermatitis, eczema, or recurrent rash. RESULTS: The prevalence of atopic dermatitis or eczema diagnosis in 2000 or 2001 was 0.8%. At least 2.4% of the cohort would be ineligible for smallpox vaccination because of active skin disease in themselves or household members. Among 94 adult respondents with atopic dermatitis, 55 (59%) correctly self-reported skin disease. Seventy-nine (60%) of 133 household contacts of adults with atopic dermatitis correctly reported the presence of skin disease in a household member. Parental recall of skin disease in children with atopic dermatitis was 70% (123 of 177). CONCLUSIONS: Identifying dermatologic contraindications to smallpox vaccination by relying only on a self-reported history of rash illnesses is likely to miss a substantial proportion of individuals who should not receive smallpox vaccine in a preexposure vaccination campaign.

Adolescent↗

PubMed2003

Long-term trends in cancer mortality in the United States, 1930-1998.

BACKGROUND: Progress against cancer can be examined by analyzing long-term trends in cancer incidence and mortality. The recent directive from the U.S. Department of Health and Human Services to adopt the 2000 U.S. standard population for the age adjustment of death rates prompted the American Cancer Society to update historical cancer mortality statistics using the new standard. METHODS: Mortality data were abstracted by race, gender, year, and age at death for 1930 through 1959 from annual volumes of Vital Statistics of the United States. For 1960 through 1998, these data were obtained from data tapes provided by the National Center for Health Statistics. Two U.S. standard million populations (1970 and 2000) were used to calculate age-adjusted rates. Average annual percent change was estimated for each decade by site, gender, and age, and the statistical significance of the change was assessed at p < 0.05. RESULTS: After long-term increases or mostly level trends that date from the 1930s for some sites, death rates for cancers of the lung (in males), prostate, female breast, colon-rectum, pancreas, leukemia, and ovary were decreasing in the 1990s. Liver cancer death rates were increasing in the 1990s. Throughout the study period, death rates for female lung cancer increased, while death rates for stomach and uterine cancers declined. CONCLUSIONS: The trends of decreasing cancer death rates for the leading cancer sites in the 1990s are encouraging. However, surveillance researchers must continue to monitor these declines to assess whether the progress seen in this decade persists. Efforts also must be made to study the sites with increasing trends and identify potential underlying causes.

Adolescent↗

PubMed2003

Diarrhea incidence and farm-related risk factors for Escherichia coli O157:H7 and Campylobacter jejuni antibodies among rural children.

Serum samples were obtained from 215 farm-resident children and 396 non-farm-resident children living in a defined rural Wisconsin population. Antibodies to Campylobacter jejuni and Escherichia coli O157:H7 lipopolysaccharide (O157 LPS) immunoglobulin G were measured, and the incidence of clinic visits for diarrheal illness was determined. Risk factors were assessed in a telephone interview. There were 363 children (59%) with C. jejuni antibodies (seropositive for >or=2 immunoglobulin classes) and 86 (14%) with O157 LPS antibodies. Increasing age and farm residence were independently associated with C. jejuni seropositivity by multivariate analysis. O157 LPS antibodies were independently associated with increasing age, female sex, manure contact, and sheep contact. The incidence of clinically recognized diarrhea was similar among children with and without antibodies to C. jejuni and O157 LPS, but the clinic visit rate for diarrhea was 46% lower among farm-resident children. These results are consistent with reduced occurrence of clinical illness from repeated antigenic stimulation in a farm environment.

Adolescent↗

PubMed2003

Measuring disease frequency in the Marshfield Epidemiologic Study Area (MESA).

The Marshfield Epidemiologic Study Area (MESA) is a rare resource for population-based health and medical research developed at Marshfield Clinic Research Foundation. Because of high population coverage and health event capture, MESA is particularly useful for determining the frequency of disease in the general population. A substantial proportion of MESA-based publications appearing in the peer reviewed literature have reported incidence or prevalence rates of disease or disease-related factors. This paper reviews the first 10 years of MESA's support of meaningful inquiry into the frequency of disease occurrence, and briefly reports on the data and methods used for such calculations using selected chronic diseases as examples. Limitations of MESA estimates are discussed as are alternate methods. Compared to limited data published for the selected conditions, occurrence rates in MESA based on diagnostic codes and general validation rules only appear somewhat high, although the observed temporal trends and relationships with demographics are consistent. Rich clinical data sources are available to be linked with MESA to improve the specificity of case ascertainment, as is typically done for disease-specific publications from MESA.

Chronic Disease↗

PubMed2003

The epidemiology of agriculture-related osteoarthritis and its impact on occupational disability.

BACKGROUND: Hip and knee osteoarthritis and undiagnosed chronic joint pain are more prevalent in agricultural workers than other occupational groups, significantly impacting the ability of small farm operators and farm workers to maintain a livelihood. METHODS: Agricultural risk factors, economic impacts, national and state AgrAbility data, gender, and farm/non-farm prevalence differences of arthritis and joint arthropathy in a Wisconsin farm cohort are reviewed. RESULTS: Agricultural workers (primarily male) are at increased risk for developing osteoarthritis of the hip and knee. In Wisconsin, the prevalence rate of osteoarthritis is higher in a male farm vs. a male rural non-farm cohort. Arthritis comprises 10%-12% of the disability referrals to state and national AgrAbility programs. Back pain, joint injury, and orthopedic injury account for another 38%. The ability to perform agricultural job duties is significantly affected by arthritis and lack of access to health care. Obesity is an additional independent risk factor for osteoarthritis in the rural population. CONCLUSIONS: The agricultural work force is at particular risk for arthritis-related disability. Improved access to health care for diagnosis and treatment can lessen disability. Prevention of arthritis is multi-factorial, involving ergonomic improvements, lifestyle modification to prevent obesity, and adequate medical treatment of arthritis.

Agricultural Workers' Diseases↗

PubMed2002

Lyme disease incidence in Wisconsin: a comparison of state-reported rates and rates from a population-based cohort.

Few studies have assessed the accuracy and completeness of Lyme disease surveillance systems. Lyme disease cases were identified through review of medical records for residents of the Marshfield Epidemiologic Study Area (MESA), a population-based cohort of nearly 80,000 in north-central Wisconsin for which comprehensive medical care data are available through the Marshfield Clinic. These cases were compared with cases reported to the Wisconsin Division of Public Health to estimate the completeness of reporting. Annual incidence rates were calculated for MESA using the cases identified from chart review. Division of Public Health data were used to calculate statewide reported incidence rates, as well as rates for an eight-county region that surrounds and includes the MESA region. Of Lyme disease cases meeting the national case definition identified in MESA, 34% were reported to the state. The average incidence of Lyme disease (1992-1998) was 19.1 per 100,000 per year in MESA, 17.0 in the surrounding eight-county region, and 9.0 statewide. Trends in reported incidence across time, gender, and age in the surrounding eight-county region were generally comparable with those observed in MESA. These findings suggest that the passive surveillance system monitored trends in Lyme disease incidence reasonably well despite underreporting of cases.

Adolescent↗

PubMed2002

Incidence of myocardial infarction in a general population: the Marshfield Epidemiologic Study Area.

BACKGROUND: Much of what is known about the occurrence of myocardial infarction (MI) in populations is derived from mortality data. International heart disease registries and recent population-based studies provide only limited incidence data from selected areas of the United States. METHODS: The Marshfield Epidemiologic Study Area (MESA), a defined geographic region where nearly all residents receive their health care from the Marshfield Clinic and affiliated hospitals, is a resource for estimating disease incidence in a general population. MI incidence rates and time trends from 1992 to 1998 were evaluated in MESA. RESULTS: A total of 1691 MESA residents had their first MI during the study period (age-adjusted rate, 292.4 per 100,000 per year). Rates in MESA were similar to some, and higher than other, incidence rates reported from US populations. About 20% of first MIs were detected only on death certificates. Overall incidence did not change much over time (-0.4% per year, P = 0.68), although rates declined 2.3% per year among women (P = 0.07). CONCLUSIONS: This is the first report of MI incidence in a general population from Wisconsin. The fairly steady incidence trend and the large number of incident events detected through death certificates demonstrate the continued need for primary prevention.

Adult↗