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S Wassertheil-Smoller

Publications and source records attributed to S Wassertheil-Smoller.

35 records · Page 2Linked to original sources
PubMed1986

Prediction of response to sodium intervention for blood pressure control.

In the Dietary Intervention Study of Hypertension (DISH) we found that patients formerly treated with drugs and assigned to sodium-reduction intervention were twice as likely to remain off medication for up to 56 weeks as were the controls assigned to no-diet intervention, after adjusting for covariates. Within the sodium-restriction group approximately 60% of 131 people were Intervention Successes (IS) (urinary sodium less than or equal to 100 mmol/day at 8 weeks). The rest were classed as Non-Intervention Successes (NIS). Of the IS group, 54% were responders (drug-free for at least 56 weeks), but about 56% of the NIS group also remained drug-free. Multiple logistics showed that no one factor was able to predict response among the IS. We conclude that the IS likely to respond to sodium reduction are not readily identifiable a priori. Furthermore, since both IS and NIS showed similar blood-pressure effects from the sodium-restriction regimen compared with controls, the questions arise: whether a factor other than sodium reduction affects the blood pressure response for the sodium-restriction group; or whether the measurement of sodium intake and excretion is sufficiently precise to distinguish compliers from non-compliers.

Antihypertensive Agents↗
PubMed1985

Plasma vitamin C and uterine cervical dysplasia.

Plasma concentrations of vitamin C were determined in a case-control study of women (n = 80) who had sought a Papanicolaou test in the Bronx Municipal Hospital Center. Controls (n = 34) were women having negative cytologic tests, negative colposcopic findings, and no known gynecologic dysfunction. Cases (n = 46) were defined as women who had either one positive or two consecutive suspicious Papanicolaou smears in a 12-month period. The mean concentration of vitamin C in the plasma was significantly lower in the cases than in the controls (0.36 versus 0.75 mg/dl, p less than 0.0001). Cases were further stratified according to the histopathologic diagnosis. The data direct attention to a possible etiologic association of vitamin C in human cervical epithelial abnormalities. A clinical trial with vitamin C intervention is suggested.

Adult↗
PubMed1985

Dietary therapy slows the return of hypertension after stopping prolonged medication.

This study asks whether prolonged antihypertensive therapy will "cure" a substantial percent of rigorously treated hypertensive patients and whether nutritional change will add an antihypertensive effect and reduce the relapse rate. Of 584 eligible patients normotensive while receiving therapy, 496 were randomized into control and discontinued-medication groups with and without dietary intervention. At 56 weeks, 50% of those who were no longer receiving medication remained normotensive by study criteria. Randomization either to weight-loss group (mean loss of 4.5 kg [10 lb]) or to sodium-restriction group (mean reduction of 40 mEq/day) increased the likelihood of remaining without drug therapy, with an adjusted odds ratio of 2.17 for the sodium group and 3.43 for the weight group. Highest success rates were in the nonoverweight mild hypertensives with sodium restriction (78%) and the overweight mild hypertensives who were reducing their weight (72%). These data demonstrate that weight loss or sodium restriction, in hypertensives controlled for five years, more than doubles success in withdrawal of drug therapy.

Clinical Trials as Topic↗
PubMed1985

Effective dietary intervention in hypertensives: sodium restriction and weight reduction.

A Dietary Intervention Study of Hypertension (DISH) was undertaken to determine whether patients whose high blood pressure had been controlled pharmacologically for a period of more than 5 years could maintain that control with sodium restriction or weight reduction instead of drugs. Four hundred ninety-six patients, classified by degree of overweight, were randomly assigned into one of seven groups. Included were those who would be withdrawn from antihypertensive medication and receive intervention for either sodium restriction or weight reduction. After 8 weeks of intervention, an average reduction of 24-hour urinary sodium output from a baseline of 158 mEq to 106 mEq (p less than .001) and from 130 mEq to 96 mEq (p less than .01) was achieved for the overweight and nonoverweight groups, respectively. That decline was still maintained at 56 weeks. Dietary estimates, obtained by analysis of 3-day food records, underestimated urinary output by an average of 12%, with blacks more likely to underestimate than whites, and the overweight more likely to underestimate than the nonoverweight. An average 10-lb weight loss was achieved, with no difference between men and women. Weight declined for 32 weeks, then leveled off and was maintained up to 56 weeks, indicating that sodium intake modification can be accomplished faster than weight reduction. Modest sodium restriction and weight reduction are feasible and achievable in a free-living population and have a positive effect on control of hypertension.

Clinical Trials as Topic↗
PubMed1979

Recent status of detection, treatment, and control of hypertension in the community.

The Hypertension Detection and Follow-up Program (HDFP), a national collaborative study, screened approximately 159,000 people for high blood pressure in 14 communities between 1973 and 1974. Results show that detection, treatment, and control of high blood pressure has improved considerably since the 1960s. Whereas in the past about half of all hypertensives knew they had high blood pressure, half of those detected were under treatment, and half of those under treatment had their high blood pressure under control, the corresponding percentages in the 14 HDFP communities a decade later indicate that 75% of hypertensives were detected, 72% of those were under treatment, and 70% of those under treatment had a diastolic blood pressure under 95 mm Hg. While the differences in prevalence of hypertension are between races rather than sexes (with black individuals in some age groups being about twice as likely as white individuals to have hypertension), the differences in detection and treatment rate are largely between sexes and not between races. Women are considerable more likely to be aware of their hypertension, to be under treatment for it, and to have their high blood pressure under control. Rates of control vary considerably among age-sex-race subgroups, from only 8% of white male hypertensives aged 30-39 to 67% of white female hypertensives aged 60--69. It appears that although efforts to combat this disease over the past decade have probably made considerable progress in improving the recognition and treatment of high blood pressure, there remain a large number of undetected, untreated, and uncontrolled hypertensives.

Adult↗
PubMed1979

Physicians' changing attitudes about striking.

Both interns and residents and practicing physicians express substantial support for physicians' organizing for collective bargaining and striking. These findings, from 1146 respondents to a 1976 survey of the alumni of the Albert Einstein College of Medicine, indicate that profound changes have occurred in physicians' views on these issues. Although the greatest support for striking came from interns and residents, with 67 per cent of them indicating they think physicians should be allowed to strike, the survey found an increasing pattern of militancy commencing with 1964 graduates. Physicians in private practice and those who spent two-thirds or more of their time in direct patient care were the most likely to support strikes by physicians (60 per cent), while the least support came from those fulltime on medical school faculties (39 per cent). No differences in support for striking were found in relation to sex, religion or size of community in which physicians practice. A longitudinal examination of the medical school Class of 1975 at matriculation, at graduation and during internship training reveals that a major growth of support for striking occurred between matriculation and graduation.

Attitude of Health Personnel↗
PubMed1979

Hydrolase activities in the rat aorta. III. Effects of regular swimming activity and its cessation.

It is possible that one of the consequences of regular physical activity could be a change of vascular metabolism. We studied the effects of regular swimming activity on specific activities of aortic hydrolases of male rats. Enzymes included: neutral alpha-glucosidase and lysosomal beta-galactosidase, N-acetyl-beta-glucosaminidase, cathepsin C, acid alpha-glucosidase, and acid cholesteryl esterase. After 8 or 16 weeks of a 1-hour/day swimming protocol, specific activities of four of the six aortic enzymes studied were increased over control levels, increases ranging from 7 to more than 42%. Acid cholesteryl esterase was one of the enzymes most affected by the exercise, increasing 25-30% above control levels. An 8-week sedentary period, after 8 weeks of a swimming regimen, resulted in return of the activity of acid cholesteryl esterase, but not those of the other hydrolases, to control levels. Decreases in body weight, blood pressure, and serum lipid levels also occurred in the swimming rats. Weight reduction per se was excluded as an explanation for the increases in aortic enzymes or decrease in serum cholesterol found with swimming. These findings show that regular physical activity is yet another factor with discrete and significant effects on the catabolic activity of vascular tissue.

Acetylglucosaminidase↗
PubMed1978

An evaluation of the utility of high blood pressure detection fairs.

Our data indicate that voluntary casual screenings in essentially middle class locations may be of limited value in attracting the young, the black, and the male relative to the target population. Our screens attracted a large proportion of individuals who where already aware of their high blood pressure. Nevertheless, these screens can be useful in getting and keeping individuals under medical care: newly detected hypertensives, those who knew they have it and even some of those under treatment for it.

Evaluation Studies as Topic↗
PubMed1975

Computer-aided management of hypertensive patients.

A computerized system has been developed which potentially enables a single expert physician to monitor a large number of hypertensive patients being seen at distant locations. The patients may receive their care directly from primary care physicians or nurse-physician surrogates. Primary care physicians can use the same data bank to monitor their own panels of patients. These goals are accomplished through a special purpose, interactive programming language which can be used to perform sophisticated data retrieval along different complexes of parameters. The physician is able to query the computer, via a terminal, about any group of patient he defines and have displayed to him the clinical data requested. The system is open-ended, enabling one query to lead to another. Four hundred and ninety-three patients have been entered into this program so far, including 29 patients with diastolic pressures greater than 115, 92 with diastolic pressures of 104 to 114, and 372 with diastolics of 90 to 104. Among patients who have been on therapy for at least six weeks, 80 per cent were at goal blood pressure. Ten to 14 weeks after therapy was initiated, 69 per cent of all patients in the program were at goal blood pressure. The system provides a useful means of monitoring a large hypertensive population of patients. Such a system can result in a more efficient utilization of medical personnel and can bring the consultative services of highly trained specialists to larger segments of the population.

Computers↗
PubMedDate not supplied

Teaching clinical epidemiology to medical students using a collaborative learning model.

Epidemiology and biostatistics are difficult to teach in medical school. To determine the feasibility of applying a collaborative learning model, we randomly assigned one section of an epidemiology and biostatistics class to use this teaching model. Students in this section did not attend lectures or follow the regular curriculum but instead learned epidemiologic concepts by identifying clinical problems of interest to them and reviewing relevant journal articles, with the group leader functioning as facilitator. All students took an identical examination and anonymously evaluated the course. Examination performance was comparable between the study group (mean 72.1%) and the other students (mean 73.5%). However, the students' evaluation of the study group method was more favorable, especially in their perceived mastery of specific cognitive skills. The data suggest that this model can be successfully applied in teaching epidemiology and biostatistics to medical students.

Biometry↗