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Biomedical subjects

T D Koepsell

Publications and source records attributed to T D Koepsell.

At least 19 recordsLinked to original sources
PubMed1992

Risk factors for amputation in patients with diabetes mellitus. A case-control study.

OBJECTIVE: To identify and quantify risk factors for lower extremity amputation in persons with diabetes mellitus. DESIGN: Case-control study. SETTING: A Veterans Affairs medical center. PATIENTS: Eighty patients having amputation associated with diabetes and 236 diabetic controls without limb lesions were enrolled before surgery from the 21,167 inpatient care and outpatient surgical patients seen at the Seattle Veterans Affairs Medical Center during a 30-month period. MEASUREMENTS: Selected vascular, neuropathic, environmental, health care, self care, nutritional, metabolic, lifestyle, and psychosocial risk factors were measured in all patients before surgery. RESULTS: Statistically significant risk factors identified from analysis included insufficient mean below-knee and foot cutaneous circulation (odds ratio, 161; 95% CI, 55.1 to 469); ankle-arm blood pressure index less than 0.45 (odds ratio, 55.8; CI, 14.9 to 209); absence of lower leg vibratory perception (odds ratio, 15.5; CI, 8.3 to 28.7); low levels of high-density lipoprotein (HDL) subfraction 3 less than or equal to 0.7 mumol/L (odds ratio, 4.9; CI, 2.9 to 8.3); and no previous outpatient diabetes education (odds ratio, 3.2; CI, 1.6 to 6.6). A logistic regression analysis done to control for the potentially confounding effects of age; race; socioeconomic status; diabetes duration, type, and severity confirmed these findings and added a statistically significant interaction between foot transcutaneous oxygen tension and peripheral vascular disease history. Clinical interventions to alter these risk factors were identified, including aggressive treatment of infection, diabetes education, protective footwear, and preventive footcare. CONCLUSIONS: Multiple risk factors exist along the continuum of conditions and events leading to lower extremity amputation in diabetes. Modification of certain risk factors by patients and health professionals may reduce the risk for amputation and thus decrease the human and dollar costs that accompany limb loss in this prevalent chronic disease.

Adult↗
PubMed1992

Assessing response bias in random-digit dialling surveys: the telephone-prefix method.

Knowledge of the characteristics of survey non-respondents is important to determine generalizability to the population of interest. In a recent random-digit dialling survey of health behaviours only 73 per cent of the households contacted provided any information about household composition, and only 74 per cent of those actually completed the extended interview, for an overall response rate of 54 per cent. To identify possible biases we grouped all attempted phone numbers by their prefix, and looked for the association between the response rate for that prefix and other summary variables known about the prefix. A simulation study showed that the method can identify non-response biases if certain assumptions are correct. The analysis suggested that our survey data under-represent older people and those with a college education. We found no significant biases in health behaviours, possibly because the basic assumptions did not hold. This method may assist in identification of non-response bias in other studies.

Adult↗
PubMed1992

Association of smoking and alcohol drinking with residential fire injuries.

To investigate whether tobacco, alcohol, and their combined use are important risk factors for fire injuries, the authors analyzed data from a population-based case-control study in King County, Washington, between 1986 and 1987. Cases (n = 116) were households with at least one fatal or nonfatal unintentional residential fire injury reported to the Washington State Fire Incident Reporting System from 1984 through 1985. Controls were selected by random digit dialing (n = 256). After adjustment for household size, number of male household members, total household income, and education of the head of the household, the odds ratio for fire injury in households whose members collectively smoked 1-9 cigarettes per day was 1.5 (95% confidence interval (CI) 0.6-4.2) relative to households with no smokers; for 10-19 cigarettes per day, the odds ratio was 6.6 (95% CI 2.5-17.5), and for 20 or more cigarettes per day, it was 3.6 (95% CI 1.9-7.2). Although households with alcohol drinkers who consumed five or more drinks per occasion were found to be at increased risk in the crude analysis, multivariate analysis suggested that this was partly because drinkers tended to live in households with higher smoking levels. Thus, even though households with alcohol drinkers who consume five or more drinks per occasion may be at increased risk of residential fire injury, smoking appears to be the more important underlying risk factor.

Accidents, Home↗
PubMed1992

Cigarette smoking, alcohol use, and subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: Subarachnoid hemorrhage remains a devastating disease. Identification of etiologic risk factors would allow the possibility of prevention. METHODS: We conducted a population-based case-control study in King County, Washington. Patients whose bleeds originated from a source other than an aneurysm were excluded. Two age- and gender-matched control subjects were identified for each case through random digit telephone dialing. A standardized in-person interview was conducted with the patient whenever possible, a proxy respondent for the case in all instances, the two control subjects, and their proxies. Analyses involved conditional logistic regression taking into account matching on age, gender and respondent type. RESULTS: Over 2 years, 169 cases were identified, and 149 participated in the case-control study. Compared with those who never smoked, the odds ratio for current heavy smokers (greater than 20 cigarettes/day) was 11.1 (95% confidence interval [CI], 5.0-24.9); for current light smokers (less than or equal to 20 cigarettes/day), 4.1 (95% CI, 2.3-7.3); and for former smokers, 1.8 (95% CI, 1.0-3.2). The risk associated with smoking was greatest in the 3 hours after a cigarette (odds ratio [OR] = 7.0; 95% CI, 3.7-13.1) and then fell, not reaching the risk in those who had never smoked until more than 10 years had passed since the last cigarette. Heavy alcohol use (greater than 2 drinks/day) was also associated with bleeds (OR = 2.2; 95% CI, 0.9-5.1, after adjusting for smoking status). These associations were not substantially altered after adjusting for several possible confounding factors, including a history of hypertension. CONCLUSIONS: Cigarette smoking and heavy alcohol use are associated with the occurrence of subarachnoid hemorrhage.

Adult↗
PubMed1992

Restricted activity days among older adults.

OBJECTIVES: The number of restricted activity days experienced by an individual in the course of a year is an important measure of functional well-being, particularly for older adults. We sought to determine multivariate associations between restricted activity days and various health conditions. METHODS: We used data from the 1984 Supplement on Aging of the National Health Interview Survey to estimate the relationship between restricted activity days and age, gender, and the presence or absence of selected chronic conditions and falls for all noninstitutionalized people aged 65 years and over. Chronic conditions and falls accounted for most of the variance in the model. RESULTS: Of an annual average of 31 restricted activity days, 6 days were associated with falls; 4 days with heart disease; 4 days with arthritis and rheumatism; 2 days each with high blood pressure, cerebrovascular disease, and visual impairment; and 1 day each with atherosclerosis, diabetes, major malignancies, and osteoporosis. CONCLUSIONS: These results can be used in estimating the potential impact of health promotion programs on the health status of noninstitutionalized older adults.

Accidental Falls↗
PubMed1992

Level of blood pressure and risk of myocardial infarction among treated hypertensive patients.

To examine the association between the level of treated blood pressure and the incidence of myocardial infarction, we conducted a population-based case-control study of 912 members of a health maintenance organization who were receiving standard clinical treatment for hypertension. We found a J-shaped relationship between the most recently measured diastolic blood pressure and the risk of myocardial infarction, the lowest risk occurring at 84 mm Hg. The relative risk of myocardial infarction at 60 mm Hg was 2.07 (95% confidence interval, 0.86 to 5.01), and at 100 mm Hg, 1.45 (95% confidence interval, 1.02 to 2.06). Treated systolic pressure bore a linear relationship to the risk of infarction. We conclude that the optimum target range for diastolic blood pressure in hypertensive patients may be 84 to 90 mm Hg. Levels outside this range may be associated with increased risk of myocardial infarction.

Adrenergic beta-Antagonists↗
PubMed1992

Occupational injuries: a study of health care workers at a northwestern health science center and teaching hospital.

1. This retrospective study examined the magnitude of the problem of work related health hazards affecting professional and non-professional employees of a state university health science center and hospital. 2. From the 1,513 injury episodes that occurred among the 9,668 employees during the 32 month study period, it was determined that the highest risk categories for both department and job were nursing, housekeeping, food service, and laboratory technicians. 3. Injury rate for females (11.2 per 100 person years) was more than twice that of males (5.1). Injury rates declined from 11.6 per 100 person years at ages 25 to 39 to 3.8 at ages over 60. Puncture wounds (32.7%), mostly by needlesticks, were the most frequently reported injury type, followed by strains and sprains (17.2%), lacerations (12.5%), and contusions (12.1%).

Academic Medical Centers↗
PubMed1992

Pregnancy outcome in women with rheumatoid arthritis before disease onset.

Pregnancy outcome before disease onset was evaluated for women with rheumatoid arthritis (RA) and control women as part of a prospective case-control study of newly diagnosed RA. An analysis of women who were ever gravid revealed no statistically significant difference in any adverse pregnancy outcome between RA cases (n = 144) and controls (n = 605) including spontaneous abortions and stillbirths. Thus, in contrast to reports both of an increase of adverse pregnancy outcomes and a decrease in women who subsequently develop RA, we found no evidence for any difference in pregnancy outcome in the RA group.

Abortion, Spontaneous↗
PubMed1991

Natural history of the eosinophilia-myalgia syndrome.

OBJECTIVE: To describe the natural history and disease progression of the eosinophilia-myalgia syndrome and to assess the therapeutic effects of orally administered steroids on the disorder as of October 1990. DESIGN: Case-series analysis. A cohort of 45 patients with the eosinophilia-myalgia syndrome was followed prospectively by periodic telephone interviews and medical examinations for an average of 14 months after onset of illness. SETTING: Washington state. PATIENTS: The cases of 47 patients were reported to the Washington State Department of Health from 1 July to 12 December 1989. Two patients were unavailable for follow-up, and the remaining 45 completed the study. MAIN RESULTS: Patients were predominantly non-Hispanic white women (87%) with an average age of 49 years. Symptoms typically progressed from early onset of myalgia and fatigue to later development of neurologic and scleroderma-like skin changes. Six (13%) patients recovered completely within 2 to 5 months of symptom onset. After 14 months of illness, over half of the patients who initially presented with myalgia, fatigue, or scleroderma-like skin changes remained symptomatic. The average severity of each major symptom was measured using interviews and patient self-reports and has improved subjectively by at least 40%. Statistical analyses showed no significant difference in long-term symptom duration or severity between patients treated and those not treated with prednisone. CONCLUSIONS: The eosinophilia-myalgia syndrome is a long-term illness characterized by progressive improvement during the first 25 weeks after symptom onset, followed by a protracted phase of symptom resolution. We could not show a clear-cut benefit of prednisone in reducing the long-term severity or duration of the disease.

Adolescent↗
PubMed1991

Antigenic stimulation and the occurrence of chronic lymphocytic leukemia.

Data from a population-based case-control study of chronic lymphocytic leukemia were analyzed to assess the possible etiologic role of chronic antigenic stimulation. The study, conducted in four geographic areas of the United States (the metropolitan areas surrounding Seattle, Washington, Salt Lake City, Utah, Detroit, Michigan, and Atlanta, Georgia) sought to identify all incident cases (n = 430) among residents diagnosed between July 1, 1977 and December 31, 1981. The responses of these cases to questions about possible sources of antigenic stimulation were compared with the responses of controls selected from the populations of these areas. Little difference between cases and controls was present for a history of most forms of viral and bacterial infection and for a history of allergies or allergy treatment. However, a relation was observed with antecedent syphilis infection (odds ratio (OR) = 5.0, 95% confidence interval (Cl) 2.0-12.9). Associations of smaller magnitude were observed with a history of tuberculosis (OR = 1.9, 95% Cl 1.0-3.7) and of urinary tract infection (OR = 1.4, 95% Cl 1.1-1.9). Overall, however, the authors found little evidence of a relation between chronic antigenic stimulation and the occurrence of chronic lymphocytic leukemia. Nonetheless, because the measure of prior antigenic stimulation was restricted to that obtained through interviews and undoubtedly was an insensitive one, these negative results should not be interpreted as ruling out antigenic stimulation as a possible cause of some cases of chronic lymphocytic leukemia.

Aged↗
PubMed1991

Sampling elderly in the community: a comparison of commercial telemarketing lists and random digit dialing techniques for assessing health behaviors and health status.

A study of health behaviors in four communities in the western United States in 1988 provided the opportunity to compare two methods of sampling elderly respondents for a telephone interview. The Polk telemarketing lists were used to identify 1,407 respondents aged 65 years and older in four communities, where 253 respondents in the same age group were also identified by the method of random digit dialing. Individuals identified from the Polk lists received a letter prior to the initial telephone contact. The overall response rate was 49.3% for random digit dialing and 57.3% for the Polk lists. On the average, the identification of one elderly respondent using the Polk lists required about 20-25% as much interviewer time per subject identified as was required by the random digit dialing method. The elderly identified by the Polk lists were significantly older than those identified by random digit dialing, and the proportions of the Polk sample who were married, white, or had an income of greater than $10,000 were slightly higher than those of the random digit dialing sample. Among 40 variables measuring various health behaviors, indicators of health status, and participation in health-related programs and classes, only three differed significantly between the two samples. The authors conclude that sampling from commercial telemarketing lists was an efficient method of identifying elderly respondents and that in these four communities, the estimates of health behaviors and health status were comparable with those obtained by random digit dialing techniques.

Aged↗
PubMed1991

Rheumatoid arthritis in women. Incidence rates in group health cooperative, Seattle, Washington, 1987-1989.

As part of a prospective case-control study of newly diagnosed rheumatoid arthritis (RA) in women, we identified all cases of probable, definite, or classic RA diagnosed in 1987-1989 in 18-64-year-old women who were members of a health maintenance organization based in the Seattle, Washington area. Using both the 1958 and the 1987 American Rheumatism Association criteria for the diagnosis of RA and enrollment data from the health maintenance organization, we calculated the incidence by age and diagnostic class. Rates of RA incidence in women increased steadily with age. The incidence of probable, definite, or classic RA ranged from 13.1 per 100,000 person-years at risk for 18-29-year-old women to 82.1 per 100,000 person-years for 60-64-year-old women. The overall incidence rate, age-adjusted to the 1980 US female population, was 27.9/100,000 person-years. The overall incidence rate for definite/classic RA, age-adjusted to the 1980 US female population, was 23.9 per 100,000 person-years. When compared with adjusted rates of incidence of definite RA in Rochester, Minnesota, in 1950-1974, the incidence rates we found were 44.7% lower. Methodologic differences, changes in diagnostic criteria, and a declining incidence of RA among women over time may all be partial explanations for these results. The possible effects of reproductive factors, including oral contraceptives use, are discussed.

Adolescent↗
PubMed1991

An approach to several problems in using large databases for population-based case-control studies of the therapeutic efficacy and safety of anti-hypertensive medicines.

In this paper we discuss approaches to two distinct problems in using large computerized databases to conduct population-based case-control studies. The first topic, concerning case ascertainment, is a methodologic problem, and the second, concerning confounding by indication, is an analytic problem. The first involves attempting to ascertain all incident cases of coronary disease among enrollees of Group Health Cooperative of Puget Sound (GHC), a large health-maintenance organization. Methodologic studies reported here have helped us improve the efficiency of using the large computerized databases for case ascertainment at GHC. The second problem involves the issue of confounding by drug indication. Drugs such as beta-blockers have multiple indications, including the treatment of both high blood pressure and angina. These two indications may make it difficult in an observational study to determine whether beta-blockers may prevent coronary disease in patients with high blood pressure. We discuss here our current thinking about the best analytic approach to this problem.

Adrenergic beta-Antagonists↗
PubMed1991

Hypotheses to explain the association between vigorous physical activity and amyotrophic lateral sclerosis.

Many epidemiologic studies indicate a relation between vigorous physical activity and amyotrophic lateral sclerosis. Physical activity itself is unlikely to cause amyotrophic lateral sclerosis, but could it modify the effects of other etiologic factors such as neurotoxins? Vigorous physical activity could potentiate the effect of a toxin to motor neurons by any of several mechanisms, especially if the toxin's effects were mediated through excitation. Exercise could alter the extent of exposure or could influence the distribution, metabolism or potency of an excitotoxin. Future epidemiologic studies of amyotrophic lateral sclerosis should include sufficient detail about vigorous physical exercise to explore this relationship further.

Amyotrophic Lateral Sclerosis↗
PubMed1991

The evaluation of the Henry J. Kaiser Family Foundation's Community Health Promotion Grant Program: design.

The Kaiser Family Foundation's Community Health Promotion Grant Program (CHPGP) provides funding and technical assistance in support of community-based efforts to prevent major health problems. The first phase of the program was implemented in 11 communities in the western United States. This paper describes the evaluation design of the CHPGP in the West, the methods of data collection, and the baseline comparability of intervention and control communities. Major features of the evaluation design include: (1) the randomization of qualified communities making application into funded and unfunded comparison groups; (2) a second set of matched control communities for some intervention sites; (3) data gathering through repeated surveys of community residents (probability samples of adults and adolescents) and institutions (health-related organizations and randomly sampled grocery stores and restaurants); and (4) the use of secondary data to monitor health events. Selected baseline data show that intervention and control communities differ in racial/ethnic composition, but relevant health behaviors and ratings of community activation for health promotion appear comparable.

Adolescent↗
PubMed1991

Data analysis and sample size issues in evaluations of community-based health promotion and disease prevention programs: a mixed-model analysis of variance approach.

The growing interest in community-based approaches to health promotion and disease prevention (HP/DP) has been accompanied by a growing need to evaluate the effectiveness of such programs. Special issues that arise in these evaluation studies include (1) entire communities are assigned to intervention and control groups, (2) only a small number of communities can usually be studied, (3) the time course of changes in behavior and other outcomes is often of interest, and (4) surveys to measure such changes over time can be conducted with either repeated cross-sectional samples or with longitudinal samples. This paper shows how these issues can be addressed under a mixed-model analysis of variance approach. This approach serves to unify several ideas in the literature on evaluation of community studies, including use of time-series regression and the question of whether the individual or the community should be the unit of analysis. We also describe how the method can be used to estimate sample size requirements, statistical power, or minimum detectable program effect.

Analysis of Variance↗