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Biomedical subjects

Thomas D Koepsell

Publications and source records attributed to Thomas D Koepsell.

At least 19 recordsLinked to original sources
PubMed2007

Release from prison--a high risk of death for former inmates.

BACKGROUND: The U.S. population of former prison inmates is large and growing. The period immediately after release may be challenging for former inmates and may involve substantial health risks. We studied the risk of death among former inmates soon after their release from Washington State prisons. METHODS: We conducted a retrospective cohort study of all inmates released from the Washington State Department of Corrections from July 1999 through December 2003. Prison records were linked to the National Death Index. Data for comparison with Washington State residents were obtained from the Wide-ranging OnLine Data for Epidemiologic Research system of the Centers for Disease Control and Prevention. Mortality rates among former inmates were compared with those among other state residents with the use of indirect standardization and adjustment for age, sex, and race. RESULTS: Of 30,237 released inmates, 443 died during a mean follow-up period of 1.9 years. The overall mortality rate was 777 deaths per 100,000 person-years. The adjusted risk of death among former inmates was 3.5 times that among other state residents (95% confidence interval [CI], 3.2 to 3.8). During the first 2 weeks after release, the risk of death among former inmates was 12.7 (95% CI, 9.2 to 17.4) times that among other state residents, with a markedly elevated relative risk of death from drug overdose (129; 95% CI, 89 to 186). The leading causes of death among former inmates were drug overdose, cardiovascular disease, homicide, and suicide. CONCLUSIONS: Former prison inmates were at high risk for death after release from prison, particularly during the first 2 weeks. Interventions are necessary to reduce the risk of death after release from prison.

Adolescent↗
PubMed2006

Hormonal exposures and the risk of intracranial meningioma in women: a population-based case-control study.

BACKGROUND: The role of exogenous hormone exposures in the development of meningioma is unclear, but these exposures have been proposed as one hypothesis to explain the over-abundance of such tumors in women. METHODS: The association between oral contraception (OC) or hormone replacement therapy (HRT) and intracranial meningioma in women was investigated using a population-based, matched case-control study. Exposures for 143 cases and 286 controls matched on age within five years were obtained by interview. Diagnoses were confirmed histopathologically and estrogen and progesterone receptor assays conducted. RESULTS: Although risk of meningioma appeared modestly elevated in past OC users (OR = 1.5, 95% CI 0.8 - 2.7), and in current users (OR = 2.5, 95% CI 0.5 - 12.6), the confidence intervals were wide. No significant association between meningioma risk and duration of OC use was found. Likewise, risk of meningioma was only weakly associated with past use of HRT (OR = 0.7, 95% CI 0.4 - 1.3), and not at all with current use of HRT (OR = 1.0, 95% CI 0.5 - 2.2). Of 142 available specimens, 2 (1%) expressed estrogen receptors, whereas 130 (92%) expressed progesterone receptors (PR). OC use was associated with increased risk of a meningioma expressing less rather than more PR (OR = 3.2, 95% CI 1.3 - 8.0). Overall, in post menopausal women, HRT use appeared to confer a non-significant protective effect, and was not associated with low or high PR expressing meningiomas. CONCLUSION: This study found little evidence of associations between meningioma and exogenous hormone exposures in women but did suggest that some hormonal exposures may influence tumor biology in those women who develop meningioma.

Adult↗
PubMed2006

Pediatricians' clinical decision making: results of 2 randomized controlled trials of test performance characteristics.

OBJECTIVE: To determine whether presenting test performance characteristics influences clinical management. DESIGN: Two questionnaire-based, randomized controlled trials. SETTING: Mailed surveys with 2 clinical vignettes. PARTICIPANTS: Randomly selected US pediatricians (N=1502). INTERVENTION: Vignette-specific, randomly assigned test information: no additional information (control), test characteristics (TC), or TC defined. In the pertussis vignette, the TC group received the direct fluorescent antibody test's sensitivity and specificity, and the TC defined group received the same information with definitions. In the urinalysis vignette, the TC group received the false-positive rate of persistent microhematuria in predicting renal disease, and the TC defined group received a definition of this information. MAIN OUTCOME MEASURES: In the pertussis vignette, diagnostic test choice and management of erythromycin therapy and hospital discharge plans. In the urinalysis vignette, serum laboratory testing and nephrology referral plans. RESULTS: Six hundred fifty-three participants (49.5% of those eligible) returned completed surveys. In the pertussis vignette, significantly more of the TC (73%) and TC defined (71%) groups ordered the best-performing test than did controls (21%) (P<.001 for both comparisons). Receiving test characteristics did not significantly affect erythromycin therapy or hospital discharge plans (P>or=.40). In the urinalysis vignette, the TC defined group referred to nephrology (30%) and checked laboratory tests (88%) significantly more often than did controls (19%, P=.01; 78%, P=.01, respectively), but the TC and control groups' testing and referral plans did not differ significantly (22% vs 19%, P=.36; 75% vs 78%, P=.48, respectively). CONCLUSION: Providing test performance characteristics influenced certain clinical decisions, sometimes in unexpected ways.

Adult↗
PubMed2006

Maternal DDT exposures in relation to fetal and 5-year growth.

BACKGROUND: Dichlorodiphenyltrichloroethane (DDT) is an organochlorine pesticide still used in areas of the world where malaria vector control is needed. Few studies have examined in utero exposures to DDT in relation to fetal and early childhood growth in populations with substantial exposure to DDT. Furthermore, only a portion of these studies have investigated in utero exposures and growth during childhood. METHODS: To assess the role of in utero exposures to DDT on fetal and early childhood growth, we analyzed data from mothers and children who participated in the Child Health and Development Study (CHDS), a cohort study of 20,754 women and their pregnancies conducted in the San Francisco Bay area during the 1960s. We measured p,p'-DDE, o,p'-DDT, and p,p'-DDT concentrations from the stored sera of 399 women collected during pregnancy. Outcomes were measured at the child's birth and at 5 years of age. RESULTS: Maternal p,p'-DDE concentrations were considerable in this study, averaging 6.9 micrograms per gram lipid. After covariate adjustment, a small increase in gestational age was observed with increases in p,p'-DDT and o,p'-DDT, but there was no association with p,p'-DDE. At 5 years of age, an increase from the 25th to the 75th percentile in p,p'-DDE was related to a 2-mm increase in head circumference (95% confidence interval = 0 to 4). Overall effect sizes were small and imprecise. Furthermore, there was little evidence of specificity for a given outcome or exposure at either age. CONCLUSIONS: At the concentrations studied in this sample, DDT compounds did not appear to impair fetal or 5-year growth.

Adult↗
PubMed2006

The risk of reinjury in relation to time since first injury: a retrospective population-based study.

BACKGROUND: Trauma victims have been found to be at increased risk for reinjury. Determining the risk factors for reinjury and the temporal pattern of reinjury risk can help with targeting of intervention strategies for preventing trauma recurrence. METHODS: We performed a retrospective, population-based study in Washington State from 1986 to 2001. Individuals aged 15 to 64 years who were hospitalized for injury were followed for 5 years for hospitalization or death because of reinjury. Poisson regression was used to determine the rate ratio of reinjury, compared with the baseline rate of injury, as a function of time since first injury. Among those injured, proportional hazards regression was used to determine risk factors for reinjury. RESULTS: The risk of subsequent injury hospitalization or death was elevated 2.59-fold (95% CI: 2.50, 2.68) during the period from 6 months to 5 years after the initial injury. Excluding from analysis the first 6 months after initial injury, the risk of reinjury was highest at 4.10 (95% CI: 3.83, 4.40) between 6 and 12 months after first injury, and then declined to approximately 2.0-fold increased risk above baseline by 30 months. Individuals with self-inflicted injuries were found to be at particularly high risk of reinjury [Hazard Ratio (HR) 2.60 (2.21, 3.05)]. Increasing age, male gender, and alcohol use were also associated with increased reinjury risk. Any injury to the face, spine, and extremities were associated with a decreased risk of reinjury. CONCLUSIONS: Reinjury risk is highest soon after injury, but persists for at least 5 years after initial injury. Periodic interventions through 5 years after injury, particularly in certain high-risk groups, might have lasting effects on reinjury rates.

Abbreviated Injury Scale↗
PubMed2006

German short forms of the Oral Health Impact Profile.

OBJECTIVES: We report the development and psychometric evaluation of short forms of the Oral Health Impact Profile German version (OHIP-G) - an instrument to assess oral health-related quality of life (OHRQoL). METHODS: A five-item short form was developed using best subset regression in 2050 subjects from a national survey. Two 14-item versions were derived from English-language short forms and a 21-item version from previous factor analytic work. A second sample from the general population (n = 163) and a sample of clinical patients with temporomandibular disorders (TMD; n = 175) were used to investigate validity and internal consistency. Test-retest reliability was evaluated in 30 prosthodontic patients before treatment. Responsiveness was assessed in 67 patients treated for their TMD pain. RESULTS: Associations between short form summary scores and self-report of oral health and four oral disorders in the general population and in TMD patients were interpreted as support for convergent/groups validity. The instruments' responsiveness (effect measures of 0.55-0.98), test-retest reliability (intraclass correlation coefficients: 0.72-0.87), and internal consistency (Cronbach's alpha: 0.65-0.92) were sufficient. CONCLUSIONS: Sufficient discriminative and evaluative psychometric properties of short forms of the OHIP-G make the instruments suitable to assess OHRQoL in cross-sectional as well as longitudinal studies.

Adolescent↗
PubMed2005

Epidemiology of musculoskeletal injuries among high school cross-country runners.

To determine the incidence of lower-extremity injury among high school cross-country runners and to identify risk factors for injury, the authors prospectively monitored a cohort of 421 runners competing on 23 cross-country teams in 12 Seattle, Washington, high schools during the 1996 cross-country season. Collected were daily injury and athletic exposure (AE) reports, a baseline questionnaire on prior running and injury experience, anthropometric measurements, and coaches' training logs. The overall incidence rate of injury was 17.0/1,000 AEs. Girls had a significantly higher overall injury rate (19.6/1,000 AEs) than boys did (15.0/1,000 AEs) (incidence rate ratio = 1.3, 95% confidence interval: 1.0, 1.6). Compared with boys, girls had significantly higher rates of injuries resulting in >or=15 days of disability. For the overall sample and for girls, Cox regression revealed that a quadriceps angle of >or=20 degrees and an injury during summer running prior to the season were the most important predictors of injury. For boys, a quadriceps angle of >or=15 degrees and a history of multiple running injuries were most associated with injury. Results suggest that the incidence of lower-extremity injuries is high for cross-country runners, especially girls. Preseason screening to determine risk factors should be examined as a preventive approach for identifying high-risk runners.

Adolescent↗
PubMed2005

Do cases and controls matched on the first eight digits of their telephone number share geographic proximity and socioeconomic characteristics?

PURPOSE: The aim of this study is to assess the geographic proximity of cases and controls who share the same "stem" of their telephone number (area code, prefix, and next two digits) and compare their socioeconomic characteristics. METHODS: We compared residential proximity and characteristics of case-control sets selected in this way with sets consisting of the same cases matched to different controls on all variables except telephone number stem. RESULTS: Mean distance between telephone stem-matched pairs was much less than that between pairs not matched by telephone number stem (3.53 and 20.14 km, respectively). There was slight agreement between cases and controls for some measures of socioeconomic status in both sets. We also compared distances between residences of control respondents who shared the same telephone number stem with those between residences of respondents who shared only the same telephone area code and prefix. Mean distances for the two groups were similar. CONCLUSIONS: Geographic proximity between cases and controls can be achieved by matching on either telephone number stem or only telephone area code and prefix. Adjustment for socioeconomic factors may be needed even if cases and controls live close to each other.

Age Factors↗
PubMed2005

Elevated prevalence of hepatitis C infection in users of United States veterans medical centers.

Several studies suggest veterans have a higher prevalence of hepatitis C virus infection than nonveterans, possibly because of military exposures. The purpose of this study was to estimate the prevalence of anti-hepatitis C antibody and evaluate factors associated with infection among users of Department of Veterans Affairs medical centers. Using a two-staged cluster sample, 1288 of 3863 randomly selected veterans completed a survey and underwent home-based phlebotomy for serological testing. Administrative and clinical data were used to correct the prevalence estimate for nonparticipation. The prevalence of antihepatitis C antibody among serology participants was 4.0% (95% CI, 2.6%-5.5%). The estimated prevalence in the population of Veterans Affairs medical center users was 5.4% (95% CI, 3.3%-7.5%) after correction for sociodemographic and clinical differences between participants and nonparticipants. Significant predictors of seropositivity included demographic factors, period of military service (e.g., Vietnam era), prior diagnoses, health care use, and lifestyle factors. At least one traditional risk factor (transfusion or intravenous drug use) was reported by 30.2% of all subjects. Among those testing positive for hepatitis C antibody, 78% either had a transfusion or had used injection drugs. Adjusting for injection drug use and nonparticipation, seropositivity was associated with tattoos and incarceration. Military-related exposures were not found to be associated with infection in the adjusted analysis. In conclusion, the prevalence of hepatitis C in these subjects exceeds the estimate from the general US population by more than 2-fold, likely reflecting more exposure to traditional risk factors among these veterans.

Adult↗
PubMed2005

Colorectal cancer among Asians and Pacific Islanders in the U.S.: survival disadvantage for the foreign-born.

BACKGROUND: Asian Americans and Pacific Islanders (AAPI) have better colorectal cancer survival than other racial populations. However, immigrants face challenges that may place them at higher risk for late diagnosis and death. METHODS: To compare survival between the foreign- and U.S.-born, we identified 17,302 AAPI colorectal cancer patients between 1973 and 1998 from the Surveillance, Epidemiology, and End-Results (SEER) Program. Patients were categorized as foreign-born or U.S.-born using multiple imputation methods. RESULTS: Foreign birth was associated with higher risk for death from any cause (hazard ratio [HR] 1.29; 95% CI 1.23-1.36) and with modestly higher risk after adjustment for selected demographic characteristics (HR 1.13; 95% CI 1.05-1.21) and registry site (HR 1.05; 95% CI 0.98-1.14). Although foreign-born AAPI were more likely to present later, additional adjustment for cancer stage reduced but did not eliminate their higher risk of death (HR 1.09; 95% CI 1.01-1.18) CONCLUSIONS: Compared to the U.S.-born, foreign-born AAPI have poorer survival following colorectal cancer diagnosis. Future investigation of the care processes after diagnosis may be important in understanding these differences.

Aged↗
PubMed2005

The acute medical care costs of fall-related injuries among the U.S. older adults.

OBJECTIVES: Falls in the older adults are a major public health concern. The growing population of adults 65 years or older, advances in medical care and changes in the costs of care motivated our study of the acute health care costs of fall-related injuries among the older adults in the United States of America. DESIGN AND SETTINGS: The Market Scan Medicare Supplemental database 1998 was used to estimate reimbursed costs for hospital, emergency department (ED), and outpatient clinic treatments for unintentional falls among older adults. RESULTS: A fall on the same level due to slipping, tripping, or stumbling was the most common mechanism of injury (28%). Mean hospitalisation cost was 17,483 US dollars(S.D.: 22,426 US dollars) in 2004 US dollars. Femur fracture was the most expensive type of injury (18,638 US dollars, S.D.: 19,990 US dollars). The mean reimbursement cost of an ED visit was 236 US dollars and 412 US dollars for an outpatient clinic visit. CONCLUSION: The magnitude of the economic and social costs of falls in older adults underscores the need for active research in the field of falls prevention.

Accidental Falls↗
PubMed2005

Evaluating diagnostic accuracy in appendicitis using administrative data.

BACKGROUND: Research techniques using administrative data have been used to assess quality of care in the management of appendicitis, but their validity has not been assessed. This study assessed the validity of a research technique using administrative data to determine whether patients undergoing an appendectomy actually had appendicitis or if they had a negative appendectomy (NA). MATERIALS AND METHODS: A retrospective study of patients at Group Health Cooperative of Puget Sound undergoing appendectomy from 1991-1999 was conducted to compare the accuracy of administrative codes with data abstracted from medical records. RESULTS: Of 1823 nonincidental appendectomies (mean age 31 +/- 18.6 years, 49.6% female), 280 did not have appendicitis by criteria applied to administrative data (15.4%). The accuracy of this method for determining appendicitis was determined by medical record evaluation revealing sensitivity (98.6%), specificity (48.6%), positive predictive value for appendicitis (83.8%), and negative predictive value for NA (70.4%). When the administrative-data technique did not classify a patient as having had appendicitis, chart-abstracted data indicated appendicitis in 6.4%, and an incorrectly labeled incidental appendectomy in 23.2%. The administrative-data technique for detecting NA erroneously included many cases of incidental appendectomy and missed many cases of clinically confirmed NA. More than half of clinical NAs were missed by the administrative technique. CONCLUSIONS: In this setting, the sensitivity of administrative-data techniques for the detection of appendicitis was excellent, but their adequacy for identifying patients undergoing NA was limited. The use of this technique as a quality measure should be reconsidered.

Adolescent↗
PubMed2005

Psychiatric distress amplifies symptoms after surgery for chronic rhinosinusitis.

BACKGROUND: Psychiatric disorders are associated with increased symptom burden when combined with chronic medical conditions. However, there are no reports of how psychiatric distress influences outcomes with surgical treatment for chronic rhinosinusitis (CRS). We hypothesized that subjects with psychiatric distress (somatization, anxiety, and depression) would report more severe long-term sinus symptoms and worse quality of life (QOL) than subjects without psychiatric distress. METHODS: This is a community-based, prospective, observational cohort study of patients diagnosed with CRS presenting for surgery. Patients were interviewed before surgery; CT scans were reviewed, and questionnaires were completed about sinusitis-related symptoms (SNOT-16), general health status and QOL (SF-36), and psychiatric distress (BSI and PHQ). Outcomes were also assessed 1, 3, 6, and 12 months postoperatively. RESULTS: Ninety-five patients had complete records for analysis. Psychiatric distress was prevalent, with 31% screening positive for somatization, 17% positive for anxiety, and 25% positive for depressive disorders. Subjects with somatization had significantly worse SNOT-16 scores at each time point compared with those without somatization ( P < 0.05). Subjects with depression reported more severe symptoms at 6 and 12 months after surgery than those without depression ( P < 0.05). The presence of somatization preoperatively was also independently associated with worse symptom severity 12-months after surgery, even after adjusting for prior sinus surgery, CT stage, Charlson Index, and deviated septum. In addition, subjects with psychiatric distress reported significantly worse SF-36 physical and mental component summary scores 12-months after surgery than subjects without psychiatric distress. CONCLUSIONS: Psychiatric distress is associated with worse reported sinus symptoms and lower QOL throughout surgical management of chronic rhinosinusitis. Despite this, subjects with psychiatric distress report a similar degree of improvement in sinus symptoms after surgery compared with those without distress. CLINICAL SIGNIFICANCE: Psychiatric distress should be considered in patients with persistent symptoms after surgery. Psychiatric distress should also be considered in efforts to design a chronic sinusitis staging system.

Anxiety Disorders↗
PubMed2005

Evaluation of a community-based handgun safe-storage campaign.

OBJECTIVE: Safe storage of firearms has been recommended as a means of preventing gun-related pediatric injuries, yet few interventions have led to significant improvements in storage practices. This study examined a multifaceted community education campaign to promote safe handgun storage and the campaign's impact on firearm locking and loading practices in households with children. METHODS: Beginning in 1997, a safe-storage campaign consisting of television and radio announcements, educational materials, billboards, and discount coupons for lock boxes was conducted in King County, Washington. The campaign evaluation used a quasi-experimental design and compared the intervention site with 9 control counties outside Washington State and west of the Mississippi River. Cross-sectional, random-digit-dial telephone surveys of handgun-owning households with children were conducted in all study counties both before the intervention in 1996 (n = 302) and again in 2001 (n = 255). The main analyses assessed whether greater improvements in household firearm-storage practices occurred between 1996 and 2001 in the intervention, compared with the control, counties. Primary outcomes were based on up to 3 handguns per household and included (1) all stored with trigger locks, lock boxes, or gun safes (formal locking devices), (2) all stored in lock boxes or gun safes, (3) any stored loaded, (4) any stored loaded without a formal locking device, and (5) any stored loaded and not in a lock box or gun safe. Data were also collected on up to 1 long gun per household; long-gun outcomes included (1) stored with a trigger lock or gun safe and (2) stored loaded. RESULTS: Overall, handguns and long guns were generally more likely to be stored locked and less likely to be loaded in 2001 compared with 1996, with these trends seeming to be more consistent in the intervention county. Even so, more than one quarter of households with children and handguns in 2001 failed to store all of their handguns with a formal locking device, and up to 8% continued to possess at least 1 loaded handgun that was not stored with a formal device. The majority of households that stored their handguns with formal devices used lock boxes or gun safes. Storage of handguns in lock boxes or gun safes became more common in both the intervention (adjusted odds ratio [aOR]: 1.71; 95% confidence interval [CI]: 1.03-2.84) and control households (aOR: 1.66; 95% CI: 1.01-2.72) between 1996 and 2001. None of the other measured changes reached statistical significance, such as storing any household handgun loaded (aOR: 0.71; 95% CI: 0.35-1.42 [intervention]; aOR: 1.08; 95% CI: 0.58-2.00 [control]) or keeping any household handgun loaded and not stored in a lock box or gun safe (aOR: 0.59; 95% CI: 0.22-1.55 [intervention]; aOR: 0.67; 95% CI: 0.30-1.49 [control]). Moreover, the intervention county did not experience significantly greater overall improvements in household storage practices for handguns or long guns than did control counties. CONCLUSIONS: In both the intervention and control counties, households were more likely to lock all handguns in 2001 compared with 1996. After accounting for temporal trends, this educational campaign, combined with economic incentives to purchase lock boxes, did not seem to significantly change safe storage practices in households with handguns and children. Even if the campaign did result in small improvements in firearm safe storage, simultaneous national and state-specific gun-safety activities or legislative efforts may have drawn increasing attention to gun-related issues in the control counties, thereby making it more difficult to identify effects of our specific handgun storage intervention.

Accident Prevention↗
PubMed2005

Medicaid acceptance and availability of timely follow-up for newborns with Medicaid.

OBJECTIVE: Decreased physician participation in Medicaid has been shown to affect adversely timeliness of adult acute care and pediatric specialty care, but it is not clear whether this is the case for newborn follow-up. The objectives of this study were to determine whether there is a difference within clinics in the timeliness of follow-up appointments that are given to newborns with Medicaid compared with newborns with private insurance and to determine whether there is a difference between clinics that do and do not accept Medicaid in the timeliness of appointments that are given for newborn follow-up. METHODS: A randomized crossover study was conducted among general pediatric clinics and practices that were identified from the yellow pages and Internet searches of hospitals and health departments in 8 metropolitan areas from September 2003 to March 2004. A simulated parent telephoned clinics to find the earliest available appointment for a 1-day-old infant who needed routine follow-up after discharge that day. Clinics were randomly assigned to receive a first call from a patient with either Medicaid or private insurance; each clinic received the same call at least 3 weeks later with the patient's insurance status reversed. The main outcome measure was whether the appointment was timely (< or =2 days from the day of the call). RESULTS: Of 401 participating clinics, 22% did not accept Medicaid. Among clinics that accepted Medicaid, availability of a timely appointment for a newborn with Medicaid was similar to that for a newborn with private insurance (87% vs 90%, respectively). Appointments that were provided to privately insured newborns were as likely to be timely in clinics that accept Medicaid as in clinics that do not accept Medicaid (89.5% vs 93.4%, respectively). However, providing timely appointments was significantly less likely in clinics that were in high-poverty locations compared with clinics that were not (86.1% vs 92.7%, respectively). CONCLUSIONS: Although newborns with Medicaid did not have access to >20% of clinics because of their insurance, among clinics that did accept Medicaid, timeliness of available follow-up was similar for newborns with Medicaid compared with newborns with private insurance and similar between clinics that did and did not accept Medicaid. However, to the extent that care for newborns with Medicaid is concentrated in clinics in high-poverty areas, some newborns with Medicaid may not be able to receive timely appointments.

Community Health Services↗
PubMed2005

Glycemic control and the risk of multiple microvascular diabetic complications.

BACKGROUND AND OBJECTIVES: Tight glycemic control in type 2 diabetes reduces risk of certain end-organ complications. However, among patients with one complication already, it is unknown whether tight glycemic control reduces the risk of subsequent complications in another organ. We sought to determine if glycemic control is associated with the risk of a second, distinct, end-organ diabetic complication. METHODS: Subjects were a retrospective cohort of 250 patients with type 2 diabetes, at least one microvascular diabetic complication, and at least one hemoglobin A1c (HbA1c) measurement after that complication. Proportional hazard models estimated the relative hazard of developing another diabetic complication in a second organ system, as predicted by either (1) mean HbA1c level over the study period or (2) first HbA1c after the initial complication. RESULTS: Thirty-eight patients had a second complication; the average follow-up duration was 3.7 years. The mean HbA1c model showed an adjusted relative hazard of 1.25 (95% confidence interval [CI]=1.04, 1.51) per percentage-point elevation in mean HbA1c. The first HbA1c model showed an adjusted relative hazard of 1.23 (95% CI=1.08, 1.40) per percentage-point elevation in first HbA1c. CONCLUSIONS: Among these type 2 diabetes patients with an initial complication, tight glycemic control was associated with reduced risk of additional complications in other organs.

Adult↗
PubMed2005

A short acculturation scale for Mexican-American populations.

Acculturation is important to examine variables that differentiate members of ethnic groups so that interventions can be appropriately targeted. By using a population-based sample of Mexican-origin adults, we sought to validate an acculturation scale for Mexican-American populations. The acculturation instrument included eight items adapted from the Acculturation Rating Scale for Mexican Americans (ARSMA). By using principal component analysis, we calculated eigenvalues for the eight items. The first principal component accounted for 66% of the variance. Language spoken most of the time, by itself, explained 62.4% of the variance of the full model, whereas birthplace, by itself, accounted for 74%. Slight increases in correlation values were observed beyond a four-item model that included language spoken most of the time, language thought, ethnic identity, and birthplace. Future studies should compare this scale with other multidimensional scales.

Acculturation↗