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Biomedical subjects

W M O'Fallon

Publications and source records attributed to W M O'Fallon.

At least 253 records · Page 14Linked to original sources
PubMed1989

A population-based case-control study of temporal arteritis: evidence for an association between temporal arteritis and degenerative vascular disease?

The first population-based incident case-control study of temporal arteritis (TA) in the US was conducted using the unique data resources of the Rochester Epidemiology Project. During the period 1950-1985, 88 newly diagnosed cases of biopsy-proven TA were identified among residents of Olmsted County, Minnesota. Cases were each matched to four Olmsted County community controls on age, sex and duration of community medical record. Odds ratios (OR) were calculated for marital status, education, Quetelet index, pregnancy, age at menopause, thyroid disease, diabetes, smoking, hypertension, angina, myocardial infarction, peripheral vascular disease, and stroke. Multivariable conditional logistic regression analysis identified statistically significant adjusted OR for smoking (2.3, 95% CI = 1.3-4.1). Elevated ORs which were not statistically significant were noted for angina, myocardial infarction, and peripheral vascular disease. These data suggest that TA and arteriosclerosis may share a common causal pathway. Alternatively, histopathological misclassification of temporal artery biopsies may have resulted in the observed association. Due to the limited power of this population-based study, multicentre collaboration should be encouraged to more precisely define the epidemiology of TA.

Aged↗
PubMed1989

Epidemiology of vertebral fractures in women.

Vertebral fracture prevalence was assessed in an age-stratified random sample of Rochester, Minnesota women aged 50 years and over. Vertebral fractures, including wedge and concavity as well as compression fractures, were common and increased with age. The estimated incidence of new vertebral fractures also rose with age, reaching 29.6 per 1,000 person-years in women aged greater than or equal to 85 years. The prevalence of one or more vertebral fractures also increased with declining bone mass, reaching 42% in women with spinal bone mineral density less than 0.6 g/cm2 by dual photon absorptiometry. Bone mass and age contributed independently to the risk of vertebral fracture, but "age" may reflect other manifestations of osteoporosis.

Adult↗
PubMed1989

Incidence rates of stroke in the eighties: the end of the decline in stroke?

Studies of the population of Rochester, Minnesota, have provided the only data on temporal trends for the incidence of stroke in North America. Among the residents of Rochester, the average annual incidence rate of stroke declined by 46%, from 213 to 115 per 100,000 population, between 1950-1954 and 1975-1979. The decline occurred in all age and sex groups, but it occurred earlier in women than in men. The rates stabilized in the 1970s, and did so earlier in women. For 1980-1984, the incidence rate of stroke was 17% higher than that for 1975-1979. The onset of the decline in incidence rates coincided with the introduction of effective antihypertensive therapy, but stabilized and increased rates were associated with continuing improvement in the control of hypertension. The increase in the incidence rates of stroke coincided with the introduction of computed tomography, which appeared to increase the detection of less severe strokes.

Age Factors↗
PubMed1989

Has there been a decline in subarachnoid hemorrhage mortality?

We studied subarachnoid hemorrhage in the population of Rochester, Minnesota, for the 40-year period from 1945 through 1984. The average annual incidence rate of subarachnoid hemorrhage in Rochester has remained constant at approximately 11 per 100,000 population. Age-specific incidence rates increased with age. However, the average annual mortality rate for subarachnoid hemorrhage in Rochester has shown a decreasing trend, from 6.8 per 100,000 population in 1955-1964 to 4.3 in 1975-1984. It is likely that this is due to a decrease in case-fatality rates from 57% in 1945-1974 to 42% in 1975-1984 (p = 0.10). This decreasing trend was also evident in annual mortality rates from subarachnoid hemorrhage for US white men and women. The reason for the improved case-fatality rate is unclear, but it may be related to changes in management. The interval from onset of subarachnoid hemorrhage to surgery decreased from a median of 12 days in 1975-1979 to 2 days in 1980-1984, and of those who survived to receive medical attention, more patients received some form of medical treatment in 1980-1984. Whether either or both of these changes have led to the decrease in the case-fatality rate is uncertain.

Adolescent↗
PubMed1989

Unequal decrease in bone density of lumbar spine and ultradistal radius in Colles' and vertebral fracture syndromes.

We measured bone mineral density (BMD) at the lumbar spine (LS-BMD) and ultradistal radius (UDR-BMD) in 42 postmenopausal normal women and in 108 postmenopausal osteoporotic women (55 with vertebral fracture, 34 with Colles' fracture, and 19 with both fractures). By receiver operating characteristic analysis, LS-BMD was better than UDR-BMD (P less than 0.01) as an indicator of vertebral fracture; the converse was true for Colles' fracture (P less than 0.01). Although UDR-BMD and LS-BMD were lower in each of the three fracture groups than in controls (P less than 0.01), the pattern of bone loss differed (P less than 0.001, analysis of variance): with vertebral fracture, LS-BMD decreased relatively more than UDR-BMD; with Colles' fracture, UDR-BMD decreased relatively more than LS-BMD; and with both fractures, decreases in LS-BMD and UDR-BMD were similar. We conclude that both types of fracture are caused by excessive bone loss but the difference in bone loss at the two sites is a major factor in determining which will fracture.

Absorptiometry, Photon↗
PubMed1989

Therapeutic radiation and hyperparathyroidism. A case-control study in Rochester, Minn.

A case-control study was conducted among residents of Rochester, Minn, to assess the influence of prior therapeutic radiation on the risk of primary hyperparathyroidism. Fifty-one cases of surgically proven primary hyperparathyroidism diagnosed from 1975 through 1983 were each matched by age and gender to two control subjects, with radiation exposure documented through preexisting medical records. The overall odds ratio for any prior therapeutic radiation therapy was 1.9 (95% confidence interval, 0.9 to 4.4) and it was 2.3 (95% confidence interval, 0.9 to 5.7) when limited to those with prior head and neck radiation. Among women, the figures were 2.9 (95% confidence interval, 1.1 to 7.5) for any prior therapeutic radiation and 3.4 (95% confidence interval, 1.2 to 10.2) for head and neck exposure. This study confirms the association between primary hyperparathyroidism and prior therapeutic radiation exposure, at least for women in this population.

Adenoma↗
PubMed1988

Trends in incidence and clinical presentation of temporal arteritis in Olmsted County, Minnesota, 1950-1985.

Ninety-four Olmsted County, Minnesota residents with temporal arteritis (TA) initially diagnosed between 1950 and 1985 (incidence cohort) were identified. The age- and sex-adjusted incidence of TA per 100,000 population age 50 years or older was 17.0 (95% confidence interval [CI] 13.6-20.5), with a marked increase in incidence with age and a threefold greater incidence in women (23.4, 95% CI 18.2-28.7) than in men (7.4, 95% CI 3.7-11.0). The previously described secular increase in TA incidence in Olmsted County women continued from 1970 through 1985, while TA incidence in men declined in this latter time period. Although the frequency of classic clinical manifestations of TA declined over time, the percentage of patients undergoing biopsy who have positive specimens remained relatively constant (women 41%, men 26%). The incidence rate of temporal artery biopsy also increased for women during this period, but declined for men, suggesting that the differing trends in TA incidence by sex may be partially attributable to a detection bias. Future research in TA etiology and epidemiology should focus on possible causal factors linked to the differential TA incidence by sex.

Aged↗
PubMed1988

Cancer after exposure to metronidazole.

We assessed the risk of occurrence of cancer associated with exposure to metronidazole in the 771 female residents of Rochester, Minnesota, who were treated with metronidazole for vaginal trichomoniasis during the period 1960 through 1969 and were followed up for a total of 12,628 person-years. Standardized morbidity and mortality ratios were determined by using an expected number calculated by applying age-specific incidence rates from Rochester studies and Cancer Surveillance, Epidemiology, and End-Results Reporting (SEER) data to the person-years of follow-up. The overall standardized morbidity ratios for cancer at all sites were 1.4 (Rochester, 1978 through 1983), 1.5 (SEER data for Iowa, 1978 through 1981), and 1.2 (SEER data for Connecticut, 1978 through 1981). By site of the cancers, the standardized morbidity ratios greater than unity were those for malignant lesions of the lung, breast, thyroid, bladder, brain, kidney, nasopharynx, and oral cavity, as well as for multiple myeloma and malignant melanoma; however, the only significantly elevated standardized morbidity ratio was that for bronchogenic carcinoma. After adjustment for smoking status, the standardized morbidity ratio for bronchogenic cancer was 2.5 (95% confidence interval of 1.3 to 4.4). The standardized mortality ratio for cancer at all sites was 1.4 (95% confidence interval of 0.9 to 2.2). The analysis of these data suggests no significant increase in cancer-related morbidity or mortality for women exposed to metronidazole for treatment of vaginal trichomoniasis.

Carcinoma, Bronchogenic↗
PubMed1988

A community blood pressure survey: Rochester, Minnesota, 1986.

To determine the prevalence and control of hypertension in the adult population of Rochester, Minnesota, a blood pressure survey was conducted among a stratified random sample of 2,122 subjects 35 years of age or older. Hypertension--defined as a history of hypertension or a systolic pressure of 160 mm Hg or more, a diastolic pressure of 95 mm Hg or more, or both at the time of interview--was found in 663 subjects (31%). Among these hypertensive subjects, 82 (12%) had no prior history of hypertension. Of the 581 subjects with a history of hypertension, 447 (77%) were taking antihypertensive medication, 127 (22%) had a systolic pressure of 160 mm Hg or more, a diastolic pressure of 95 mm Hg or more, or both, and 288 (50%) had a systolic pressure of 140 mm Hg or more, a diastolic pressure of 90 mm Hg or more, or both. Of the treated patients with hypertension, 75% were taking a diuretic either alone or in combination with one or more other agents. Side effects of therapy were reported by 12% of subjects taking antihypertensive medication.

Adult↗
PubMed1988

A population-based model for predicting blood pressure.

Multiple regression analysis were used to investigate the relationship between blood pressure and age, sex, relative weight, antihypertensive medication, diabetes mellitus, diet (low-salt, low-cholesterol, and weight-reducing regimens), cigarette smoking, coffee drinking, and aerobic exercise among a stratified random sample of the population of Rochester, Minnesota, 35 years of age or older. Age, sex, relative weight, antihypertensive medication, and cigarette smoking were significantly correlated with blood pressure and were incorporated in regression models of systolic and diastolic pressure. These models were used to predict average (geometric mean) blood pressure values for the adult population of Rochester and to predict age-, sex-, and relative weight-specific blood pressure percentiles.

Adult↗
PubMed1988

Anorexia nervosa in Rochester, Minnesota: a 45-year study.

The incidence of anorexia nervosa during a 45-year period (1935 through 1979) was determined for the population of Rochester, Minnesota, from the epidemiology archives at the Mayo Clinic. The medical records of local residents with the diagnosis of anorexia nervosa were the primary source for case ascertainment, although records of those whose diagnoses might have been shielding anorexia nervosa were also screened. Standard criteria for diagnosis were applied. We identified 140 (128 female and 12 male) residents of the community who fulfilled the diagnostic criteria for anorexia nervosa. No significant long-term trend in rates was ascertained. The overall age- and sex-adjusted incidence rate was 7.3 per 100,000 person-years. The highest age-specific incidence rate (56.7 per 100,000 person-years) occurred in female residents 15 to 19 years old. The prevalence rate on Jan. 1, 1980, for Rochester residents with a history of the disease, age- and sex-adjusted to the 1970 US white population, was 113.1 per 100,000 (203.9 for female and 16.9 for male residents).

Adolescent↗
PubMed1988

Carpal tunnel syndrome in Rochester, Minnesota, 1961 to 1980.

The incidence of carpal tunnel syndrome in the population of Rochester, Minnesota, from 1961 through 1980 was determined by use of the medical records-linkage system of the Rochester Epidemiology Program Project at the Mayo Clinic; 1,016 patients (1,600 affected hands) were identified. Incidence (cases per 100,000 person-years) was 99 (crude) overall, whereas the age-adjusted rates were 52 for the men, 149 for the women, and 105 for both sexes combined. Age-adjusted incidence rates increased from 88 during the 1961 to 1965 quinquennium to 125 during the 1976 to 1980 quinquennium; these rates probably reflect better recognition rather than a true increase in incidence rates. Age-specific rates generally increased with age in men, whereas in women a peak was reached in the 45 to 54 age group.

Adolescent↗
PubMed1988

Epidemiology of persistent proteinuria in type II diabetes mellitus. Population-based study in Rochester, Minnesota.

Clinical risk factors for nephropathy were assessed in a population-based study of Rochester, Minnesota, residents with diabetes mellitus initially diagnosed between 1945 and 1969 (incidence cohort). The 1031 Rochester residents with non-insulin-dependent diabetes mellitus (NIDDM) were followed through their complete medical records in the community to 1 January 1982. The prevalence of persistent proteinuria was 8.2% at the diagnosis of NIDDM. Among those initially free of persistent proteinuria, the subsequent incidence was 15.3/1000 person-yr. Twenty years after the diagnosis of diabetes, the cumulative incidence of persistent proteinuria was 24.6%. A proportional hazards model identified the following risk factors for persistent proteinuria in NIDDM: elevated initial fasting blood glucose (P less than .01); older age at onset of diabetes (P less than .01); male gender (P = .05); and presence of macrovascular disease (P = .05), diabetic retinopathy (P = .05), or glycosuria (P = .07) at the diagnosis of diabetes. Separate analyses controlling for attained age indicated no association between duration of NIDDM and the incidence of persistent proteinuria. Stratified analysis of the two most significant risk factors (fasting blood glucose and age) indicated that hyperglycemia was a stronger risk factor for proteinuria in younger diabetic subjects, perhaps because of a competing risk of death in the elderly diabetic patient. In contrast to a recently described decreasing secular trend of proteinuria in Danish insulin-dependent diabetes mellitus patients, there was no decrease over the past 40 yr in proteinuria risk in this NIDDM incidence cohort.

Adult↗
PubMed1988

The natural history of unruptured intracranial arteriovenous malformations.

The authors conducted a long-term follow-up study of 168 patients to define the natural history of clinically unruptured intracranial arteriovenous malformations (AVM's). Charts of patients seen at the Mayo Clinic between 1974 and 1985 were reviewed. Follow-up information was obtained on 166 patients until death, surgery, or other intervention, or for at least 4 years after diagnosis (mean follow-up time 8.2 years). All available cerebral arteriograms and computerized tomography scans of the head were reviewed. Intracranial hemorrhage occurred in 31 patients (18%), due to AVM rupture in 29 and secondary to AVM or aneurysm rupture in two. The mean risk of hemorrhage was 2.2% per year, and the observed annual rates of hemorrhage increased over time. The risk of death from rupture was 29%, and 23% of survivors had significant long-term morbidity. The size of the AVM and the presence of treated or untreated hypertension were of no value in predicting rupture.

Adolescent↗
PubMed1988

Clinical trial of naltrexone in premenstrual syndrome.

Twenty women with the diagnosis of premenstrual syndrome (PMS) participated in a double-blind, placebo-controlled, crossover study to evaluate the efficacy of naltrexone, an oral opiate antagonist. This study was designed to test the hypothesis that inhibition of opiate withdrawal would aid in the treatment of PMS. The subjects received either placebo or naltrexone from days 9-18 of the cycle for three consecutive cycles. The mean scores of the three day-25 Menstrual Distress Questionnaires of 16 patients on naltrexone were compared with the mean scores of the same patients on placebo. Scores were at least ten points lower on naltrexone in 11 patients and at least ten points higher on naltrexone in two patients. Score changes of less than ten points were noted in the other three patients. The mean scores dropped 28 points on naltrexone (P = .016). The general acceptability of naltrexone was good, with side effects including nausea, decreased appetite, and dizziness. These results suggest that naltrexone alleviates many PMS symptoms and may be an effective treatment for this syndrome.

Administration, Oral↗
PubMed1988

Value of beta 2-microglobulin level and plasma cell labeling indices as prognostic factors in patients with newly diagnosed myeloma.

Beta 2-microglobulin (beta 2M) has been proposed as a prognostic factor in multiple myeloma (MM), but beta 2M levels are reported to correlate with other prognostic indicators such as stage and creatinine level. This study addressed the independent prognostic values of these and other variables, including plasma cell labeling indices (LI), in patients with newly diagnosed MM. beta 2M levels were measured with an enzyme-linked immunosorbent assay. LI were determined with a [3H]thymidine autoradiography method. By multivariate analysis and Kaplan-Meier survival analysis, the uncorrected beta 2M level remained the most significant prognostic factor after adjustment for age. Stage and creatinine level were closely related to beta 2M level and were no longer predictive of outcome after adjustment for age and beta 2M. Plasma cell LI varied independently of beta 2M level and remained predictive. A subset of patients with plasma-blastic myeloma had poor survival since beta 2M level and plasma cell LI were high. By using beta 2M level and LI, three risk groups were defined: low (beta 2M less than 4 micrograms/mL and LI less than 0.4%, median survival 48 months); intermediate (beta 2M less than 4 micrograms/mL and LI greater than or equal to 0.4%, median survival 29 months); and high (beta 2M greater than or equal to 4 micrograms/mL, median survival 12 months). Such grouping may better identify MM patients who might benefit from new treatment regimens.

Bone Marrow↗
PubMed1988

Epidemiology of diaphyseal and distal femoral fractures in Rochester, Minnesota, 1965-1984.

Over the 20-year period from 1965 to 1984, 370 residents of Rochester, Minnesota experienced 402 femoral fractures exclusive of the hip, giving an overall incidence rate of 37.1 per 100,000 person-years (95% confidence interval, 33.4-40.8). Of these, 54 were subtrochanteric and 210 were diaphyseal, while 123 involved the distal femur and 15 were at unspecified femoral sites. Fifty-eight percent of these fractures were caused by severe trauma. The incidence of femoral fractures due to severe trauma was greatest in young patients, especially for diaphyseal fractures, and showed a male excess. One-third of the fractures were associated with moderate trauma and were responsible for the rising incidence rates with age at all three fracture sites. These increases were greater in women. Eighty percent of patients 35 years of age or older with fractures due to moderate trauma had prior evidence of generalized osteopenia or a condition likely to cause localized osteopenia in the fractured femur. These data confirmed similar findings from Sweden, providing evidence for a relationship between osteoporosis and femoral fractures distal to the hip.

Adolescent↗