Search PubMed⌕ Search

Biomedical subjects

Arch G Mainous

Publications and source records attributed to Arch G Mainous.

At least 37 records · Page 2Linked to original sources
PubMed2005

The effect of race and residence on the receipt of childhood immunizations: 1993-2001.

OBJECTIVE: To determine if rural minority children ages 3-71 months are more likely than similar aged urban minorities to have delays in their immunization status. METHODS: Secondary analysis of the National Health Interview Survey (NHIS) for the years 1993-2001. FINDINGS: There were no substantial differences between the up-to-date immunization status of children living in metropolitan areas compared to children living in rural areas. There does appear to be a delay in introducing new vaccines into rural areas compared to metropolitan areas during the first 2 years of the vaccine recommendation. There were no significant differences in immunization status between Whites, Blacks and Hispanics living in metropolitan and rural areas. CONCLUSIONS: Rural minority children are no more likely than other children to have delayed immunizations.

Child, Preschool↗
PubMed2005

Relation of time spent in an encounter with the use of antibiotics in pediatric office visits for viral respiratory infections.

OBJECTIVE: To examine the relationship between the time a physician spends in an office encounter with the prescribing of antibiotics for pediatric patients with presumed viral respiratory infections. DESIGN AND SETTING: Cross-sectional analysis of the 2000 National Ambulatory Medical Care Survey in physician offices in the United States. PARTICIPANTS: Children and adolescents (aged < or = 18 years) with a diagnosis of upper respiratory infections or bronchitis. MAIN OUTCOME MEASURE: The time spent by a physician with a patient in an office encounter. RESULTS: Analysis of 269 office encounters representing 12,366,162 annual office visits for upper respiratory infections and bronchitis. The mean (SE) number of minutes a doctor spent with a patient in encounters for colds or bronchitis that resulted in an antibiotic prescription was 14.24 (0.85) minutes while 14.18 (1.03) minutes were spent in encounters without antibiotics prescribed. In multivariate analysis, the likelihood that the time spent by a physician was above or below the median visit time of 15 minutes was not associated with the use of antibiotics when controlled for patient age, race, sex, participation in a prepaid plan, or whether the encounter was with the patient's primary care physician. CONCLUSIONS: Prescribing antibiotics for children with upper respiratory infections or bronchitis is not associated with a reduction in the time that a physician spends with a patient in an office encounter. The impact on physician productivity of injudicious antibiotic prescribing for upper respiratory infections and bronchitis may not be as great as previously believed.

Adolescent↗
PubMed2005

The association between weight fluctuation and mortality: results from a population-based cohort study.

Previous studies evaluating the association between weight fluctuation and mortality are limited and have conflicting results. This study will further evaluate the association between weight fluctuation and mortality in a nationally representative cohort by performing survival analysis of NHANES I and NHANES I Epidemiologic Follow-up Study (n = 8479; weighted sample = 68,200,905). This cohort was followed from 1971 to 1992 and categorized using weight change over five time points into stable non-obese, stable obese, weight gain, weight loss and weight fluctuation groups. All-cause mortality (ACM) and cardiovascular mortality (CM) were evaluated. Respondents with weight fluctuation had higher ACM (HR: 1.83, 95% CI: 1.25-2.69) and CM hazards ratios (HR: 1.86, 95% CI: 1.10-3.15) than the stable non-obese group, even after controlling for pre-existing disease, initial BMI and excluding those in poor health or incapacitated. Increased mortality was also seen in the weight loss group (ACM HR: 3.36, 95% CI: 2.47-4.55), (CM HR 4.22, 95% CI: 2.60-6.84). The stable obese group did not have increased ACM, but did have increased CM prior to the exclusion of those in poor health or incapacitated. (HR: 2.17, 95% CI: 1.10-4.28). Weight fluctuation is associated with a higher risk of all-cause and cardiovascular disease mortality in the US population, even after adjustment for pre-existing disease, initial BMI and the exclusion of those in poor health or incapacitated. Thus, health care providers should promote a commitment to maintaining weight loss to avoid weight fluctuation and consider patients' weight histories when assessing their risk status.

Adult↗
PubMed2005

Association between dietary arginine and C-reactive protein.

OBJECTIVE: We investigated whether a dietary intake of arginine is associated with risk for cardiovascular disease as determined by levels of C-reactive protein (CRP). METHODS: We analyzed the Third National Health Nutrition and Examination Survey, a national public-use dataset collected between 1988 and 1994. Arginine intake was calculated from the 24-h dietary recall using the nutrient composition database of the University of Minnesota Nutrition Coordinating Center. A logistic regression model was used to evaluate the relation between arginine intake and serum levels of CRP while controlling for age, sex, race, exercise, total caloric intake, body mass index, smoking status, diabetes, hypertension, and fiber intake. RESULTS: In the unadjusted model, the likelihoods of having a high level of CRP (>3.0 mg/L), from the lowest to the highest level of arginine intake, were 34.8%, 31.0%, 27.7%, and 18.4% respectively. Arginine intake below the median range was associated with higher levels of CRP (P < 0.05), and arginine intake above the median range was associated with lower levels of CRP (P < 0.05). In the adjusted regression, subjects in the highest level (90th percentile) of arginine intake were 30% less likely to have a CRP above 3.0 mg/L than were subjects with a median arginine intake (odds ratio= 0.70, 95% confidence interval = 0.56 to 0.88). CONCLUSIONS: The results of this study show a relation between arginine intake and CRP level that persisted after controlling for factors associated with CRP. Individuals may be able to lower their risk for cardiovascular disease by consuming more arginine-rich foods such as nuts and fish.

Adult↗
PubMed2005

Race and diet in the overweight: association with cardiovascular risk in a nationally representative sample.

OBJECTIVE: Because dietary differences may account for much of the racial and ethnic disparities in cardiovascular risk status, we evaluate the effect of race on cardiovascular risk after adjustment for dietary factors. METHODS: Prevalence of healthy diets in overweight U.S. adults (body mass index > or = 25 kg/m(2), age > or = 18 y) by race or ethnicity was determined by using 24-h dietary recalls from the National Health and Nutrition Examination Survey of 1999 to 2000. Dietary recalls included daily total calories, percentage of calories obtained from saturated fat, cholesterol, dietary fiber, and sodium and potassium intakes. Logistic regressions were used to evaluate the association between race/ethnicity, dietary factors, and cardiovascular risk markers (high levels of total cholesterol, C-reactive protein, systolic blood pressure, and diastolic blood pressure and low levels of high-density lipoprotein). RESULTS: The percentage of respondents who met healthy diet parameters ranged from 11.2 to 63.3. Non-Hispanic whites without diagnosed disease were less likely to have healthy diets than were African Americans or Hispanics, except with regard to cholesterol and fiber intake. After controlling for dietary factors, African American ethnicity was associated with a lower risk of hypercholesterolemia (odds ratio 0.587, 95% confidence interval 0.403 to 0.855), lower level of high-density lipoprotein (odds 0.440, 95% confidence interval 0.236 to 0.763), and a greater risk of high systolic blood pressure (odds ratio 2.383, 95% confidence interval 1.043 to 5.442) compared to whites. CONCLUSIONS: Differences in adherence to healthy diet parameters by race/ethnicity exist. However, after adjustment for diet and other modifiable factors, African Americans have a decreased risk of hypercholesterolemia and low level of high-density lipoprotein but an increased risk of systolic hypertension. Further research into the genetic basis for these differences is suggested.

Adult↗
PubMed2005

Dietary magnesium and C-reactive protein levels.

OBJECTIVE: Current dietary guidelines recommend adequate intake of magnesium (310-420 mg daily) in order to maintain health and lower the risk of cardiovascular disease. Recent evidence from animal and clinical studies suggests that magnesium may be associated with inflammatory processes. The objective of this study was to determine whether dietary magnesium consumption is associated with C-reactive protein (CRP), a marker of inflammation, in a nationally representative sample. METHODS: Analysis of adult (> or =17 years) participants in a cross-sectional nationally representative survey (National Health and Nutrition Examination Survey 1999-2000 [NHANES]) who were not taking magnesium or magnesium-containing supplements. The primary outcome measure was high sensitivity CRP (elevated > or =3.0 mg/L). RESULTS: Among US adults, 68% consumed less than the recommended daily allowance (RDA) of magnesium, and 19% consumed less than 50% of the RDA. After controlling for demographic and cardiovascular risk factors, adults who consumed or =RDA (Odds Ratio [OR] for intake <50% RDA = 1.75, 95% Confidence Interval [CI] 1.08-2.87). Adults who were over age 40 with a BMI >25 and who consumed <50% RDA for magnesium were 2.24 times more likely to have elevated CRP (95% CI 1.13-4.46) than adults > or =RDA. CONCLUSIONS: Most Americans consume magnesium at levels below the RDA. Individuals with intakes below the RDA are more likely to have elevated CRP, which may contribute to cardiovascular disease risk.

Adolescent↗
PubMed2005

The relationship between the National Board of Medical Examiners' prototype of the Step 2 clinical skills exam and interns' performance.

PURPOSE: To examine the relationship between graduates' performances on a prototype of the National Board of Medical Examiners' Step 2 CS and other undergraduate measures with their residency directors' ratings of their performances as interns. METHOD: Data were collected for the 2001 and 2002 graduates from the study institution. Checklist and interpersonal scores from the prototype Step 2 CS, along with United States Medical Licensing Examination (USMLE) Step 1 and 2 scores and undergraduate grade-point average (GPA), were correlated with residency directors' ratings (average score for six competencies, quartile ranking, and isolated interpersonal communication competency score). Stepwise linear regression was used to identify the best outcome predictors. RESULTS: Quartile ranking was more highly correlated with GPA than Step 2 CS prototype interpersonal score, USMLE Step 2 score, USMLE Step 1 score, and Step 2 CS prototype checklist score. The average score on the residency director's survey was more highly correlated with GPA than USMLE Step 2 score, USMLE Step 1 score, Step 2 CS prototype interpersonal score, and Step 2 CS prototype checklist score. The best predictors for both quartile ranking and average competency score were GPA and Step 2 CS prototype interpersonal score (R(2) = 0.26 and 0.28). CONCLUSION: Both scores from the Step 2 CS prototype significantly correlated with the interns' quartile ranking and average competency score. Only GPA and Step 2 CS prototype interpersonal score accounted for most of the variance of performance in the regression model.

Clinical Competence↗
PubMed2005

Prevalence of breastfeeding and acculturation in Hispanics: results from NHANES 1999-2000 study.

BACKGROUND: A more current estimate to evaluate ethnic and acculturation differences in breastfeeding is warranted, given the rapid growth of the Hispanic population in the United States and the proliferation of breastfeeding promotion programs. The study objective was to describe current national estimates of the prevalence of breastfeeding and evaluate differences in reasons not to breastfeed by acculturation status. METHODS: Secondary data analysis of the National Health and Nutrition Examination Survey (NHANES) 1999-2000 was performed on a nationally representative sample of non-Hispanic white women born in the U.S. and Hispanic women with at least one live birth. Acculturation status among Hispanics was assessed using a validated language scale, and prevalence of breastfeeding was based on maternal self-report. RESULTS: Prevalence of breastfeeding was higher in less acculturated Hispanic women (59.2%) than high acculturated Hispanic women (33.1%) and white women (45.1%). Less acculturated Hispanic women were more likely to cite their child's physical/medical condition as a reason not to breastfeed (53.1%), whereas whites and more acculturated Hispanics were more likely to cite their child preferred the bottle (57.5% and 49.8%, respectively). A logistic regression analysis revealed no significant differences in likelihood to breastfeed between non-Hispanic whites and Hispanics after controlling for education, age, and income. Higher acculturated women were less likely to breastfeed their children than low acculturated women (95% CI: 0.14-0.40) even after education, age, and income were taken into account. CONCLUSIONS: Acculturation differences in prevalence of breastfeeding and reasons not to breastfeed may be the result of attitudinal changes that occur due to acculturation. Further research into the acculturation process and its impact on breastfeeding may help to prevent the decline in breastfeeding that occurs as mothers become more acculturated. Meanwhile, patient education that addresses women's perceptions of the child's health condition and benefits of breastfeeding would be helpful.

Acculturation↗
PubMed2005

Impact of providing a medical home to the uninsured: evaluation of a statewide program.

Lack of health insurance and a regular source of care (RSOC) are associated with suboptimal health care. This study examined the impact of a statewide program called the Community Healthcare Access Program (CHAP), which provided a RSOC for uninsured persons in Delaware. This cohort study used survey data to compare health care utilization from baseline to six months after enrollment in CHAP. The 795 eligible enrollees had significant increases in Pap tests, mammograms, breast exams, cholesterol tests, sigmoid/colonoscopy and influenza immunizations but not stool blood tests or pneumococcal immunizations. There was a significant decrease in the proportion with emergency department visits but not hospitalizations, and there was a significant improvement in satisfaction with care. Delaware's CHAP program is associated with significant improvements across many measures of health care utilization and represents a successful and financially feasible method for states to improve health care for their uninsured populations.

Adolescent↗
PubMed2005

Nonprescribed antimicrobial drugs in Latino community, South Carolina.

We investigated in a sample of Latinos the practices of antimicrobial drug importation and use of nonprescribed antimicrobial drugs. In interviews conducted with 219 adults, we assessed health beliefs and past and present behaviors consistent with acquiring antimicrobial drugs without a prescription in the United States. Many (30.6%) believed that antimicrobial drugs should be available in the United States without a prescription. Furthermore, 16.4% had transported nonprescribed antimicrobial drugs into the United States, and 19.2% had acquired antimicrobial agents in the United States without a prescription. A stepwise logistic regression analysis showed that the best predictors of having acquired nonprescribed antimicrobial drugs in the United States were beliefs and behavior consistent with limited regulations on such drugs. Many persons within the Latino community self-medicate with antimicrobial drugs obtained without a prescription both inside and outside the United States, which adds to the reservoir of antimicrobial drugs in the United States.

Adult↗
PubMed2005

Cholesterol, transferrin saturation, and the development of dementia and Alzheimer's disease: results from an 18-year population-based cohort.

BACKGROUND AND OBJECTIVES: Oxidative stress plays a role in Alzheimer's disease (AD), and iron and cholesterol together have been linked to oxidative stress. This study examined the relationship between transferrin saturation (TS) and cholesterol to see if both are necessary to increase the risk for the subsequent development of AD. METHODS: We analyzed data from US adults (ages 40-74 years at baseline) followed from baseline in 1971-1974 to 1992 (n=6,558) in the cohort study, the National Health and Nutrition Examination Survey I Epidemiologic Followup Study (NHEFS). RESULTS: The unadjusted relative risk of developing AD when both TS and cholesterol were at the 75th percentile was 3.19 (95% CI, 1.31-7.75). In adjusted models when only one marker was elevated, there was no significant increased risk for AD. The risk of AD increased as both markers increased. Even at the 85th percentile, individuals had no significant risk of AD when only having elevated cholesterol (>280 mg/dl) but not elevated TS (39.6%). Findings were similar for individuals with elevated TS but not elevated cholesterol. CONCLUSIONS: In this population-based cohort, the risk of developing AD when one has both elevated cholesterol and elevated TS is much larger than the risk associated with elevation of either of these factors alone.

Adult↗
PubMed2005

Differences in posttraumatic stress disorder symptoms between elderly non-Hispanic Whites and African Americans.

This study was a secondary analysis of two similar data sets to examine potential differences in PTSD symptoms between elderly whites and African Americans (n=90). Without regard to trauma type, there were no differences between the races in the distribution of PTSD diagnosis or specific symptom constellations (e.g., re-experiencing, avoidance, or arousal). No significant differences were yielded for individuals who experienced a physical trauma. However, in cases of nonphysical trauma, elderly whites were significantly more likely than elderly African Americans to report hyperarousal symptoms. These results suggest the need to better understand coping strategies used by whites and African Americans in the face of trauma.

Black or African American↗
PubMed2004

Prehypertension and mortality in a nationally representative cohort.

The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 7 recommendations include early identification of prehypertension (120 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic). Although prehypertension is a risk factor for hypertension, little is known of prehypertension's independent risk for mortality. We conducted an analysis of a nationally representative cohort in the second National Health and Nutrition Examination Survey 1976 to 1980 (NHANES II) and the NHANES II Mortality Study, 1992. The cohort included 9,087 patients aged 30 to 74 years at baseline, who represented nearly 95 million Americans. Cox proportional-hazards models were conducted for both cardiovascular disease (CVD) and all-cause mortality. The unadjusted relative risk of both all-cause (hazard ratio [HR] 1.27, 95% confidence interval [CI] 1.02 to 1.58) and CVD (HR 1.66, 95% CI 1.21 to 2.26) mortality is increased for patients with prehypertension over patients with normal blood pressure (BP). Almost all patients with hypertension (93%), prehypertension (90%), and normal BP (85%) have other CVD risk factors. When the presence of any CVD risk factor is adjusted for in the survival analysis, the adjusted relative risk of both all-cause (HR 0.82, 95% CI 0.64 to 1.04) and CVD (HR 1.00, 95% CI 0.72 to 1.39) mortality is no longer increased for patients with prehypertension. Similarly, in analyses of patients aged >/=55 years, there is no significant independent mortality risk for prehypertension. Lifestyle interventions targeting multiple risk factors including BP may be the most effective prevention strategy.

Adult↗
PubMed2004

Antibiotics for the secondary prevention of ischemic heart disease: a meta-analysis of randomized controlled trials.

BACKGROUND: Infections have been suspected in the pathogenesis of ischemic heart disease (IHD) for more than 100 years. Chlamydia pneumoniae has been identified in atherosclerotic specimens, and in some studies antibody titers to C pneumoniae have been related to the risk of myocardial infarction. The numerous clinical trials that have studied the use of antibiotics in the secondary prevention of IHD have had conflicting results. METHODS: This study is a meta-analysis of the published randomized controlled trials on the secondary prevention of IHD with antibiotics. Studies included in the analysis were limited to those studies that used antibiotics effective against C pneumoniae, enrolled patients with known IHD, and examined clinical outcomes related to IHD. Inclusion in the analysis was limited to well-designed randomized controlled trials that met inclusion criteria established by an expert panel. RESULTS: Nine published studies, with a total of 11 015 participants, were identified that met the criteria for this meta-analysis. Four of the studies reported a benefit from antibiotics, whereas 5 found no effect. A funnel plot of the published studies did not suggest the existence of other unpublished data. The combined effect found no benefit from antibiotics in the prevention of cardiovascular events in subjects with known IHD (relative risk, 0.94 [95% confidence interval, 0.86-1.03]) or mortality (relative risk, 0.94 [95% confidence interval, 0.79-1.12]). CONCLUSION: In patients with known IHD, macrolide antibiotics for C pneumoniae did not result in a statistically significant reduction in recurrent cardiac events or mortality over 3 months to 3 years.

Anti-Bacterial Agents↗
PubMed2004

Association of ferritin and lipids with C-reactive protein.

C-reactive protein (CRP) and lipids (e.g., low-density lipoprotein [LDL]) are both markers of cardiovascular disease risk, yet they are not highly correlated. Oxidative stress of lipids induced by iron may play a role in vascular inflammation, as indicated by CRP. The purpose of this study was to examine, in a representative sample of United States adults, the relation between ferritin, lipids, and CRP. We analyzed data on adults (aged > or =25 years) in the National Health and Nutrition Examination Survey III, a national public-use data set collected between 1988 and 1994. Ferritin, total cholesterol, LDL, high-density lipoprotein, and ferritin-lipid combinations were analyzed in relation to CRP in age-, gender-, and race-adjusted models as well as models with other potential confounding variables. In adjusted models, neither elevated ferritin (odds ratio [OR] 1.11, 95% confidence interval [CI] 0.94 to 1.32) nor elevated LDL was significantly associated with elevated CRP (OR 1.03, 95% CI 0.79 to 1.33). Patients with elevated ferritin and elevated LDL were more likely to have elevated CRP (OR 1.68; 95% CI 1.06 to 2.68). Patients with elevated ferritin and low high-density lipoprotein were also more likely to have elevated CRP (OR 1.71; 95% CI 1.28 to 2.27). These results suggest that both iron and lipids induce inflammation. Future research needs to focus on preventive medicine to decrease iron in patients with elevated lipids.

Adult↗
PubMed2004

The role of pharmacists in the delivery of influenza vaccinations.

OBJECTIVES: The purpose of this study is to determine whether influenza vaccine rates have increased in states where pharmacists can give vaccines. METHODS: Secondary analysis of the Behavioral Risk Factor Surveillance System (BRFSS) from the years 1995 and 1999. Information regarding legislation allowing pharmacists to administer vaccines was obtained from the American Pharmaceutical Association. RESULTS: Individuals aged 65 years and older who lived in states where pharmacists could provide vaccines had significantly higher (P < 0.01) influenza vaccine rates than individuals of this age who resided in states where pharmacists could not provide vaccines. CONCLUSIONS: Allowing pharmacists to provide vaccinations is associated with higher influenza vaccination rates for individuals aged 65 years and older.

Adolescent↗