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Biomedical subjects

D M Becker

Publications and source records attributed to D M Becker.

At least 37 records · Page 2Linked to original sources
PubMed1997

Exaggerated reactivity to mental stress is associated with exercise-induced myocardial ischemia in an asymptomatic high-risk population.

BACKGROUND: This study was done to determine whether cardiovascular reactivity to mental stress is associated with exercise-induced occult ischemia in an asymptomatic population at high risk for premature coronary heart disease (CHD). METHODS AND RESULTS: One hundred fifty-two siblings of persons with premature CHD underwent mental stress testing. Exercise thallium tomography and 24-hour Holter monitoring were also performed. Hemodynamic changes were monitored during both stressors. Siblings positive for exercise-induced ischemia were offered cardiac catheterization. During mental stress, siblings with an abnormal exercise ECG and/or thallium scan (n=15) had greater maximal increases in systolic blood pressure (SBP, P=.0004) and diastolic blood pressure (DBP, P=.05) and had greater heart rate variability in the normalized low frequency domain of an analysis of Holter monitor recordings, compared with siblings without exercise-induced ischemia. Coronary arteriography confirmed coronary atherosclerosis in 85% of siblings with exercise-induced ischemia. Regression analyses showed that occult ischemia during exercise was a strong independent predictor of maximal change in SBP and DBP during mental stress. A multivariate logistic model demonstrated that siblings with exercise-induced occult ischemia were 21 times more likely to be "hot" responders (top quartile of change in SBP and DBP) during mental stress. CONCLUSIONS: An exaggerated cardiovascular response to mental stress is associated with exercise-induced myocardial ischemia in persons with preclinical coronary heart disease.

Adult↗
PubMed1997

Cigarette sales to African-American and white minors in low-income areas of Baltimore.

OBJECTIVES: This study documented illegal sales of cigarettes to minors in low-income African-American and White urban areas in East Baltimore. METHODS: Six youths, aged 14 through 16 years, were sent to a random sample of 83 corner stores to attempt to purchase cigarettes. The youths provided the investigators with data on merchant, store, and purchase characteristics. RESULTS: The youths successfully purchased cigarettes in 85.5% of the stores; 58% of the stores displayed five or more cigarette advertisements outside their premises. CONCLUSIONS: Cigarette sales to minors and associated advertising remain prevalent in this urban community.

Adolescent↗
PubMed1997

The feasibility of a street-intercept survey method in an African-American community.

OBJECTIVES: This study evaluates the feasibility of a nonquota, street-intercept survey method that utilized random selection of interview sites. METHODS: The street-intercept survey was compared with a random digit-dial telephone survey conducted in the same catchment area among African-American adults aged 18 or older. RESULTS: The street-intercept survey's response rate was 80.2%; residence rate, 85.3%; interview completion rate, 97.9%; interference rate, 4.0%; and yield rate, 2.5 interviews per interviewer per hour. The street-intercept method produced more representative distributions of age and sex than the random-digit-dial survey. CONCLUSIONS: The street-intercept method is a feasible alternative to traditional population survey methods and may provide better access to harder-to-reach segments of the urban population in a safe manner.

Adolescent↗
PubMed1996

Cancer screening and informed patient discussions. Truth and consequences.

While screening for asymptomatic cancer has become one of the principal clinical activities of primary care physicians, patients are generally not involved directly in screening decisions. To help physicians better communicate the potential benefits and burdens of cancer screening, this article concisely presents information necessary for patients to make a reasoned decision as to whether to proceed with screening: the probability of developing cancer, the operating characteristics of available screening tests, the likelihood that screening will result in an improved outcome for the individual patient, and the potential burdens associated with screening. Screening tests for breast, colorectal, cervical, and prostate cancers are reviewed, including mammography, clinical breast examination, fecal occult blood testing, Papanicolaou smear, digital rectal examination, and prostate-specific antigen. Better communication about cancer screening will promote shared decision making--a central tenet of the physician-patient relationship.

Decision Making↗
PubMed1996

D-dimer testing and acute venous thromboembolism. A shortcut to accurate diagnosis?

D-dimer fragments can be measured easily in plasma and whole blood, and the presence or absence of D-dimer could be useful in the diagnostic evaluation of venous thromboembolism. We systematically reviewed the English literature for articles that compared D-dimer results with those of other tests for deep venous thrombosis or pulmonary embolism. Twenty-nine studies were selected for detailed review, and we noted wide variability in assay performance, heterogeneity among subjects, and failure to define absence or presence of venous thromboembolism by a comprehensive criterion standard for diagnosis. These methodologic problems limit the generalizability of the published estimates of D-dimer accuracy for deep venous thrombosis or pulmonary embolism, and the clinical utility of this potentially important test remains unproved.

Acute Disease↗
PubMed1996

Exercise thallium tomography predicts future clinically manifest coronary heart disease in a high-risk asymptomatic population.

BACKGROUND: Exercise testing, even when combined with radionuclide perfusion imaging, does not accurately predict future clinical coronary heart disease (CHD) in low-risk asymptomatic populations. We hypothesized that these tests would perform better in a higher-risk population with a high prevalence of occult CHD. Siblings of persons with premature CHD represent such a group in whom it would be advantageous to identify affected individuals before the occurrence of clinically manifest CHD. METHODS AND RESULTS: Exercise thallium scintigraphy was performed in 264 asymptomatic individuals less than 60 years of age who had a sibling with documented CHD before age 60. Despite an average age of only 46 years at the time of screening, 19 of 264 siblings developed clinical CHD (sudden death in 1, myocardial infarction in 10, coronary revascularization in 8) over a mean of 6.2 years (range, 1 to 9 years) of follow-up. Abnormal thallium scans were observed in 29% of men and 9% of women, while abnormal exercise ECGs occurred in 12% and 5% respectively. Of men >/= 45 years of age, 45% had an abnormal exercise ECG, thallium scan, or both. In contrast, only 3% of women < 45 years of age had an abnormal test result. Although abnormal exercise ECGs and thallium scans were both predictive of future clinical CHD, the thallium scan was associated with a higher relative risk. After adjustment for age, sex, and exercise ECG results, the relative risk of developing clinical CHD was 4.7 for an abnormal scan. Siblings with a concordant abnormal exercise ECG and thallium scan had a relative risk of 14.5. These siblings were all men > 45 years of age at the time of screening and had a strikingly high incidence of CHD (6 of 12, 50%). CONCLUSIONS: Exercise thallium scintigraphy appears to be useful in the risk assessment of asymptomatic siblings of patients with premature CHD, particularly in male siblings who are 45 years of age or older.

Adult↗
PubMed1995

Accuracy of laboratory and portable monitor international normalized ratio determinations. Comparison with a criterion standard.

BACKGROUND: Portable instruments that measure the prothrombin time and automatically calculate the international normalized ratio (INR) with the use of a drop of whole blood have simplified the treatment of patients who are receiving warfarin therapy. The accuracy of these portable monitors has never been determined by comparing INR results with a criterion (gold) standard INR determination. METHODS: Duplicate whole-blood INR determinations were made with two commercially available portable INR monitors. Duplicate frozen-plasma samples were measured with four different thromboplastin reagents, each with a different international sensitivity index. The criterion standard INR was determined by using an international reference thromboplastin and the manual tilt-tube technique. Agreement was evaluated by determining how accurately laboratory and monitor INR determinations matched criterion standard values in designating a sample to be within or outside of currently recommended INR target ranges. RESULTS: Two of the laboratory methods, which used relatively sensitive thromboplastins, showed close agreement with the criterion standard, whereas two laboratory methods that used less sensitive thromboplastin reagents showed poor agreement. Both of the portable monitors fell between these extremes. The two best laboratory methods ere significantly better (P < .003) than both monitors, which in turn were better (P < .003) than the remaining two laboratories. CONCLUSIONS: There is large interlaboratory variation in the accuracy of INR determinations. Laboratory methods that used insensitive (high international sensitivity index) thromboplastins performed poorly. Accuracy of monitor measurements appears satisfactory.

Adult↗
PubMed1995

The effect of fasting status on the determination of low-density and high-density lipoprotein cholesterol.

PURPOSE: To determine the effect of a self-selected meal on concentrations of low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) in a screening setting and to determine the effect of using nonfasting values to classify individuals according to National Cholesterol Education Program guidelines. SUBJECTS AND METHODS: Study subjects were 115 employees who had previously participated in worksite total cholesterol screening, selected by stratified random sampling for sex and total cholesterol levels. Total cholesterol, triglycerides, HDL-C, and estimated LDL-C were determined before subjects ate a self-selected breakfast and 3 and 5 hours after eating it. RESULTS: LDL-C values determined 3 and 5 hours following breakfast were approximately 7% and 2.5% lower, respectively, than fasting values. Use of 3-hour and 5-hour LDL-C determinations to classify individuals with elevated fasting levels (> or = 3.36 mmol/L) resulted in false-negative rates of 20% and 14%, respectively. Three- and 5-hour HDL-C values were approximately 4% and 1.5% lower, respectively, than fasting levels. Use of 3-hour HDL-C values to classify individuals with low fasting levels (< 0.91 mmol/L) resulted in no false-negatives, whereas 1 of 7 individuals with low fasting HDL-C was misclassified when 5-hour values were used. CONCLUSIONS: These results support the 1993 National Cholesterol Education Program guidelines that LDL-C levels should be determined only in fasting persons, and that nonfasting HDL-C values may be acceptable for screening purposes.

Adult↗
PubMed1995

Roles of nurses and health workers in cardiovascular health promotion.

Community-based nurses and health workers who supplement physician office-based practice are known to be effective in promoting cardiovascular health. They enhance the effectiveness of programs to influence individual and population lifestyles, self-care practices, and long-term adherence to recommendations. As a team they are able to focus on economic, psychosocial, and behavioral factors in culturally relevant ways, often missed in traditional medical care, by attending comprehensively to education, income, employment status, living arrangements, and daily needs. Much can be learned about these teams from the past by reviewing the roles, supporting data, and practice-related issues. There are two important points to be made about the nurse and the community health worker in cardiovascular health promotion: (1) these roles are not new; and (2) reported control rates for high blood pressure and other risk factors are highest when multidisciplinary teams help patients actively participate in the treatment/prevention program. Promoting cardiovascular health across all segments of society with greater emphasis on prevention will require that the barriers to interdisciplinary collaboration and full community partnership be reduced or eliminated.

Cardiovascular Diseases↗
PubMed1995

Tuberculosis screening in adults who have received bacille Calmette-Guérin vaccine.

The incidence of tuberculosis among immigrants to the United States is 12 times that in the native-born population. Screening immigrants for tuberculosis is complicated by the widespread use of bacille Calmette-Guérin (BCG) vaccination. To determine the utility of tuberculin testing in adults who have been vaccinated with BCG vaccine, we studied the tuberculin reactions of 80 adults who came to us for naturalization physical examinations. No adverse effects were reported from tuberculin testing. Subjects from regions with a low prevalence of tuberculosis who had received BCG vaccine were significantly more likely to have a positive reaction than subjects who had not received BCG vaccine. However, among subjects from regions with a high prevalence of tuberculosis, there was no difference in the prevalence of positive reactions between those who reported having BCG vaccinations and those who said they had not. Interpretation of tuberculin reactions in immigrants who receive BCG vaccinations depends on the prevalence of tuberculosis in the country of origin. Adults receiving BCG vaccination who have a positive reaction and no evidence of active tuberculosis should receive prophylactic therapy or be observed carefully.

Adjuvants, Immunologic↗
PubMed1995

Vena cava filter devices.

Vena cava filters are effective in preventing pulmonary embolism (PE) in patients with deep vein thrombosis or PE who either have contraindications to anticoagulation or have sustained a PE despite adequate anticoagulation. Although vena cava filters are not without complications, clinically significant morbidity and mortality are low. The use of vena cava filters as primary prophylaxis or therapy for deep vein thrombosis and PE should await the results of controlled trials.

Anticoagulants↗
PubMed1994

Anticoagulation therapy and primary care internal medicine: a nurse practitioner model for combined clinical science.

The anticoagulation clinics at the University of Virginia Health Sciences Center and the University of California at Davis Medical Center are nurse-practitioner-operated, are affiliated with the general medicine clinic, and rely on portable prothrombin time (PT) monitors that use whole blood and provide timely as well as accurate results reported in PT seconds or as the international normalized ratio (INR). On-site PT/INR testing at these clinics simplifies anticoagulation, mandates direct patient contact, and facilitates primary as well as comprehensive care for patients requiring multispecialty services in large tertiary care centers. Encounters are relatively brief, averaging 19 minutes; 72% of the encounter time involves anticoagulation care and 28% involves primary care. Anticoagulation results using portable PT/INR monitors are safe and accurate based on comparisons with results from clinics relying on standard instruments.

Academic Medical Centers↗
PubMed1994

A comparison of education methods and their impact on behavioral change in patients with hyperlipidemia.

We sought to determine the efficacy of a hospital-based, professionally-taught program emphasizing cardiovascular health. Similar programs are in existence throughout the country without documentation of their long-term benefits. Thirty-six hyperlipidemic individuals were treated as a control group or participated in one of two intensive educational interventions. The educational program was based on information obtained from focus group methodology to elicit attitudes about dietary change and learning style preferences. Behavioral changes in smoking, dietary salt and saturated fat intake, stress and tension, physical activity, and departure from ideal body weight were documented using health questionnaires and Lifestyle Risk Indices. At three months of follow-up, there was no change in serum lipids, total fat intake, or cardiovascular risk behavior in either the control or intervention group. We conclude that a one-day program, whether designed by the target population or experts, did not improve cardiovascular risk behaviors, suggesting that more innovative methods are required to address health behaviors in this high risk group.

Female↗
PubMed1994

Outpatient use of a portable international normalized ratio/prothrombin time monitor.

We review our collective experience over the past 4 years using a portable instrument that measures the International Normalized Ratio (INR) and the prothrombin time (PT). The device can be used readily in ambulatory clinic settings and by patients in their homes. The major advantage of the monitor is that the INR/PT can be measured quickly; if a change in the dose of warfarin is necessary, instructions can be discussed directly with the patient at the time of the visit. Compared with clinical laboratory determinations, monitor INRs are quite accurate, with approximately 85% of measurements within 0.9 INR units of the corresponding laboratory value. If necessary, monitor INRs can be adjusted to approximate a specific clinical laboratory's INRs with a regression formula derived from analysis of duplicate INRs using the monitor and the laboratory. Although the Food and Drug Administration has not yet approved use of the monitor by patients at home, use of a portable measuring device in the home by home health agencies may be valuable in selected cases.

Ambulatory Care↗
PubMed1993

Heart, body, and soul: a church-based smoking-cessation program for Urban African Americans.

BACKGROUND: This article provides a descriptive overview of the implementation process of the Heart, Body, and Soul program. The program objective was to test strategies to reduce the prevalence of cigarette smoking among urban African Americans in East Baltimore. METHOD: This study constitutes a prospective randomized trial among inner-city African Americans designed to improve quit rates among church attenders. A random-digit-dialing survey was conducted to establish baseline levels of self-reported cigarette smoking, examine attendant attitudes, and determine the presence of known cardiovascular risk factors among community residents of the catchment area. A similar survey was conducted among churchgoers to establish a baseline. Twenty-two churches were recruited and randomly assigned to either intensive or minimal (self-help) intervention strategies. Baseline health screenings were held in all participating churches. Innovative culturally specific smoking cessation strategies mediated through lay volunteers from participating churches were implemented in the intensive intervention churches. RESULTS: Pastors of all churches were directly involved in all aspects of the planning and implementation process. A total of 29 volunteer lay smoking-cessation specialists were trained and successfully implemented the intensive interventions in churches. An additional 272 church members were trained to conduct their church's health screenings. CONCLUSION: The essential component of this successful implementation process were building trust and acceptance and providing the technical support to encourage smoking-cessation strategies. This description of the project is presented to assist others involved in church-based trials in urban African American communities.

Adult↗