Biomedical subjects

D P Kiel

Publications and source records attributed to D P Kiel.

At least 19 recordsLinked to original sources

PubMed1992

Smoking eliminates the protective effect of oral estrogens on the risk for hip fracture among women.

OBJECTIVE: To determine if the association between smoking and osteoporotic fractures is related to the quantity of cigarettes smoked and to determine if smoking modifies the protection by estrogens. DESIGN: Cohort study. SETTING: A population-based cohort study, the Framingham Study. PARTICIPANTS: A total of 2873 women in the Framingham Study followed through examination 19 (1985-1987). MEASUREMENTS: All fractures of the proximal femur sustained by women in the Framingham Study from 1948 to 1987 were ascertained. At almost all examinations, available information on cigarette smoking was used to classify women as "ever smokers" compared with "never smokers," and, among "ever smokers," "current" compared with "former smokers." A similar classification for estrogen use was created. Information on potentially confounding variables was taken from each examination, including age, adiposity (weight/height2), alcohol consumption (ounces per week), and caffeine intake (coffee and tea). RESULTS: Overall, 207 hip fractures occurred among 34,700 woman-examinations of observation. In the entire cohort, current smoking did not appear to increase hip fracture risk (adjusted odds ratio [AOR], 1.22; 95% CI, 0.76 to 1.95; P greater than 0.2). Also overall, current estrogen use appeared to be protective (AOR, 0.38; CI, 0.12 to 1.21, P = 0.10). Among current smokers, however, estrogen use did not protect against fracture (AOR for current use, 1.26; CI, 0.29 to 5.45), whereas estrogen was protective in nonsmokers (AOR for current or past use, 0.37; CI, 0.19 to 0.75; P = 0.005). CONCLUSIONS: Overall, smoking does not appear to increase the risk for hip fracture in women. Although estrogen replacement protects nonsmokers from fracture, smoking may negate the protective skeletal effects of estrogen replacement therapy.

Administration, Oral↗

PubMed1991

Thiazide diuretics and the risk of hip fracture. Results from the Framingham Study.

Thiazide diuretics may preserve bone mass and prevent elderly women's osteopenic fractures, but studies have not distinguished between thiazide preparations or examined former users. We performed a case-control study looking at thiazide use and subsequent hip fracture in postmenopausal female members of the Framingham Study cohort. Cases who had experienced a first hip fracture (n = 176) were compared with age-matched controls (n = 672). Results showed a modest protective effect of any recent thiazide use (not significant). However, recent pure thiazide users experienced significant protection against fracture (adjusted odds ratio, 0.31; 95% confidence interval, 0.11 to 0.88), whereas recent users of combination drugs containing thiazides experienced no protection (adjusted odds ratio, 1.16; 95% confidence interval, 0.44 to 3.05). Combination drugs generally contained only 25 mg of hydrochlorothiazide, suggesting that the small amount of thiazide was insufficient to preserve bone mass. Former thiazide users were not protected against fracture. In sum, recent pure thiazide use in women protects against hip fracture.

Aged↗

PubMed1991

Health care utilization and functional status in the aged following a fall.

Falls in the aged may lead to increases in health care utilization and declines in functional status. The Longitudinal Study of Aging was analyzed to test the hypotheses that use of the health care system is greater in elderly persons subsequent to a fall in the preceding year than in those who have not fallen and that fallers are more likely to decline in function than are nonfallers. One-time fallers and, especially repeated fallers, (2 or more falls in the preceding year) were at greater risk of subsequent hospitalization, nursing home admission, and frequent physician contact than were nonfallers, after controlling for age, sex, self-perceived health status, and difficulties with activities of daily living. Similarly, one-time fallers, and especially repeated fallers, were at greater risk of reporting subsequent difficulties with activities of daily living, instrumental activities of daily living, and more physically demanding activities. These findings highlight the significant impact that falls have on the health care system and on the individual.

Accidental Falls↗

PubMed1991

Falls.

Falls occur commonly enough in community-dwelling elderly, and have sufficient morbidity and mortality, to argue for increased recognition of the problem by physicians. Whereas in the past these falls may have been considered an inevitable part of aging, it is now clear that distinct risk factors can be identified. Physicians can evaluate patients by using relatively simple assessment tools, including the history, physical examination and, most importantly, direct observation of position changes and gait maneuvers used in everyday activities of daily living. Interventions to prevent falls can be based on the individual assessment of risk factors. The implications of effective preventive practices for Rhode Island are substantial given the relatively high percentage of older persons in the state and the limited long term care facilities required to care for the older person whose decline in function follows a fall.

Accidental Falls↗

PubMed1990

Caffeine and the risk of hip fracture: the Framingham Study.

Caffeine increases urinary calcium output and has been implicated as a risk factor for osteoporosis. The authors examined the effect of caffeine on hip fracture risk in 3,170 individuals attending the 12th (1971-1973) Framingham Study examination. Coffee and tea consumption, age, Framingham examination number, weight, smoking, alcohol consumption, and estrogen use were used to evaluate hip fracture risk according to caffeine intake. Hip fractures occurred in 135 subjects during 12 years of follow-up. Fracture risk over each 2-year period increased with increasing caffeine intake (one cup of coffee = one unit of caffeine, one cup of tea = 1/2 unit of caffeine). For intake of 1.5-2.0 units per day, the adjusted relative risk (RR) of fracture was not significantly elevated compared with intake of one or less units per day. Consumption of greater than or equal to 2.5 units per day significantly increased the risk of fracture. Overall, intake of greater than two cups of coffee per day (four cups of tea) increased the risk of fracture. In summary, hip fracture risk was modestly increased with heavy caffeine use, but not for intake equivalent to one cup of coffee per day. Since caffeine use may be associated with other behaviors that are, themselves, risk factors for fracture, the association may be indirect. Further studies should be performed to confirm these findings.

Age Factors↗

PubMed1990

Multiple stumbles: a risk factor for falls in community-dwelling elderly. A prospective study.

To better understand risk factors for falls among community-dwelling elderly, we analyzed data from a sample of elderly Medicare beneficiaries interviewed in 1987 and a year later. Demographic, social, medical, and functional information were obtained by telephone interviews with 736 subjects (68% women) whose average age was 76.5 (range, 65-99). At baseline, 63 subjects reported a fall and 67 reported two or more stumbles without a fall in the past month. At the second interview follow-up information on falls in the past year was obtained on 586 subjects. One hundred twenty-seven (22%) subjects reported one or more falls. Baseline risk factors that were independent predictors of a fall at the second interview included two or more stumbles (adjusted odds ratio [AOR] 2.3, 95% confidence interval [CI], 1.2-4.5), one or more falls (AOR 5.9, 95% CI 2.9-12.2), having spent 4 or more days in bed in the past month (AOR 7.7, 95% CI 1.9-31.0), and self-reported declining health status (AOR 2.0, 95% CI 1.1-3.5). Falls and stumbles are prevalent among community-dwelling elderly. After controlling for covariates, we found subjects who reported two or more stumbles in the past month are at increased risk for a fall in the following year.

Accidental Falls↗

PubMed1989

Sex hormones and lipoproteins in men.

PURPOSE: To clarify the conflicting evidence of an association between endogenous sex hormones and lipoprotein metabolism in men, we examined the relationship between sex hormone levels, total cholesterol, and high-density lipoprotein cholesterol (HDL-C), taking into account the coronary artery disease (CAD) status of the subjects. PATIENTS AND METHODS: Sex hormone levels, total cholesterol, and HDL-C were measured in 67 men with CAD from among 191 consecutive male patients between the ages of 25 and 75 undergoing coronary angiography, in 26 men without angiographic evidence of CAD, and in 55 men who were clinically free of CAD. RESULTS: There was a consistently positive correlation between total estradiol or calculated free estradiol and both total cholesterol and HDL-C, which persisted after adjustment for potential confounders. Total cholesterol was associated with total testosterone after controlling for age, adiposity, and the presence or absence of CAD, but not with calculated free testosterone. No association was noted between total testosterone or calculated free testosterone and HDL-C. A significant interaction was observed between estradiol and testosterone with respect to total cholesterol. CONCLUSION: This study demonstrates an association between sex hormone levels and lipoprotein metabolism, specifically between estradiol levels and both total cholesterol and HDL-C. Unlike most previous investigators, we were able both to control for the CAD status of our subjects and to consider unbound, biologically active hormone levels. In addition, we documented a complex interaction between endogenous testosterone and estradiol in relation to lipoprotein levels; this association should be considered in future studies.

Adult↗

PubMed1989

Impaired vision and hip fracture. The Framingham Study.

Falls affect a large proportion of the elderly and can result in a variety of injuries, including hip fractures. Several studies have suggested that visual impairment contributes to falls, but studies have not used standardized definitions of visual impairment and have not examined injurious falls or fractures. We looked at the risk of hip fracture associated with visual impairment in those members of the Framingham Study Cohort who took part in the Framingham Eye Study in 1973-75. Of 2,633 subjects followed for 10 years after the eye exam, 110 sustained hip fractures. The fracture rates in those with moderately impaired (20/30 to 20/80) vision (8.5%) and poor (20/100 or worse) vision (11.3%) were higher than in those with good (20/25 or better) vision (3.0%). After adjustment for age, sex, weight, alcohol consumption, and (in women) estrogen use, the relative risk of fracture in those with moderate impairment was 1.54 (95% CI = 0.95-2.49), while for those with poor vision, the relative risk was 2.17 (95% CI = 1.24-3.80). Of note, those with moderately impaired vision in one eye and good vision in the other had a higher risk of fracture (relative risk = 1.94) than those with a similar degree of binocular impairment (relative risk = 1.11). Poor vision in one or both eyes was linked to an elevated fracture risk. This suggests that good stereoscopic vision may be necessary to prevent falls. The risk of fracture with poor and moderately impaired vision combined was increased in women (relative risk = 1.96, 95% CI = 1.23-3.11) but not in men (relative risk = 0.79, 95% CI = 0.23-2.72).(ABSTRACT TRUNCATED AT 250 WORDS)

Accidental Falls↗

PubMed1988

Alcohol consumption and hip fractures: the Framingham Study.

Alcoholics often sustain hip and other fractures. However, a detailed examination of the association between alcohol consumption and hip fractures has not been undertaken. Specifically, the effects of moderate alcohol intake, of alcohol consumption in the elderly, and of changes in consumption have not been studied. Using a retrospective cohort design, the authors evaluated this association in the population-based Framingham Heart Study cohort, a group studied over 35 years and queried repeatedly about their alcohol consumption. In 117,224 person-years of observation, 217 hip fractures occurred. Heavy current alcohol consumption (defined as seven or more ounces (207 ml or more) per week) was associated with a modestly increased risk of hip fracture for women (relative risk (RR) = 1.54) and for men (RR = 1.26) after adjustment for age. In a logistic regression analysis controlling for age, sex, weight, and smoking, current alcohol consumption was associated with a significant (p = 0.01) increase in risk of fracture. The relative risks at different ages were not uniform. For those aged less than 65 years, moderate (2-6 ounces (59.14-177.4 ml) per week) and heavy (seven or more ounces (207 ml or more) per week) were associated with a substantial and significant increased risk, but there was only a marginal and nonsignificant increase in risk in those aged 65 years or more. Examination of the effect of changing alcohol consumption over time indicated that among present heavy alcohol users, past light alcohol consumption reduced the risk (p = 0.03) of fracture, whereas in those with present light consumption, past heavy intake had little effect on fracture risk (p = nonsignificant). In conclusion, alcohol consumption, especially if long-term and heavy, increases the risk of hip fracture.

Accidental Falls↗

PubMed1987

Hip fracture and the use of estrogens in postmenopausal women. The Framingham Study.

To assess the effect of postmenopausal use of estrogens on the subsequent risk of hip fracture, we performed a retrospective cohort study of 2873 women in the Framingham Heart Study. Information obtained at routine biennial examinations about the use of estrogens, body weight, age at menopause, smoking, and alcohol consumption was used to evaluate the risk of hip fracture among postmenopausal women who received estrogens. Hip fractures occurred in 179 postmenopausal women, at a rate that increased exponentially after the age of 50. The risk of fracture was inversely related to weight at all ages. The relative risk of hip fracture in subjects who had taken estrogens at any time was 0.65 after adjustment for age and weight (95 percent confidence interval, 0.44 to 0.98). The adjusted relative risk in women who had taken estrogens within the previous two years was further reduced, to 0.34 (95 percent confidence interval, 0.12 to 0.98). Taking estrogens within four years of menopause also protected against fracture. The number of women in each age group who took estrogens was insufficient for a definitive evaluation of risk, but recent use of estrogens appeared to be protective in women under the age of 65 (no fractures among those who took estrogens) and those 65 to 74. We cannot exclude some degree of selection bias among the women who received estrogen-replacement therapy. Nevertheless, this large cohort study supports the hypothesis that postmenopausal use of estrogens protects against subsequent hip fracture in women.

Age Factors↗

PubMed1987

Receptor-mediated ingestion responses by lung macrophages from a canine model of ARDS.

Receptor-mediated ingestion was examined in macrophages derived from a canine model of the adult respiratory distress syndrome (ARDS). The results showed that Fc-mediated ingestion by alveolar macrophages (AM) and macrophages from lung parenchyma (PM) was significantly diminished when compared with their respective controls. Pulsing all the experimental groups with lipopolysaccharide (LPS) for 1 hr in vitro failed to either enhance the response or return the activity to levels achieved by control cells. In parallel studies, an analysis of C3b-mediated ingestion showed that both the experimental AM and PM performed this function only at a magnitude equal to the control cells. Similar responses were observed when an LPS pulse was performed. Although there was a reduction in Fc-mediated ingestion and an apparent restraint of the C3b-mediated ingestion, both AM and PM expressed a significantly enhanced ability to spread. These results suggested that the canine model of ARDS alters at least one select macrophage function that may be important to subsequently protect the host. Such disturbances in the cellular immune response may contribute to the progression of infection and lung pathology associated with this disease process.

Animals↗

PubMed1987

Sex hormones and coronary artery disease.

Previous investigators have found an increased risk of coronary heart disease in men with high levels of circulating estrogens. To elucidate further this relationship, a case-control study of atherosclerotic coronary artery disease (ASCAD) and sex hormones was undertaken in male patients. Hormone levels in men with severe ASCAD documented at angiography were compared with those in men found to be virtually free from disease and with those in a group of control subjects without signs or symptoms of ASCAD. Significantly lower total testosterone levels were observed among men with severe ASCAD compared with either control group; the free testosterone level was significantly lower than in angiographically disease-free control subjects. The same pattern of hormone levels persisted after control of covariates. Epidemiologic analysis demonstrated a fivefold decrease in risk for severe ASCAD between the lowest and the highest quartile of total testosterone. No overall pattern of association was seen between ASCAD and free or total estrogens.

Adult↗

PubMed1987

The urinalysis: a critical appraisal.

The urinalysis, an inexpensive office test, is often performed unnecessarily. Improved chemical testing using reagent strips obviates the need for routine microscopy in many cases. More information is needed to make specific recommendations on the use of the routine urinalysis as a screening procedure.

Bacteriuria↗

PubMed1987

Cyclophosphamide-sensitive activity of suppressor T cells during treponemal infection.

When hamsters were infected with Treponema pallidum subspecies endemicum, the composition and activity of the cellular immune components were markedly altered compared to those of sham-infected controls. A population of suppressor T cells (Ts) developed that diminished the ability of the macrophage (M phi) to perform C3b receptor-mediated ingestion (C3bMI) of erythrocytes coated with antibody and complement. Using cyclophosphamide (CY) we examined node and peritoneal cells to determine their role in regulating M phi activity during this infection. In vitro the node and peritoneal T cells from treponemal-infected/CY-treated animals showed considerably less suppressive activity than treponemal-infected/untreated T cells when co-cultured with M phi from infected animals. This response was greater with node T cells compared to peritoneal T cells. Moreover, a quantitative analysis of the mononuclear leucocyte populations from each of these regions showed that CY-treated/uninfected animals had a decreased percentage of node T cells. Despite this reduction of node T cells, peritoneal T-cell populations were only minimally reduced. However, treponemal-infected hamsters concomitantly treated with CY had a significant reduction in the T-cell percentages in both compartments. These results imply that, during this infection, most Ts generated in the node remain there although some are dispersed to supplementary regions. Thus, the development of a suppressor system that effects M phi function may be one way in which treponemes escape total elimination by the host.

Animals↗

PubMed1986

Oculopharyngeal muscular dystrophy as a cause of dysphagia in the elderly.

A case of oculopharyngeal muscular dystrophy in an elderly woman of French-Canadian background presenting with dysphagia is discussed. Typical features of the clinical presentation include bilateral ptosis and dysphagia with significant potential for morbid outcomes of aspiration pneumonia and malnutrition. Although relatively uncommon, this diagnosis should be considered in an elderly person with dysphagia, a history of ptosis, and the proper family background. Surgical treatment appears to improve the signs and symptoms of this disease.

Aged↗

PubMed1986

Alveolar macrophage function in a canine model of endotoxin-induced lung injury.

Humans with bacterial sepsis are predisposed to acute lung injury with respiratory failure and have an increased risk of pulmonary infection. Because the alveolar macrophage is the resident phagocyte in the lung and a defect in antimicrobial activity could predispose to infection, we assessed the functional integrity of these cells in vitro in a canine model of Escherichia coli endotoxin-induced lung injury with respiratory failure. Dogs were given 2 or 20 mg/kg of E. coli endotoxin 055:B5, and alveolar macrophages from pulmonary lavage were compared with those from control dogs. The physiologic criteria for the adult respiratory distress syndrome and pathologic confirmation of acute lung injury were produced in all endotoxin-treated animals. The production of acute lung injury with respiratory failure by E. coli endotoxin was associated with several alterations in alveolar macrophage function. Adherence was significantly reduced for cells from the endotoxin groups. The alveolar macrophages from endotoxin-treated animals differed from those from control animals, with significantly greater production of hydrogen peroxide, significantly greater peaks in chemiluminescence, significantly reduced phagocytosis of Staphylococcus aureus and E. coli at all times, and a diminished ability to kill cell-associated S. aureus and E. coli over time. These derangements could play a role in the therapeutic failures of pneumonia, an increased risk for nosocomial pneumonias, or the propagation of acute lung injury with respiratory failure.

Animals↗

PubMed1986

Cellular uptake and cell-associated activity of third generation cephalosporins.

The ability of the third generation cephalosporins to penetrate human polymorphonuclear leukocytes (PMNs) and their antibacterial activity against cell-associated Staphylococcus aureus (SA) and Haemophilus influenzae, type b (Hib) were studied. Utilizing radioactive uptake experiments, the cellular to extracellular concentration ratios were determined to be less than one for all cephalosporins at 10 and 120 min: cefotaxime (0.08 +/- 0.02, 0.34 +/- 0.08), ceftizoxime (0.21 +/- 0.11, 0.52 +/- 0.18), ceftriaxone (0.12 +/- 0.04, 0.38 +/- 0.23), and N-formimidoyl thienamycin (0.18 +/- 0.09, 0.33 +/- 0.14). Third generation cephalosporins were similar to penicillin in their exclusion from PMNs. The killing of cell-associated SA and Hib were evaluated in a preopsonized cell-associated bacterial assay with radiolabelled SA/Hib (cfu/cpm) comparing activity of PMNs + antibiotics to the PMN cell control (no antibiotics) at 0.5, 2, and 4 h. PMNs alone killed less than or equal to 0.5 log SA/Hib over 4 h. Clindamycin killed significantly more SA (p less than 0.01) than all other antibiotics; nafcillin killed significantly fewer SA (p less than 0.05) than all other antibiotics. Although each third generation cephalosporin showed good activity against cell-associated Hib, chloramphenicol had a significantly greater effect (p less than 0.05). N-formimidoyl thienamycin demonstrated good activity only after the concentration was increased in vitro to 8 micrograms/ml. Although cellular penetration of antibiotics may be important in the eradication of cell-associated pathogens, the overall cellular activity would appear to be multifactorial.

Adult↗

PubMed1985

Phagocytosis of type III group B streptococci by neonatal monocytes: enhancement by fibronectin and gammaglobulin.

The potential of fibronectin to enhance phagocytosis of type III group B streptococci by cultured neonatal monocytes was evaluated. Fibronectin had significantly less effect on phagocytosis compared with type-specific antibody to group B streptococci; fibronectin increased the cell association of organisms to a level comparable to that of adult pooled serum and significantly more than that of serum-free controls. Microbicidal activity suggested that this cell association consisted of attachment but not ingestion, and electron micrographs showed the extracellular location of these organisms. In contrast, the effect of fibronectin on type III group B streptococci preopsonized with intravenous gammaglobulin revealed significantly greater numbers of cell-associated organisms than did addition of type-specific antibody to group B streptococci, pooled adult serum plus fibronectin, or serum-free controls. Phagocytosis was similar when assessed by microbicidal activity compared with the cultures with added type-specific antibody and significantly greater when compared with those with added pooled serum, and results were confirmed by electron microscopy. Therefore, fibronectin together with intravenous gammaglobulin enhanced ingestion of type III group B streptococci by neonatal monocytes.

Cells, Cultured↗