Obesity management in primary care: changing the status quo.
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Body Mass Index↗
Biomedical subjects
E E Logue
Publications and source records attributed to E E Logue.
Antigenic stimulation and multiple myeloma. A prospective study.
BACKGROUND: A causal relationship between antigenic conditions and multiple myeloma was suggested by case reports. Although controlled studies identified associations with individual conditions, they failed to give overall support to the hypothesis. Using a prospective cohort representative of the U.S. population, the authors hypothesized that immune-stimulating conditions are a risk factor for multiple myeloma. METHODS: The First National Health and Nutrition Examination Survey cohort of 14,407 persons were interviewed from 1971 to 1975 by the National Center for Health Statistics. Vital status with cause of death and hospitalizations were ascertained from 1982 to 1985 and in 1986. From the initial questionnaire, four risk factors were constructed: allergies (asthma, hives, hay fever, food allergies, and other allergies); autoimmune conditions (arthritis, thyroid disease and/or medication, rheumatic fever, diabetes, pernicious anemia); chronic bacterial conditions (chronic bronchitis or emphysema, chronic cough, tuberculosis, ulcers); and inflammatory conditions (gout, gallstones, recurrent or chronic enteritis, pleurisy). RESULTS: Eighteen multiple myeloma (MM) cases were documented. The rate ratio (RR) of MM increased as the number of reported inflammatory conditions increased (one condition, RR = 2.0, 95% confidence interval [CI] = 1.2-3.3; 2 or more conditions, RR = 4.3, 95% CI = 1.5-12.4). The RR of myeloma also increased (P = 0.0002) with time since start of inflammatory conditions (RR = 1.6 for every 10 years of exposure). When cases were restricted to those with more than five years of follow-up, myeloma risk increased with the number of inflammatory conditions (two conditions, RR = 4.6, 95% CI = 1.5-13.8). CONCLUSIONS: Although the number of cases is small and exposure may be misclassified, the prospective nature of the study design strengthens the results of the study.
Adult↗
Does family practice at residency teaching sites reflect community practice?
BACKGROUND: Family medicine has aspired to train residents and conduct research in settings that closely resemble community practice. The purpose of this study was to compare the patient characteristics of the ambulatory teaching centers of a consortium of seven community-based university-affiliated family practice residency programs in northeast Ohio with the National Ambulatory Medical Care Survey (NAMCS) results for family physicians (FPs) and general practitioners (GPs). METHODS: Ninety-eight faculty and resident physicians at the residency training site of the Northeastern Ohio Universities College of Medicine collected data on all ambulatory patient visits (N = 1498) for one randomly chosen week between July 1, 1991, and June 30, 1992. We compared these data with patient visits reported in the 1990 NAMCS for FPs and GPs. RESULTS: The residency training sites saw slightly more children, women, blacks, and Medicare and Medicaid patients. The most common reason for an office visit in both populations was an undifferentiated symptom. Fifteen of the top 20 "reason for visit" codes were identical, as were 14 of the top 20 diagnoses. More preventive and therapeutic services were offered or performed at our residency training sites but fewer diagnostic services were performed. There were fewer consultations requested at our residency training sites but similar hospitalization rates for patients. The mean duration of visit differed by only 1 minute. CONCLUSIONS: The residency training sites of the Northeastern Ohio Universities College of Medicine provide patient care opportunities similar to those found in a national survey of family and general practitioners.
Adolescent↗
Modeling heart disease mortality with census tract rates and social class mixtures.
The relationship between social class and 1980 heart disease (HD) mortality in eight urban U.S. counties was examined by regressing age and sex adjusted census tract specific HD rates (N = 1211) on tract social class characteristics. The regression model indicated that lower middle class residents experienced a HD mortality rate 1.9 (95% CI = 1.3, 2.8) times the rate in the upper middle/middle class, while the working poor experienced a HD rate 4.4 (95% CI = 3.5, 5.7) times the rate in the referent class. Similar class effects were seen for both black and nonblack residents. The crude race effect (1.3 with 95% CI = 1.2, 1.4) was explainable by the concentration of blacks in the lower classes. The methods illustrate the ecologic regression of mixtures of mortality rates on mixtures of exposure in the presence of random tract effects which eliminates some of the problems associated with small denominators or zero rates in some tracts.
Coronary Disease↗
Hyperacute T-wave criteria using computer ECG analysis.
Hyperacute T waves (HATWs) have been described as tall-amplitude, primary T-wave abnormalities sometimes seen in the early phases of transmural myocardial infarction. Despite numerous human and animal studies addressing the presence and significance of HATWs, there are no widely held, reliable ECG criteria for their accurate identification. Using a specially designed computer program on a Hewlett-Packard Realm ECG analysis system, we screened 13,393 adult ECGs to identify those having T-wave amplitudes greater than accepted standards (limb leads, greater than 0.5 mV; precordial leads, greater than 1.0 mV). Patients with other known causes of primary and secondary tall T waves were excluded from the study sample. Patients with tall-amplitude T-waves who then developed clinically verifiable myocardial infarction were labeled the HATW group. The HATW group (21) represented 4.1% of the tall T wave group (513) and 0.16% of the entire sample. The remaining patients, who did not meet HATW criteria, were called the early repolarization variant (ERV) group (51). Both groups underwent comparative computer morphology analysis. Nine parameters were statistically significant in discriminating HATWs from early repolarization variants. A combination of J-point position/T-wave amplitude of more than 25%, T-wave amplitude/QRS amplitude of more than 75%, J-point position of more than 0.30 mV, and age of more than 45 years predicted HATWs from a control group with a specificity of 98.0% and a sensitivity of 61.9% and with positive and negative predictive values of 92.9% and 86.2%, respectively. We conclude that HATWs have characterizable discriminating ECG morphology as determined by computer ECG analysis compared with a control group.
Electrocardiography↗
Life-table methods for detecting age-risk factor interactions in long-term follow-up studies.
Methodological investigation has suggested that age-risk factor interactions should be more evident in age of experience life tables than in follow-up time tables due to the mixing of ages of experience over follow-up time in groups defined by age at initial examination. To illustrate the two approaches, age modification of the effect of total cholesterol on ischemic heart disease mortality in two long-term follow-up studies was investigated. Follow-up time life table analysis of 116 deaths over 20 years in one study was more consistent with a uniform relative risk due to cholesterol, while age of experience life table analysis was more consistent with a monotonic negative age interaction. In a second follow-up study (160 deaths over 24 years), there was no evidence of a monotonic negative age-cholesterol interaction by either method. It was concluded that age-specific life table analysis should be used when age-risk factor interactions are considered, but that both approaches yield almost identical results in absence of age interaction. The identification of the more appropriate life-table analysis should be ultimately guided by the nature of the age or time phenomena of scientific interest.
Actuarial Analysis↗
Symptom reports and mortality in an occupational cohort.
The relationship between baseline symptom reports and subsequent mortality over a 24-year period was examined in a group of 1,224 white male nonsupervisory paper workers. Symptom reports were measured via the Cornell Medical Index, and the vital status of each participant was ascertained by reviewing company personnel records and death certificates. Analyses based on proportional hazards models suggest that symptom reports are predictive of mortality (RR = 1.24; P = .0002), independent of the participant's age and biologic risk status at intake. Analyses based upon age-specific and age-standardized mortality ratios confirm that the paper workers were subject to a "healthy worker effect" (standardized mortality ratio [SMR] = 0.66), and that the healthy worker effect is attenuated (SMR = 0.77) among those participants reporting ten or more symptoms at the beginning of the follow-up period.
Adult↗
Ischemic heart disease risk factors and twenty-year mortality in middle-age Evans County black males.
Ischemic heart disease (IHD) risk factors and 20-year mortality rates were studied in middle-aged Evans County black males. We hypothesized, a priori, that blood pressure, cholesterol, and smoking would be predictive of mortality in black males; that black-white differences in mortality would be due to differences in risk factor levels and not risk functions per se; and that social status would be associated with risk factor levels and would be a predictor of mortality. Multivariate analyses of cumulative risk of dying and time to death suggest that the major IHD risk factors are predictors of all-cause and IHD mortality in black males. Black-white differences in risk functions, specifically for cholesterol, were explained by social status: black males and lower social status white males had similar risk functions, different from those of higher social status white males. Black males and lower social status white males had almost identical survival curves, each less favorable than those of higher social status white males.
Adult↗
Physical conditioning augments the fibrinolytic response to venous occlusion in healthy adults.
The effects of a 10-week physical-conditioning program on fibrinolytic activity at rest and after stimulation by venous occlusion were studied in 69 healthy adults 25 to 69 years old. Physical conditioning was documented by treadmill performance, and fibrinolysis was measured with a newly developed radioenzymatic assay. Whereas fibrinolysis declined at rest from 16.2 +/- 1.3 to 11.4 +/- 0.8 units (mean +/- S.E.M.) (P = 0.0017), the increment in fibrinolysis produced by venous occlusion was increased from 21.7 +/- 2.9 to 33.8 +/- 4.7 units (P = 0.0037). This augmentation was most marked in women, persons with low initial levels of stimulated fibrinolysis, and persons with low initial physical fitness. We conclude that physical conditioning can enhance the augmentation of fibrinolytic activity that occurs in response to venous occlusion. Enhanced fibrinolysis in response to thrombotic stimuli could be an important mechanism in the beneficial effect of habitual physical activity on the risk of cardiovascular disease.
Adult↗