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E Eaker

Publications and source records attributed to E Eaker.

At least 19 recordsLinked to original sources
PubMed2000

Incidence and predictors of atrial flutter in the general population.

OBJECTIVES: The goal of our study was to determine the incidence and predictors of atrial flutter in the general population. BACKGROUND: Although atrial flutter can now be cured, there are no reports on its epidemiology in unselected patients. METHODS: The Marshfield Epidemiological Study Area (MESA), a database that captures nearly all medical care among its 58,820 residents was used to ascertain all new cases of atrial flutter diagnosed from July 1, 1991 to June 30, 1995. To identify predisposing risk factors, we employed an age- and gender-matched case-control study design using eight additional variables. RESULTS: A total of 181 new cases of atrial flutter were diagnosed for an overall incidence of 88/100,000 person-years. Incidence rates ranged from 5/100,000 in those <50 years old to 587/100,000 in subjects older than 80. Atrial flutter was 2.5 times more common in men (p < 0.001). The risk of developing atrial flutter increased 3.5 times (p < 0.001) in subjects with heart failure and 1.9 times (p < 0.001) for subjects with chronic obstructive pulmonary disease. Among those with atrial flutter 16% were attributable to heart failure and 12% to chronic obstructive lung disease. Three subjects (1.7%) without identifiable predisposing risks were labeled as having "lone atrial flutter." CONCLUSIONS: This study, the first population-based investigation of atrial flutter, suggests this curable condition is much more common than previously appreciated. If our findings were applicable to the entire U.S. population, we estimate 200,000 new cases of atrial flutter in this country annually. At highest risk of developing atrial flutter are men, the elderly and individuals with preexisting heart failure or chronic obstructive lung disease.

Adult↗
PubMed2000

Failure of a motilin receptor agonist (ABT-229) to relieve the symptoms of functional dyspepsia in patients with and without delayed gastric emptying: a randomized double-blind placebo-controlled trial.

INTRODUCTION: Motilin-receptor agonists are prokinetics; whether they relieve the symptoms of functional dyspepsia is unknown. We aimed to test the efficacy of the motilin agonist ABT-229 in functional dyspepsia patients with and without delayed gastric emptying. METHODS: Patients were randomized with postprandial symptoms and documented functional dyspepsia by endoscopy (n=589 in intention-to-treat analysis). Patients were assigned to either the delayed or normal gastric emptying strata, based on a validated 13C octanoic acid breath test. Patients were then further randomized within each strata, to receive one of four doses of ABT-229 (1.25, 2. 5, 5 or 10 mg b.d. before breakfast and dinner) or placebo for 4 weeks, following a 2-week baseline. The primary outcome was the assessment of change in symptom severity over the 2 weeks from baseline to final visit, based on a self-report questionnaire measuring severity on visual analogue scales. RESULTS: Baseline characteristics across the treatment arms were very similar. No significant differences in the upper abdominal discomfort severity score (maximum 800 mm) were observed for any active treatment arm vs. placebo (mean change from baseline -139, -141, -145, -160 and -134 mm for placebo, 1.25, 2.5, 5, and 10 mg, respectively, at 4 weeks by intention-to-treat). More patients on placebo reported a good or excellent global response than patients on 1.25 or 5 mg of active therapy (both P < 0.05). The results were very similar in those with and without delayed gastric emptying. Helicobacter pylori status did not predict response. Excluding patients with any baseline heartburn (total remaining n=240), ABT-229 10 mg was inferior to placebo in relief of upper abdominal discomfort. CONCLUSIONS: ABT-229 was of no value for relief of symptoms in functional dyspepsia, compared with placebo.

Adult↗
PubMed1998

Coronary artery disease in diabetic and nondiabetic patients with lower extremity arterial disease: A report from the Coronary Artery Surgery Study Registry.

OBJECTIVE: Patients with lower extremity arterial disease (LEAD) are at an increased risk of having coronary artery disease (CAD). Diabetics are at especially high risk for having LEAD with concomitant CAD. This study was undertaken (1) to define the clinical and arteriographic features associated with CAD among diabetics and nondiabetics with LEAD and (2) to determine the long-term survival and predictors of mortality of diabetics and nondiabetics with LEAD and CAD. RESEARCH DESIGN AND METHODS: Two hundred sixty-three diabetics and 1137 nondiabetics from the Coronary Artery Surgery Study who had evidence of LEAD, who were 50 years and older, and who had arteriographically proven CAD were monitored for a mean of 12.8 years. RESULTS: Among all the subjects with LEAD there was a high prevalence of current and past smoking, history of previous myocardial infarction, systemic hypertension, congestive heart failure, high degrees of angina pectoris and unstable angina pectoris, and use of beta-blockers. On arteriographic evaluation a high prevalence of three-vessel epicardial coronary disease and involvement of multiple coronary segments with > or =50% diameter narrowing was found. Multivariate analysis showed the number of coronary segments with >50% occlusion, the presence of cerebrovascular disease, the use of digitalis, and elevated systolic blood pressure were independently associated with diabetes. On follow-up diabetics had a significantly higher mortality rate (mostly cardiac) than nondiabetics: median survival, 8.1 years and 12.7 years, respectively. At 15 years the mortality rates were 77.1% and 62.0%, respectively. On multivariate analysis, age, number of coronary occlusions, number of significantly narrowed epicardial arteries, diminished myocardial contractility, hypertension, and smoking were significant predictors of mortality in the total group and in each subgroup. Coronary artery bypass grafting surgery was protective. The presence of diabetes was an independent risk factor for mortality. CONCLUSIONS: The presence of LEAD is associated with multivessel epicardial and multiple coronary segment occlusion. On long-term follow-up there is a high mortality rate. In patients with LEAD and diabetes, CAD is especially severe and prognosis is poor.

Angina Pectoris↗
PubMed1997

Reliability of reported age at menopause.

Age at menopause is an important epidemiologic characteristic whose reliability of reporting in the US population is not known. The authors examined four hypotheses about the reliability of reported age at menopause in the United States: 1) women with hysterectomy-induced menopause more reliably report their age at menopause than women who have undergone natural menopause; 2) reliability declines with time since menopause; 3) reliability declines with age; and 4) women with higher educational levels report their age at menopause more reliably than women with less education. The authors used linear regression models among 2,545 women in the First National Health and Nutrition Examination Survey and Followup Study (1971-1984) and compared responses at first and follow-up interviews. Among women who had undergone a natural menopause, 44% reported their age at menopause within one year from the first to second interviews; among women who had undergone a hysterectomy-induced menopause, 59% reported their age at menopause within one year from first to follow-up interviews. Only hysterectomy status and years from menopause to follow-up interview were significantly associated with the absolute difference between age at menopause reported at first and follow-up interviews. The authors conclude that caution in studies involving age at menopause may enhance our understanding of this critical event in the lives of women.

Adult↗
PubMed1997

Coronary artery disease in diabetic patients with lower-extremity arterial disease: disease characteristics and survival. A report from the Coronary Artery Surgery Study (CASS) registry.

OBJECTIVE: Patients who have diabetes and lower-extremity arterial disease (LEAD) are at an increased risk of dying from coronary artery disease (CAD). This study was undertaken to: 1) define the clinical and arteriographic factors associated with LEAD among diabetic patients; 2) determine the long-term survival and predictors of mortality of diabetic patients with LEAD, compared to those without LEAD; and 3) determine if the presence of LEAD is an independent risk factor for mortality among diabetic patients with CAD. RESEARCH DESIGN AND METHODS: A total of 263 diabetic patients from the Coronary Artery Surgery Study (CASS) registry with LEAD, who were > or = 50 years of age, and who had arteriographically proven CAD, were identified and followed for a mean of 12.8 years. A total of 1,349 comparably aged diabetic patients from the CASS registry with CAD and no evidence of LEAD were followed for an equivalent period of time. RESULTS: Compared with diabetic patients without LEAD, diabetic patients with LEAD were characterized by the presence of cerebrovascular disease, a high rate of current smoking, elevated systolic blood pressure, high grades of angina pectoris, and digitalis use. Severity of epicardial CAD and extent of CAD were not independent predictors of the presence of LEAD. On follow-up, diabetic patients with LEAD had significantly higher mortality (mostly cardiovascular) than diabetic patients without LEAD, with a median survival of 8.1 and 10.9 years, respectively. On multivariate analysis, age, the number of significantly narrowed coronary arteries, and the presence of left ventricular dysfunction predicted mortality in both subsets of diabetic patients. Among all the diabetic patients with CAD, the presence of LEAD was an independent risk factor for mortality. CONCLUSIONS: Diabetic patients with LEAD have a higher mortality rate (mostly cardiovascular) than diabetic patients without LEAD, despite no apparent anatomic differences in the severity and extent of CAD. This suggests that factors associated with the presence of LEAD, other than the anatomy of the coronary circulation, may play a role in determining survival among diabetic patients with LEAD and CAD.

Aged↗
PubMed1995

Plasma lipid levels and psychologic characteristics in men.

Results of several studies suggest that either a reduction in the serum level of total cholesterol level or a persistently low cholesterol level may be associated with an increase in violent deaths. Although there are several possible explanations for these observations, it has been suggested that the cholesterol level could influence various behaviors. We therefore examined the cross-sectional relation of several psychologic characteristics, assessed by the Diagnostic Interview Schedule and the Minnesota Multiphasic Personality Inventory, to levels of total cholesterol, high-density lipoprotein cholesterol, and triglycerides among 3,490 men aged 31-45 years who were examined in 1985-1986. (All men had served in the US Army between 1965 and 1971). Compared with that of other men, the mean total cholesterol level was 5 mg/dl higher among 697 men diagnosed with generalized anxiety disorder (possibly because of increased catecholamine levels) and 7 mg/dl lower among 325 men with antisocial personality disorder (p < 0.01 for each association). These differences could not be attributed to education, relative weight, cigarette smoking, use of various medications, or other potential confounders. In contrast, cholesterol levels were not significantly associated with major depression or hostility; levels of high-density lipoprotein cholesterol and triglycerides were not related to any diagnosis. If the serum level of total cholesterol is found to be predictive of antisocial personality disorder in longitudinal analyses, this association may have implications for cholesterol-lowering recommendations.

Adult↗
PubMed1995

Endothelin-1 expression in myenteric neurons cultured from rat small intestine.

Endothelin is a potent vasoactive peptide. More recently, endothelin-1 (ET-1) has been found in neural tissues such as spinal cord, brain and peripheral ganglion cells. Inagaki (Gastroenterology 101 (1991) 47) reported evidence of ET-1-like immunoreactivity in enteric neurons, but there are no reports of ET-1 peptide or mRNA expression specifically in myenteric neurons. Using a primary culture of myenteric neurons, we set out to evaluate ET-1 peptide and mRNA expression. Myenteric neurons were cultured using a dissection and enzyme dispersion technique. ET-1 reactivity was localized to neurons and ET-1 levels from cells and media were assayed by radioimmunoassay under a variety of media conditions or with depolarizing buffer or veratridine (75 microM). Prepro ET-1 mRNA expression was determined by Northern analysis of total RNA utilizing a rat ET-1 cDNA. ET-1 immunoreactivity was observed almost exclusively in myenteric neurons. Cells contained 0.78 pg/micrograms protein and did not vary with variations in media conditions. Basal release/secretion into media occurred but was not enhanced by depolarizing media or veratridine. High levels of ET-1 mRNA expression were identified. These results of high level constitutive expression of ET-1 linked with previous reports of ET-1 modulation of cholinergic intestinal smooth muscle contraction suggest a neuromodulatory role.

Animals↗
PubMed1995

Poverty and death in the United States--1973 and 1991.

We conducted a survival analysis to determine the effect of poverty on mortality in a national sample of blacks and whites 25-74 years of age (in the First National Health and Nutrition Examination Survey and National Health Examination Follow-up Survey). We estimated the proportion of mortality associated with poverty from 1973 through 1984 and in 1991 by calculating the population attributable risk. We assessed confounding by major known risk factors, such as smoking, serum total cholesterol, and inactivity. In 1973, 16.1% of U.S. mortality among black and white persons 25-74 years of age was attributable to poverty; in 1991, the proportion increased to 17.7%. In 1991, the population attributable risk of poverty on mortality was lowest for white women, 1.7 times higher for white men, 2.6 times higher for black women, and 3.6 times higher for black men. Potential confounders explained 40% of the effect of poverty on mortality among women. The proportion of mortality attributable to poverty among U.S. black and white adults has increased in recent decades and is comparable to that attributable to cigarette smoking. The effect of poverty on mortality must be explained by conditions other than commonly recognized risk factors.

Adult↗
PubMed1994

Coronary artery disease and coronary artery bypass grafting in diabetic patients aged > or = 65 years (report from the Coronary Artery Surgery Study [CASS] Registry).

A cohort of 317 diabetic patients, aged > or = 65 years, with angiographically proven coronary artery disease, was analyzed and followed for a mean of 12.8 years. Compared with 1,843 age-matched nondiabetic patients, diabetic patients were more likely to (1) have a higher number of coronary occlusions, (2) not be current smokers, (3) have higher systolic but lower diastolic blood pressures, (4) have evidence of peripheral vascular disease, and (5) be women. They did not differ significantly with respect to total cholesterol, family history of coronary artery disease, history of hypertension, or left ventricular hypertrophy. In the total elderly cohort, diabetes was found to be an independent predictor of mortality, conferring a 57.0% increased risk of death. Survival analysis showed that diabetic subjects consistently had higher mortality than nondiabetics. However, the relative survival benefit of coronary artery bypass graft surgery versus medical therapy was comparable in diabetic and nondiabetic patients. Surgical therapy conferred a reduction in mortality of 44%.

Aged↗
PubMed1993

Depressed affect, hopelessness, and the risk of ischemic heart disease in a cohort of U.S. adults.

Major depression has been associated with mortality from ischemic heart disease (IHD). In addition, a symptom of depression--hopelessness--has been suggested as a determinant of health status. We studied the relation of both depressed affect and hopelessness to IHD incidence using data from a cohort of 2,832 U.S. adults age 45-77 years who participated in the National Health Examination Follow-up Study (mean follow-up = 12.4 years) and had no history of IHD or serious illness at baseline. We used the depression subscale of the General Well-Being Schedule to define depressed affect and a single item from the scale to define hopelessness. At baseline, 11.1% of the cohort had depressed affect; 10.8% reported moderate hopelessness, and 2.9% reported severe hopelessness. Depressed affect and hopelessness were more common among women, blacks, and persons who were less educated, unmarried, smokers, or physically inactive. There were 189 cases of fatal IHD during the follow-up period. After we adjusted for demographic and risk factors, depressed affect was related to fatal IHD [relative risk = 1.5; 95% confidence interval (CI) = 1.0-2.3]; the relative risks of fatal IHD for moderate and severe levels of hopelessness were 1.6 (95% CI = 1.0-2.5) and 2.1 (95% CI = 1.1-3.9), respectively. Depressed affect and hopelessness were also associated with an increased risk of nonfatal IHD. These data indicate that depressed affect and hopelessness may play a causal role in the occurrence of both fatal and nonfatal IHD.

Aged↗
PubMed1993

The descriptive epidemiology of selected physical activities and body weight among adults trying to lose weight: the Behavioral Risk Factor Surveillance System survey, 1989.

Few population-based studies have described the physical activity patterns of individuals trying to lose weight. We analysed cross-sectional, self-reported data from 6125 men and 12,557 women (> or = 18 years of age) from 40 states who reported in the 1989 Behavioral Risk Factor Surveillance System (BRFSS) survey that they were trying to lose weight. The BRFSS is a state-based telephone survey of non-institutionalized US adults, which utilizes a multi-stage cluster design based on the Waksberg method of random digit dialing. Walking was the most prevalent physical activity (48%), followed by aerobics (8%), gardening (5%), cycling (5%), and running (4%); however, activity choices varied by socio-demographic characteristics. Among both sexes, the prevalence of overweight (BMI > or = 30 kg/m2) decreased significantly with increasing level of activity (P < or = 0.001). Regression results showed that among both sexes and in most age groups, those who ran or jogged, performed aerobics, or cycled weighed less (P < or = 0.001) than those who reported no activity--independent of height, race, education, smoking, and caloric restriction. Walking was also associated with lower weight (P < or = 0.001) among persons aged 40 or older. Because walking is highly prevalent among persons in most socio-demographic strata and is accessible and low risk, its relative merits should be stressed in developing interventions for weight loss and maintenance.

Adult↗
PubMed1992

The risk of acute myocardial infarction after oestrogen and oestrogen-progestogen replacement.

OBJECTIVE: To determine the relative risk of developing a first acute myocardial infarction after treatment with oestrogens alone or oestrogen-progestogen combinations. DESIGN: Prospective cohort study utilizing a prescription-based and record linkage system for a follow-up period from 1977 to 1983. Average individual observation time was 5.8 years. SETTING: The entire female population of the Uppsala Health Care Region (1.4 million inhabitants), one-sixth of the total Swedish population. SUBJECTS: 23,174 women aged 35 years and older, identified from pharmacy records as having been prescribed non-contraceptive oestrogens during 1977-1980. OUTCOMES: Admissions to hospitals for first acute myocardial infarctions. RESULTS: Overall, 227 cases of a first acute myocardial infarction were observed as against 281:1 expected, RR = 0.81 (95% confidence limits 0.71 to 0.92). Women who were younger than 60 years at entry into the study and prescribed oestradiol compounds (1-2 mg) or conjugated oestrogens (0.625-1.25 mg) showed a significant 30% reduction of the relative risk (RR = 0.69, 0.54 to 0.86). Those prescribed a combined oestradiol-levonorgestrel brand also demonstrated a significantly lowered relative risk (RR = 0.53, 0.30 to 0.87). The risk estimates were near unity during the first year of follow-up but decreased during subsequent years. Exposure to the weak oestrogen oestriol did not alter the risk. CONCLUSION: Hormonal replacement therapy with oestrogens alone, and maybe also when cyclically combined with progestogens, can reduce the risk of acute myocardial infarction.

Adult↗
PubMed1992

The role of public health surveillance: information for effective action in public health.

Public health surveillance can provide the quantitative information needed for setting priorities and establishing rational health policy. Although there are many examples of the effective use of such information, the full potential for surveillance has not yet been realized. To a large degree, failure to achieve this potential has resulted from limited perspectives regarding the role and conduct of surveillance. Both practitioners (those who conduct surveillance) and users (those who apply surveillance data in a real-world setting) have fallen victim to such myopia. Public health surveillance must be advocated as an essential part of the global health agenda if we are to achieve international goals for improving health status. As we improve our appreciation of the variety of uses for public health surveillance data, we need to understand more fully the determinants of the decision-making process. Effective dissemination of information and effective communication are as important as data collection and analysis. No longer do we have--or should we have--the luxury of collecting information for its own sake. The information collected must have a demonstrated utility. Developing and training personnel to have expertise in public health surveillance will necessarily incur opportunity costs. Bridging gaps in data methodology and coverage will force us to weigh alternatives and to compromise. We hope that the International Symposium on Public Health Surveillance will accomplish several goals. First, we wish to foster international understanding of the definition, role, and importance of surveillance in reducing morbidity and mortality, in improving quality of life, and in setting effective health priorities. Second, we hope that this symposium will serve as a springboard for identifying issues and topics that can be addressed in greater depth at future international meetings. Finally, we see the symposium as an essential step in developing a firm commitment on the part of countries, donor agencies, and multilateral organizations to develop the essential capacity for public health surveillance throughout the world. Each country should have the capacity to measure and monitor changes in health status, risk factors, and health-service access and utilization among its people. All countries should have the means to detect emerging health problems and implement measures for their control, to evaluate the impact of health policies and programs, and to communicate health information in a meaningful fashion to policymakers and the public. If we are successful in these endeavors, the long-term effects on the public's health will be well worth the struggle required to achieve them.(ABSTRACT TRUNCATED AT 400 WORDS)

Global Health↗
PubMed1990

Differences between black and white men in correlates of high density lipoprotein cholesterol.

Although socioeconomic status has been positively related to levels of high density lipoprotein (HDL) cholesterol in white Americans, limited evidence suggests that an inverse association may exist among blacks. These associations were further examined using data collected in 1985-1986 from 3,562 white and 500 black men who ranged in age from 31 to 45 years. Overall, mean levels of HDL cholesterol were 8 mg/dl higher among blacks than among whites and, in each group, levels were related positively to alcohol consumption and negatively to Quetelet index and cigarette smoking. A statistically significant interaction, however, was observed between race and educational achievement: no association was seen between educational achievement and levels of HDL cholesterol among white men, but there was an inverse association among blacks. For example, a 13 mg/dl (55 vs. 42 mg/dl) difference in levels of HDL cholesterol was observed between black and white men who did not complete high school, but only a 3 mg/dl black excess (47 vs. 44 mg/dl) was seen among college graduates. About 40 percent of this reduction could be attributed to the effects of cigarette smoking, alcohol consumption, and relative weight. These results indicate that the higher levels of HDL cholesterol frequently found among black men in the United States may not apply to all social strata. Other characteristics, such as physical activity and diet, may account for the differing race-specific associations with educational achievement.

Adult↗