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Biomedical subjects

E J Boyko

Publications and source records attributed to E J Boyko.

At least 91 records · Page 5Linked to original sources
PubMed1993

Reproductive history, glucose tolerance, and NIDDM in Hispanic and non-Hispanic white women. The San Luis Valley Diabetes Study.

OBJECTIVE: To ascertain whether childbearing would decrease oral glucose-stimulated insulin and C-peptide levels and increase the risk of NIDDM and impaired glucose tolerance in a population of Hispanic and non-Hispanic white women residing in the San Luis Valley of Colorado. Several investigators have related childbearing to subsequent abnormal glucose tolerance. RESEARCH DESIGN AND METHODS: In a population-based case-control epidemiological study, diabetic patients 20-74 yr of age (n = 196) and randomly sampled control women subjects (n = 735) underwent a glucose tolerance test, a physical examination, and an in-person standardized interview. The relations between the live-birth number and fasting and oral glucose stimulated glucose, insulin and C-peptide concentrations, and NIDDM and impaired glucose tolerance were estimated using linear or logistic regression to adjust for extraneous variables. RESULTS: In women selected as control subjects, the live-birth number was related to a significant decrease in the sum of 1- and 2-h C-peptide concentrations (coefficient = -0.077, P < 0.001) and the logarithm of the sum of 1- and 2-h insulin concentrations (coefficient = -0.014, P = 0.02). After adjustment for subscapular skin-fold thickness, the relative odds of NIDDM for the live-birth number, which was small and of borderline significance, diminished (odds ratio = 1.04 for one birth, P = 0.18). Findings were similar for impaired glucose tolerance. CONCLUSIONS: Childbearing was related to lower C-peptide and insulin levels in Hispanic and non-Hispanic women of the San Luis Valley. It had little apparent effect on later risk of NIDDM or impaired glucose tolerance.

Adult↗
PubMed1993

Use of a reflectance photometer as a diabetes mellitus screening tool under field conditions.

OBJECTIVE: Investigate the Accu-Chek II and visual Chemstrip bG methods for non-insulin dependent diabetes mellitus (NIDDM) screening under field conditions with the aid of local providers. METHODS: Compare simultaneous random Chemstrip bG, Accu-Chek II and plasma glucose levels using a 6.7 mM cut-off, followed by a 75 gram 2 hour oral glucose tolerance test while screening 1124 people in 15 Alaskan villages with the aid of local personnel during winter field conditions. RESULTS: The Accu-Chek II and visual Chemstrip bG methods detected 92% and 96%, respectively, of those newly diagnosed with NIDDM whose plasma screen was > or = 6.7 mM. The Accu-Chek II provided correlations of 0.774, 0.850, 0.923, and 0.946 with random, fasting, 1 and 2 hour plasma glucose. The mean Accu-Chek II, Chemstrip bG and plasma levels at which NIDDM was diagnosed were not statistically different. Receiver operator characteristic (ROC) curve analysis revealed optimum screening cut-off values for subsequent new diagnosis of NIDDM to be 8.3, 7.7, and 8.0 mM for visual, Accu-Chek II and hexokinase methods (p = NS). CONCLUSION: The Accu-Chek II and Chemstrip bG provided accurate glucose data in random NIDDM screening under field conditions with multiple local providers.

Adult↗
PubMed1992

The role of age in susceptibility to pneumococcal infections.

Whether or not age by itself increases susceptibility to pneumococcal infections separate from the effects of chronic disease is controversial. To address this issue, data collected for a retrospective cohort study of pneumococcal infections among 63 middle-aged and older veterans and 126 uninfected controls were reanalysed. Univariate analysis suggested a linear increase in risk with increasing age for patients 50 years old and older (p = 0.03). Subjects over age 80 years seemed to be at particularly high risk when compared with patients under 50 (odds ratio = 4.3, p less than 0.03). The odds of pneumococcal infection increased by an estimated factor of 1.33 (95% confidence interval = 1.03, 1.71) for each 10-year increase in age. Controlling for other risk factors did not appreciably change the point estimate of the age effect, but statistical significance was lost. This result however suggests that age has an independent association with the risk of pneumococcal infections. The potential impact of this finding on public policy urges that the association of age with the risk of pneumococcal disease be re-examined in a study of sufficient sample size to resolve the issue.

Age Factors↗
PubMed1992

Diabetes mellitus in Alaskan Yup'ik Eskimos and Athabascan Indians after 25 yr.

OBJECTIVE: To estimate the prevalence of diabetes mellitus and overweight in two populations of Alaska Natives and to compare the results with previous data. RESEARCH DESIGN AND METHODS: Participants' heights, weights, and random plasma glucose levels were determined. Those with a glucose of greater than or equal to 6.72 mM received a follow-up glucose-tolerance test, interpreted by WHO criteria. Overweight was defined by National Center for Health Statistics criteria and also by criteria used in previous studies. The subjects were Eskimo and Athabascan residents greater than or equal to 40 yr of age in 15 villages in southwestern Alaska. RESULTS: Diabetes prevalence was 4.7% for Eskimos and 10.0% for Indians. Among Eskimo men and women, the prevalence of overweight was 34 and 56%, respectively, among Indian men and women, it was 29 and 55%, respectively. Comparisons with past data indicate that the prevalence of diabetes has increased from 1.7% in 1962 for Eskimos and 1.8% in 1969 for Indians. CONCLUSIONS: The prevalence of diabetes appears to have increased among Eskimos and Indians in Alaska. Overweight appears to be a significant problem in both groups.

Alaska↗
PubMed1992

A prospective study of Staphylococcus aureus nasal colonization and intravenous therapy-related phlebitis.

BACKGROUND: Intravenous (IV) therapy-associated phlebitis is common, but its causes are ill defined. Some cases may be related to bacterial colonization of the skin surrounding the IV catheter, especially by Staphylococcus aureus. This prospective study examined the association of phlebitis with anterior nares S aureus carriage, as well as with other potential risk factors. METHODS: Selected demographic and clinical data and a nares culture were collected from patients on designated wards by us and from the IV therapy team at the time of initial IV catheter placement. Patients were followed up for signs and symptoms of phlebitis for the duration of the initial catheter's use and for up to two additional IV placements. Potential risk factors were compared for patients who developed phlebitis and those who did not by the Cox multivariate proportional hazards model. RESULTS: During 10 weeks, 273 men with a total of 416 catheter placements had fully evaluable data. Phlebitis occurred during 13.7% of the catheter placements. Nasal cultures yielded S aureus from 14.3% of the patients, but none of the IV team nurses. Surprisingly, S aureus nasal colonization was related (at borderline statistical significance) to a reduction in phlebitis risk. Location of the patient on a surgical ward, the presence of infection at any site, and a larger-gauge catheter were each significant independent risk factors for phlebitis. The highest risk of phlebitis appeared to have been within 12 to 24 hours of catheter placement. CONCLUSIONS: The primary finding of this study was that nasal colonization with S aureus did not increase the risk of developing IV catheter-associated phlebitis. Our rate of IV catheter-associated phlebitis was similar to that in other studies, but the factors predisposing to phlebitis differed somewhat from those in previous studies.

Catheterization, Peripheral↗
PubMed1991

Relationships between requests for psychiatric consultations and psychiatric diagnoses in long-term-care facilities.

OBJECTIVE: The authors' objective was to investigate reasons for referral of elderly nursing home residents for psychiatric consultation and the relationship of these reasons for referral to psychiatric diagnoses. METHOD: They examined 197 nursing home residents consecutively referred to a consulting team in a university-affiliated mental health center. These patients represented all patients evaluated by the consulting team at six nursing homes over a 2-year period (Sept. 1, 1984, through Aug. 30, 1986). RESULTS: Reasons for referral were diverse but fell into seven broad clusters: behavioral problems; mood-related problems; consultations requested by involuntary treatment services, patients, physicians, or other referring agencies; psychotic features; physical signs; impaired activities of daily living; and other. Behavioral problems were most commonly cited and tended to be associated with dementia diagnoses. Mood-related reasons for referral were most strongly associated with diagnoses of affective disorders, and diagnoses of schizophrenia and adjustment disorder were each associated with two or more reasons for referral. However, reasons for referral were distributed widely across diagnostic groups and were relatively weak predictors of diagnoses. CONCLUSIONS: The results illustrate the variety of problems for which nursing home staff are willing to seek psychiatric consultation but emphasize the need for professional psychiatric evaluation to establish a diagnostic base on which treatment interventions can be built.

Adjustment Disorders↗
PubMed1991

Chronology and determinants of tissue repair in diabetic lower-extremity ulcers.

The natural history of tissue repair and the critical determinants of faulty healing of diabetic ulcers remain obscure despite recent advances in our knowledge of the cellular physiology of normal cutaneous healing. To characterize the chronology and identify important factors affecting healing, we applied an objective method to quantify the rate of wound healing of full-thickness lower-extremity ulcers in 46 diabetic outpatients who received local wound care under a standardized clinical protocol. The initial ulcer healing rate, eventual status of tissue repair, and definitive clinical outcome were not significantly associated with age; diabetes type, duration, or treatment; level or change in glycosylated hemoglobin; current smoking; presence of sensory neuropathy; ulcer location or class; initial infection; or frequency of recurrent infections. However, direct measures of local cutaneous perfusion, estimated by periwound measurements of transcutaneous O2 tension (TcPo2) and transcutaneous CO2 tension (TcPco2), were significantly associated with the initial rate of tissue repair (P = 0.003 and 0.005, respectively). The strong prediction of early healing by these parameters of local skin perfusion was independent from the effects of segmental Doppler arterial blood pressure at the dorsalis pedis, although eventual ulcer reepithelialization was significantly related to foot blood pressure and periwound TcPo2 and TcPco2. We conclude that periwound cutaneous perfusion is the critical physiological determinant of diabetic ulcer healing, indicating a 39-fold increased risk of early healing failure when the average periwound TcPo2 is less than 20 mmHg.

Adult↗
PubMed1991

Higher insulin and C-peptide concentrations in Hispanic population at high risk for NIDDM. San Luis Valley Diabetes Study.

Hyperinsulinemia has been demonstrated in Hispanics with normal glucose tolerance and in other populations at higher risk for non-insulin-dependent diabetes mellitus (NIDDM). We compared fasting and glucose-stimulated insulin and C-peptide levels in a community-based sample of 464 Hispanic and 676 non-Hispanic white adult residents of the San Luis Valley of Colorado. All subjects had normal glucose tolerance as confirmed by oral glucose tolerance testing interpreted with World Health Organization criteria. Mean fasting and 1- and 2-h post-glucose load insulin levels were significantly higher in Hispanics versus non-Hispanic whites (fasting 0.08 vs. 0.07 nM, P = 0.0026; 1 h 0.52 vs. 0.47 nM, P = 0.0129; 2 h 0.36 vs. 0.27 nM, P less than 0.0001), even after adjustment for age, sex, body mass index, waist-hip ratio, family history of diabetes mellitus, concurrent plasma glucose level, and fasting insulin level. Mean fasting and 1- and 2-h glucose-stimulated C-peptide levels in Hispanics also significantly exceeded those in non-Hispanic whites (fasting 0.58 vs. 0.54 nM, P = 0.0119; 1 h 2.72 vs. 2.46 nM, P less than 0.0001; 2 h 2.25 vs. 1.97 nM, P less than 0.0001). The C-peptide-insulin molar ratio was greater in non-Hispanic whites than Hispanics at all times measured. These findings confirm that Hispanics with normal glucose tolerance are hyperinsulinemic and that increased insulin secretion is at least partly responsible for this phenomenon. The lower levels of C-peptide compared with insulin in Hispanics suggest that the hyperinsulinemia seen in this ethnic group may be due in part to decreased hepatic insulin extraction.

Blood Glucose↗
PubMed1990

The use of risk factors in medical diagnosis: opportunities and cautions.

We discuss in this paper the extent to which disease risk factors may assist in the diagnostic process. We caution that disease risk factors need not be very sensitive or specific. Risk factor specificity and sensitivity may be further reduced if, in the former case, the risk factor is related to other illnesses having the same clinical presentation as the disease of interest, or if, in the latter case, the risk factor disappears with the onset of illness. We illustrate these points in a discussion of the utility of smoking as a diagnostic test for malignancy in two clinical situations, the patient with asymptomatic microscopic hematuria and the patient with a solitary pulmonary nodule. Risk factors hold great promise as aids to medical diagnosis, as this information is readily available to clinicians at little or no cost. Clinicians, however, should exercise caution when using risk factors of unproven diagnostic utility in medical diagnosis, as their presence may have little or no effect on disease probability.

Confounding Factors, Epidemiologic↗
PubMed1990

Randomized, controlled trial of a 10-day course of amifloxacin versus trimethoprim-sulfamethoxazole in the treatment of acute, uncomplicated urinary tract infection. Amifloxacin Multi-Center Trial Group.

We conducted a randomized controlled trial of orally administered amifloxacin versus trimethoprimsulfamethoxazole (TMP-SMX) as treatments of acute uncomplicated urinary tract infection in women. Amifloxacin at a dosage of 200 mg twice a day appeared as safe and effective as TMP-SMX, but amifloxacin at 400 mg twice a day tended to cause adverse events more frequently than did TMP-SMX.

Administration, Oral↗
PubMed1990

Effects of childbearing on glucose tolerance and NIDDM prevalence.

The goal of this study was to estimate the effects of childbearing on subsequent glucose tolerance and non-insulin-dependent diabetes mellitus (NIDDM) prevalence. A sample of subjects from 64 different locations in the United States were recruited for inclusion in the Second National Health and Nutrition Examination Survey. A complex survey design was used to select a probability sample of subjects from each location. A total of 4577 women were recruited, of whom 3057 underwent clinical and laboratory evaluation for the presence of diabetes mellitus. Women were classified as to their glucose tolerance based on the results of an oral glucose tolerance test or previous physician diagnosis of diabetes mellitus combined with current use of hypoglycemic medication. Childbearing was defined as number of live births experienced by each woman at the time of the interview. Fasting plasma glucose increased linearly with increasing number of live births (coefficient 0.009, 95% confidence interval [CI] 0.006-0.012), as did the 2-h value (coefficient 0.015, 95% CI 0.009-0.021). Adjustment for age, body mass index (BMI), education, and income substantially reduced the magnitude of the association between childbearing and either plasma glucose measurement. When the prevalence of NIDDM in relation to childbearing was examined with logistic regression analysis, a significant linear increase in diabetes prevalence was seen with increasing number of live births (relative prevalence of NIDDM, 1 birth vs. 0 = 1.73, 95% CI 1.39-2.15), but adjustment for age, BMI, education, and income greatly reduced the magnitude of this association (relative prevalence of NIDDM, 1 birth vs. 0 = 1.07, 95% CI 0.98-1.17).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Increased incidence of infections in intravenous drug users.

To ascertain the incidence of infections in intravenous users of illicit drugs, we performed a retrospective study of 270 intravenous drug users (IVDUs) and 562 controls who did not use drugs over a seven-year period from 1978-1985. IVDUs had an increased overall incidence of infections (P less than 0.001) compared to controls, which was explained to a large degree by an increased incidence of hepatitis. Endocarditis and disseminated gonococcal infection were seen with increased frequency in IVDUs (P less than 0.05), but abscess and cellulitis were not. Neither acquired immunodeficiency syndrome (AIDS), tuberculosis, Pneumocystis pneumonia, nor disseminated viral or fungal infection were seen in IVDUs or controls. Heroin users, but not other IVDUs, had an increased incidence of infections not thought to be associated with needle use, suggesting impaired immunity. This study demonstrates that IVDUs have an increased incidence of infection compared to control subjects, but the kinds of infections have changed substantially over the past two decades. The presence of opportunistic pathogens in these patients should suggest concurrent infection with human immunodeficiency virus (HIV).

Adult↗
PubMed1989

NIDDM and prevalence of nasal Staphylococcus aureus colonization. San Luis Valley Diabetes Study.

Previous studies of hospitalized and ambulatory patients have found a higher prevalence of Staphylococcus aureus nasal colonization in diabetic than nondiabetic subjects. We examined this association in a geographically based study among 551 residents of the San Luis Valley of Colorado and found no statistically significant increase in the relative risk of nasal S. aureus colonization in 188 non-insulin-dependent diabetic (NIDDM) versus 363 nondiabetic subjects (relative risk 1.3, 95% confidence limits 0.9-1.8). Adjustment for confounding by age, sex, ethnicity, county of residence, and frequency of hospitalizations or physician visits in the previous year did not affect the results. Among the diabetic subjects, S. aureus colonization was not associated with type of treatment for diabetes, level of glucose control, clinical duration of diabetes, or frequency of hospitalizations or physician visits in the previous year. In this population-based study, diabetes mellitus did not increase S. aureus nasal colonization, suggesting that factors other than diabetes mellitus may have caused the higher colonization rate found in previous clinic-based studies.

Colorado↗
PubMed1989

Coffee and alcohol use and the risk of ulcerative colitis.

We performed a population-based, case-control study of the risk of ulcerative colitis associated with coffee and alcohol use among the 304,000 members of a prepaid health plan. We compared coffee and alcohol use histories before ulcerative colitis onset in 209 cases and an equal number of age- and sex-matched controls selected from the enrollment file of the prepaid health plan. Neither coffee use, amount of coffee consumed daily, or cumulative coffee consumption before disease onset altered the risk of developing ulcerative colitis. A decreased risk of ulcerative colitis was associated with alcohol consumption before disease onset among never-smokers only. This risk declined as daily alcohol consumption increased. These results suggest that alcohol consumption may lower ulcerative colitis incidence.

Coffee↗
PubMed1988

Weather and occurrence of eclampsia.

The authors performed a population-based case-control study of the association between weather and occurrence of eclampsia in Washington State. Women who were recorded as having eclampsia on Washington birth certificates from 1980 to 1983 were compared to a random sample of all women who gave birth during those years. For each woman studied, National Oceanic and Atmospheric Administration weather data were used to determine the temperature, relative humidity, precipitation, and wind speed on the date of birth at the station nearest the hospital of birth. Categorical analysis revealed that eclampsia was not associated with low temperature, high relative humidity, precipitation, or high wind speed. These results were unchanged after adjustment for race, parity, maternal age, and late initiation of prenatal care. These results do not support an association between eclampsia and weather on the date of delivery in this population.

Birth Certificates↗