Re: A. W. Hsing et al., Diet, tobacco use, and fatal prostate cancer: results from the Lutheran Brotherhood Cohort Study. Cancer Res., 50: 6836-6840, 1990.
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Cohort Studies↗
Biomedical subjects
E Taioli
Publications and source records attributed to E Taioli.
Early predictors of smoking cessation after myocardial infarction.
The determinants of long-term smoking cessation were evaluated in 80 patients who smoked cigarettes and survived a myocardial infarction. All patients underwent a program of rehabilitation and secondary prevention including in-hospital counseling and physician-guided reinforcing sessions at 1, 3, and 6 months after discharge. At 18 months of follow-up, 53 patients (66.3%) had quit smoking. Variables associated with smoking cessation were duration of hospital stay greater than or equal to 19 days (79 vs. 48%; p less than 0.005) and peak creatine phosphokinase (CPK) elevation greater than or equal to 500 U/l (76 vs. 54%; p less than 0.05). Males tended to quit in higher proportion than females (68 vs. 44%). Age, prior myocardial infarction, other cardiovascular risk factors, infarction location, Killip class at entry, and duration of stay in coronary care unit did not significantly affect the quitting rates. Logistic regression analysis singled out the duration of hospital stay as a significant predictor of smoking cessation (p less than 0.005). Early and intensive secondary prevention during the hospital stay is crucial in promoting sustained smoking cessation after myocardial infarction.
Age Factors↗
Analysis of diagnostic procedure costs for cerebrovascular disease admission to a highly specialized hospital.
Length of stay and hospital costs for cerebrovascular disease admissions depend on several hospital-, patient- and disease-related factors. To determine the incidence of each of these factors we studied 240 admissions for cerebrovascular diseases in a neurology division and in two medical divisions of a highly specialized hospital. Statistical analysis of the data collected from the case records revealed the effect of several factors. Some increased only the length of stay (severe neurological sequels on discharge; stay in general medicine, diagnosis of hemorrhage, arterial hypertension). Others increased investigation costs (length of stay, marital status), and costs were higher in a specialists ward. Length of stay was shorter where the nurse/bed ratio was higher. Old age and male sex were associated with a lower cost of diagnostic procedures.
Adult↗
Role of reproductive and menstrual history in the etiology of pre- and postmenopausal breast cancer.
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Adult↗
Dietary habits and breast cancer: a comparative study of United States and Italian data.
Dietary habits in the United States and northern and southern Italy were compared and related to mortality rates for breast cancer. In 1981, southern Italy had the lowest breast cancer mortality rate (19.1 deaths in 100,000), followed by northern Italy (26.1 in 100,000) and the United States (27.1 in 100,000). Among the dietary variables, meat intake was twice as high in the United States as in southern Italy; bread, pasta, and fruit intakes were almost twofold greater in Italy than in the United States. Consumption of saturated fats and linoleic acid was lower and consumption of monounsaturated lipids was higher in southern Italy than in the United States. Our data confirm that diet influences the development of breast cancer. The role of dietary fats and fibers on breast cancer risk, as well as the type of fats consumed, needs further investigation.
Adolescent↗
Possible role of diet as a host factor in the aetiology of tobacco-induced lung cancer: an ecological study in southern and northern Italy.
Statistical data on smoking and dietary habits in northern and southern Italy were compared and related to mortality rates for lung cancer. Age-adjusted mortality rates for lung cancer in the years 1980 and 1982 were lower in southern than in northern Italy. The proportion of smokers, as surveyed in 1977, was similar in the two geographical areas. Dietary habits in southern Italy, however, were characterized during the years 1960 through 1965, by a low consumption of saturated and polyunsaturated lipids, and a high consumption of foods of vegetable origin. Our data suggest that diet may modify the carcinogenic effect of tobacco in lung cancer.
Adolescent↗
[The length of pre- and postoperative surgical stays. The role of factors relative to the patient, to the type of intervention and to hospital services].
The one-year most important and frequent surgical procedures performed in eight surgical departments of a large Italian general hospital were studied in order to describe the determinants of pre-, postoperative and total length of stay. The average length of stay (ALS) for the 724 hospitalized cases was 18.1 days (7.9 preoperative and 10.2 postoperative), with large variations in the preoperative ALS across the departments. Multiple regression analysis showed that total ALS was positively associated with age, type of surgical procedure and department of admission. Preoperative ALS was longer in intervention on colon (12 days) and stomach (11 days) than in saphenectomies (8 days) and in appendectomies (4 days). The degree of access to operating rooms was associated to preoperative ALS, while the type of intervention and age to postoperative ALS. ALS was reduced by the urgency of the case, the availability of diagnostic facilities in the department of admission and the patient's condition of student. Hospital's structure and organization need to be modified in order to reduce preoperative length of stay. The easier access of older patients to long-stay hospitals or home care would reduce postoperative length of stay.
Age Factors↗
Effects of a screening program for hypertension in a community.
The effect of a population screening for hypertension was assessed through a subsequent survey performed 1 year later. All the hypertensives identified at the first visit (239 subjects, 15.6% of the whole screened population) were invited for a re-examination: the adhesion rate was 84.5%. After the screening, a high proportion of subjects (74.7%) had contacted their physicians because of their blood pressure. The most common advice physicians gave was to have further measurements of blood pressure (72.8%). Laboratory tests were prescribed in 62 patients (41.1%), but a complete assessment of a target organ damage was carried out in few cases (1.9%). Only 19.5% of patients started a course of treatment during the year following the screening and no more than one-third of those with moderate to severe hypertension. Out of the 176 subjects showing other cardiovascular risk factors at the screening, only 12 reported they had modified their habits 1 year later. Our results suggest that a screening for hypertension, when performed without any liaison with other medical facilities, seems to have a poor impact on physicians' and patients' attitudes towards hypertension.
Adult↗
Left ventricular diastolic function in normotensive adolescents with different genetic risk of hypertension.
Abnormalities of the diastolic function of the left ventricle are the first sign of cardiac involvement in arterial hypertension. We have studied the diastolic function in a group of normotensive adolescents with confirmed family history of hypertension. M-mode echocardiography was performed in 86 normotensive males aged 14-19 years: 41 sons of at least one hypertensive parent (SHT) and 45 sons of normotensive parents (SNT). Cross-sectional area of the left ventricle and left ventricular (LV) mass index were significantly greater in the SHT than in the SNT group (10.05 +/- 1.84 vs. 8.9 +/- 1.56 cm/m2, p less than 0.01 and 129.3 +/- 296.3 vs. 109.23 +/- 25.7 g/m2, p less than 0.002, respectively). No significant difference between the two groups was observed in the indices of left ventricular diastolic function, except for mitral valve opening rate (463.51 +/- 90.45 in SHT vs. 416.71 +/- 78.84 mm/s in SNT; p less than 0.02). From the analysis of the subgroup of adolescents having left ventricular mass greater than the upper normal value, we observed that they showed mean time of rapid filling significantly longer than SNT: this could represent an early marker of the pathological character of such hypertrophy. Our results suggest that the higher LV mass observed in the SHT is not associated with chamber and myocardial stiffness abnormalities.
Adolescent↗
[Relations between pressure overload and early signs of cardiac involvement in arterial hypertension].
In arterial hypertension the indexes of left ventricular hypertrophy are not related to resting blood pressure, whereas a positive association with exercise blood pressure has been observed. It has not been investigated a possible relationship between response to stress and left ventricular diastolic function, the latter being early involved in arterial hypertension even before the development of ventricular hypertrophy. The present study was aimed at assessing a possible relationship between blood pressure response to dynamic exercise and index of left ventricular mass, systolic and diastolic function in a group of untreated hypertensives. fourty hypertensives aged 16-56 years were studied, 27 with mild hypertension and 13 with moderate or severe hypertension. The control group consisted of 23 normotensive healthy subjects, aged 14-40 years. All the subjects underwent a maximum-graded bicycle exercise in the supine position and a M-mode echocardiogram under the B-mode drive. Average values of the indexes of ventricular hypertrophy and of systolic function were overlapping in the 3 groups. Significant differences were observed in the indexes of diastolic function; with regard to normatensive controls, hypertensive subjects showed an increase in isovolumic relaxation time and rapid filling time, a decrease of isovolumic and rapid filling rates and a reduction of mitral valve closing and opening velocities.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Assessment of ventricular function in arterial hypertension with radionuclide ventriculography.
Diastolic function of the left ventricle was assessed in 29 untreated patients with mild to moderate hypertension and in 21 normotensive control subjects using gated radionuclide ventriculography. In hypertensive patients, the time to peak filling rate was significantly longer (p less than 0.01) than that in control subjects, and first-third filling fraction and peak filling rate were significantly reduced (p less than 0.001). The ejection fraction and peak ejection rate were also significantly reduced in hypertensive patients (p less than 0.001). No relation was observed between diastolic functional impairment and age, cardiac hypertrophy, or severity of hypertension. Thus, early impairment of ventricular filling is present in hypertension, even in young patients without evidence of cardiac hypertrophy.
Adult↗
Death from cardiovascular disease in Italy, 1972-1981: decline in mortality rates and possible causes.
Mortality rates for cardiovascular disease vary widely between countries, and epidemiological patterns (trends in incidence rates, prevalence of risk factors, availability of medical care) are heterogeneous even among industrialized nations. We studied mortality from cardiovascular disease in Italy from 1972 to 1981 and compared mortality to trends in risk factors during the same period. Age-adjusted mortality rates for acute ischaemic heart disease (IHD) have increased in Italy from 1972 to reach a peak in 1978 (180.53/100,000 in males, 51.55/100,000 in females), then declined between 1978 and 1981, by 7% in males and 5% in females. The decline was more evident in males and in the younger age groups. Deaths from chronic IHD reached a peak in 1973 in females and in 1975 in males, then decreased, respectively by 24.8% and 35.7% until 1981. Mortality for cerebrovascular disease declined from 1972 to 1981 by 16.2% in males and 21.5% in females. Data from national statistics and sample surveys in different areas of Italy show an increase in total calorie intake, in animal proteins, fats and dairy products and raised average serum cholesterol levels plus an increase in smoking prevalence but a possible decline in blood pressure levels. The roles of hypertension treatment and of access to specialized medical care are discussed as possible contributors to the new declining trend of IHD, and the need is stressed for preventive strategies in health promotion.
Adult↗
Prevalence of symptoms generally attributed to hypertension or its treatment: study on blood pressure in elderly outpatients (SPAA).
A number of symptoms that appear to be associated with high blood pressure (headache, dizziness, epistaxis, tinnitus, weakness, drowsiness), and are usually regarded as secondary to hypertension or to antihypertensive drug therapy, were studied in 3858 elderly patients, 67.8% of whom were hypertensive. Of the hypertensive patients, 71.2% were under treatment. Headaches and dizziness were significantly more prevalent in the hypertensive than in the normotensive subjects (32.5 versus 27.4% and 41.5 versus 35.3%, respectively; P less than 0.05) and in treated compared with untreated hypertensives (33.3 versus 29.4% and 43.3 versus 37.1%; P less than 0.05). These differences disappeared after statistical correction for 'awareness of hypertension'. In multiple logistic analysis, female sex, age and awareness of hypertension were significantly associated with a higher prevalence of symptoms, whereas hypertension and antihypertensive treatment were not. We conclude that the presence of these symptoms does not constitute a reliable criterion for starting antihypertensive treatment or judging its efficacy.
Aged↗
Feasibility of a large prospective study in general practice: an Italian experience. Gruppo di Studio sulla Pressione Arteriosa nell'Anziano.
A study of blood pressure control in elderly outpatients was carried out with the participation of 444 Italian general practitioners. Of 4096 patients aged 65 years or over who were considered for recruitment, 3959 (96.7%) fulfilled all the criteria of admission and were followed up for 12 months. The findings regarding one of the aims of the study--that is, to assess the feasibility of a large scale trial in general practice--are reported. Most (87%) of the doctors completed the study. Their adherence to the protocol was highly satisfactory, leading to an acceptable quality of work. Patients' compliance was also good; 98.6% (3898) of the patients who had fulfilled the admission criteria agreed to participate in the study, and only 4% (158) dropped out. Both of these observations support the feasibility of carrying out prospective studies in general practice. The creation of networks of general practitioners who are prepared to carry out research in their practices would allow treatment and preventive measures to be studied simply and at low cost in the appropriate setting.
Aged↗
Arm position as a source of error in blood pressure measurement.
The present study was designed to assess the value of correct positioning of a patient's arm when measuring blood pressure (BP). A total of 181 subjects were examined, 141 hypertensives on treatment, 25 untreated hypertensives, 15 normotensives. All the subjects underwent three BP measurements after a 5-min resting period in supine position. Then two BP readings were recorded in standing position with the arm either positioned by the patient's side or supported passively at patient's heart level. Average systolic BP (SBP) in standing position were 144.6 +/- 20.2 mmHg with the arm at the side and 136.4 +/- 21.1 mmHg with the arm at the heart level (p less than 0.001); average diastolic pressures were 99.0 +/- 12.0 mmHg and 90.2 +/- 12.3 mmHg (p less than 0.001), respectively. A fall in SBP greater than or equal to 20 mmHg from the supine to the upright position was detected in 18.2% of cases when measurement was performed at heart level; such a reduction was inapparent in two-thirds of cases when the arm was placed at the patient's body side. Incorrect positioning of a patient's arm during BP measurements in standing position leads to overestimation of BP values and masks the presence of postural hypotension.
Adult↗
Left ventricular structure and function in normotensive adolescents with a genetic predisposition to hypertension.
It has been suggested that the heart plays an active role in the pathogenesis of arterial hypertension. If this is true, there must be early cardiac involvement in young normotensive subjects who develop hypertension later in life and differences in cardiac morphology or function may exist between young normotensive subjects with different risks of developing hypertension. M-mode echocardiography was performed in 51 normotensive male adolescents with at least one hypertensive parent (SHT). These subjects were compared with 55 normotensive sons of normotensive parents (SNT) and with 25 adolescents with borderline hypertension (BH). Control groups were matched for sex and age. The following morphologic parameters were significantly greater in the SHT group than in the SNT group: interventricular septum (0.54 +/- 0.08 vs 0.49 +/- 0.09 cm/m2; p less than 0.01) and posterior wall (0.54 +/- 0.11 vs 0.50 +/- 0.08 cm/m2; p less than 0.05) thickness, left ventricular mass (125.0 +/- 29.1 vs 109.2 +/- 25.4 gm/m2; p less than 0.005), and cross-sectional area (9.9 +/- 1.8 vs 8.9 +/- 1.6 cm2/m2; p less than 0.005). No significant differences between SHT and BH subjects were observed. Excursion of left ventricular posterior wall was significantly higher in the BH group. No differences were observed between SHT and SNT subjects. These data show that the same kinds of changes in cardiac morphology are present in normotensive subjects with a family history of hypertension and in subjects with borderline hypertension, suggesting that cardiac involvement may precede elevation of blood pressure.
Adolescent↗
Accuracy of the anamnestic ascertainment of parental history of hypertension.
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Adolescent↗
Role of blood pressure response to provocative tests in the prediction of hypertension in adolescents.
To assess the value of exercise stress testing and of mental stress as predictors of hypertension, we studied 130 normotensive males 14-18 years of age. Sixty-five had at least one hypertensive parent (SHT), while 65 had normotensive parents (SNT). Systolic (SBP) and diastolic (DBP) blood pressure, rate-pressure product (RPP) and 12-lead ECG were recorded at rest, throughout the tests and during the recovery phase. The two groups were not significantly different at rest for the examined variables. However, the SHT group showed a greater average SBP than the SNT group (198.4 +/- 18.7 vs 189.5 +/- 14.9 mmHg; P less than 0.05) at the peak of exercise. A significantly higher proportion of SHT subjects (40.0% vs 18.5%: P less than 0.01) had SBP greater than 200 mmHg. No difference in the ECG pattern between the two groups was observed. During mental stress, no significant differences in the examined variables between the two groups were noted, although SBP, DBP, HR and RPP were slightly higher in SHT than in SNT subjects. These data suggest that the SBP response to dynamic exercise may be a good predictor of hypertension in subjects at risk.
Adolescent↗