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F DeStefano

Publications and source records attributed to F DeStefano.

At least 55 records · Page 3Linked to original sources
PubMed1993

Trends in nonfatal coronary heart disease in the United States, 1980 through 1989.

BACKGROUND: Although coronary heart disease mortality has been decreasing, little is known about trends in morbidity from coronary heart disease. We evaluated trends in nonfatal coronary heart disease in the United States during 1980 through 1989. METHODS: We analyzed data from the National Health Interview Survey, an ongoing survey of representative samples of the civilian, noninstitutionalized population of the United States. Survey respondents were determined to have coronary heart disease if they reported ever having a myocardial infarction or heart attack, angina pectoris, or coronary heart disease. Incidence was defined as initial onset of a coronary heart disease condition during the year preceding the interview date. RESULTS: About 6 million people were estimated to be living with coronary heart disease. The age-standardized prevalence was relatively constant at about 25 per 1000. Among white men, however, prevalence increased significantly over the 10-year period. Among 75- to 84-year-old men, prevalence increased from 100 per 1000 in 1980 to 179 per 1000 in 1989. Among men and women 45 to 54 years old, prevalence decreased. Overall, the incidence rate of nonfatal coronary heart disease was relatively flat (at about 3 per 1000 per year after 1983). Among white women, the incidence rate increased from 1.4 to 2.8 per 1000, and by the end of the decade it nearly equaled the incidence rate among white men. CONCLUSIONS: Overall, the burden of nonfatal coronary heart disease remained fairly constant during the 1980s. The trends, however, were not uniform in all population groups. The apparent increasing incidence among women deserves continued monitoring. An encouraging trend is the decreasing prevalence in the younger age groups.

Aged↗
PubMed1993

Surveillance for diabetes mellitus--United States, 1980-1989.

PROBLEM/CONDITION: In the United States, diabetes mellitus is the most important cause of lower-extremity amputation and end-stage renal disease; the major cause of blindness among working-age adults; a major cause of disability, premature mortality, congenital malformations, perinatal mortality, and health-care costs; and an important risk factor for the development of many other acute and chronic conditions (e.g., diabetic ketoacidosis, ischemic heart disease, stroke). Surveillance data describing diabetes and its complications are critical to increasing recognition of the public health burden of diabetes, formulating health-care policy, identifying high-risk groups, developing strategies to reduce the burden of this disease, and evaluating progress in disease prevention and control. REPORTING PERIOD COVERED: In this report, data are summarized from CDC's diabetes surveillance system; trends in diabetes and its complications are evaluated by age, sex, and race for the years 1980-1989. DESCRIPTION OF SYSTEM: CDC has established an ongoing and evolving surveillance system to analyze and compile periodic, representative data on the disease burden of diabetes and its complications in the United States. Data sources currently include vital statistics, the National Health Interview Survey, the National Hospital Discharge Survey, and Medicare claims data for end-stage renal disease. RESULTS AND INTERPRETATION: In 1989, approximately 6.7 million persons in the United States reported that they had diabetes mellitus, and a similar number probably had this disabling chronic disease without being aware of it. The disease burden of diabetes and its complications is large and is likely to increase as the population grows older. Effective primary, secondary, and tertiary prevention strategies are needed, and these efforts need to be intensified among groups at highest risk, including blacks. Important gaps exist in periodic and representative data for describing the disease burden. ACTIONS TAKEN: CDC is assisting diabetes control programs in 26 states and one territory. These programs attempt to reduce the burden of diabetes by preventing blindness, lower-extremity amputations, cardiovascular disease, and adverse outcomes of pregnancy among persons with diabetes. Because of important limitations in measuring the burden of diabetes, CDC is exploring sources of surveillance data for blindness, adverse outcomes of pregnancy, and the public health burden of diabetes among minority groups.

Adult↗
PubMed1993

Dental disease and risk of coronary heart disease and mortality.

OBJECTIVE: To investigate a reported association between dental disease and risk of coronary heart disease. SETTING: National sample of American adults who participated in a health examination survey in the early 1970s. DESIGN: Prospective cohort study in which participants underwent a standard dental examination at baseline and were followed up to 1987. Proportional hazards analysis was used to estimate relative risks adjusted for several covariates. MAIN OUTCOME MEASURES: Incidence of mortality or admission to hospital because of coronary heart disease; total mortality. RESULTS: Among all 9760 subjects included in the analysis those with periodontitis had a 25% increased risk of coronary heart disease relative to those with minimal periodontal disease. Poor oral hygiene, determined by the extent of dental debris and calculus, was also associated with an increased incidence of coronary heart disease. In men younger than 50 years at baseline periodontal disease was a stronger risk factor for coronary heart disease; men with periodontitis had a relative risk of 1.72. Both periodontal disease and poor oral hygiene showed stronger associations with total mortality than with coronary heart disease. CONCLUSION: Dental disease is associated with an increased risk of coronary heart disease, particularly in young men. Whether this is a causal association is unclear. Dental health may be a more general indicator of personal hygiene and possibly health care practices.

Adult↗
PubMed1993

Recent trends in the identification and treatment of high blood cholesterol by physicians. Progress and missed opportunities.

OBJECTIVE: To investigate recent trends in the percentage and characteristics of patients being treated by a physician for high blood cholesterol (HBC) and to assess missed clinical opportunities to screen for HBC. DESIGN, SETTING, PARTICIPANTS: Telephone interviews of 154,735 adults in 37 states that participated in the Behavioral Risk Factor Surveillance System during 1988-1990 to assess trends in the percentage of patients treated for HBC by a physician. An opportunity was considered missed if a person did not report being screened for HBC despite seeing a physician for preventive care in the last 2 years. RESULTS: Between the first quarter of 1988 and the last quarter of 1990, the percentage of persons treated by a physician for HBC increased from 7.6% to 11.7% (P < .001). However, since an estimated 36% of US adults need treatment for HBC, fewer than one third of persons who need treatment are receiving it. Persons with two or more cardiac risk factors were more likely to be treated, while men, blacks, persons in lower socioeconomic groups, and persons between 20 and 34 years of age were less likely to be treated. Among the 126,571 persons who had seen a physician for preventive care within the last 2 years, missed opportunities to screen for HBC were most common among persons aged 20 through 34 years (59%) and among women who had seen obstetricians/gynecologists for preventive care (43%). CONCLUSIONS: Fewer than one third of persons who need treatment for HBC as estimated by data from the second National Health and Nutrition and Nutrition Examination Survey are receiving treatment. Better use of clinical opportunities to screen for HBC could substantially accelerate the progress in identifying persons, young adults in particular, who are likely to benefit from cholesterol reduction.

Adult↗
PubMed1993

Risk factors for coronary heart disease mortality among persons with diabetes.

Although coronary heart disease is a leading cause of morbidity and mortality among persons with diabetes, the risk factors for coronary heart disease have not been well established for this population. The authors performed a case-control analysis by using data from two large population-based surveys. Cases of persons who died of coronary heart disease were identified from the 1986 National Mortality Followback Survey, and controls were taken from behavioral risk factor surveys conducted in 35 states in 1988. Diabetic women younger than 55 years with no other risk factors for coronary heart disease had a 16-fold higher risk of dying from coronary heart disease than did women without diabetes. About one-third of younger women who died of coronary heart disease had diabetes. Diabetic men less than 45 years old with no other risk factors for coronary heart disease had an eightfold higher risk of coronary heart disease mortality. Among older white men and women, diabetes increased the risk of mortality from coronary heart disease about twofold. In younger diabetics, current cigarette smoking was associated with a 50% increase in risk, and high blood pressure increased the risk more than threefold. In the older age group, risk factors for coronary heart disease mortality were similar among those with and those without diabetes: Cigarette smoking and high blood pressure each were associated with about a twofold increase in risk. Diabetes is a particularly strong risk factor for mortality from coronary heart disease in young adults. Smoking and blood pressure control represent major opportunities to reduce the risk of coronary heart disease among persons with diabetes.

Adult↗
PubMed1993

Diabetes-associated mortality in Native Americans.

OBJECTIVE: To describe diabetes-associated mortality among Native Americans. RESEARCH DESIGN AND METHODS: In this population-based study, we analyzed diabetes-associated mortality data from the IHS and the NCHS. We also examined diabetes data from the 1986 NMFS. RESULTS: IHS area-specific diabetes mortality rates for 1984-1986 ranged from 10 to 93/100,000, compared with 15/100,000 for the total U.S. population. NCHS data for the same period listed diabetes as the underlying cause of 708 deaths among Native Americans and the contributory cause of 1252 deaths; 63% of the latter deaths were attributable to circulatory diseases. The 1986 NMFS demonstrated that Native American heritage is underreported by 65% on death certificates. Using deaths identified as Native American by NMFS, the age-adjusted mortality rate for diabetes as the underlying cause for Native Americans (96/100,000) was 4.3 times that for whites and two times that for blacks. Where diabetes was a contributory cause of death, the mortality rate for Native Americans (264/100,000) was 3.7 times that for whites and 2.4 times that for blacks. CONCLUSIONS: The excessive diabetes-associated mortality among Native Americans is consistent with other indicators of the magnitude of the diabetes problem in this population. Further epidemiological research and expanded diabetes control interventions are needed.

Age Factors↗
PubMed1993

Comparison of coronary heart disease mortality risk between black and white people with diabetes.

Coronary heart disease (CHD) is the leading cause of mortality among people with diabetes. Although diabetes is more prevalent among blacks than among whites, little is known about CHD risk among black people with diabetes. We performed a case-control analysis to assess CHD mortality risk among people with diabetes. Coronary heart disease mortality cases were identified from the 1986 National Mortality Followback Survey, and controls were taken from behavioral risk factor surveys conducted in 35 states in 1988. In the young age groups (men younger than 45 years and women younger than 55), both white and black people with diabetes and no other CHD risk factors had about a thirteen-fold greater risk of CHD mortality compared to people without diabetes and with no other CHD risk factors. In the older age groups, diabetes was associated with a lower risk of CHD mortality among blacks (OR = 1.6) than among whites (OR = 2.5). With the exception of smoking in young people with diabetes, we found smoking, high blood pressure, and body mass to carry generally similar relative risks of CHD mortality in black people with diabetes as in white people with diabetes. Further study of other CHD risk factors is needed in black people with diabetes.

Black People↗
PubMed1992

The relation of computer-based measures of sperm morphology and motility to male infertility.

We investigated the relation between various sperm characteristics, including morphometric parameters, and impaired fertility among 596 men who participated in a national study. Semen was collected and processed by using a standardized protocol, and sperm measurements were made using a computer-aided sperm analysis instrument. We defined infertility in two ways: (1) the inability to father a child after trying for a year or longer, and (2) the number of children fathered. We found that all measures of sperm motion were decreased among men with impaired fertility. After adjustment for the other motion parameters and various potential confounders, however, only the percentage of progressive cells was associated with infertility. One morphometric parameter, the mean length/width ratio, was consistently associated with both measures of infertility, even after adjustment for potential covariates. This measure was also strongly associated with infertility among various subgroups defined by poor sperm concentration, motility, and morphology. The sperm length/width ratio appears to be an important correlate of infertility in males.

Adult↗
PubMed1992

The associations of alcohol drinking and drinking cessation to measures of the immune system in middle-aged men.

To estimate the association between the immunologic responses of the cell-mediated and humoral systems and alcohol drinking, we used data from the Vietnam Experience Study conducted by the Centers for Disease Control. That study, conducted from 1985 to 1986, was based on a random sample of 4462 male, Vietnam-era, U.S. veterans. By using linear regression, we evaluated how (1) the number of alcoholic drinks the subjects consumed per month and (2) the drinking cessation of certain subjects were associated with their relative and absolute T, B, CD4, and CD8 lymphocyte counts and immunoglobulin A (IgA), IgM, and IgG levels. We used geometric means and percentage differences in geometric means of immune status to measure the associations and adjusted these values to account for the effect of covariates. The results indicated that measures of immune status differed among the drinking categories and that, generally, the differences changed after adjustment for covariates. These differences consisted, as alcohol consumption increased, of higher IgA and IgM levels, relative T and CD4 lymphocytes, and the ratio of CD4 to CD8 cells, and of lower IgG levels, relative B and CD8 lymphocytes, absolute lymphocyte, and lymphocyte subset counts after adjusting for other covariates. Among former drinkers, we found no clear-cut pattern in measures of immunity for a few years after cessation and then found that values of former drinkers tended to return toward values of nondrinkers as they continued to abstain.

Adult↗
PubMed1992

Trends in diabetes and diabetic complications, 1980-1987.

OBJECTIVE: Although diabetes is a major source of morbidity and mortality in the United States, only recently has a unified national surveillance system begun to monitor trends in diabetes and diabetic complications. RESEARCH DESIGN AND METHODS: We established a diabetes surveillance system using data for 1980-1987 from vital records, the National Health Interview Survey, the National Hospital Discharge Survey, and the Health Care Financing Administration's records to examine trends in the prevalence and incidence of diabetes, diabetes mortality, hospitalizations, and diabetic complications. RESULTS: From 1980 through 1987, the number of individuals known to have diabetes increased by 1 million--to 6.82 million. Age-standardized prevalence for diabetes increased 9% during this period, from 25.4 to 27.6/1000 U.S. residents (P = 0.03). The incidence of diabetes increased among women (P = 0.003), particularly among those greater than 65 yr old (P = 0.02). Age-standardized mortality rates (for diabetes as either an underlying or contributing cause) per 100,000 individuals with diabetes declined 12%, from 2350 to 2066. Annual mortality rates from stroke (as an underlying cause and diabetes as a contributing cause) and diabetic ketoacidosis declined 29% (P = 0.003) and 22% (P less than 0.001), respectively. During these 8 yr, hospitalization rates for major CVD and stroke (as the primary diagnoses and diabetes as a secondary diagnosis) increased 34% (P = 0.006) and 38% (P = 0.01), respectively. Also during this period, hospitalization rates increased 21% for diabetic ketoacidosis (P = 0.01) and 29% for lower-extremity amputations (P = 0.06). From 1982 through 1986, treatment for end-stage renal disease related to diabetes increased greater than 10% each year (P less than 0.001). The prevalence of diagnosed diabetes was nearly twice as high in blacks as in whites (P = 0.04). Blacks also had increased rates of lower-extremity amputation (P = 0.02), diabetic ketoacidosis (P less than 0.001), and end-stage renal disease (P = 0.01). CONCLUSIONS: Diabetes surveillance data will be useful in planning, targeting, and evaluating public health efforts designed to prevent and control diabetes and its complications.

Amputation, Surgical↗
PubMed1991

Risk factors for mortality from all causes and from coronary heart disease among persons with diabetes. Findings from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study.

Coronary heart disease is the leading cause of mortality among persons with diabetes mellitus, but the factors that account for this high coronary heart disease mortality remain unclear. In the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study, conducted from 1982 to 1984, 92 deaths from coronary heart disease were found to have occurred among 602 diabetic participants and 558 deaths from coronary heart disease were found to have occurred among 12,562 nondiabetic participants during the follow-up period (1971-1984; average follow-up, 10 years). Using proportional hazards analysis, the authors found age, male sex, severe overweight, and non-leisure-time physical inactivity to be significantly associated with coronary heart disease mortality among persons with diabetes. Age, male sex, current smoking, hypertension, and non-leisure-time physical inactivity were associated with all-cause mortality. Cholesterol showed a more complex relation to all-cause mortality. The strength of the associations between risk factors and all-cause and coronary heart disease mortality did not differ significantly among persons with and without diabetes. These results reinforce the importance of controlling coronary heart disease risk factors among persons with diabetes.

Adult↗
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↗
PubMed1989

Are racial differences in the prevalence of diabetes in adults explained by differences in obesity?

To determine whether the higher prevalence of diabetes found among blacks in the United States is explained by racial differences in obesity, we examined the prevalence of diabetes adjusted for adiposity, education, and income in a cohort of US Army veterans from the Vietnam era. Among 12,558 white men and 1677 black men, aged 30 to 47 years, blacks were more likely than whites to have diagnosed diabetes (adjusted prevalence ratio, 1.9; 95% confidence interval, 1.3 to 2.7). Within every age, adiposity, and socioeconomic stratum, blacks had a higher prevalence of diagnosed diabetes than whites. In a subgroup of veterans for whom fasting serum glucose values were measured, blacks were more likely than whites to have fasting hyperglycemia (fasting serum glucose value greater than or equal to 7.8 mmol/L) (adjusted prevalence ratio, 5.7; 95% confidence interval, 2.7 to 12.0). These data provide evidence that the higher prevalence of diabetes found among blacks is not explained by differences in obesity.

Adult↗
PubMed1989

Semen characteristics of Vietnam veterans.

As part of an epidemiologic study of the health status of a randomly selected group of Vietnam veterans, we measured the semen characteristics of 324 Vietnam veterans and compared them with a similar group of 247 veterans who did not serve in Vietnam. The participation rate was 81% in both groups. Measurements of sperm concentration, movement characteristics, and head dimensions were performed, using the Cellsoft computer-assisted semen analysis system. We found that Vietnam veterans had significantly (p less than 0.05) lowered mean sperm concentrations (64.8 x 10(6) sperm/mL for Vietnam veterans vs 79.8 x 10(6) sperm/mL for non-Vietnam veterans), and Vietnam veterans were twice as likely to have sperm concentrations less than or equal to 20 million/mL (odds ratio = 2.7, 95% confidence interval = 1.3-5.7). Vietnam veterans also had a significantly lowered mean proportion of morphologically normal sperm heads (57.9% vs 60.8%), with significantly longer mean major axis length and head circumference. The proportion of motile cells, velocity, linearity, amplitude of lateral head displacement, and beat frequency were not different between the two groups. Despite differences in sperm characteristics, Vietnam and non-Vietnam veterans reported fathering similar numbers of children.

Adult↗
PubMed1988

New application of the autotrans: autologous support of the organ donor and salvage of the donor's red blood cells for the transfusion support of organ recipients.

Organ donation is usually limited to solid tissues; paradoxically, organ donors undergoing explant are often transfused in preparation for or during surgery. This practice increases the requirement for blood and adds immunological and infectious risks for both recipients and donors of grafts. We have investigated the possibility of supporting an explant with intraoperative blood salvage and, in the case of a cadaver donor, at the end of the operation, salvaging blood for potential use in the graft recipient. This preliminary report describes the technique and the results obtained in two procedures. The volume of red cells with a hematocrit of 55% obtained from the two donors was 2,090 and 1,180 ml, respectively. These components were employed for the transfusion support of the organ recipients.

Blood Component Removal↗
PubMed1987

Underreporting of alcohol-related mortality on death certificates of young US Army veterans.

We assessed the validity of death certificate data for alcohol-related mortality in a population-based follow-up study of young, male US Army veterans. In a random sample of more than 18,000 men who entered the service between 1965 and 1971, there were 446 postservice deaths through Dec 31, 1983. For 426 of these deaths, we obtained both the death certificate and all other available medical and legal records pertaining to cause of death. A nosologist recorded each death certificate in accordance with the ninth revision of the International Classification of Diseases. A medical panel, without having access to the death certificates, assigned underlying and contributory causes of death on the basis of a review of only the medical and legal records. The panel recorded 133 alcohol-related deaths, or more than six times the number (21 deaths) determined by the original death certifiers. Omission of elevated blood alcohol levels in deaths due to injury accounts for most of the underreporting of alcohol-related mortality on the death certificates. Our findings suggest that death certificate data grossly underestimate the contribution of alcohol to mortality, especially in the area of injury, and the validity of official vital statistics for alcohol-related deaths would be enhanced if death certifiers incorporated all available antemortem and postmortem diagnostic information.

Adult↗
PubMed1985

Long-term risk of menstrual disturbances after tubal sterilization.

We analyzed data from the Walnut Creek Contraceptive Drug Study to compare the menstrual characteristics of 719 women who had tubal sterilizations and 1083 women whose partners had undergone a vasectomy. Study participants were enrolled from 1968 to 1972 and followed up through 1976. The tubal sterilization group had slightly increased, though in most instances not statistically significant, risks of moderate to severe menstrual cramps and adverse menstrual bleeding. At follow-up intervals longer than 2 years, the tubal sterilization group had significantly increased risks of abnormal menstrual cycles and combinations of two or more adverse menstrual outcomes. Tubal sterilization was not associated with an increased risk of premenstrual symptoms. These findings suggest that the types of tubal sterilization procedures which were performed during the early 1970s possibly carry some increased risk of menstrual disturbances, particularly abnormal cycles, and that it may take more than 2 years for the increased risk to become apparent.

Adolescent↗