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Biomedical subjects

G A Colditz

Publications and source records attributed to G A Colditz.

513 records · Page 29Linked to original sources
PubMedDate not supplied

Is upper gastrointestinal radiography necessary in the initial management of uncomplicated dyspepsia? A randomized controlled trial comparing empiric antacid therapy plus patient reassurance with traditional care.

STUDY OBJECTIVE: To compare two strategies for the evaluation and management of patients who have had acute dyspepsia for four days or more: empiric high-dose antacid therapy combined with patient reassurance (empiric care) versus therapy based on prompt upper gastrointestinal radiography (traditional care). DESIGN: Prospective, randomized trial. The patients in the empiric care group were reassured that upper gastrointestinal radiography was not necessary and were subsequently treated with high-dose empiric antacid therapy (15-30 ml of high-potency antacid one and three hours after meals and at bedtime). The traditional care group after meals and at bedtime). The traditional care group received upper gastrointestinal radiography as part of the initial evaluation. Subsequent treatment was determined by individual physicians based on test results. SETTINGS: Fee-for-service, hospital-based primary care practice and Veteran's Administration medical center outpatient clinic. PATIENTS: All patients were less than 70 years of age and without gastrointestinal bleeding, anemia, significant weight loss, or other specified symptoms of severe acid peptic disease. Fifty patients were randomized to traditional care, and 51 to empiric care. Pre-randomization clinical features were identical with the exception of sex distribution and baseline disability. MEASUREMENTS AND MAIN RESULTS: After six months of follow-up, there were no significant differences in symptom scores, disability, satisfaction, and quality of life measures (as measured by the Sickness Impact Profile scores) between the two groups. Findings were unchanged when adjusted for sex, study site, alcohol consumption, and cigarette smoking. Of the radiographs obtained in the traditional care group, 13 (27%) showed duodenal ulcer disease, gastritis, or duodenitis. There were no serious complications of ulcer disease or therapy noted in either group. The average costs per patient associated with traditional care at one study site were greater, $286 versus $116 (p less than 0.0001). CONCLUSIONS: Select patients with dyspepsia receiving a combination of reassurance and empiric antacid therapy do as well as patients whose initial management strategy includes upper gastrointestinal radiography, at a substantially lower cost.

Adult↗
PubMedDate not supplied

The impact of different therapies on symptoms of benign prostatic hyperplasia: a prospective study.

We conducted an observational study to evaluate prospectively the effectiveness of four modes of treatment for benign prostatic hyperplasia (BPH)-watchful waiting, alpha-blocker therapy, finasteride therapy, and surgery (transurethral prostatectomy). A total of 1459 men aged 48 to 84 years, who were diagnosed for the first time by physicians as having BPH in 1994 and who had not received treatment, participated in the study. During 1 year of follow-up, 1064 (72.9%) men remained on no treatment (watchful waiting), 156 (10.7%) were treated with finasteride, 198 (13.6%) were treated with an alpha-blocker, and 41 (2.8%) underwent prostatectomy. The American Urological Association (AUA) Symptom Index was administered to the cohort before the initiation of treatment in 1994, as well as 1 year later. Improvements in lower urinary tract symptoms, as measured by the AUA Symptom Index, were assessed using linear and logistic regression, adjusting for age and baseline. Men who underwent prostatectomy reported the biggest improvements in lower urinary tract symptoms, whether assessed by mean changes in symptom scores relative to no treatment (-5.44; 95% confidence interval [CI]-6.91 to -3.97) or by the odds of improving by 5 or more points on the AUA Symptom Index (odds ratio, 12.66; 95% CI, 5.93 to 27.0). Irrespective of the initial degree of symptom severity, prostate surgery resulted in larger improvements than those reported for either finasteride or alpha-blocker therapy. In this prospective, observational study, prostatic surgery was associated with statistically and clinically significant improvements in BPH symptoms.

Adrenergic alpha-Antagonists↗
PubMedDate not supplied

Moderate alcohol consumption and bone density among postmenopausal women.

Chronic alcohol abuse is associated with low bone density and high risk of fracture. However, moderate alcohol consumption may help to maintain bone density in postmenopausal women by increasing endogenous estrogens or by promoting secretion of calcitonin. We conducted a prospective study among a sample of 188 white postmenopausal women (ages 50-74) from the Nurses' Health Study who participated in a health examination between 1993 and 1995 that included bone density assessments of the lumbar spine and proximal femur. Long-term alcohol intake was calculated as the average of the 1980 and 1990 measures from a food frequency questionnaire. Women who consumed 75 g or more of alcohol per week had significantly higher bone densities at the lumbar spine compared with non-drinking women (0.951 vs. 0.849 g/cm2, p = 0.002) after adjusting for age, body mass index (kg/m2), age at menopause, use of postmenopausal estrogens, and smoking status. Further adjustment for physical activity and daily intakes of calcium, vitamin D, protein, and caffeine did not alter the results. We also observed a linear increase in spinal bone density over increasing categories of alcohol intake (p = 0.002), suggesting that alcohol intakes of less than 75 g/week may also be of benefit. This positive association was observed among both current users and never users of postmenopausal estrogens. In contrast to the lumbar spine, femoral bone density was not higher among drinkers compared with nondrinkers, although density did increase among drinkers with increasing level of alcohol consumption. Further research is needed to determine whether moderate alcohol consumption can help to protect against spinal fractures in postmenopausal women. This finding must also be evaluated within a larger scope of the risks and benefits of alcohol on heart disease, breast cancer, and hip fractures.

Aged↗
PubMedDate not supplied

[Validity and reproducibility of a questionnaire on physical activity and non-activity for school children in Mexico City].

OBJECTIVE: To assess the validity and reproducibility of a self-reported questionnaire on physical activity and inactivity, developed for children aged 10-14 in Mexico City. MATERIAL AND METHODS: Between May and December 1996, a self-reported physical activity and inactivity questionnaire was developed and applied twice to a sample of 114 students aged 10 to 14, from a low and middle income population of Mexico City. The children's mothers completed the same questionnaire, and two 24-hour recalls of physical activity were used for comparison. Statistical analysis consisted of central tendency and dispersion measures and Pearson's correlation coefficient. RESULTS: Correlations between hours per day spent in physical activity and inactivity from the children's questionnaire and the 24-hour recall data, were 0.03 for moderate activity, 0.15 for vigorous activity, and 0.51 (p = 0.001) for watching television, adjusted by age, gender, town, and illness prior to the administration of the questionnaire. Compared to the 24-hour recall data, the questionnaire overestimated the time spent watching television, reading or participating in vigorous activity, and underestimated the time engaged in moderate activity. Statistically significant (p < 0.05) six-month reproducibility values were observed for watching television (r = 0.53), sleeping (r = 0.40), moderate (r = 0.38), and vigorous activity (r = 0.55). CONCLUSIONS: Among children of Mexico City aged 10-14, the questionnaire showed acceptable validity in estimating the time watching television, and acceptable reproducibility of the time watching television, vigorous and moderate activity.

Adolescent↗
PubMedDate not supplied

A prospective study of aspirin use and primary prevention of cardiovascular disease in women.

OBJECTIVE: The aim of the study was to examine prospectively the association between regular aspirin use and the risk of a first myocardial infarction and other cardiovascular events in women. DESIGN: Prospective cohort study including 6 years of follow-up. SETTING: Registered nurses residing in 11 US states. PARTICIPANTS: US registered nurses (n = 87,678) aged 34 to 65 years and free of diagnosed coronary heart disease, stroke, and cancer at baseline. Followup was 96.7% of total potential person-years of follow-up. MAIN OUTCOME MEASURES: Incidence of myocardial infarction, stroke, cardiovascular death, and all important vascular events. RESULTS: During 475,265 person-years of follow-up, we documented 240 nonfatal myocardial infarctions, 146 nonfatal strokes, and 130 deaths due to cardiovascular disease (total, 516 important vascular events). Among women who reported taking one through six aspirin per week, the age-adjusted relative risk (RR) of a first myocardial infarction was 0.68 (95% confidence interval [CI], 0.52 to 0.89; P = .005), as compared with those women who took no aspirin. After simultaneous adjustment for risk factors for coronary disease, the RR was 0.75 (95% CI, 0.58 to 0.99; P = .04). For women aged 50 years and older, the age-adjusted RR was 0.61 (95% CI, 0.45 to 0.84; P = .002) and the multivariate RR was 0.68 (95% CI, 0.50 to 0.93; P = .02). We observed no alteration in the risk of stroke (multivariate RR = 0.99; P = .94). The multivariate RR of cardiovascular death was 0.89 (P = .56) and of important vascular events was 0.85 (P = .12). When examined separately, the results were nearly identical for the subgroups who took one through three and four through six aspirin per week. Among women who took seven or more aspirin per week, there were no apparent reductions in risk. CONCLUSIONS: The use of one through six aspirin per week appears to be associated with a reduced risk of a first myocardial infarction among women. A randomized trial in women is necessary, however, to provide conclusive data on the role of aspirin in the primary prevention of cardiovascular disease in women.

Adult↗
PubMedDate not supplied

Maternal smoking during pregnancy and expenditures on neonatal health care.

Cigarette smoking during pregnancy substantially increases the risk of low-weight birth, and infants born to smokers weigh less, on average, than those born to nonsmokers. Low birth weight is an important predictor of neonatal morbidity and death, and the intensity of neonatal care is significantly higher for low-birth-weight infants. In this study, we estimate expenditures on neonatal care based on the relation between maternal smoking during pregnancy and the incidence of low-weight births. Our results indicate that maternal smoking during pregnancy was responsible for 35,816 low-weight births in the U.S. in 1983, or about 14.5% of all low-weight births. We also estimate that 14,977, or 6.6%, of all admissions to neonatal intensive care units were a result of maternal smoking and that these admissions cost approximately $272 million, representing 8.5% of total national expenditures on neonatal intensive care services. We estimate that the average cost of neonatal care was $288 higher for infants born to smokers than for those born to nonsmokers.

Birth Weight↗
PubMedDate not supplied

Models of breast cancer show that risk is set by events of early life: prevention efforts must shift focus.

We have recently published a mathematical model of the etiology of breast cancer based on the data from the Nurses Health Study that extends the Pike model of breast cancer (see Appendix). The most salient feature of the model is that it identifies the years before the first birth of a child as the most crucial in establishing future risk of breast cancer. The extended model includes several additional details of reproductive risk factors, allowing us to quantify the relative importance of each of the reproductive risk factors and to estimate the effect of changes in key determinants of breast cancer. In this review, we present the evidence from both animal studies and epidemiological research that corroborate the critical importance of the exposures that occur before first birth. We argue that research and preventive interventions should now focus on youth. Population-wide prevention strategies are necessary because the inherited genetic risk for breast cancer accounts for no more than 10-15% of all breast cancer cases, leaving 85% of cases diagnosed among women who are not in this high-risk subgroup of the population. An example of a population-based intervention would be the promotion of increased physical activity among young girls that could result in the delay of menarche. An example of additional research that focuses on the importance of early life exposures would be an analysis of the relation between diet and other lifestyle factors during adolescence and the subsequent risk of breast cancer and studies of precursor lesions (atypical hyperplasia). Shifting the focus of breast cancer prevention to this age group is urgently needed.

Age Factors↗