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G Cutter

Publications and source records attributed to G Cutter.

At least 37 records · Page 2Linked to original sources
PubMed1998

The prospective relationships between smoking and weight in a young, biracial cohort: the Coronary Artery Risk Development in Young Adults Study.

This study examined the relationship between smoking status and weight change from baseline to Year 7 in a large biracial cohort, the Coronary Artery Risk Development in Young Adults study. Unadjusted for covariates, only male smokers weighed less than nonsmokers, with no effect among women. Adjusted for covariates, male and female smokers weighed less than nonsmokers at baseline, adjusted for age, total energy intake, alcohol intake, and physical fitness. Over the 7-year follow-up, all smoking status groups gained weight, including continuous smokers and initiators. Weight gain was greatest among those who quit smoking. Weight gain attributable to smoking cessation was 4.2 kg for Whites and 6.6 kg for Blacks. Smoking had a small weight-attenuating effect on Blacks. No such effects, however, were observed among Whites. These results suggest, at least in younger smokers, that smoking has minimal impact on body weight.

Adolescent↗
PubMed1997

Recommendations from the National Multiple Sclerosis Society Clinical Outcomes Assessment Task Force.

This article provides recommendations from the National Multiple Sclerosis Society's Clinical Outcomes Assessment Task Force. The Task Force was appointed in 1994 and charged with recommendending improved approaches for clinical outcomes assessment in future controlled clinical trials. The recommendations herein follow extensive deliberation and data analysis during 2.5 years. General principles and desirable measurement attributes were used to assess alternative measurement techniques and clinical scales. On the basis of the analysis of existing multiple sclerosis (MS) data sets, a new measurement approach is proposed. The approach is based on quantitative functional composites that consist of simple quantitative measures from the major clinical dimensions of MS combined into a single score. Quantitative functional composites are likely to provide improved precision and sensitivity in future MS clinical trials. Studies necessary to further refine quantitative functional composites as useful MS clinical trial outcomes are delineated.

Clinical Trials as Topic↗
PubMed1996

Clinical outcomes assessment in multiple sclerosis.

This article represents initial deliberation of an international task force appointed by the US National Multiple Sclerosis Society to develop recommendations for optimal clinical assessment tools for multiple sclerosis clinical trials. Presented within this article are the key issues identified by the task force during its initial year of deliberation. These include the precise purpose for a clinical assessment tool, the clinical dimensions to be measured in a multidimensional outcome measure, desirable attributes of an optimal clinical outcome measure, the complexities of multidimensional outcome measures, the relative merits of categorical clinical ratings and quantitative functional assessments, and a number of other important design issues that relate to the use of a multidimensional outcome measure. An action plan for analysis of existing data is summarized, as are the plans for more detailed recommendations from the task force.

Clinical Trials as Topic↗
PubMed1995

Psychological correlates of weight fluctuation.

This investigation attempted to determine psychological correlates of weight fluctuation in a sample of 497 normal weight and obese adults who were enrolled in a prospective, natural history study. Subjects were stratified by gender, obesity, and age and classified as weight maintainers, gainers, or losers based on their changes in weight over a 1-year period. Subjects were further classified as either weight fluctuators or nonfluctuators based on historical self-report. Nonfluctuators reported significantly higher general well-being, greater eating self-efficacy, and lower stress than weight fluctuators, regardless of body weight. Weight maintainers had more favorable eating self-efficacy related to negative affect than weight gainers. Results suggest that weight fluctuation is strongly associated with negative psychological attributes in both normal weight and obese individuals. Future research should focus on the assessment and treatment of weight fluctuation and on weight maintenance, irrespective of weight status.

Adult↗
PubMed1995

Impact of patient history on residents' evaluation on child sexual abuse.

OBJECTIVE: To determine if historical information influences residents' interpretation of physical findings in sexually abused children. METHODOLOGY: In a pediatric residency training program, all residents viewed 15 slides of children's genitalia (8 normal, 7 abnormal) with either a history specific for sexual abuse or one which was nonspecific. Three weeks later the same slides were viewed but with the alternate history scenario. The residents were asked if the physical findings were specific for sexual abuse. RESULTS: Sixty-four percent of residents completed both surveys. Correct response rate did not vary by gender or year of training. Responses were most often correct when the slide and history were normal (87%). Responses were least accurate when normal historical information was presented with abnormal slides (49%). A logistic regression model demonstrated that residents were less accurate when history and physical did not agree (95% CI = .54- .78). Reexamination of the data using areas under the Receiver Operating Characteristic (ROC) curve confirmed that residents performed on a less accurate ROC curve when the slide and history were incongruent (p < .01). CONCLUSION: Incongruency between patient history and physical exam findings negatively affected this group of residents' ability to discriminate between abuse and nonabuse findings.

Attitude of Health Personnel↗
PubMed1994

Characteristics of severe hypoglycemia in the patient with insulin-dependent diabetes.

To avoid, delay, or ameliorate the microvascular complications of diabetes, intensive insulin therapy with the goal of normoglycemia is required. In most patients with insulin-dependent diabetes mellitus (IDDM), this cannot be achieved because of severe hypoglycemia, which is one of the major causes of morbidity in diabetic patients. To assess the frequency and characteristics of severe hypoglycemia in a single diabetologist's practice, we surveyed 211 consecutive patients with IDDM for a history of severe hypoglycemia (SH), defined as events requiring the assistance of another person. Of these 211 patients, 135 (64%) had at some time had SH. Those with SH had a longer duration of IDDM, currently took more insulin injections, had a higher prevalence of neuropathy and nephropathy, and were less likely to be using human insulin. No difference was found in age, average glycosylated hemoglobin level, frequency of home glucose monitoring, or presence of retinopathy. Half of the patients with SH had confusion and were treated with glucose orally. The remainder were in coma and received i.v. glucose or IM glucagon. Perceived causes of SH were lack of food, excessive insulin, and unusual exercise. We conclude that the frequency of SH is underestimated in clinical practice. Risk factors for SH are longer duration of IDDM, presence of neuropathy and nephropathy, and use of animal insulin. Better education in avoidance and treatment of SH would reduce the morbidity of SH.

Adult↗
PubMed1994

Effect of a National Cancer Institute Clinical Alert on breast cancer practice patterns.

PURPOSE: This study evaluates the effect of the 1988 National Cancer Institute Clinical Alert regarding treatment of early-stage breast cancer on the patterns of treatment provided to patients. PATIENTS AND METHODS: Data analyzed were collected from the hospital and outpatient records of 12,534 female patients with a primary diagnosis of breast cancer (stages I and II) initially diagnosed during the years 1983 through 1989. RESULTS: Analyses revealed that the proportions of patients with a negative lymph node status diagnosed after the May 1988 Clinical Alert who received adjuvant treatment (tamoxifen and/or multidrug chemotherapy) were significantly greater than predicted from treatment trends established before the Alert's release. Proportions of patients with positive lymph node status receiving adjuvant therapy subsequent to the Alert's release, in contrast, did not fall outside the projected confidence intervals for that group. Additional analyses showed a significant effect of the Clinical Alert among several subgroups of node-negative patients. CONCLUSION: Findings suggest that the Clinical Alert mechanism, followed by publication in the peer-reviewed scientific literature, is an effective way to communicate important research findings to practitioners in the community. However, the Alert mechanism is controversial and should be used judiciously to ensure its credibility.

Adult↗
PubMed1994

Diagnoses, symptoms, and attribution of symptoms among black and white inpatients admitted for coronary heart disease.

OBJECTIVES: This study examined health care-seeking behaviors to elucidate factors that contribute to differences in patterns of coronary heart disease between African Americans and Whites. The prevalence of diagnosed coronary heart disease, patients' perceptions of symptoms and attribution of symptoms, and predictors of painful symptoms and attribution of cardiac symptoms were examined. METHODS: The study involved 2416 patients admitted with diagnoses of coronary artery disease, ischemic heart disease, or myocardial infarction or to rule out myocardial infarction. Structured interview questions were used to obtain demographic information, symptoms precipitating admission, and patients' attribution of their symptoms. Discharge diagnoses were obtained from hospital records. RESULTS: Acute myocardial infarction, unstable angina, nonacute ischemic heart disease, and atherosclerosis were more frequent in White patients. For Blacks, the odds of reporting painful symptoms were only 64% of the odds found for Whites when other factors were controlled, and the odds of attributing symptoms to cardiac origins were almost 50% lower for Blacks than for Whites. CONCLUSIONS: The tendency of Blacks to report fewer painful symptoms and to attribute their symptoms to noncardiac origins may contribute to differences in care-seeking and in medical management of heart disease in Blacks.

Black or African American↗
PubMed1994

A study of the reliability and comparative validity of the cardia dietary history.

This study evaluated the reliability and comparative validity of the dietary history survey method developed for CARDIA, a longitudinal investigation of life-styles and the evolution of cardiovascular risk factors in young adults. The method was tested in a sample of 30 white men, 33 white women, 33 black men, and 32 black women, aged 18 to 35 years, in four regions reflecting the race, sex, age, and geographical distribution of CARDIA participants. For 64 of the participants, two dietary history interviews, 1 month apart, were conducted by trained nutritionists. These data were used to examine the reliability of the method. For all participants, seven telephone- assessed 24-hour dietary recalls were randomly scheduled during a 28-day period and were followed by a dietary history interview. These data were used to examine the comparative validity of the method. Calories, total fat, saturated fat, polyunsaturated fat, monounsaturated fat, dietary cholesterol, protein, carbohydrate, alcohol, potassium, calcium, and vitamin A were selected by the CARDIA Nutrition Working Group as the nutrients for comparison. Mean nutrient values from the first history tended to be higher than those obtained from the last history. However, for a majority of the nutrients, the differences were significant for blacks but not for whites. The correlations for the log-transformed nutrient values and calorie-adjusted nutrient values from the two histories were generally in the range of 0.50 to 0.80 for whites. For blacks, the correlations were lower, with a majority in the range of 0.30 to 0.70. The average nutrient values estimated from the histories were higher than those estimated from the average of the seven 24-hour recalls. The differences in blacks were larger than in whites. For both the log-transformed nutrient values and the calorie-adjusted nutrient values, the correlations between the two methods were generally larger than 0.50 for whites. However, for blacks, the correlations were lower, and for several macronutrients, the correlations were close to zero. These results suggest that the CARDIA dietary history is a reasonably reliable and valid dietary survey method for obtaining information about habitual intakes in whites. In blacks, the results are less consistent. The black-white differences remained when the analyses were stratified by education. These results raise a question about differences in reporting between blacks and whites.

Adolescent↗
PubMed1993

Rose Questionnaire responses among black and white inpatients admitted for coronary heart disease: findings from the Birmingham-BHS Project.

Evidence of higher coronary heart disease mortality rates among blacks than among whites raises questions concerning differences in health care-seeking for heart disease between blacks and whites. As part of a larger project evaluating health care-seeking behavior for coronary heart disease, we interviewed hospitalized patients who had diagnoses of coronary artery disease, ischemic heart disease, chest pain, or myocardial infarction, or who were admitted to rule out myocardial infarction. The sample included 1140 white men, 347 black men, 574 white women, and 355 black women. The interview included demographic information, usual care, access to usual care, and chest pain items. Demographic and medical care access differences emerged between African-American and white participants. We also compared the prevalence of Rose Questionnaire angina between blacks and whites. Among patients who scored positively for Rose angina, black men reported more recent onset of their angina and fewer episodes during the past 6 months compared to all other groups, and they sought medical care less often compared with white men. Multiple logistic regression analyses suggest that African-American respondents were less likely to score positively for Rose angina and were less likely to seek treatment for their symptoms among those who had angina, when controlled for demographic, risk factor, and access to care variables. Blacks and whites in our sample also differed in factors associated with scoring positive for angina and seeking medical care for their symptoms, among those who reported angina. We interpret these findings as suggesting that promoting routine usual care among whites may be an important approach for increasing care-seeking for coronary heart disease symptoms. For blacks, improved coronary heart disease case identification and/or educational approaches to promote greater awareness of symptoms and of the need for seeking treatment for symptoms may be important to increase the likelihood that they will seek medical care for their symptoms.

Black or African American↗
PubMed1993

The relationship between maternal hematocrit and pregnancy outcome: black-white differences.

Racial differences in hematocrit levels and the relationship between low and high hematocrit, intrauterine growth retardation, and preterm delivery were studied in a population of 17,149 low-income, iron- and folate-supplemented pregnant women. Hematocrit levels drawn during four gestational periods were considered. Evaluating pregnancy outcome in regard to hematocrit values at specific gestational ages eliminated the bias resulting in the previously reported association between a low hematocrit and preterm delivery in blacks. In contrast, in this study, in blacks, hematocrits of 27% to 30% were associated with lower but not significant reductions in the rates of intrauterine growth retardation and preterm delivery. Our major finding was that at 31 to 34 weeks, hematocrits > or = 40% were associated with significantly higher odds ratios for intrauterine growth retardation for both blacks and whites. These findings should prompt more attention to women who have high hematocrits in pregnancy while reducing concern for women of either race with low hematocrits.

Adult↗
PubMed1991

Oral leukoplakia and adolescent smokeless tobacco use.

The recent increase in smokeless tobacco (ST) use has prompted investigators to assess the health effects of ST use. This study attempted to evaluate the prevalence of oral leukoplakia among adolescent users and to determine factors associated with its presence. During their annual physical examination, 1116 teenaged football players (567 black, 546 white) answered a 34-question survey and received an oral screening examination. Results indicated that 0.5% of nonusers, 1.5% of previous users, and 13% of current users had clinically evident oral leukoplakia. Factors statistically associated with higher leukoplakia rates included history of ST use, regular ST use, years of ST use, and the weekly quantity consumed. Factors not associated included use of alcohol, use of cigarettes, type of ST used, and hours of ST use. One brand of snuff was found to be associated with a relative risk of leukoplakia higher than that of another brand of snuff. Overall, in ST users oral leukoplakia was six times more likely to develop than in nonusers. Earlier ages of ST use may lead to greater periods of use (in years) and to possible increases in deleterious long-term health effects in current adolescents.

Adolescent↗
PubMed1991

The relationship between maternal hematocrit and pregnancy outcome.

The relationship between maternal hematocrit and pregnancy outcome at various times in pregnancy was studied in 17,149 iron- and folate-supplemented pregnant women. On univariate analysis, early-pregnancy hematocrits below 37% were associated with preterm delivery. However, this relationship was not confirmed by multivariate analysis controlling for other risk factors. On both univariate and multivariate analyses, both early and later in pregnancy, hematocrits above 40% were associated with preterm delivery. In every gestational time period, at least part of the excess of preterm births was explained by an increase in indicated preterm deliveries. In both early and late pregnancy, and in both the univariate and multivariate analyses, only high hematocrits were associated with fetal growth retardation. The strongest association (odds ratio above 2) between high hematocrit and both fetal growth retardation and preterm delivery occurred with hematocrits at or above 43% at 31-34 weeks' gestation.

Female↗
PubMed1990

The effect of thiazide therapy on glucose, insulin and cholesterol metabolism and of glucose on potassium: results of a cross-sectional study in patients from the Hypertension Detection and Follow-up Program.

Fasting and one hour post-glucose load blood samples were obtained from 497 participants in the Hypertension Detection and Follow-up Program (HDFP), 79.8% of whom were on antihypertensive therapy at the time of their five-year examination. Major findings include a positive correlation between glucose/insulin ratio and serum potassium (P = 0.0014) and a weaker negative correlation between fasting insulin and serum potassium (P = 0.004). These data are compatible with a primary effect of hypokalaemia producing insulin 'resistance'. In addition, the glucose load was followed by a mean reduction in serum potassium of 0.135 +/- 0.525 meq/l (P less than 0.001). Twenty percent of participants experienced a drop of more than 0.5 meq/l. Cholesterol was associated with the fasting glucose/insulin ratio (P less than 0.032). The results are compatible with the hypothesis that prevention of hypokalaemia may prevent certain metabolic effects attributed to thiazide.

Adult↗
PubMed1989

Preliminary results from the Collaborative Alabama and Scandinavian Study of Successive Small-for-Gestational Age Births.

The study "Successive Small-for-Gestational Age Births" (SGA study) was initiated and is sponsored by the National Institutes of Health (N.I.H.) in the U.S.A. Its purpose is to describe and characterize the different types of intra-uterine growth retardation and their consequences, to assess the associated risk factors, and to provide a basis for preventive measures. Starting in 1986, it runs concurrently in Bergen and Trondheim (Norway), Uppsala (Sweden) and Birmingham, Alabama (U.S.A.), recruiting pregnant para 1 and 2 mothers at high risk of having an SGA birth and a random (control) sample of the total pregnant population. Data collection will end in late 1989, when the last-born children have reached 13 months of age. At the present symposium, investigators from all four study centers and the N.I.H. described the study design and discussed problems of methodology. Strict standardization of parameters to determine gestational age (ultrasound, menstrual dates) is a prerequisite for comparison of results over time and between study centers. Some preliminary results were presented.

Alabama↗
PubMed1988

Factors associated with discontinuation of continuous subcutaneous insulin infusion.

Fifty-five patients who had been started on continuous subcutaneous insulin infusion (CSII) more than 1 year previously were surveyed to determine the difference between those who had continued and those who had discontinued CSII. These retrospective results were used to determine characteristics that predict a suitable candidate for CSII which could be tested in a future prospective study and would guide our clinical choice of candidates for CSII. Twenty patients had discontinued CSII (Group D) and 35 patients had continued CSII (Group C). Group D contained younger patients, more likely to be women who had had a shorter duration of diabetes, more frequent antecedent episodes of diabetic ketoacidosis (DKA), and more frequent doctor visits. The major rationale for starting CSII in Group D was poor control with keotacidosis whereas Group C started CSII for poor control with hypoglycemia. The reasons for stopping CSII in Group D were interference with lifestyle (40%), needle site abcesses (40%), psychological rejection (10%), and poor insulin absorption (10%). Group D patients had a significantly higher incidence of psychological rejection of CSII, dermatological problems, and needle site abcesses. For patients in Group D, glycosylated hemoglobin levels during CSII were similar to those prior to CSII. Group C patients had improved glycosylated hemoglobin levels and were more satisfied with CSII despite a slightly higher incidence of pump runaway. Group C patients had a trend toward more frequent hypoglycemia while on CSII; however, in patients who had reported severe hypoglycemia before starting CSII, there was a significant decline in the frequency of severe hypoglycemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMed1988

Relationships of low density lipoprotein cholesterol with age and other factors: a cross-sectional analysis of the CARDIA study.

Presumed evolution of low density lipoprotein cholesterol (LDL-C) was studied in a baseline cross-sectional survey of 4955 18-30 year old men and women of various sociodemographic backgrounds. Specifically studied were the influences on LDL-C and the change of LDL-C with age of race, gender, education, diet, physical activity, fatness and fitness. Men increased about 20 mg/dl per 10 years of age, while women increased about 3 mg/dl. Increasing education was found to be associated with higher LDL-C in blacks, but with lower LDL-C in whites. Higher Keys diet score and body mass index were positively associated with LDL-C, while higher total caloric intake, vigorous physical activity, duration on a treadmill exercise test and usual intake of alcohol were negatively associated with LDL-C. The finding of a different relationship of LDL-C to increasing education in whites than in blacks suggests a cultural or behavioral influence in rate of increase in LDL-C.

Adolescent↗