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Biomedical subjects

J A Grisso

Publications and source records attributed to J A Grisso.

At least 19 recordsLinked to original sources
PubMed1997

Risk factors for hip fracture in men. Hip Fracture Study Group.

To identify risk factors for hip fracture in men, the authors conducted a case-control study involving 20 hospitals in Philadelphia, Pennsylvania, and 14 hospitals in Kaiser Permanente Medical Care Program of northern California. The 356 enrolled men had been admitted with a radiologically confirmed first hip fracture. The 402 control men either were from the Philadelphia area or were members of Kaiser Permanente and were frequency matched to the cases by age and ZIP code or telephone exchange. Information on potential risk factors was obtained through personal interviews. Men in the lowest quintile of body mass had a greatly increased risk of hip fracture compared with men in the heaviest quintile (odds ratio (OR) 3.8, 95% confidence interval (CI) 2.3-6.4). Premorbid lower limb dysfunction was associated with increased risks for hip fracture (OR 3.4, 95% CI 2.1-5.4). Increased risks were also observed with the use of cimetidine (OR 2.5, 95% CI 1.4-4.6) and psychotropic drugs (OR 2.2, 95% CI 1.4-3.3). Smoking cigarettes or a pipe increased the risk of hip fracture, and this association was independent of body mass. Finally, previous physical activity was markedly protective. Factors thought to affect bone density as well as factors identified as risk factors for falls appear to be important determinants of the risk of hip fracture in men. Physical activity may be a particularly promising preventive measure for men. Additional studies of the use of cimetidine on osteoporosis and osteoporotic fractures are indicated.

Activities of Daily Living↗
PubMed1997

Hospital controls versus community controls: differences in inferences regarding risk factors for hip fracture.

In case-control studies using cases identified from persons admitted to hospitals, two types of controls are most often used: persons from the communities served by the hospitals and persons admitted to the same hospitals as those to which the cases were admitted. It is often unclear which is the more appropriate choice, and whether the use of one or the other type of control group will lead to biased conclusions. The purpose of the present analysis was to determine whether the choice of hospital controls versus community controls would influence conclusions regarding risk factors for hip fracture. Cases (n = 425), hospital controls (n = 312) and community controls (n = 454) were drawn from a case-control study of risk factors for hip fracture in women. Study participants were white and black women aged 45 years or older and living in New York City or Philadelphia, Pennsylvania, who were selected between September 1987 and July 1989. Using community controls but not hospital controls, investigators would have concluded that having a fall during the previous 6 months, current smoking, and moving during the previous year were associated with an increased risk of hip fracture. Associations of hip fracture risk with stroke and prior use of ambulatory aids were stronger using community controls, but associations with estrogen use and body mass index were not influenced by choice of control group. Community controls were quite similar to representative samples of community-dwelling elderly women, whereas hospital controls were somewhat sicker and more likely to be current smokers. The authors conclude that community controls comprise the more appropriate control group in case-control studies of hip fracture in the elderly.

Aged↗
PubMed1997

Tube feeding preferences among nursing home residents.

OBJECTIVE: To determine the preferences of nursing home residents regarding the use of tube feedings and to characterize the clinical, functional, and psychosocial factors that are associated with preferences. DESIGN: In-person survey. SETTING: Forty-nine randomly selected nursing homes. PATIENTS/PARTICIPANTS: Three hundred seventy-nine randomly selected, decisionally capable, nursing home residents. MAIN RESULTS: Thirty-three percent of participants would prefer tube feedings if no longer able to eat because of permanent brain damage. Factors positively associated with preferences for tube feedings include male gender. African-American race, never having discussed treatment preferences with family members or health care providers, never having signed an advance directive, and believing that tube feeding preferences will be respected by the nursing home staff. Twenty-five percent of the participants changed from preferring tube feedings to not preferring tube feedings on learning that physical restraints are sometimes applied during the tube feeding process. CONCLUSIONS: Demographic and social factors are associated with preferences for tube feedings. The provision of information about the potential use of physical restraint altered a proportion of nursing home residents' treatment preferences.

Advance Directives↗
PubMed1997

Ovarian aging and hormone replacement therapy. Hormonal levels, symptoms, and attitudes of African-American and white women.

OBJECTIVES: To characterize reproductive hormone levels, symptoms, and attitudes related to menopause among healthy, menstruating white and African-American women aged 44 to 49 years. DESIGN: Pilot study; cross-sectional survey. SETTING: Community-based convenience sample of women in the Philadelphia metropolitan area. PARTICIPANTS: Thirty-three African-American and 35 white women. MEASUREMENTS: The survey instrument collected demographic data, medical and reproductive history, health practices and behaviors. It included previously validated function, depression, and quality-of-life instruments, and a Menopause Attitude Scale that included two factors, attitudes toward the menopause and attitudes toward medical therapy. Anthropometric measurements were taken at enrollment, and reproductive hormones and daily symptom logs were followed over two menstrual cycles. MAIN RESULTS: The two groups were comparable in mean age (African-American 46.2 years, white 46.9 years). Serum levels of estradiol, follicle-stimulating hormone, dihydroepiandrosterone-sulfate, and progesterone were comparable. Symptoms were similar in type and frequency. However, the African-American women had significantly more positive attitudes toward menopause, were more likely to rely on family for information about menopause, and were less likely to have been recommended hormone replacement therapy by their physicians. A majority of women in each group expressed satisfaction with the care they had received. CONCLUSIONS: Perimenopausal African-American and white women have different expectations of menopause and the role of medical care in menopause. This bears directly on women's acceptance of hormone replacement therapy. Conclusions are limited by the small sample size and convenience nature of the study population: further work with larger samples is needed to confirm these apparent differences.

Black or African American↗
PubMed1996

Injuries among inner-city minority women: a population-based longitudinal study.

Active emergency department-based surveillance was conducted to determine the incidence of fatal and nonfatal injuries in an urban, female African American population from 1987 through 1990. Nearly 40% of the women studied sustained one or more injuries that required emergency care or resulted in death. By 1989, violence had surpassed falls as the leading cause of injuries, the rate increased by 55% over the study period. Injury rates were highest among young women for nearly every major cause of injury. The rate of death due to injuries was also highest among young women, for whom violence was the leading cause of death. In summary, injuries to women in this inner-city minority community were extremely common and increased significantly from 1987 to 1990. Injuries in young inner-city minority women should be considered a priority health problem in the United States.

Adult↗
PubMed1995

Nursing home residents' preferences for life-sustaining treatments.

OBJECTIVES: To determine life-sustaining treatment preferences among nursing home residents, whether information regarding cardiopulmonary resuscitation (CPR) affected these preferences, and with whom treatment preferences had been discussed, and to identify factors associated with CPR preferences. DESIGN: In-person survey. SETTING: Forty-nine randomly selected nursing homes. SUBJECTS: Four hundred twenty-one randomly selected nursing home residents capable of making decisions. MAIN OUTCOME MEASURES: Preferences regarding CPR, hospitalization, and enteral tube feedings, and individual factors associated with CPR preferences. RESULTS: Of 1458 randomly selected nursing home residents assessed for the ability to participate in the study, 552 residents (38%) were eligible to participate and 421 agreed to be interviewed. Sixty percent of participants able to participate in the decision reported that they would elect CPR, 89% would choose hospitalization if seriously ill, and 33% would elect enteral tube feedings if no longer able to eat because of permanent brain damage. Individual factors associated with preferences for CPR included the following: African-American ethnicity, high self-reported physical mobility, belief that most important medical care decisions should be made by the doctor, moderate-to-severe impairment in daily decision-making skills, and not having a spouse. Fourteen percent changed their preference from preferring CPR to not preferring CPR after receiving additional information about CPR procedures. Twelve percent reported having discussed preferences with health care providers, and 31% discussed preferences with family members. CONCLUSIONS: More than half of nursing home residents capable of making decisions preferred the use of CPR. Few had discussed their preferences with health care providers. Individual preferences should be assessed when considering the use of life-sustaining treatments.

Advance Care Planning↗
PubMed1995

Occupational injuries in a poor inner-city population.

This study aims to characterize occupational injuries in a defined poor inner-city population in terms of demographic features, types, and circumstances of injuries, and medical and financial consequences. It is a case series drawn from a larger population-based injury registry in emergency departments that serve 17 poor census tracts in Philadelphia. Of 335 patients from the study area who had been treated at the emergency departments under study for occupational injuries, 107 could be contacted by telephone 2 to 3 years after their injuries. Interviews sought information on the patients, their employment, their injuries, and the consequences. Respondents were almost all African-American, approximately 50% male, and had a median age of 32. Approximately one third were employed in the health care industry, one fourth in the service sector (including conventional service firms, restaurants, and hotels), and the remainder in construction, retail and wholesale trade, education, transportation, and manufacturing. Major causes of injuries included overexertion, contact with sharp objects, and falls. Major types on injuries included sprain/strains and lacerations. Approximately half the respondents had missed more than 3 days of work, with 15% missing more than 1 month. Almost 40% of respondents reported persistent health problems after their injuries. Only about one quarter had received workers' compensation. We conclude that poor and minority workers are at risk of a wide range of occupational injuries, which may result in considerable lost work time and have serious medical and economic consequences. More, attention to the workplace risks of these relatively marginalized workers and more vigorous preventive interventions are needed.

Accidents, Occupational↗
PubMed1994

Risk factors for hip fracture in black women. The Northeast Hip Fracture Study Group.

BACKGROUND: Although more than 1 percent of black women 80 years of age or older have hip fractures each year, little is known about risk factors for hip fracture in these women. METHODS: We carried out a case-control study involving 144 black women admitted with a first hip fracture to 1 of 30 hospitals in New York and Philadelphia. The control were 218 black women living in the community who were matched to the case patients according to age and ZIP Code or telephone exchange and 181 hospitalized black women matched according to age and hospital. Information was obtained through personal interviews and was studied by multivariable logistic-regression analysis. RESULTS: When the case patients were compared with the control subjects from the community, the women in the lowest quintile for body-mass index had a markedly increased risk of hip fracture as compared with the women in the highest quintile (odds ratio, 13.5; 95 percent confidence interval, 4.2 to 43.3). Postmenopausal estrogen therapy for one year or more was protective for women under 75 years of age (odds ratio, 0.1; 95 percent confidence interval, < 0.1 to 0.5). Factors associated with an increased risk of hip fracture included a history of stroke (odds ratio, 3.1; 95 percent confidence interval, 1.2 to 8.1), use of aids in walking (odds ratio, 5.6; 95 percent confidence interval, 2.7 to 11.5), and consumption of seven or more alcoholic drinks per week (odds ratio, 4.6; 95 percent confidence interval, 1.5 to 14.1). The results were similar when the case patients were compared with the hospitalized control subjects. CONCLUSIONS: Among black women thinness, previous stroke, use of aids in walking, and alcohol consumption are associated with an increased risk of hip fracture. Postmenopausal estrogen therapy protects against hip fracture in women under 75 years of age.

Aged↗
PubMed1994

A longitudinal study of injury morbidity in an African-American population.

OBJECTIVE: To improve understanding of the patterns of injury morbidity and mortality in an urban African-American population. DESIGN: Prospective survey of emergency department records for a geographically defined population from 1987 through 1990. SETTING: Eleven hospital emergency departments in Philadelphia, Pa. PARTICIPANTS: The approximately 68,000 people living in 17 census tracts in western Philadelphia. RESULTS: A total of 46,260 injury events were identified in the survey (168.8 events per 1000 population annually). Half of the population made an emergency department visit for one or more injuries during the 4 years of study. There were 2796 hospital admissions (10.2/1000 population) and 403 deaths (1.5/1000 population) as a result of these injuries. Although in 1987 falls were the most frequent type of injury resulting in an emergency department visit, by 1989 the number of interpersonal intentional injury events exceeded the number of falls. Interpersonal intentional injuries accounted for 31.2% of hospital admissions and 42.7% of deaths. Of men 20 through 29 years old, 94.3% visited an emergency department at least once in the 4 years because of an injury, and 40.9% of men in this age group sought treatment for one or more interpersonal intentional injuries. The likelihood of future interpersonal intentional injury-related visits increased with the number of previous injuries of this type. CONCLUSIONS: Interpersonal intentional injury occurs frequently in this population. More attention needs to be paid to prevention and intervention to reduce the toll of this violence. The high prevalence of injury in certain age strata may make general, population-based efforts for injury prevention more efficient than efforts targeted to subgroups.

Accidental Falls↗
PubMed1994

Diagnostic ultrasound in pregnancy and low birthweight.

Diagnostic ultrasound has been used increasingly in obstetric practice over the past decade. To date, adverse effects of ultrasound on the fetus have not been reported, but studies have been done on small sample sizes. This study looks specifically at the association of ultrasound exposure during pregnancy and the risk of low birthweight in the offspring. A validation case-control study was also performed based on information from a sample of medical charts. With a database of more than 13,000 pregnancies, there was no indication of an adverse effect of ultrasound performed during the first two trimesters of pregnancy.

Adolescent↗
PubMed1993

Making comparisons.

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Case-Control Studies↗
PubMed1993

Parity, lactation and hip fracture.

The relationship between parity, lactation and the occurrence of hip fracture was investigated in a case-control study of white women. The cases were patients (n = 174) aged 45 years and over with a radiologically confirmed first hip fracture sampled from among admissions to 30 hospitals in New York and Philadelphia between September 1987 and July 1989. Controls (n = 174) were selected from general surgical and orthopedic services during the same time period and were frequency-matched to cases by age and hospital. Ever having a live birth was associated with reduced odds of hip fracture, controlling for age and hospital of recruitment (odds ratio = 0.65; 95% confidence interval = 0.41-1.04). When body mass index was also controlled, each birth was associated on average with a 9% reduction in the odds of hip fracture (odds ratio = 0.92 [0.78-1.08]), although the trend was not statistically significant. After adjusting for number of births, lactation was not associated with hip fracture (adjusted odds ratio for 12 months of lactation or less = 0.80 [0.42-1.55]; adjusted odds ratio for more than 12 months = 1.08 [0.45-2.60]).

Aged↗
PubMed1993

An injury prevention program in an urban African-American community.

OBJECTIVES: Injury is a major US public health problem, particularly in urban minority communities. This paper evaluates the impact of the Safe Block Project, a comprehensive injury prevention trial, on home hazards and injury prevention knowledge in a poor urban African-American community. METHODS: Nine census tracts in the community were allocated to either the intervention area or the control area. The intervention, carried out by trained community outreach workers, consisted of (1) home modification for simple prevention measures, (2) home inspection accompanied by information about home hazards, and (3) education about selected injury prevention practices. Approximately 12 months after the intervention, random samples of control and intervention homes were assessed for home hazards and injury prevention knowledge. RESULTS: A significantly larger proportion of intervention homes than control homes had functioning smoke detectors, syrup of ipecac, safely stored medications, and reduced electrical and tripping hazards. No consistent differences were observed between control and intervention homes on home hazards requiring major effort to correct. CONCLUSIONS: There was a distinct difference between control and intervention homes with respect to safety knowledge and home hazards requiring minimal to moderate effort to correct. The Safe Block Project could serve as a model for future urban injury prevention efforts.

Accidents, Home↗
PubMed1993

Hospitalized elders. Risk of confusion with hip fracture.

Although frequently underdiagnosed, more than half of all patients admitted for the treatment of hip fracture are confused at the time of hospital admission or develop confusion sometime during the course of hospitalization. This study reveals the profound vulnerability of severely confused patients with hip fracture. Severely confused patients experience higher overall rates of medical complications and are more likely to be discharged to a nursing home. In addition to being at higher risk for medical complications, severely confused patients also appear to be at greater risk for being physically restrained.

Aged↗
PubMed1993

Economic analysis of malaria control for migrant workers in eastern Thailand.

A randomized, double-blind field trial was carried out to compare the economic impact of permethrin-treated nets with that of untreated nets as a method of malaria control. The study was conducted in 261 long-term migrant workers and 138 seasonal agricultural migrant workers in the eastern rural areas known to be highly endemic for multidrug-resistant Plasmodium falciparum infection. One hundred and twenty-six longterm migrants and 59 seasonal migrants used treated nets, while 135 and 79, respectively, used untreated nets. The impregnated-nets program was cost-saving as well as offering improved effectiveness. The net benefit of using a treated net was US$1.17 per worker from the Malaria Division's perspective and US$1.61 per worker from the worker viewpoint. The use of impregnated nets with large-scale primary health care programs likely will be the most cost-effective and cost-beneficial method for controlling malaria in eastern Thailand.

Cost-Benefit Analysis↗
PubMed1992

A case-control study of hip fracture: evaluation of selected dietary variables and teenage physical activity.

Recent diet, teenage physical activity and teenage calcium consumption were examined as risk factors for hip fracture in a case-control study. Cases were 161 white women admitted to one of 30 participating hospitals with a first hip fracture. Controls included 168 white women from general and orthopedic surgical services frequency-matched to cases by age group and hospital. Information on exposure to possible risk factors was obtained by in-person interview. No association was found between recent intake of calcium, phosphorus, protein, vitamin C or caffeine and hip fracture. Also, teenage calcium intake and milk drinking were not related to hip fracture risk. Recreational activities in adolescence and early adulthood appeared to afford protection against hip fracture. The highest quartile of recreational activity (greater than or equal to 4 times/week) was associated with an odds ratio of 0.24 (95% confidence interval 0.08-0.75) relative to the lowest quartile (less than 1 time/week).

Adolescent↗