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Biomedical subjects

J A Grisso

Publications and source records attributed to J A Grisso.

At least 37 records · Page 2Linked to original sources
PubMed1999

Racial differences in menopause information and the experience of hot flashes.

OBJECTIVE: To compare the prevalence of hot flashes and health education regarding menopause in African-American and white American women in the late reproductive years. DESIGN: Cross-sectional study. SETTING: Population-based sample recruited through random digit dialing. PARTICIPANTS: The sample was 436 women between the ages of 35 and 48 years with regular menses. Half the sample was African American and half was white American. MAIN RESULTS: African-American women (53%) were more likely than white American women (29%) to have experienced hot flashes (p < .001). The difference remained after adjustment for body-mass index, education, menstrual cycle characteristics, and gynecologic and medical history. Despite the high prevalence of symptoms, few women had discussed menopausal management with their physicians. For white women the media were the primary source of menopause-related information, whereas African-American women reported that their family was the primary source of information. CONCLUSIONS: These results indicate that hot flashes occur commonly among women in their thirties and forties who have regular menstrual cycles and that the prevalence of hot flashes appears to differ by race. Studies should be designed to evaluate the hormonal and physiologic implications of these symptoms among women in their late reproductive years. Few of these women had discussed menopause with their physicians. Given the differences in sources of information about menopause, development of culture-specific health education programs should be considered.

Adult↗
PubMed1999

Body mass and fracture risk. A study of 330 patients.

Low body mass is a major risk factor for low energy hip fractures among women. The purpose of this study was to ascertain whether normal body mass also protects against low energy wrist fractures. A retrospective analysis of body mass indices of 330 women who sustained hip or wrist fractures from falls was performed. Data were grouped by race and age. The mean body mass index for white patients with wrist fractures was 26.4, compared with a mean body mass index of 22.3 in white patients with hip fractures. For black patients, those with wrist fractures had a mean body mass index of 28.5, compared with a mean body mass index of 22.9 for those with hip fractures. Using data from The National Health and Nutrition Examination Surveys, the mean body mass index of patients with wrist fractures was seen to be equal to or greater than the national mean body mass index, whereas that of patients with hip fractures was substantially below average. Accordingly, normal body mass was protective against hip fractures but not against wrist fractures. Because adipose tissue more typically is distributed about the hip than the wrist, the protective mechanism of normal body mass against osteoporotic fractures may promote better preventative interventions against this disease.

Accidental Falls↗
PubMed1999

The effect of dehydroepiandrosterone supplementation to symptomatic perimenopausal women on serum endocrine profiles, lipid parameters, and health-related quality of life.

Dehydroepiandrosterone (DHEA), an androgenic steroid hormone, exhibits an age-related decline. Perimenopausal women have only approximately 50% of peak DHEA levels. Despite limited scientific data, DHEA has gained recognition as a dietary supplement to reduce the symptoms of aging and improve well-being. This randomized, double-blind placebo-controlled trial examined the effects of 50 mg/day of oral DHEA supplementation, for 3 months, on 60 perimenopausal women with complaints of altered mood and well-being. Changes in the serum endocrine profile of women in the DHEA group were significantly greater than the placebo group, including a 242% [95% confidence interval (CI) +60.1, +423.9] increase in DHEAS, a 94.8% (95% CI +34.2, +155.4) increase in testosterone, and a 13.2% (95% CI -27.88, +0.5) decline in cortisol compared to baseline. Women receiving DHEA had a 10.1% (95% CI -15.0, -5.1) decline in high-density lipoprotein and an 18.1% (95% CI -32.2, -3.9) decline in Lp(a) from baseline, but these declines did not significantly differ from women who received placebo. Women receiving DHEA did not have any improvements significantly greater than placebo in the severity of perimenopausal symptoms, mood, dysphoria, libido, cognition, memory, or well-being. DHEA supplementation significantly effects the endocrine profile, may affect the lipid profile, but does not improve perimenopausal symptoms or well-being compared to placebo.

Affect↗
PubMed1999

Predictors of injury among adult recreational in-line skaters: a multicity study.

OBJECTIVES: This study examined risk factors for injury, injury prevalence, safety gear use, and skating habits of adult recreational in-line skaters. METHODS: Randomly selected in-line skaters in 6 major US cities were interviewed. RESULTS: Only 6% of skaters consistently wore all 4 recommended types of safety gear. Skaters with greater skating experience were more likely to perform tricks, wear less safety gear, and sustain an injury. CONCLUSION: More experienced adult recreational in-line skaters are at increased risk for injury. Safety gear use in alarmingly low in adult recreational in-line skaters, especially experienced skaters. Safe skating education programs should consider targeting this newly recognized at-risk skating population.

Adult↗
PubMed1998

Characteristics of falls and risk of hip fracture in elderly men.

The steep rise in hip fracture incidence rates with age is not fully explained by an increase in the frequency of falls or by reduction in bone mineral density, suggesting that circumstances of falls may also affect the risk of hip fracture. Previous studies conducted mainly among women have identified the importance of the orientation of a fall in the etiology of hip fracture. In this case-control study among men of 45 years and older, we evaluated how the circumstances of falls affect the risk of hip fracture. We compared 214 cases with hip fracture due to a fall with 86 controls who had fallen within the past year but did not sustain a hip fracture. As expected, in multivariable age-adjusted analyses men who reported hitting the hip/thigh in a fall had a markedly elevated risk of hip fracture (OR = 97.8; 95% CI = 31.7-302). Hitting the knee in a fall was associated with reduced risk (OR = 0.24; 95% CI = 0.09-0.67). Other factors that were associated with reduced risk of hip fracture among men who fell were more hours of physical activity in the past year (OR = 0.84; 95% CI = 0.73-0.97, for each additional 4 h per week), a greater body mass index (OR = 0.60; 95% CI = 0.40-0.90, for each additional 4 kg/m2), and a history of a fracture when age 45 years or older (OR = 0.26; 95% CI = 0.10-0.69). Reported lower limb dysfunction was associated with increased risk of hip fracture (OR = 6.41; 95% CI = 2.09-19.6) among fallers. The increased risk associated with hitting the hip/thigh in a fall and the reduced risk associated with high body mass index suggest that preventive efforts for older men at high risk might include protective hip pads to reduce the force on the hip in a fall. Exercise and strength training programs may also reduce the risk of hip fracture among men who fall.

Accidental Falls↗
PubMed1998

The relationship between physical restraint removal and falls and injuries among nursing home residents.

BACKGROUND: A major reason cited for continued restraint use in American nursing homes is the widely held belief that restraint reduction will lead to fall-related incidents and injuries. METHODS: This study represents an analysis of data collected in a clinical trial of interventions aimed at reducing the use of restraints in nursing homes. Two different designs were employed to test the relationship between restraint reduction and falls/injuries. First, multiple logistic regression was used to compare fall/injury rates in subjects who had restraints removed (n = 38) to those who continued to be restrained (n = 88); second, survival analysis was employed to test the relationship between physical restraint removal and falls/injuries at the institutional level by comparing fall/injury rates among three nursing homes (n = 633) with varying rates of restraint reduction. RESULTS: Based on the multiple logistic regression analysis, there was no indication of increased risk of falls or injuries with restraint removal. Moreover, restraint removal significantly decreased the chance of minor injuries due to falls (adjusted odds ratio: 0.3, 95% CI: 0.1, 0.9; p < .05). The survival analysis demonstrated that the nursing home that had the least restraint reduction (11%) had a 50% higher rate of falls (p < .01) and more than twice the rate of fall-related minor injuries (p < .001) when compared to the homes with 23% and 56% restraint reduction, respectively. CONCLUSIONS: Physical restraint removal does not lead to increases in falls or subsequent fall-related injury in older nursing home residents.

Accidental Falls↗
PubMed1998

Cardiovascular risk factors in economically disadvantaged women: a study of prevalence and awareness.

This study examined the prevalence of cardiovascular risk factors among low-income women and assessed the level of awareness and attitudes about these risk factors in the community. A survey instrument was developed and administered by a single researcher to a convenience sample of women in health clinics and nonclinical community settings. These settings included: an academic clinic, community clinics, women's shelters, free meal sites, community centers, public housing units, and private homes in Philadelphia, Pennsylvania. Two hundred two women were selected without regard to age or race. The mean number of cardiovascular risk factors per subject was 2.6 (SD 1.4). Each of eight established cardiovascular risk factors was identified by 4% to 34% of subjects. Among those women with a specific risk factor, only 0% to 45% reported that they were at increased risk due to the presence of that factor. The prevalence of cardiovascular risk factors among low-income women is substantial. Knowledge and understanding of these risk factors is suboptimal, particularly among women personally affected by risk factors for cardiovascular disease.

Adolescent↗
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

Evaluating minority recruitment into clinical studies: how good are the data?

PURPOSE: There has been much publicized concern about difficulty with minority recruitment into research studies, particularly since minority inclusion in randomized clinical trials was mandated by the 1993 National Institutes of Health Revitalization Act. We reviewed recruitment data in published reports from clinical studies to assess the actual degree of success in recruiting minorities versus whites and to identify barriers to recruitment. METHODS: We abstracted articles published between September 1993 and February 1995 that reported detailed results of participant recruitment for studies conducted in the United States. RESULTS: Of 65 articles meeting our eligibility criteria (median sample size, 1323), only one (1.5%) reported the racial/ethnic composition of potential study participants. Only two articles (3.1%) provided information about the racial/ethnic composition of eligible subjects, and only one (1.5%) provided information about the racial/ethnic composition of refusing subjects. For enrolled subjects, race/ethnicity was less likely to be reported (58.5%) than were age (90.8%) or gender (80.0%). CONCLUSIONS: The published literature currently contains insubstantial data to either refute or prove that there are differential recruitment rates among minorities as compared with whites. Changes in reporting will be needed in order to track progress in this area.

Clinical Protocols↗
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↗