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Biomedical subjects

J G Spangler

Publications and source records attributed to J G Spangler.

At least 37 records · Page 2Linked to original sources
PubMed1995

Smokeless tobacco: epidemiology, health effects and cessation strategies.

Smokeless tobacco is an extremely addictive substance with a high rate of use in certain demographic groups, such as adolescents and Native Americans. In the past 20 years, the use of smokeless tobacco has almost tripled. Health risks include leukoplakia (a premalignant oral lesion), oral cancer and systemic nicotine effects such as elevated blood pressure and serum cholesterol levels. To avoid or control these effects, family physicians should identify patients who use smokeless tobacco and encourage and support cessation efforts. Patients who are unsure about quitting need the risks of their habit personalized, and those who are actively trying to stop using smokeless tobacco need emotional and, in some cases, therapeutic support (e.g., nicotine replacement therapy). The family physician should encourage patients who appear motivated to stop using smokeless tobacco to set a quit date in the very near future. However, all smokeless tobacco users--regardless of their motivation to quit--need to be followed to ensure compliance with cessation advice or to detect medical complications from use of this form of tobacco.

Algorithms↗
PubMed1995

Screening, health promotion, and prevention in women.

Many health promotion and disease prevention recommendations are specific to adult women. Given their strategic position within families, women often hold the responsibility for the health and well-being of all family members.

Adult↗
PubMed1994

Uses and safety of acyclovir in pregnancy.

Acyclovir, an antiviral nucleoside analogue, is a widely used agent highly specific for herpes simplex and varicella-zoster viruses. Unintended exposure to acyclovir early in pregnancy, which is not uncommon, may cause excessive maternal and physician anxiety. This drug has not been studied prospectively in large numbers of pregnant women and lacks the Food and Drug Administration's approval for gestational use unless benefits clearly outweigh potential fetal harm. However, data published since acyclovir became available do not indicate increased adverse effects related to its use in pregnancy, especially if prescribed in selected situations, such as disseminated primary herpes simplex infections or maternal varicella pneumonia. This article reports the impact of inadvertent acyclovir exposure on a woman during the first trimester of pregnancy and reviews the literature on acyclovir's pharmacology, safety profile, and potential uses during pregnancy.

Acyclovir↗
PubMed1993

The influence of gender and race on mean body temperature in a population of healthy older adults.

Body temperature is known to vary with environmental conditions, physical activity, and illness. There is also some suggestion that body temperature is higher in women than men, and higher in blacks than whites. This study was undertaken to determine if previously described differences in body temperature found in relatively uncontrolled settings associated with gender and race can be reproduced under carefully controlled conditions. Temperature was measured orally with calibrated mercury-in-glass thermometers in 92 healthy community-dwelling volunteers aged 64 years and older. Environmental conditions were carefully controlled and patients with physical conditions or medication regimes known to alter body temperature were excluded. The mean body temperature for all subjects was 36.86 degrees C +/- 0.23 degrees C. The means for white men and women did not differ significantly. There was a statistically significant difference between black and white women, with blacks having 0.13 degrees C higher temperature. We conclude that body temperature varies with race in older women. No significant gender-related difference in normal body temperature was found in these healthy elderly white men and women. Differences in body temperature between men and women found in younger patient populations may reflect the temperature elevations in women associated with menstruation.

Age Factors↗
PubMed1993

Predicting exercise and smoking behaviors in diabetic and hypertensive patients. Age, race, sex, and psychological factors.

OBJECTIVE: To predict exercise and smoking behaviors in primary care patients with chronic diseases (insulin-dependent diabetes mellitus [IDDM], non-insulin-dependent diabetes mellitus [NIDDM], and hypertension) using standardized measures of stress, affect, and family function. DESIGN: Survey by a self-administered health risk appraisal and the Family APGAR Scale (measuring family function), the Brief Encounter Psychosocial Instrument (measuring coping with psychological stress), and the Affect Balance Scale (measuring positive and negative affect). SETTINGS: Large family practice center, university medical center pediatrics clinic, and community health center. PARTICIPANTS: Volunteers meeting World Health Organization criteria for IDDM (n = 83) or NIDDM (n = 322), and volunteers with documented hypertension (n = 140). MAIN OUTCOME MEASURES: Exercise levels at or above 2510 kJ/wk; smoking status; and number of cigarettes consumed per day. RESULTS: Smoking status in all groups was lower than that measured nationally. Stepwise logistic regression showed a correlation between positive affect and higher exercise levels among patients with IDDM and NIDDM, but lower levels among hypertensives. Psychological stress correlated with current smoking among patients with IDDM. In pooled models, whites were much more likely than blacks to exercise at higher levels and to be former or nonsmokers; however, among smokers, whites consumed more cigarettes per day. Among smokers with IDDM, males were much more likely to be moderate to heavy smokers. CONCLUSIONS: Among patients with IDDM, NIDDM, and hypertension, psychosocial stress, affect, age, race, and sex differentially predict exercise and smoking behaviors. The lower-than-national prevalence of smoking in these groups may indicate increased responsiveness to the stop-smoking message. Black diabetic and hypertensive patients, in particular, may require increased health promotion efforts.

Adult↗
PubMed1993

Prevalence and predictors of problem drinking among primary care diabetic patients.

BACKGROUND: Alcohol abuse among patients with diabetes mellitus is dangerous and complicates therapy, but its prevalence and the factors that predict it are unknown. This study examined the prevalence of problem drinking among a large number of primary care diabetic patients, exploring its relation to age, race, sex, psychological factors, and other health behaviors. METHODS: Volunteers with insulin-dependent diabetes mellitus and non-insulin-dependent diabetes mellitus were surveyed at three primary care practice sites. Patients completed a health risk appraisal designed to elicit alcohol use and other health practices, and two psychometric instruments: the Brief Encounter Psychosocial Instrument and the Affect Balance Scale. Fasting blood glucose and hemoglobin A1C levels were also determined. RESULTS: Of 395 diabetic patients, 32 (8.1%) had a drinking problem as defined by answering yes to the question "Have you ever had a drinking problem?" or reporting their last drink to be within 24 hours, or both. Patients with a drinking problem coped less well with psychological stress and had a more highly negative affect than those without a drinking problem. Depression, black race, and male sex were significantly associated with problem drinking (odds ratios = 8.42, 2.70, and 3.80, respectively). Problem drinking did not predict glycemic control but was associated with smoking and less frequent glucose monitoring. CONCLUSIONS: The prevalence of problem drinking among patients with diabetes mellitus appears lower than among other medical outpatient populations and is in keeping with the prevalence found in community surveys. While the lack of association between problem drinking and glycemic control in diabetic patients may be surprising, these data help define the characteristics of this subgroup of diabetic patients and highlight the need for family physicians to intensify alcohol screening efforts in this population.

Adolescent↗
PubMed1989

Vibrio cholerae non-serogroup O1 cystitis.

We report a case of a patient who developed cystitis caused by non-serogroup O1 Vibrio cholerae after swimming in the Chesapeake Bay. Treatment was empirical, with complete symptomatic resolution. Genitourinary tract infections by Vibrio spp. are uncommon but should be considered when cystitis occurs after saltwater exposure in appropriate geographic regions.

Adult↗
PubMed1977

False aneurysm of the descending aorta: a complication of umbilical artery catheterization.

A patient had an aneurysm of the descending aorta secondary to aortitis arising from umbilical artery catheterization and in association with coarctation of the aorta. The aortitis probably was the direct result of bacterial contamination of the umbillicus and catheter with Staphylococcus aureus and the placement of the catheter tip just distal to a coarctation of the aorta. The patient required surgical resection of the coarctation and aneurysm of the descending aorta and placement of a tubular Dacron graft at 6 month of age. This is, to our knowledge, a hitherto unreported complication of umbilical artery catheterization.

Aneurysm, Infected↗
PubMed1976

Secundum atrial septal defect encountered in infancy.

From 1953 to 1972, approximately 170 patients less than 16 years old were seen at the Mayo Clinic for isolated secundum atrial septal defect. Thirteen of these patients were initially seen when they were less than 2 years old. Eleven of the patients had symptoms, and one of these died. Four patients failed to respond to medical management and underwent successful repair of their defects before they were 2 years old. Infants with isolated secundum atrial septal defect and significant symptoms are at an increased risk of death. Consideration should be given to early surgical closure of the defect in those infants who do not respond promptly and completely to medical therapy. Surgical repair in infancy can be accomplished with minimal risk and excellent early and long-term clinical results.

Age Factors↗
PubMed1975

Echocardiographic contrast studies: initial experience.

Echocardiograms were obtained simultaneously with the standard indocyanine green injections performed during cardiac catheterization. When injected into cardiac chambers, indocyanine green produced a cloud of echoes that enabled us to visualize characteristic flow patterns in the presence of normal and abnormal cardiac hemodynamics. More than 300 echocardiographic contrast studies have been recorded in patients with various congenital and acquired cardiac defects. The patterns obtained were reproducible, sensitive, and specific.

Cardiac Catheterization↗
PubMedDate not supplied

Hyperinsulinemia in hypertension: associations with race, abdominal obesity, and hyperlipidemia.

OBJECTIVE: To determine the relative contributions of race, sex, abdominal obesity, and hyperlipidemia to the development of hyperinsulinemia among patients with hypertension. DESIGN: Cross-sectional survey. SETTING: A large family practice ambulatory care unit in Winston-Salem, NC. PATIENTS: One hundred and forty adult patients with essential hypertension (systolic blood pressure > or = 160 mm Hg or diastolic blood pressure at or above 90 mm Hg on 2 or more occasions) or who were receiving antihypertensive treatment. MAIN OUTCOME MEASURES: Fasting insulin, lipid, and glucose levels; glycosylated hemoglobin; waist-hip ratio; and resting blood pressure. METHODS: Among 4 patient subgroups (hypertension alone; hypertension and abdominal obesity; hypertension and hyperlipidemia; and hypertension, abdominal obesity, and hyperlipidemia) logistic regression analysis was used to determine correlates of elevated fasting insulin levels. RESULTS: Controlling for age and blood pressure, black males had the highest fasting insulin levels (135 +/- 70 pmol/L [18.8 +/- 9.6 microU/mL] and 265 pmol/L [37.0 +/- 0.0 microU/mL] [mean +/- SD] for obese and nonobese black males, respectively); nonobese white males had the lowest fasting insulin levels (23 +/- 22 pmol/L [3.2 +/- 3.0 microU/mL]). Multivariate logistic regression indicated that the addition of abdominal obesity or hyperlipidemia to pure hypertension more than doubled the risk of hyperinsulinemia (adjusted odds ratio, 2.69; 95% confidence interval, 1.04-6.89; and adjusted odds ratio, 2.62; 95% confidence interval, 0.37-8.6, respectively). The combination of abdominal obesity and hyperlipidemia exerted additive effects among patients with hypertension for elevated insulin levels (adjusted odds ratio, 5.1; 95% CI, 1.59-16.4). CONCLUSIONS: Race, sex, abdominal obesity, and hyperlipidemia interact to produce increases in fasting insulin levels. This knowledge may help physicians prevent sequelae from hyperinsulinemia syndrome among their patients with hypertension.

Adult↗
PubMedDate not supplied

Smoking status and psychosocial variables in type 1 diabetes mellitus.

While depression, anxiety, and negative affect are associated with smoking and smoking cessation outcomes in healthy individuals, these associations have not been established in smokers with chronic diseases such as diabetes mellitus, a condition which greatly increases cardiovascular disease risk. Other psychosocial variables such as stress and locus of control may also be associated with smoking but are seldom reported. We examined stress, affect, and locus of control by smoking status in patients with type 1 diabetes mellitus. Results indicated that current smokers reported significantly higher levels of perceived stress, a more negative affect, and higher powerful others locus of control compared with nonsmokers. These findings indicate that those patients who have diabetes and who smoke are at greater risk for depressive symptoms. This knowledge may aid clinicians in their attempts to help these patients quit smoking.

Adolescent↗
PubMedDate not supplied

Oral health behaviors in medical patients with diabetes mellitus.

PURPOSE: Periodontal disease is common among patients with noninsulin dependent diabetes mellitus (NIDDM) and insulin dependent diabetes mellitus (IDDM) and interferes with diabetic control. However, no study has examined predictors of oral health behavior among patients with diabetes in a medical setting. This study describes self-reported oral hygiene among primary care patients with IDDM and NIDDM, evaluating age, race, gender, psychosocial stress, family dysfunction, and other health predictors of preventive oral behaviors. METHODS: A written survey of oral health behaviors, psychological stress, and family function was conducted among 390 out of 473 possible primary care dentate patients with diabetes (IDDM=81; NIDDM=309). Fasting blood sugar and hemoglobin A1C also were obtained. Data were collected between January 1989 and June 1991, and analyzed using Mantel-Haenszel's chi-square and logistic regression. RESULTS: Patients with IDDM with severe family dysfunction were less likely to brush, floss, or visit a dentist regularly than those with better reported family function. Whites with NIDDM were more likely to practice these oral health behaviors than were blacks. Female gender correlated with flossing in the group of patients with IDDM, and with brushing in both groups. Patients with NIDDM who exercised were also more likely to visit the dentist annually. Age was positively associated with a history of periodontal disease in the group with IDDM. CONCLUSIONS: These data document for the first time the relationship between family dysfunction and oral health practices of patients with IDDM, and corroborate the known associations among white race, female gender, and oral hygiene. This information could be used to coordinate diabetic oral health promotion between primary care physicians and oral health professionals.

Adolescent↗