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Biomedical subjects

M Szklo

Publications and source records attributed to M Szklo.

135 records · Page 8Linked to original sources
PubMedDate not supplied

A community-based study of explanatory factors for the excess risk for early renal function decline in blacks vs whites with diabetes: the Atherosclerosis Risk in Communities study.

CONTEXT: The explanation for the excess risk for diabetic renal disease in blacks is uncertain. OBJECTIVES: To compare the incidence of early renal function decline in black and white adults with diabetes and to examine possible explanatory factors for racial differences. DESIGN: Prospective cohort study. SETTING: Four US communities participating in the Atherosclerosis Risk in Communities study. PARTICIPANTS: Community-based sample of 1434 diabetic adults aged 45 to 64 years. MEASUREMENTS: Detailed baseline assessment using structured interview, results of physical examination, and laboratory measurements. MAIN OUTCOME: Development of early renal function decline defined by an increase in serum creatinine of at least 35.4 micromol/L (0.4 mg/dL) during 3 years of follow-up. RESULTS: During 3 years of follow-up, early renal function decline developed in 45 blacks (28.4 per 1000 person-years [PY]) and 25 whites (9.6 per 1000 PY). After adjustment for age, sex, and baseline serum creatinine level, early renal function decline was more than 3 times as likely to develop in blacks than whites (odds ratio, 3.15; 95% confidence interval, 1.86-5.33). Additional adjustment for education, household income, health insurance, fasting glucose level, mean systolic blood pressure, smoking history, and physical activity level reduced the relative odds in blacks to 1.38 (95% confidence interval, 0.71-2.69), corresponding to a 82% reduction in excess risk. CONCLUSIONS: These data suggest that early renal function decline is 3 times more likely to develop in blacks than whites and that potentially modifiable factors, including lower socioeconomic status, suboptimal health behaviors, and suboptimal control of glucose level and blood pressure, account for more than 80% of this disparity.

Black People↗
PubMedDate not supplied

Predictors of ventricular fibrillation or cardiac arrest in patients hospitalized for acute myocardial infarction.

A community-wide study of patients hospitalized with acute myocardial infarction in metropolitan Baltimore was conducted to examine socio-demographic and clinical characteristics in association with ventricular fibrillation and cardiac arrest (VF/CA). Multivariate analyses revealed that variables significantly associated with occurrence of VF/CA included older age (60 years or older), male sex, and a history of cigarette smoking. These factors allow the identification of subgroups of patients hospitalized with acute myocardial infarction at high risk for the subsequent development of VF/CA, in whom prophylactic therapy and close surveillance are especially recommended.

Female↗
PubMedDate not supplied

Selective screening: when should screening be limited to high-risk individuals?

Issues related to selective screening are discussed. The distinction between test accuracy and program accuracy is presented in the context of impact on cost/true case detection, which in turn reflects the gain in specificity and loss in sensitivity for the total target population. When two or more risk factors are combined to define high-risk subjects, a gain in program accuracy and a relative reduction in cost/true case found ensue if there is additive interaction between these risk factors. The author also discusses periodicity of screening and emphasizes the inappropriateness of using the notion of risk for disease occurrence as a criterion to define periodicity.

Costs and Cost Analysis↗
PubMedDate not supplied

Thyroid hormones and duration of ovulatory activity in the etiology of breast cancer.

We conducted the present study with the hypothesis that conflicting reports on the association between mild hypothyroidism and breast cancer may be due to failure to consider the potential interaction between thyroid and ovarian hormones. Seventy-three cases of breast cancer and 75 hospital controls were studied. The overall matched multivariate odds ratio of breast cancer for the lowest tertile of free T4 (< or = 1.10 ng/dl) versus the two other tertiles was 1.7 (95% confidence limits, 0.6-5.0). However, there was a statistically significant linear trend (P = 0.04) in the odds ratios for breast cancer related to subnormal free T4 levels across tertiles of duration of ovulatory activity. These results suggest that women combining low levels of circulating free T4 with long duration of ovulatory activity may be at increased risk for this disease.

Adult↗