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Biomedical subjects

R A Carleton

Publications and source records attributed to R A Carleton.

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

Nutrition and health practices of diabetic and nondiabetic men and women from two southeastern New England communities.

Diabetes occurs in at least 13 million persons in the United States and is a major cause of morbidity and premature mortality. Diet is the cornerstone of diabetes management, and the purpose of this investigation was to examine dietary intakes and health practices among diabetic and nondiabetic individuals from a recently surveyed population-based sample from two communities in southeastern New England. Data were collected during cross-sectional home health surveys conducted in random population samples of two New England communities during 1987-1988, 1989-1990, and 1992-1993. A food frequency questionnaire was completed by 1,897 of 2,077 eligible respondents who made up our study sample. Statistical analyses suggest that diabetic individuals do not appear to be adhering to measures known to improve metabolic control (i.e., weight reduction and physical activity). Furthermore, both diabetic and nondiabetic individuals alike should be targeted for educational programs aimed at improving dietary intakes which lead to a reduction in consumption of total and saturated fatty acid.

Adolescent↗
PubMed1995

The Pawtucket Heart Health Program: community changes in cardiovascular risk factors and projected disease risk.

OBJECTIVES: Whether community-wide education changed cardiovascular risk factors and disease risk in Pawtucket, RI, relative to a comparison community was assessed. METHODS: Random-sample, cross-sectional surveys were done of people aged 18 through 64 years at baseline, during, and after education. Baseline cohorts were reexamined. Pawtucket citizens of all ages participated in multilevel education, screening, and counseling programs. RESULTS: The downward trend in smoking was slightly greater in the comparison city. Small, insignificant differences favored Pawtucket in blood cholesterol and blood pressure. In the cross-sectional surveys, body mass index increased significantly in the comparison community; a similar change was not seen in cohort surveys. Projected cardiovascular disease rates were significantly (16%) less in Pawtucket during the education program. This difference lessened to 8% posteducation. CONCLUSIONS: The hypothesis that projected cardiovascular disease risk can be altered by community-based education gains limited support from these data. Achieving cardiovascular risk reduction at the community level was feasible, but maintaining statistically significant differences between cities was not. Accelerating risk factor changes will likely require a sustained community effort with reinforcement from state, regional, and national policies and programs.

Adolescent↗
PubMed1995

Physical activity, physical fitness, and coronary heart disease risk factors.

The relationships between physical activity, physical fitness, and coronary heart disease risk factors measured in a large community sample were evaluated. Self-reported physical activity using a single question, maximal oxygen consumption estimates derived from the Pawtucket Heart Health Step Test, blood pressure, nonfasting lipids, and body mass index were cross-sectionally evaluated in 381 men and 556 women. The correlation of estimated maximal oxygen consumption and self-reported physical activity was modest but statistically significant (r = 0.13 in men and r = 0.19 in women). Blood pressure, body mass index, and HDL cholesterol were correlated with physical fitness (r = 0.24-0.65) and correlated to self-reported physical activity (r = 0.09-0.14). Evaluation of coronary heart disease risk factors using both physical activity and physical fitness revealed a complex relationship that generally showed a stronger relationship with measures of physical fitness than with physical activity. This study suggests that simultaneous measurement of physical activity and physical fitness may be useful in epidemiologic studies of habitual physical activity and chronic disease.

Adolescent↗
PubMed1995

Sedentary lifestyle and risk of coronary heart disease in women.

Relatively few studies have assessed the prospective relationship of sedentary lifestyle and coronary heart disease (CHD) in women. We performed a nested case-control study, identifying 50 cases of acute CHD in women and 150 age-matched controls. Risk factors including sedentary lifestyle, cigarette smoking, hypertension, diabetes mellitus, total, and HDL cholesterol levels had been previously determined in this cohort using household survey techniques. The odds ratio (OR) of CHD in sedentary women was 2.1 (95% CI 1.0-4.3, P = 0.046). The odds ratio was similar (OR = 2.3, 95% CI 1.0-5.7, P = 0.051) after adjusting for potential confounders of hypertension, cigarette smoking, low HDL cholesterol, diabetes mellitus, and being U.S. born. This study suggests that sedentary lifestyle may be an independent risk factor for CHD in women, but its results are open to several contradictory interpretations. Further studies to investigate the prospective relationship of sedentary lifestyle and the risk of CHD in women are needed.

Case-Control Studies↗
PubMed1994

Prevention of cardiovascular disease--opportunities for progress.

Steady progress has been made in the prevention of cardiovascular disease. There has been a favorable trend in major risk factor reduction and an average 3% annual decline in cardiovascular disease death rates over the past decade. Yet, CVD death rates still exceed that for many countries and not all segments of the U.S. population have benefited equally. Cardiovascular disease remains the leading cause of death and disability in this country. The role of epidemiologic research and prevention strategies in addressing this issue has been underestimated. Unresolved research questions require further epidemiologic research in order to improve application of known preventive measures and explore other approaches toward the prevention of cardiovascular disease. It is well established that attention to life-style changes and pharmacologic approaches can prevent cardiovascular disease in those at high risk and reduce the likelihood of subsequent cardiac events among patients with known cardiovascular disease. Furthermore, small changes in the distribution of risk factors through community intervention can have tremendous impact on cardiovascular disease morbidity and mortality. Preventive research requires an appropriate framework and plan to satisfy or exceed the needs in keeping with the national goals for Healthy People 2000. The National Heart, Lung, and Blood Institute has addressed this issue by creating a Task Force to develop research priorities for epidemiology and prevention.

Arteriosclerosis↗
PubMed1994

Dietary differences in smokers and nonsmokers from two southeastern New England communities.

OBJECTIVE: Previous studies based on 24-hour dietary recall data have shown that smokers tend to consume less healthful diets than nonsmokers. We tested this hypothesis using data from food frequency questionnaires (FFQs) in a group of men and women. DESIGN: Characteristics of smokers and nonsmokers were compared using data collected from a cross-sectional household health survey. SUBJECTS: Adults aged 18 through 64 years from two communities in southeastern New England were randomly selected for the study and interviewed in their homes by trained personnel. The interview included questions on demographic and behavioral characteristics. Height, weight, blood pressure, and serum lipids were measured using standard protocols. The Willett FFQ was completed by 1,608 of 2,531 eligible respondents who made up our study sample. STATISTICAL ANALYSES PERFORMED: Respondents were categorized as current cigarette smokers or nonsmokers. Demographic, behavioral, physiologic, and dietary characteristics were compared between smokers and nonsmokers by analysis of covariance with age as the covariate. RESULTS: Eligible respondents who did not complete the FFQ differed from respondents with respect to age, gender, smoking prevalence, and several other demographic characteristics. Smokers consumed more energy, fat, alcohol, and caffeine than nonsmokers. Smoking status was inversely associated with intake of vitamins A and C, dietary fiber, folate, and iron among women, whereas differences were smaller and not significant among men. Women who smoked consumed fewer servings of fruits and vegetables than nonsmokers, but this trend was not noted in men. The association between diet and smoking was only slightly diminished by multivariate adjustment for age, income, regular exercise, marital status, and working status but most clinically relevant associations remained. The interaction between gender and smoking was not statistically significant for most dietary variables. CONCLUSIONS: These results suggest that health promotion messages targeted to smokers should include dietary instructions, especially for women.

Adult↗
PubMed1994

Who participates in cardiovascular disease risk factor screenings? Experience with a religious organization-based program.

Adult members who declined participation in cardiovascular disease risk factor screenings offered at religious organizations were randomly selected and asked to participate in screenings at their homes. Relationships between screening participation and sociodemographic, behavioral, and physiological measures were examined. Age, knowledge of cardiovascular disease risk factors, body mass index, current smoking status, previous report of elevated blood pressure, current diastolic blood pressure measurement, frequency of worship service attendance, and residential distance from the religious organization screening site were important predictors of screening response. Those with conspicuous risk factors appeared less likely to initially respond to religious organization site screening invitations.

Adult↗
PubMed1994

A processes of change model for weight control for participants in community-based weight loss programs.

The processes of change model has been successful in predicting behavior change across a wide range of both addictive and nonaddictive problem behaviors. This study was designed to examine the application of the processes of change model to weight control. Study participants included 285 women and men enrolled in three community-based weight loss programs. Results based on structural equation analyses showed that the processes of change model fit the data better than several plausible alternative models. In addition, structural analyses revealed the existence of two general (higher order) processes of change for weight control, the experiential and behavioral processes. These results are similar to those previously reported for eight other problem behaviors. Limitations of the current work and future directions for this line of research are discussed.

Adolescent↗
PubMed1994

Prevalence of hypertension, dyslipidemia, and dyslipidemic hypertension.

BACKGROUND: It has been proposed that dyslipidemic hypertension is part of a distinct metabolic syndrome related to insulin resistance. This paper describes the prevalence and cross-sectional relations of dyslipidemic hypertension in a population-based sample of men and women. METHODS: In two southeastern New England communities, 11,199 randomly selected participants were evaluated as part of a cross-sectional surveillance program of coronary heart disease risk factors between 1981 and 1990. RESULTS: The frequency of dyslipidemia was 38% and of hypertension was 26.5%; the conjoint frequency (dyslipidemic hypertension) was 15.0%, which is 1.49 times the expected value if the two diseases were independent P < .05). Using a discrete multivariate model, dyslipidemia and hypertension were associated with sex, obesity, and diabetes mellitus. The excess association of dyslipidemic hypertension, compared with individual effects of dyslipidemia and hypertension, was not related to these factors. CONCLUSIONS: This study suggests that dyslipidemic hypertension is common but may not be a unique entity associated with a distinct metabolic syndrome.

Adolescent↗
PubMed1993

Possible influence of the prospective payment system on the assignment of discharge diagnoses for coronary heart disease.

BACKGROUND: The prospective payment system, under which diagnosis-related groups (DRGs) are used to reimburse hospitals for the care of Medicare patients, replaced the fee-for-service method of payment in Rhode Island in 1983 and in Massachusetts in 1985. Changes in financial incentives resulting from the use of the DRG system may have influenced the assignment of discharge diagnostic codes away from those with lower reimbursement toward codes with higher reimbursement. METHODS: We collected data from the hospital records of patients 35 through 74 years of age who were discharged with codes 410 through 414 (representing various categories of coronary heart disease) of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). The patients were discharged from seven hospitals in two New England communities (one in Rhode Island and one in Massachusetts) between 1980 and 1988. The rates of diagnosis of various forms of coronary heart disease were determined by studying ICD-9-CM hospital discharge codes (codes 410 and 411 for acute forms of coronary heart disease and codes 412, 413, and 414 for chronic forms) and by using a computerized diagnostic algorithm designed to detect definite myocardial infarction and fatal coronary heart disease. RESULTS: The rates of definite coronary events diagnosed by the algorithm and by the study of ICD-9-CM codes 410 through 414 were constant or increased slightly during the study period. However, the frequency of assignment of codes for the acute forms of coronary heart disease (which entail higher reimbursement) rose from 35.2 percent to 48.4 percent among discharged patients with cardiac disease after the institution of DRGs. The majority of this increase was associated with the code for unstable angina pectoris. The frequency of assignment of codes for the chronic forms of coronary heart disease (which entail lower reimbursement) decreased reciprocally, from 64.8 percent to 51.6 percent (P < 0.001). CONCLUSIONS: Our data are consistent with the hypothesis that the prospective reimbursement system has influenced the assignment of hospital discharge codes in a way that would increase payment to hospitals. However, the data do not permit us to distinguish whether hospitals began to assign more precise diagnoses with the advent of the DRG system, or whether they began to favor diagnoses of acute conditions solely for financial reasons.

Acute Disease↗
PubMed1993

Correlates of postmenopausal estrogen use and trends through the 1980s in two southeastern New England communities.

Correlates and prevalence of current postmenopausal estrogen use were examined in two southeastern New England communities for the period 1981 through 1990. Data were obtained from five biennial cross-sectional household health surveys, with current use of postmenopausal estrogen determined by inspection of medication bottles. Analysis included 3,279 women aged 40-64 years, of whom 2,215 (67.6%) were postmenopausal. The prevalence of estrogen use among all postmenopausal women increased from 5.3% (95% confidence interval (CI) 3.2-7.4) in 1981-1982 to 10.9% (95% CI 7.5-14.4) in 1989-1990. Among women with surgical menopause, prevalence increased from 11.4% (95% CI 6.6-16.2) to 20.3% (95% CI 13.6-27.0), while use among women with natural menopause increased from 1.5% (95% CI 0.04-2.9) to 3.5% (95% CI 0.74-6.2). Logistic regression was used to compute age-adjusted prevalence of estrogen use according to demographic characteristics and cardiovascular risk factors. Postmenopausal estrogen use was positively associated with income, and a positive trend with education was suggested. Estrogen use was positively associated with high density lipoprotein cholesterol and was inversely associated with body mass index. Nonsmokers, women who exercised at least once per week, and women who reported having their cholesterol checked in the past year were more likely to use estrogen. These findings suggest that estrogen users have a more healthy profile than do nonusers. In addition, the prevalence of postmenopausal estrogen use appears to be substantially lower in women with natural versus surgical menopause throughout the period studied.

Adult↗
PubMed1993

Prevalence and descriptors of aspirin use as an antiplatelet agent in two New England communities.

OBJECTIVE: To determine the overall prevalence of aspirin use as an antiplatelet agent in a population-based sample of respondents between the ages of 18 and 64 years, and to describe their sociodemographic characteristics. DESIGN: Data were derived from five biennial cross-sectional household surveys conducted between 1981 and 1990 in two southeastern New England communities by the Pawtucket Heart Health Program. Individuals reporting aspirin use as an antiplatelet agent were identified using data from a structured medication interview. RESULTS: The prevalence of aspirin use per 1000 population was 2.5 (95 percent confidence interval [CI] 0.5, 4.4), 5.0 (95 percent CI 2.4, 7.6), 7.8 (95 percent CI 4.6, 11.0), 7.5 (95 percent CI 4.3, 10.6), and 11.8 (95 percent CI 7.1, 16.5) in the first through the fifth survey periods, respectively (p = 0.0002). The prevalence of aspirin use per 1000 men increased from 4.9 (95 percent CI 0.6, 9.1), 8.7 (95 percent CI 3.3, 14.1), 12.3 (95 percent CI 6.1, 18.5), 8.5 (95 percent CI 3.5, 13.5) to 23.2 (95 percent CI 13.4, 32.9) for the first through the fifth survey periods, respectively. The corresponding prevalence rates of aspirin use per 1000 women were 0.7 (95 percent CI 0, 2.1), 2.43 (95 percent CI 0.05, 4.80), 4.6 (95 percent CI 1.4, 7.8), 6.6 (95 percent CI 2.7, 10.6), and 2.7 (95 percent CI 0, 5.7). Both a gender trend (p = 0.0002) and a survey trend (p = 0.0001) were detected. A gender-survey interaction was not found. CONCLUSIONS: In this population, aspirin use was reported primarily by middle-aged men who had coexisting cardiovascular disease as indicated by concurrent medications. Aspirin use as antiplatelet therapy increased in the population-based samples of two New England communities over the past nine years, with slightly more than one percent of the respondents reporting its use in the fifth cross-sectional survey conducted in 1989-1990. This finding may reflect the publication of important clinical trials near the time the survey was performed and subsequent dissemination of the findings both in the professional and lay press.

Adolescent↗
PubMed1992

Comparison of "Rose Questionnaire Angina" to exercise thallium scintigraphy: different findings in males and females.

Validation of the London School of Hygiene (Rose) Questionnaire with objective measures of myocardial ischemia is incomplete. Therefore, we compared the Rose Questionnaire with exercise thallium-201 myocardial scintigraphy in 147 male and 97 female patients with chest pain referred for clinical exercise testing. Of those with "Rose Questionnaire angina", 26% of the females and 73% of the males had positive thallium-201 scans. Negative results on both the Rose Questionnaire and thallium-201 scintigraphy were observed in 71% of the females and 47% of the males. The sensitivity of the Rose Questionnaire was similar in females (41%) and males (44%). The specificity was 77% in males, while in females it was significantly lower at 56%. The specificity values reflect the higher (p less than 0.05) prevalence of "false positive" Rose Questionnaire results in females (75%) compared with males (27%). In addition, males had a greater (p less than 0.05) number of "false negative" results (53%) than females (29%). The accuracy of the Rose Questionnaire for myocardial ischemia was 0.19 in females, 0.48 in males, and 0.29 overall when including both males and females. Our results indicate a generally poor relationship between Rose Questionnaire angina and thallium-201 scintigraphy, an objective measure of myocardial ischemia in patients with chest pain referred to clinical exercise testing. Further, there are gender-specific differences in this relationship between the questionnaire and exercise thallium-201 imaging.

Aged↗
PubMed1992

Is aerobic dance an effective alternative to walk-jog exercise training?

In order to compare the physiological effects of an 8 week aerobic dance program to those of a walk-jog exercise training program, 60 male and female University employees ages 24-48 years were randomly assigned to an aerobic dance program (N = 22), a walk-jog program (N = 24), or a sedentary control group (N = 15). Subjects who had an exercise compliance rate less than or equal to 85% were dropped from the study, as were control subjects who had scheduling conflicts or illnesses precluding post-treatment testing. Thirty-five subjects completed the 8 week period with a compliance rate greater than or equal to 85%, leaving 14 in the aerobics group, 11 in the walk-jog group and 10 in the control group. Significant increases (p less than 0.001) in maximal oxygen uptake occurred in both the aerobics (+3.9 ml/kg-1/min-1) and walk-jog group (+3.4 ml/kg-1/min-1), while no significant change was observed in the control group. Peak heart rate decreased significantly (p less than 0.05) in the aerobics (-4 b/min-1) and walk-jog groups (-3 b/min-1 but was unchanged in the control group (-1 b/min-1) following the treatment period. Body weight, peak respiratory exchange ratio and peak minute ventilation remained the same in the aerobics, walk-jog and control groups throughout the treatment period. It is concluded that aerobic dance programs can result in similar improvements in aerobic power as a walk-jog program. Thus, an aerobic dance program is an effective alternative to a traditional walk-jog training regime.

Adult↗
PubMed1991

A successful physician training program in cholesterol screening and management.

METHOD: Thirty-six resident physicians received a blood cholesterol training program which included training in blood cholesterol screening using a fingerstick method and a desktop analyzer, diet assessment and counseling, and a management protocol for follow-up diet and drug treatment. The program also included feedback to residents about their blood cholesterol screening activity, incentives, and biweekly articles in the department newsletter. RESULTS: Between 1986-1987 (baseline) and 1987-1988 (intervention), the percentage of the target patient population (ages 20-65 years, nonpregnant, not screened in the previous year) that was screened for hypercholesterolemia in this primary care practice increased from 16.2 to 23.2% [rate difference (RD) = 7.0; 95% confidence interval (CI) = 4.75-9.25]. The mean value of the screening tests decreased from 5.36 mmol/liter (207.2 mg/dl) to 5.08 mmol/liter (196.6 mg/dl; t = 2.98, P = 0.003) and the percentage of the population screened needing further evaluation decreased from 36.8 to 27.6% (RD 9.2; CI = 2.00-14.00). In the intervention year, compared with the baseline year, patients with a borderline blood cholesterol and cardiovascular risk factors were more likely to have a follow-up test (28.8% vs 11.9%, RD = 16.9; 95% CI = 0.80-33.00) and the low-density lipoprotein cholesterol test was used less for screening (8.2% vs 19.4%, P less than 0.0001). Conclusion. We conclude that this program was effectively integrated into a busy primary care practice, leading to improvement in blood cholesterol screening and management practices.

Adult↗