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Biomedical subjects

R Garrison

Publications and source records attributed to R Garrison.

17 recordsLinked to original sources
PubMed2000

Body mass index and the prevalence of hypertension and dyslipidemia.

OBJECTIVE: To describe and evaluate relationships between body mass index (BMI) and blood pressure, cholesterol, high-density lipoprotein-cholesterol (HDL-C), and hypertension and dyslipidemia. RESEARCH METHODS AND PROCEDURES: A national survey of adults in the United States that included measurement of height, weight, blood pressure, and lipids (National Health and Nutrition Examination Survey III 1988-1994). Crude age-adjusted, age-specific means and proportions, and multivariate odds ratios that quantify the association between hypertension or dyslipidemia and BMI, controlling for race/ethnicity, education, and smoking habits are presented. RESULTS: More than one-half of the adult population is overweight (BMI of 25 to 29.9) or obese (BMI of > or =30). The prevalence of high blood pressure and mean levels of systolic and diastolic blood pressure increased as BMI increased at ages younger than 60 years. The prevalence of high blood cholesterol and mean levels of cholesterol were higher at BMI levels over 25 rather than below 25 but did not increase consistently with increasing BMI above 25. Rates of low HDL-C increased and mean levels of HDL-C decreased as levels of BMI increased. The associations of BMI with high blood pressure and abnormal lipids were statistically significant after controlling for age, race or ethnicity, education, and smoking; odds ratios were highest at ages 20 to 39 but most trends were apparent at older ages. Within BMI categories, hypertension was more prevalent and HDL-C levels were higher in black than white or Mexican American men and women. DISCUSSION: These data quantify the strong associations of BMI with hypertension and abnormal lipids. They are consistent with the national emphasis on prevention and control of overweight and obesity and indicate that blood pressure and cholesterol measurement and control are especially important for overweight and obese people.

Adult↗
PubMed1994

Risk factors for the incidence of social phobia as determined by the Diagnostic Interview Schedule in a population-based study.

The Diagnostic Interview Schedule was used to identify 89 incident social phobia cases in wave 2 household subjects from 9437 at risk persons age 18 or older as part of the Epidemiologic Catchment Area study. Crude annual incidence of Diagnostic Interview Schedule/DSM-III social phobia was estimated at 9 per 1000 population per year. Onset of social phobia was associated with low education, never having been married and female gender. First onsets occurred throughout the life course of this adult sample. Nervousness, headache, panic spells, palpitations, other phobias, binge pattern of alcohol consumption, dysthymia and schizophrenic symptoms were also predictive of social phobia onset. There was no difference in predictive factors when "primary" social phobia (without premorbid panic) was analyzed separately.

Adolescent↗
PubMed1993

A proposed model for a residency experience in mass gathering medicine: the United States Air Show.

STUDY OBJECTIVE: Mass gathering medicine is an increasingly important responsibility for emergency physicians. A formal experience in mass gathering medicine can introduce emergency medicine residents to this aspect of community medicine. DESIGN: Educational model based on field experience and retrospective chart review from 1981 through 1991. SETTING: The US Air Show is a summer event that attracts an average of 223,000 spectators annually. Medical care is provided by physicians, nurses, and technicians operating within an organized system of care. Emergency medicine resident physicians (first-, second-, and third-year) evaluate and treat patients appropriate for the resident's level of responsibility. Residents provide immediate medical control and are integrated into the event disaster plan. On-site attending physician supervision is available at all times. Didactic instruction and event orientation are integrated into the residency curriculum. Residents participate in the planning stages of the event. RESULTS: During the study period, 2,091 patients were seen. The most common presenting problems were heat illness (28%), blisters and scrapes (25%), headaches (23%), fractures and lacerations (9%), and eye injuries (5%). One hundred forty-eight patients (7%) required transportation to the hospital. Approximately 16 residents participate each year and treat an average of 13.7 patients during their four-hour shift. A resident training model for a mass gathering experience is proposed to include adequate crowd size to generate useful patient volumes; a regularly scheduled event; organized medical and disaster preparations meeting local or published standards; didactic instruction on history, principles, and current issues; on-site attending supervision; degree of responsibility appropriate for training level; participation in planning and organizing the event; and postevent debriefing. CONCLUSION: A residency experience and training program in mass gathering medicine can introduce the principles of planning and providing care for crowds attending large public events.

Curriculum↗
PubMed1992

Alcoholism and occupations: a review and analysis of 104 occupations.

A review of the many attempts to establish an association between occupations and alcoholism reveals that most do not deal with data about clinically defined alcoholism but instead use data about cirrhosis mortality, self-reported alcohol problems, and frequent and heavy drinking. The present study establishes an association between occupations and diagnoses of Alcohol Dependence Disorder and Alcohol Abuse Disorder, using data from a large population-based household interview study. Statistical adjustment using logistic methods reveals that apparent associations between occupations and alcohol-related disorders previously reported in the literature are due to characteristics of those employed in various occupations. The prevalence of alcohol dependence and abuse in two high risk industries, construction and transportation, is confirmed. More than one in four construction laborers and one in five skilled construction trades workers received a DIS/DSM-III diagnosis related to alcohol abuse. In the transportation industry one in six heavy truck drivers and material movers received an alcohol diagnosis. Analyses of the data from individuals currently employed and not employed in their occupation reveals reduction in risk for those who leave some occupations and increased risk for those who leave other occupations. Evidence is presented that employment in some occupations may be protective for Alcohol Dependence. The findings support the view that occupation may be associated with Alcohol Dependence and Alcohol Abuse independent of demographic variations. Previously proposed explanatory models for associations between occupations and alcohol problems are called into question because they do not take into account the demographic characteristics and employment status of workers.

Adult↗
PubMed1992

Secretaries, depression and absenteeism.

This study examines the prevalence of Major Depressive Disorder; missed work; and mental health services use among secretaries and other women employed full-time. In a random sample of 3,484 women employed full-time, women employed as secretaries were significantly more likely to be depressed than other women even after controlling for socio-demographic characteristics (odds ratio = 1.69, 95% confidence interval = 1.05, 2.73). Secretaries were significantly more likely to report missing work in the last three months (odds ratio = 1.77, confidence interval = 1.01, 3.11); a finding not attributable to depression. Secretaries were also more likely to seek mental health services, but this finding was not significant (odds ratio = 1.78, confidence interval = 0.55, 5.78). It is possible that these findings are attributable to a selection effect whereby depressed women, and women who are likely to miss work, become secretaries. A second possibility is that women employed as secretaries have more "nonwork role stress" than other employed women. Alternatively, job conditions which result in dissatisfaction and stress may lead to depression and absenteeism. We believe our findings warrant further investigation into the work environment of secretaries.

Absenteeism↗
PubMed1991

Occupational characteristics and the occurrence of psychotic disorders.

This study was undertaken to investigate whether individuals working under various occupational stressors are at increased risk of three forms of psychotic conditions. This paper presents prospective analyses of antecedent occupational stressors in psychotic conditions with interview data from a community sample in five US metropolitan areas--the NIMH Epidemiologic Catchment Area Program. Three non-overlapping conditions were defined using DSM-III definitions as assessed by the Diagnostic Interview Schedule (DIS): (1) DSM-III schizophrenia criterion A; (2) full schizophrenia; and (3) criterion A and affective episode. Artistic (RR = 3.32, 95% CI 1.08-10.14) and construction trades occupations (RR = 2.58, 95% CI 1.15-5.77), "noisome working conditions" occupations (RR = 1.20, 95% CI 0.99-1.47) and physically demanding occupations (RR = 1.39, 95% CI 1.05-1.72) were associated with increased risk of developing DIS/DSM-III schizophrenia criterion A, even after adjustment for sociodemographic and psychopathology factors including alcohol and marijuana use. Psychologically demanding occupations (RR = 0.85, 95% CI 0.75-0.95) were associated with decreased risk of developing DIS/DSM-III schizophrenia. This finding is supported by results from experimental studies on the arousability of pre-schizophrenics. Finally, teachers (RR = 11.35, 95% CI 2.56-50.38), sales occupations (RR = 4.16, 95% CI 1.00-21.30) and occupations characterized by low control over work were associated with increased risk of developing DIS criterion A and affective episode, resembling previous findings on occupational stressors and depression. Overall, our results replicate and extend previous work on occupational stressors and psychotic conditions through use of prospective data, several psychotic conditions, multiple assessment of occupational stressors and adjustment for potential confounders.

Adolescent↗
PubMed1990

Occupations and the prevalence of major depressive disorder.

The prevalence of depression has rarely been studied in a manner permitting comparisons across a range of occupations. This analysis reveals considerable range in prevalence in 104 occupations of major depressive disorder as defined by the Diagnostic and Statistical Manual (ed 3), and measured by the National Institute of Mental Health's Diagnostic Interview Schedule. Five occupations had prevalence rates above 10%. When adjusted for sociodemographic factors, three occupations yield prevalences with statistically significant elevations in the rate, compared with employed persons generally. The three are lawyers, with an odds ratio of 3.6; other teachers and counselors, with an odds ratio of 2.8; and secretaries, with an odds ratio of 1.9. Exploration of possible sources of these differences concludes the paper.

Computers↗
PubMed1988

Body mass index and mortality among nonsmoking older persons. The Framingham Heart Study.

The relationship of weight at age 65 years and subsequent mortality was examined in a population of 1723 nonsmokers who were followed up from one to 23 years (mean, 9.5 years) during the Framingham Heart Study. In sex-specific proportional hazards analyses, risks of mortality were increased for men and women at the high and low extremes of body mass index, even when accounting for potential effects of excess weight on serum cholesterol level, blood glucose level, and systolic blood pressure. For those at the lower extreme of body mass index, the relative risk of death was almost twice as high in the years immediately after age 65 years as in later follow-up, suggesting that the increased early death rate was due to disease that was already present. At the upper extreme, risk of death was twofold over the entire follow-up period for persons with body mass indexes at or above the 70th percentile at both 55 and 65 years of age. We conclude that, even when accounting for cardiovascular risk factors, being overweight is a serious health problem for older people, especially for those with long-standing weight problems.

Aged↗
PubMed1988

Hazards of obesity--the Framingham experience.

Measurements of height, weight, skinfolds and waist girth were used as indicators of general and regional obesity in the Framingham study population of 5,209 men and women. Mean values of cholesterol, blood pressure, blood glucose and uric acid increased with increasing body mass index (BMI). Weight gain was associated with increases and weight loss with decreases in these risk factors. Cigarette smoking was more prevalent in men and women with low quintile BMI. Upper quintile values of BMI, subscapular skinfolds, and waist girth were associated with increased relative risks of death from all causes, coronary heart disease (CHD) and cerebrovascular disease but relative risks for intermittent claudication were not increased. General and central obesity each made independent contributions to risk of CHD but central obesity was a better predictor in males. BMI, cholesterol, systolic blood pressure and blood glucose were significantly independent predictors of CHD. These data show that increased relative weight and central obesity are associated with elevated levels of risk factors, with increased incidence of cardiovascular disease and with increased death rates for all causes combined. Mortality rates are also increased among the leanest members of the population, especially among older men.

Adipose Tissue↗
PubMed1986

Amylase.

The laboratory determination of serum and urine amylase activity is commonly requested by the Emergency physician. While depressed levels are occasionally seen, they are almost always secondary to chronic pancreatitis and pancreatic destruction. The typical abnormality is an elevation that may represent a normal physiologic process, a benign inflammation, the concomitance of ongoing disease, or an emergent problem. The differential diagnosis of hyperamylasemia is difficult, but most high levels are caused by pancreatitis and biliary tract disease. Serial determinations of amylase levels, as well as simultaneous assessments of urine and serum amylase, may be useful in determining the source of the problem. The laboratory methods for measurement are many and varied, reflecting the lack of a perfect test. Because of the different procedures, confusion has ensued over the units of description and the normal or reference ranges. Any standard equipped medical laboratory should be able to determine amylase activity in both serum and urine in a timely fashion. The average cost per amylase determination is $17.75. The actual time to perform the test in the laboratory is approximately 7.5 minutes, though turnaround times usually exceed 1 hour. The fractionation of amylase into isoenzymes is a sophisticated procedure requiring equipment not routinely found in a typical hospital laboratory.

Amylases↗
PubMed1978

An evaluation of the intrapair relationship for personal attributes in the NHLBI twin study.

We have considered a group of questions which attempt to define the environments of twins in our study both within and between twin pairs. Only 8 of 31 questions on which twins compared themselves to their co-twins were reliable and showed discordance for twin pairs. Comparing discordant twins for cardiovascular risk factors, few significant results were obtained. Cigarette smoking seemed to be most closely related to the environmental differences; but negatively related to achievement in grade school and high school and to which twin was stronger in childhood. Weight at examination appeared to be related to strength in childhood. In addition, there may be a negative relationship between income and blood pressure. One additional question showed MZ twins get together significantly more often than DZ twins. In terms of differnces in environmental covariance, the question "how frequently do you and your twin get together now?" may be a simple but valuable measure of similarity of twins and should be considered for inclusion in twin studies.

Body Constitution↗
PubMed1977

Genetic variability of clinical chemical values.

A study of cardiovascular risk factors in middle-aged twin men provided an opportunity to test for genetic variability in the SMA 12/60 (Technicon) battery of clinical chemistry tests. Classical twin methodology was used to analyze the variation of monozygotic and dizygotic twins. In addition, frequency of co-twin contact was used to control for effects of differences in shared environment. Genetic variability played a definite role in controlling four of the 11 reported tests: one-hour serum glucose, serum urea nitrogen, uric acid, and bilirubin. No genetic variation was found for lactate dehydrogenase, phosphorus, and alkaline phosphatase. Significantly higher means for calcium, total protein, albumin, and aspartate aminotransferase in monozygotic twins precluded any statement about heredity and environment for these tests.

Adult↗
PubMed1976

Anti-B lymphocytotoxins in renal-allograft rejection.

To determine the possible role of the B lymphocyte alloantigen system in renal-transplant rejection, we examined serum specimens from 81 allograft recipients for cytotoxic activity against a panel of normal B lymphocytes. Specimens from 22 of 25 recipients undergoing allograft rejection demonstrated strong B-lymphocyte cytotoxicity whereas only 13 of 56 recipients with normal allograft function showed similar B lymphocyte cytotoxocitiy (P less than 0.0001). In the serum samples of recipients with graft rejection who were followed sequentially, B-lymphocyte cytotoxicity preceded or was concurrent with the onset of functional impairment. The results show that anti-B-lymphocyte antibodies are associated with rejection, but it is quite possible that they are the products of rejection rather than the cause.

Antibodies↗
PubMedDate not supplied

Assessment of DSM-III personality structure in a general-population survey.

The object of this study is to assess the internal validity of DSM-III personality constructs and to explore whether the constituent elements are better explained by an alternate internally coherent classification. A two-stage stratified random sample of subjects identified at the Baltimore site of the Epidemiologic Catchment Area (ECA) program were examined by psychiatrists for DSM-III personality attributes using a semistructured instrument. Dichotomous factor analysis was used in the confirmatory mode to test whether a single factor explained each of the 11 DSM-III personality disorders. This approach rejected a single explanatory factor for all but compulsive personality disorder. Exploratory factor analysis showed that these DSM-III personality features are parsimoniously described by a five-factor model. These factors are warmth, animation, timidity, trust, and scrupulousness.

Adolescent↗
PubMedDate not supplied

Physician integration into mass gathering medical care. The United States Air Show.

INTRODUCTION: Limited information exists concerning physician staffing at mass gathering events. METHODS: A retrospective review of the preparation, planning, and provision of medical care for the United States Air Show was performed. Patient encounters from the air show for the years 1981-1991 also were evaluated. RESULTS: The frequency rate of overall encounters was 8.45 patients/10,000 spectators and hospital transport rate was 0.6/10,000 spectators. The majority of complaints were related to heat or minor injuries. During this period, emergency physicians played a vital role in both medical planning and on-site staffing. Emergency medicine residents also participated. A small patient population received direct benefit from on-site physician intervention. CONCLUSION: The on-site emergency physician is of benefit in event preplanning and reducing the burden on the EMS system during mass gathering events.

Aviation↗
PubMedDate not supplied

A suggested curriculum for teaching conscious sedation in advanced general practice programs: GPR and AEGD. American Association of Hospital Dentists.

Previously published national guidelines related to the teaching and performance of conscious sedation in dentistry have not included guidance in this area for program directors of General Practice Residency and Advanced Education in General Dentistry Programs. A suggested curriculum is presented here for use by program directors of such programs who wish to design training experiences in their own programs or as a reference for program directors who wish to compare their programs with experiences provided in other locations. Guidelines are provided for facilities, equipment, personnel, records and preparation necessary to perform conscious sedation procedures, as well as goals, objectives, and evaluation methodology for training residents in conscious sedation.

Anesthesiology↗