Search PubMed⌕ Search

Biomedical subjects

R Guthrie

Publications and source records attributed to R Guthrie.

100 records · Page 6Linked to original sources
PubMedDate not supplied

Multivariate profile of smoking in Southeast Asian men: a biochemically verified analysis.

BACKGROUND: Cigarette smoking prevalence rates among Southeast Asian males are among the highest reported in comparison with other ethnic male groups in the United States. The objective of this study is to profile current smokers, former smokers, and never smokers among Southeast Asian males, based on subject characteristics. METHODS: Southeast Asian (Cambodian, Laotian, and Vietnamese) males residing in the Greater Columbus, Ohio, area were surveyed, utilizing culturally sensitive instruments and interviewers, with respect to demographic and acculturation variables. All subjects were biochemically verified by collecting a saliva sample at the time of the interviews. RESULTS: Those Southeast Asian males who quit smoking tended to be older, employed, more assimilated into the U.S. culture, and of Cambodian ethnicity. The current smokers, relative to never smokers, tended to be older, not in the labor force, traditionally oriented to their native culture, less educated, and of Laotian or Vietnamese ethnicity. CONCLUSIONS: Specific strategies for smoking cessation programs would indicate more intense, and possibly different, efforts be directed at Southeast Asian males of Laotian and Vietnamese ethnicity who are younger, unemployed and less assimilated into the U.S. culture. On the other hand, smoking prevention programs would target those individuals who are at highest risk of smoking.

Acculturation↗
PubMedDate not supplied

Doxazosin for benign prostatic hyperplasia in primary care.

The incidence of benign prostatic hyperplasia (BPH) is increasing, and an estimated one quarter of men older than 60 years have both BPH and hypertension. Medical management of BPH is now an effective alternative to surgery, and primary care physicians are treating more patients for this condition. Alpha-adrenergic blockers reduce the tone of prostatic smooth muscle, and doxazosin, a selective alpha-1 adrenergic blocker, is effective and well tolerated in the treatment of BPH. Doxazosin can be given in a convenient once-daily dose, and its efficacy is maintained in the long term. Patients with BPH who are already being treated for hypertension with doxazosin need no alteration in their dosage regimen, and doxazosin can be used as a single agent to treat both conditions. Selective alpha-adrenergic blockers are likely to be used increasingly by primary care physicians in the treatment of BPH.

Adrenergic alpha-Antagonists↗
PubMedDate not supplied

An elective-titration study of the comparative effectiveness of two angiotensin II-receptor blockers, irbesartan and losartan. Irbesartan/Losartan Study Investigators.

This multicenter, randomized, double-masked, elective-titration study was designed to compare the effectiveness, safety, and tolerability of irbesartan and losartan, two angiotensin II subtype AT1-receptor blockers, in the treatment of patients with mild-to-moderate hypertension. After a 3-week, single-masked, placebo lead-in period, 432 patients with a mean seated diastolic blood pressure (SeDBP) of 95 to 115 mm Hg were randomly allocated to receive either irbesartan 150 mg once daily (n = 213) or losartan 50 mg once daily (n = 219). At week 4, if SeDBP at trough (i.e., 24 +/- 3 hours after the previous dose) was > or = 90 mm Hg, the daily dose was doubled (to irbesartan 300 mg or losartan 100 mg). At week 8, if trough SeDBP was > or = 90 mm Hg, hydrochlorothiazide 12.5 mg once daily was added to the regimen; consistent with the prescribing information for losartan, the dose of losartan was reduced to 50 mg once daily on the addition of hydrochlorothiazide. A total of 370 patients (178 irbesartan and 192 losartan) were evaluable for efficacy. The mean change in trough SeDBP at week 8, the primary efficacy end point, was significantly greater in patients receiving irbesartan monotherapy than in those receiving losartan monotherapy (-10.2 mm Hg vs -7.9 mm Hg, respectively). At week 12, reductions in trough SeDBP and seated systolic blood pressure were greater with irbesartan treatment than with losartan treatment (-13.8 mm Hg vs -10.8 mm Hg and -18.0 mm Hg vs -13.9 mm Hg, respectively), and a greater proportion of irbesartan patients responded to therapy (i.e., trough SeDBP < 90 mm Hg or reduction in trough SeDBP > or = 10 mm Hg) compared with losartan patients (78% vs 64%, respectively). Both regimens were well tolerated.

Adult↗
PubMedDate not supplied

Prevalence of hypertension in patients with type II diabetes in referral versus primary care clinics.

We compared the prevalence of hypertension in patients with non-insulin-dependent diabetes mellitus (NIDDM) in referral and primary care practices using definitions of The Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC-V), while controlling for other risk factors such as hypertension, obesity, smoking, and age. Patients (n = 1443) were enrolled consecutively from a large referral practice at the Jackson Diabetes Center and four primary care clinics in the vicinity. Blood pressures were measured at three clinic visits after a 5-min rest in a sitting position using a standard clinical sphygmomanometer. Charts were reviewed to determine diabetes duration, insulin usage, height, weight, smoking history, use of antihypertensive and oral hypoglycemic medications, socioeconomic status, and race. Patients were classified as hypertensive based on JNC-V definitions or if they were on antihypertensive medication. Hypertension was termed uncontrolled if blood pressure was JNC-V Stage 2 or higher while on antihypertensive medication. Seventy-eight percent of referral clinic and 55% of primary care clinic patients had either JNC-V State 1 or higher hypertension or were on antihypertensive medication. Actual blood pressures indicated that more patients had JNC-V Stage 1 (mild) or higher hypertension in referral compared to primary care clinics (62% versus 48% p = 0.01) but fewer had JNC-V Stage 2 or higher (moderate-severe) hypertension (12% versus 19% p = 0.002). Patients seen in the referral clinic were significantly more likely to have greater age, greater duration of diabetes, higher insulin dosage, longer smoking history, antihypertensive medication, and live outside the metropolitan area. By logistic regression, the odds of hypertension were significantly increased with age (OR 1.51/decade), BMI greater than 27 (OR 2.17), diabetes duration (OR 1.04/year), and insulin dosage (OR 1.74/U/kg). Current smoking and attending a referral clinic were not significantly related. The odds of moderate-severe hypertension were significantly increased with age (OR 1.23/ decade), decreased by attending a referral clinic (OR 0.45), and not significantly related to other confounders in the model. The prevalence of hypertension among patients with NIDDM was higher in referral than primary care clinics. The higher prevalence in the referral practice can be accounted for by the greater severity of associated risk factors in the referral practice patients; however, most patients will be diagnosed and treated for hypertension prior to referral. More patients in the referral practice were on hypertensive medication, which lowered the stage or severity of hypertension but still not to the normal range. The results suggest that the primary detection of hypertension in patients with type II diabetes resides with the primary care physician. Management of hypertension will require both a delineation and acceptance of responsibilities between the primary care physician and diabetes specialists.

Blood Pressure↗
PubMedDate not supplied

Omapatrilat provides long-term control of hypertension: a randomized trial of treatment withdrawal.

Omapatrilat simultaneously inhibits neutral endopeptidase and angiotensin-converting enzyme, increasing levels of vasodilatory peptides while decreasing production of angiotensin II. This study evaluated the clinical effects of withdrawal of omapatrilat after a patient's hypertension had been controlled (seated diastolic blood pressure <90 mm Hg) on omapatrilat for at least 6 months, with or without adjunctive antihypertensive medications. This double-blind study randomized 83 patients to receive either their established omapatrilat dose or placebo for 8 weeks; any concomitant antihypertensive medications were kept constant. Patients continuing on omapatrilat had no change in blood pressure. Patients whose chronic omapatrilat treatment was replaced by placebo had clinically important increases in both systolic (+16.5 mm Hg) and diastolic ((+9.6 mm Hg) blood pressures (both p<0.001). An increase in blood pressure was also seen in patients who were taking adjunctive antihypertensive medications prior to withdrawal of omapatrilat. This study demonstrates that when compared to withdrawal placebo, omapatrilat maintains clinically and statistically significant blood pressure reductions.

Adult↗
PubMedDate not supplied

Randomized prospective trial of pure porcine and conventional bovine/porcine insulin.

Use of pure porcine insulin versus partially purified insulin of bovine/porcine origin might be expected to have certain clinical benefits, e.g., a lower incidence of skin reactions, a lower insulin dosage, better diabetes regulation, and greater preservation of endogenous insulin secretion. To test this hypothesis, we randomly assigned 112 newly diagnosed, untreated, insulin-dependent diabetic children to therapy with either pure porcine or partially purified bovine/porcine insulin. They were followed for 1 yr, data being available on at least 90 subjects at each visit. More skin reactions were found in the group treated with the bovine/porcine insulin. This insulin was of higher antigenicity, and binding of radiolabeled insulin (mean +/- SE) by serum from bovine/porcine insulin treatment was 35.5 +/- 2.6 versus 16.8 +/- 1.4% (P less than .001) for pure porcine insulin treatment 12 mo after initiation of insulin therapy. However, throughout the 12 mo of observation the levels of glycosylated hemoglobin, insulin dosage, fasting plasma glucose, and C-peptide concentration were similar for the groups. Reported incidences of hypoglycemia and nocturia were also similar. Thus, insulin-antibody formation and skin reactions were minimized by the use of pure porcine versus partially purified bovine/porcine insulin, but no other clinical advantages were apparent.

Animals↗
PubMedDate not supplied

Promoting heart health for Southeast Asians: a database for planning interventions.

This paper is a report of baseline data that the authors collected on the prevalence of hypertension in a sample of 397 Southeast Asian immigrants residing in central Ohio and the implications of those data for the design of ethnically approved and scientifically valid interventions. The context for collection of these data over a 9-month period in 1989 is described. Baseline demographic characteristics including distributions by ethnicity, sex, age, and length of stay in the United States, as well as family heart health history, hypertension level, and heart health awareness of these subjects are presented. For example, 85 percent of the immigrants did not know what could be done to prevent heart disease. Implications for the design of ethnically approved and scientifically valid prevention strategies are discussed. Based on these data, the authors realized that multiple health education strategies tailored to what they were learning about Southeast Asians would be needed. Through Southeast Asian leaders, they were led to using wall calendars, with words specific to each Southeast Asian language, that had a monthly heart health slogan as one avenue to reach Southeast Asians. Another strategy was to develop videotapes featuring cultural content but including heart health "commercials." The authors concluded that, although scientific validity of risk reduction interventions are important, customizing these strategies to ethnically specific modes of interaction are equally important.

Adolescent↗
PubMedDate not supplied

An evaluation of heart health education for Southeast Asians.

We present data on the effects of a heart health education intervention targeted at adult Southeast Asians. Within each of the Cambodian, Laotian, and Vietnamese groups who received the intervention, we obtained random samples approximately three to 18 months postintervention. Comparisons were made between preintervention and postintervention knowledge of blood pressure and awareness of behaviors to prevent heart disease. Within all three ethnic samples, we found significant increases in the pre-to-post percentages of individuals who could define blood pressure and identify ways to prevent heart diseases.

Adult↗
PubMedDate not supplied

Treatment of non-insulin-dependent diabetes mellitus with metformin.

BACKGROUND: Metformin alleviates hyperglycemia of non-insulin-dependent diabetes mellitus (NIDDM) by inhibiting hepatic glucose production and improving peripheral insulin sensitivity. In contrast to sulfonylureas, metformin does not stimulate insulin-secretion, promote weight gain, exacerbate hyperinsulinemia, or cause hypoglycemia. It also favorably affects serum lipids. METHODS: A comprehensive review of the medical literature from 1968 to the present was conducted using the key words "metformin" and "non-insulin-dependent diabetes mellitus." RESULTS: Metformin monotherapy was superior to placebo and comparable to sulfonylureas in reducing fasting plasma glucose and glycosylated hemoglobin levels in patients with NIDDM uncontrolled by diet. Metformin and sulfonylureas, however, had diverse effects on body weight and fasting plasma insulin levels; both weight and insulin levels remained unchanged or decreased with metformin and increased with sulfonylureas. In patients with secondary sulfonylurea failure, the combination of metformin and a sulfonylurea synergistically improved glycemic control better than either drug alone and was comparable to insulin plus sulfonylurea. When hyperglycemia is uncontrolled by insulin after secondary sulfonylurea failure, limited data suggest the efficacy of metformin plus insulin. The mild, transient, self-limited gastrointestinal side effects that sometimes occur can be minimized by gradually increasing the doses and by taking metformin with food. Risk of metformin-associated lactic acidosis is low if prescribing guidelines are adhered to. Potential adverse drug interactions include hypoglycemia during concurrent sulfonylurea therapy and elevated metformin plasma concentrations when metformin is taken concomitantly with cimetidine. CONCLUSIONS: Metformin can be used safely and effectively as first-line monotherapy in NIDDM or in combination with a sulfonylurea when monotherapy with either agent fails. It can be particularly suitable when weight gain, hyperlipidemia, and hypoglycemia are clinically important issues.

Acidosis, Lactic↗