Biomedical subjects

Richard F Hamman

Publications and source records attributed to Richard F Hamman.

At least 37 records · Page 2Linked to original sources

PubMed2004

Achieving weight and activity goals among diabetes prevention program lifestyle participants.

OBJECTIVE: The Diabetes Prevention Program (DPP) showed that intensive lifestyle intervention reduced the risk of diabetes by 58%. This paper examines demographic, psychosocial, and behavioral factors related to achieving weight loss and physical activity goals in the DPP lifestyle participants. RESEARCH METHODS AND PROCEDURES: Lifestyle participants (n = 1079; mean age = 50.6, BMI = 33.9, 68% female, and 46% from minority groups) had goals of 7% weight loss and 150 min/wk of physical activity. Goal achievement was assessed at the end of the 16-session core curriculum (approximately week 24) and the final intervention visit (mean = 3.2 years) as a function of demographic, psychosocial, and behavioral variables. RESULTS: Forty-nine percent met the weight loss goal and 74% met the activity goal initially, while 37% and 67%, respectively, met these goals long-term. Men and those with lower initial BMI were more likely to meet activity but not weight loss goals. Hispanic, Asian, and Native Americans were more likely to meet the long-term activity goals, and whites were more likely to meet the initial weight loss goal. In multivariate analyses, meeting the long-term weight loss goal and both activity goals increased with age, while psychosocial and depression measures were unrelated to goal achievement. Dietary self-monitoring was positively related to meeting both weight loss and activity goals, and meeting the activity goal was positively related to meeting the weight loss goal. Participants who met initial goals were 1.5 to 3.0 times more likely to meet these goals long-term. DISCUSSION: Success at meeting the weight loss and activity goals increased with age. Initial success predicted long-term success. Self-monitoring and meeting activity goals were related to achieving and sustaining weight loss.

Adult↗

PubMed2004

Are low-income elderly patients at risk for poor diabetes care?

OBJECTIVE: Diabetes is common among low-income elderly, dual-eligible (DE) Medicare/Medicaid patients resulting in significant morbidity, mortality, and cost. However, the quality of diabetes care delivered to these patients has not been evaluated. The aims of this study were to describe the quality of diabetes care provided to DE patients and compare it with non-DE patients. RESEARCH DESIGN AND METHODS: This was a cross-sectional analysis of administrative claims from 1 January 1997 through 31 December 1998. A total of 9,453 patients aged 65-75 years with diabetes participated in the study. These were Colorado Medicare fee-for-service (FFS) outpatients. The main outcome measures consisted of a proportion of patients receiving an annual hemoglobin A1c test, biennial eye examination, biennial lipid test, and all three of these care processes. RESULTS: The mean patient age was 71 +/- 2.8 years. Over 22% of patients were identified as dual eligible, and they were significantly more likely to be younger, female, and of minority race/ethnicity; reside in a rural location; and have comorbid conditions compared with the non-DE population. DE patients had more visits to primary care physicians, emergency departments, and hospitalizations but were less likely to visit endocrinologists. DE patients were significantly less likely to receive an annual A1c test (73 vs. 81%; P < 0.0001), biennial ophthalmologic examination (63 vs. 75%; P < 0.0001), and biennial lipid testing (43 vs. 57%; P < 0.0001). The adjusted odds ratio of urban DE patients receiving all three care measures was 0.60 (95% CI 0.52-0.69) compared with urban non-DE patients. Minority race/ethnicity and emergency department use were significantly associated with not receiving diabetes care, whereas endocrinology visits were associated with an increased odds of receiving diabetes care. CONCLUSIONS: DE Medicare/Medicaid status was independently associated with not receiving diabetes care, especially among those in urban areas.

Aged↗

PubMed2004

Cardiovascular disease risk factors predict the development of type 2 diabetes: the insulin resistance atherosclerosis study.

OBJECTIVE: In a few previous studies, cardiovascular disease (CVD) risk factors (RFs) have been shown to predict diabetes. Our objective was to determine whether the presence of CVD RFs predict the eventual development of diabetes after controlling for known RFs, such as directly measured insulin resistance and obesity. RESEARCH DESIGN AND METHODS: We studied 872 participants with normal or impaired glucose tolerance (IGT) who were enrolled at baseline in the Insulin Resistance Atherosclerosis Study (IRAS). Of these, 143 (16%) developed type 2 diabetes in 5 years. Using these participants, a series of logistic regression models were fit to address the question. RESULTS: Significant RFs for developing type 2 diabetes included high plasminogen activator inhibitor-1, hypertension, high triglycerides, low levels of HDL cholesterol, and IGT. The 5-year cumulative incidence of type 2 diabetes by the number of RFs (0-5) was as follows: no RFs, 11 of 230 = 5%; one RF, 31 of 278 = 11%; two RFs, 36 of 202 = 18%; three RFs, 41 of 110 = 37%; four RFs, 19 of 42 = 45%; and five RFs, 5 of 10 = 50% (P < 0.001). The odds ratio (OR) for conversion to type 2 diabetes for each additional RF was 2.1 (95% CI 1.78-2.46) after adjusting for age, sex, ethnicity, and center. After further adjustment for insulin resistance, determined by the frequently sampled intravenous glucose tolerance test and waist circumference, each additional CVD RF increased the risk of type 2 diabetes significantly (OR 1.81, 95% CI 1.49-2.20). CONCLUSIONS: Individuals with multiple CVD RFs are at increased risk of type 2 diabetes, which is only partially mediated by insulin resistance or central adiposity. This information should be useful for identifying high-risk patients for developing diabetes through RF assessments.

Cardiovascular Diseases↗

PubMed2003

Association of a woman's own birth weight with her subsequent risk for pregnancy-induced hypertension.

Studies have linked low birth weight to elevated risk for adult hypertension and insulin resistance. However, the relation between birth weight and later risk for pregnancy-induced hypertension (PIH), a disorder associated with insulin resistance and predictive of chronic hypertension, has not been well studied. This case-control study used linked hospital discharge and vital record data from New York State. Subjects were healthy women born in New York State who completed a first pregnancy there between 1994 and 1998. Records from each woman's own birth (1970-1985) were linked to those from her first pregnancy. Cases were 2,180 women diagnosed with PIH. Controls were the 22,955 remaining women with no record of PIH. Birth weight showed a U-shaped relation to risk for PIH, with the highest risks associated with very low and very high birth weights. Relative to women born at 3.5-4.0 kg, odds ratios adjusted for gestational age were 2.1 (95% confidence interval (CI): 1.1, 3.9) and 1.6 (95% CI: 1.1, 2.4), respectively, for women with birth weights less than 1.5 kg and greater than 4.5 kg. Adjustment for other perinatal factors reduced the association with high birth weight to 1.1 (95% CI: 0.7, 1.7) but strengthened that with lower birth weights, leaving a strong, inverse relation between birth weight and PIH risk (p for trend < 0.0001). These findings support a possible role for early life factors, particularly fetal growth, in the etiology of PIH.

Adolescent↗

PubMed2003

Effects of the hepatic lipase gene and physical activity on coronary heart disease risk.

There are environmental determinants and genetic susceptibility to coronary heart disease (CHD); however, identifying factors that modify genetic risk has been difficult. Evidence suggests that a common polymorphism in the hepatic lipase gene (LIPC-480C>T) may be related to susceptibility to CHD and that physical activity is a behavioral factor associated with CHD. This population-based prospective study in the San Luis Valley of Colorado investigated the role of the LIPC-480C>T polymorphism in predicting clinical CHD and the modifying effect of physical activity. Hispanics and non-Hispanic Whites (n = 966) were followed for 14 years (1984-1998); 91 CHD events occurred. The LIPC-480 TT genotype predicted an increase in CHD in both ethnic groups, and physical activity altered this relation. In the full cohort, the rate of CHD was significantly elevated among subjects with the high-risk genotype and normal levels of physical activity (hazard ratio = 2.58, 95% confidence interval: 1.39, 4.77) but was not elevated among those with the high-risk genotype who participated in vigorous physical activity (hazard ratio = 0.52, 95% confidence interval: 0.12, 2.19) (reference group: LIPC-480 CC/CT, normal physical activity). Thus, in this prospective cohort study, the LIPC-480 TT genotype increased susceptibility to CHD only in those subjects with normal levels of physical activity, not in those with the high-risk genotype who were vigorously active.

Adult↗

PubMed2003

Airborne endotoxin predicts symptoms in non-mouse-sensitized technicians and research scientists exposed to laboratory mice.

Research scientists, laboratory technicians, and animal handlers who work with animals frequently report respiratory and skin symptoms from exposure to laboratory animals (LA). However, on the basis of prick skin tests or RASTs, only half are sensitized to LA. We hypothesized that aerosolized endotoxin from mouse work is responsible for symptoms in nonsensitized workers. We performed a cross-sectional study of 269/310 (87%) workers at a research institution. Subjects completed a questionnaire and underwent prick skin tests (n = 254) or RASTs (n = 16) for environmental and LA allergens. We measured airborne mouse allergen and endotoxin in the animal facility and in research laboratories. Of 212 workers not sensitized to mice, 34 (16%) reported symptoms compared with 26 (46%) of mouse-sensitized workers (p < 0.001). Symptomatic workers were more likely to be atopic, regardless of mouse sensitization status. Symptomatic non-mouse-sensitized workers spent more time performing animal experiments in the animal facility (p = 0.0001) and in their own laboratories (p < 0.0001) and had higher daily endotoxin exposure (p = 0.008) compared with asymptomatic coworkers. In a multivariate model, daily endotoxin exposure most strongly predicted symptoms to mice in non-mouse-sensitized workers (odds ratio = 30.8, p = 0.003). We conclude that airborne endotoxin is associated with respiratory symptoms to mice in non-mouse-sensitized scientists and technicians.

Adolescent↗

PubMed2003

Variation in the FABP2 promoter alters transcriptional activity and is associated with body composition and plasma lipid levels.

The fatty acid-binding proteins (FABPs) are cytoplasmic proteins involved in intracellular fatty acid transport and metabolism. FABP2, the intestinal-type FABP, is expressed exclusively in enterocytes in the small intestine. In previous studies of an Ala54Thr substitution in FABP2, the Thr-allele showed association with increased lipid oxidation, elevated plasma lipids, and impaired insulin sensitivity. We screened roughly 1 kb 5' of the FABP2 initiation codon and identified three insertion/deletion polymorphisms and four single nucleotide polymorphisms (SNPs). Three of the SNPs were in complete linkage disequilibrium with the three insertion/deletion polymorphisms, defining exactly two haplotypes (FABP2p-ID). We tested the hypothesis that this variation alters gene expression by transfecting Caco-2 cells with pGL3-Basic constructs containing opposite FABP2p-ID haplotypes. Luciferase assays showed a statistically significant two-fold increase in gene expression of the pGL3-insertion construct over the pGL3-deletion construct (P<0.001; n=5). We also tested for association between three FABP2 variants and measurements of body composition, plasma lipids, and insulin sensitivity in non-diabetic control subjects from the San Luis Valley Diabetes Study (n=714). The only informative variant, FABP2p-ID, was statistically significantly associated with body mass index (P=0.042) and marginally associated with fat mass (P=0.084), cholesterol (P=0.066), and HOMA IR (a derived measure of insulin resistance; P=0.062) in the entire cohort. Similar associations were seen only in non-Hispanics when the analysis was stratified by ethnicity. Within the non-Hispanic subgroup, the effects of FABP2p-ID on plasma lipids were sex-specific. These results suggest that genetic variation in the 5' region of FABP2 affects transcriptional activity, presumably leading to alterations in body composition and lipid processing.

Analysis of Variance↗

PubMed2003

The diabetes prevention program and its global implications.

Type 2 diabetes affects over 150 million adults worldwide and this figure is expected to double over the next 25 yr. This increase will be accompanied by a marked increase in the number of patients with ESRD due to diabetes. We hypothesized that a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes We randomly assigned 3234 nondiabetic persons with elevated fasting and postload plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7% weight loss and at least 150 min of physical activity per week. The mean age of the participants was 51 yr, and the mean body mass index was 34.0 kg/m(2); 68% were women, and 45% were members of non-Caucasian racial/ethnic groups. The average follow-up was 2.8 yr. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence of diabetes by 58% (95% CI: 48 to 66%) and metformin by 31% (95% CI: 17 to 43%), compared with placebo; the lifestyle intervention was significantly more effective than metformin. In conclusion, lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk and the lifestyle intervention was more effective than metformin. Because the lifestyle changes worked equally in all racial/ethnic groups in the Diabetes Prevention Program, they should be applicable to high-risk populations worldwide and may be able to reduce the projected progressive rise in the incidence of diabetes and the expected increase in ESRD.

Adult↗

PubMed2003

Effect of type 1 diabetes on the gender difference in coronary artery calcification: a role for insulin resistance? The Coronary Artery Calcification in Type 1 Diabetes (CACTI) Study.

The objective of this is study was to examine whether estimated insulin resistance and insulin resistance-related factors are associated with coronary artery calcification (CAC) in 1,420 asymptomatic participants in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study. A total of 656 patients with type 1 diabetes and 764 control subjects aged 20-55 years were examined. CAC was assessed by electron-beam computed tomography. Insulin resistance was computed with linear regression based on an equation previously validated in clamp studies on type 1 diabetic adults. Insulin resistance was associated with CAC (OR 1.6 in type 1 diabetes and 1.4 in control subjects, P < 0.001), independent of coronary artery disease risk factors. There was a male excess of CAC in control subjects (OR 2.7, adjusted for age, smoking, and LDL and HDL cholesterol levels) and in type 1 diabetic patients (OR 2.2, adjusted for the same factors and diabetes duration). After adjusting for insulin resistance, the CAC male excess in diabetic patients decreased from OR 2.2 (P < 0.001) to 1.8 (P = 0.04). After adjustment for waist-to-hip ratio, waist circumference, or visceral fat, the gender difference in CAC was not significant in diabetic subjects. In conclusion, gender differences in insulin resistance-associated fat distribution may explain why type 1 diabetes increases coronary calcification in women relatively more than in men.

Adult↗

PubMed2002

Cardiovascular disease mortality in Hispanics and non-Hispanic whites.

Despite a worse cardiovascular disease (CVD) risk profile, Hispanics have lower CVD mortality than non-Hispanic Whites in studies based on death certificates. This study examined 310 deaths that occurred between 1984 and 1998 among 1,862 Hispanic and non-Hispanic White participants in the San Luis Valley Diabetes Study, using medical records to classify cause of death. Among persons without diabetes, the age-adjusted all-cause mortality rate was 6.1/1,000 person-years in non-Hispanic Whites and 7.4/1,000 person-years in Hispanics. Among persons with diabetes, it was 24.3/1,000 person-years in non-Hispanic Whites and 21.9/1,000 person-years in Hispanics. Among nondiabetics, the age-adjusted CVD mortality rate was 2.5/1,000 person-years in non-Hispanic Whites and 1.6/1,000 person-years in Hispanics. Among diabetics, it was 12.9/1,000 person-years in non-Hispanic Whites and 8.8/1,000 person-years in Hispanics. Among nondiabetics, the adjusted hazard ratio for CVD death in Hispanics compared with non-Hispanic Whites was 0.65 (95% confidence interval (CI): 0.34, 1.23). The hazard ratio for coronary heart disease death was 0.95 (95% CI: 0.35, 2.59). Among diabetics, the hazard ratio for CVD death, after adjustment for conventional and diabetes risk factors, was 0.44 (95% CI: 0.26, 0.74), and for coronary heart disease death it was 0.43 (95% CI: 0.21, 0.91). A statistically significant decreased risk of CVD death was observed only in male Hispanics with diabetes. Competing mortality or factors that interact with diabetes may explain these differences.

Age Distribution↗

PubMed2002

Predictors of acute complications in children with type 1 diabetes.

CONTEXT: Diabetic ketoacidosis and severe hypoglycemia are acute complications of type 1 diabetes that are related, respectively, to insufficient or excessive insulin treatment. However, little is known about additional modifiable risk factors. OBJECTIVE: To examine the incidence of ketoacidosis and severe hypoglycemia in children with diabetes and to determine the factors that predict these complications. DESIGN, SETTING, AND PARTICIPANTS: A cohort of 1243 children from infancy to age 19 years with type 1 diabetes who resided in the Denver, Colo, metropolitan area were followed up prospectively for 3994 person-years from January 1, 1996, through December 31, 2000. MAIN OUTCOME MEASURES: Incidence of ketoacidosis leading to hospital admission or emergency department visit and severe hypoglycemia (loss of consciousness, seizure, or hospital admission or emergency department visit). RESULTS: The incidence of ketoacidosis was 8 per 100 person-years and increased with age in girls (4 per 100 person-years in < 7; 8 in 7-12; and 12 in > or =13 years; P<.001 for trend). In multivariate analyses, sex-adjusted and stratified by age (<13 vs > or =13 years), the risk of ketoacidosis in younger children increased with higher hemoglobin A(1c) (HbA(1c)) (relative risk [RR], 1.68 per 1% increase; 95% confidence interval [CI], 1.45-1.94) and higher reported insulin dose (RR, 1.40 per 0.2 U/kg per day; 95% CI, 1.20-1.64). In older children, the risk of ketoacidosis increased with higher HbA(1c) (RR, 1.43; 95% CI, 1.30-1.58), higher reported insulin dose (RR, 1.13; 95% CI, 1.02-1.25), underinsurance (RR, 2.18; 95% CI, 1.65-2.95), and presence of psychiatric disorders (for boys, RR, 1.59; 95% CI, 0.96-2.65; for girls, RR, 3.22; 95% CI, 2.25-4.61). The incidence of severe hypoglycemia was 19 per 100 person-years (P<.001 for trend) and decreased with age in girls (24 per 100 patient-years in < 7, 19 in 7-12, and 14 in > or =13 years). In younger children, the risk of severe hypoglycemia increased with diabetes duration (RR, 1.39 per 5 years; 95% CI, 1.16-1.69) and underinsurance (RR, 1.33; 95% CI, 1.08-1.65). In older children, the risk of severe hypoglycemia increased with duration (RR, 1.34; 95% CI, 1.25-1.51), underinsurance (RR, 1.42; 95% CI, 1.11-1.81), lower HbA(1c) (RR, 1.22; 95% CI, 1.12-1.32), and presence of psychiatric disorders (RR, 1.56; 95% CI, 1.23-1.98). Eighty percent of episodes occurred among the 20% of children who had recurrent events. CONCLUSIONS: Some children with diabetes remain at high risk for ketoacidosis and severe hypoglycemia. Age- and sex-specific incidence patterns suggest that ketoacidosis is a challenge in adolescent girls while severe hypoglycemia continues to affect disproportionally the youngest patients and boys of all ages. The pattern of modifiable risk factors indicates that underinsured children and those with psychiatric disorders or at the extremes of the HbA(1c) distribution should be targeted for specific interventions.

Acute Disease↗

PubMed2002

Association of a woman's own birth weight with subsequent risk for gestational diabetes.

CONTEXT: Several studies have reported links between reduced fetal growth and subsequent risk for type 2 diabetes among older adults, but the association between indices of fetal growth and gestational diabetes mellitus (GDM), a major complication of pregnancy and a strong predictor of type 2 diabetes, remains little explored. OBJECTIVE: To test the hypothesis that a woman's own fetal growth is inversely related to her later risk for GDM. DESIGN AND SETTING: Case-control study of linked hospital discharge and vital record data from the New York State Department of Health. POPULATION: Healthy women who completed their first pregnancies in New York State between 1994 and 1998 and who were also born in New York State. Records from each woman's first pregnancy were linked to those from her own birth (1970-1985). Cases were 440 women with a record of GDM. Controls were 22 955 remaining women with no indication of GDM. MAIN OUTCOME MEASURE: A woman's own birth weight, alone and adjusted for gestational age. RESULTS: Birth weight showed a U-shaped relationship to a woman's risk of GDM in her first pregnancy, with the highest risks associated with low and high birth weights. Odds ratios (ORs) adjusted for gestational age were 2.16 (95% confidence interval [CI], 1.04-4.50) for birth weight of less than 2000 g and 1.53 (95% CI, 1.03-2.27) for a birth weight of 4000 g or more. Adjustment for potential confounding factors, particularly prepregnancy body mass index and maternal diabetes, increased the OR for low birth weight to 4.23 (95% CI, 1.55-11.51), but reduced the OR for high birth weight to 0.92 (95% CI, 0.54-1.57), leaving a strong inverse dose-response relationship between birth weight and risk of GDM (adjusted P for trend <.001). CONCLUSIONS: In this large population-based study, a woman's own birth weight was strongly and inversely related to her risk of GDM, suggesting that early life factors may be important in the etiology of this disorder.

Adolescent↗

PubMed2002

Changing functional status in a biethnic rural population: the San Luis Valley Health and Aging Study.

The San Luis Valley Health and Aging Study, was designed to examine Hispanic versus non-Hispanic White differences in prevalence and incidence of aging-related outcomes in a rural population (1,358 community dwellers and 75 nursing home residents). Data presented here were gathered between 1993 and 1997. Previously reported analyses identified greater prevalence of functional dependence in daily living activities among Hispanic elderly, especially females, than among non-Hispanic White elderly. This analysis explored the degree to which incident changes explain these patterns. Comparisons of incidence, recovery, and mortality rates after 22 months revealed no significant ethnic differences, although trends were as hypothesized: greater Hispanic incidence, lower Hispanic recovery rates, and less Hispanic mortality. Overall age-adjusted incidence (activities of daily living = 9.5; instrumental activities of daily living = 15.1 per 100 person-years) exceeded reports from most other studies, while rates of recovery (activities of daily living = 14.5; instrumental activities of daily living = 9.9) and mortality (4.8 among community dwellers; 6.7 including nursing home residents) were similar to those of other reports. Patterns of new dependence, recovery, and mortality did not increase the previously observed disparity. Greater prevalent disability in the Hispanic cohort, especially in women, may reflect a reservoir accumulated during younger years and related to culture and socioeconomic status as well as to older age.

Activities of Daily Living↗

PubMed2002

Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.

BACKGROUND: Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors--elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle--are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes. METHODS: We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups. RESULTS: The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin. CONCLUSIONS: Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.

Adult↗

PubMed2002

Serum selenium and the risk of cervical cancer among women in the United States.

OBJECTIVE: To explore the relationship between serum selenium and cervical cancer. METHODS: We conducted a case-control study of cervical cancer in five areas around Birmingham, AL; Chicago, IL; Denver, CO; Miami, FL; and Philadelphia, PA. Community controls were selected by random-digit dialing and were matched to invasive cervical cancer cases by age, race/ethnicity, and telephone exchange. Serum selenium was determined by neutron activation analysis. Logistic regression analysis controlling for known risk factors of cervical cancer, including human papillomavirus (HPV) type-16 measured serologically, was performed on 227 invasive cases, 127 in-situ cases, and 526 controls. RESULTS: Values of serum selenium ranged from 67.5 to 185.0 ng/ml. Adjusted odds ratios for invasive cervical cancer by quintile were: 1.0 (highest selenium), 1.1, 1.0, 0.8, and 1.0 (lowest selenium), p for trend = 0.82. Similar patterns were observed for Stage I invasive, and Stages II-IV invasive cases, suggesting severity of disease did not influence the null results. Although no associations were seen among current or never smokers, a protective effect of selenium was suggested among former smokers. Effect modification was not evident for other variables examined. CONCLUSIONS: This study does not support a relationship between serum selenium and invasive cervical cancer at typical serum selenium levels in the US.

Adult↗

PubMed2002

Excess risk of bladder cancer in spinal cord injury: evidence for an association between indwelling catheter use and bladder cancer.

OBJECTIVES: To evaluate whether the risk of bladder cancer is greater in individuals with spinal cord injury (SCI) than in the general population and whether indwelling catheter (IDC) use is a significant independent risk factor for bladder cancer. DESIGN: Historical cohort study in which subjects with SCI were stratified according to bladder management method and followed for the development of bladder cancer. SETTING: A large rehabilitation hospital in the Spinal Cord Injury Model Systems. PARTICIPANTS: A total of 3670 patients with SCI who were evaluated for bladder cancer on at least 1 occasion by cystoscopy over a period of 1 to 47 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Bladder cancer occurring after SCI determined by diagnosis at our facility, by subject report, or by report of next of kin. RESULTS: Twenty-one cases of bladder cancer were found in the 3670 study participants. The risk of bladder cancer for subjects with SCI using IDC is 77 per 100,000 person-years, corresponding to an age- and gender-adjusted standardized morbidity ratio (SMR) of 25.4 (95% confidence interval [CI], 14.0--41.9) when compared with the general population. After controlling for age at injury, gender, level and completeness of SCI, history of bladder calculi, and smoking, those using solely IDC had a significantly greater risk of bladder cancer (relative risk [RR] = 4.9; 95% CI, 1.3--13.8) than those using nonindwelling methods. Mortality caused by bladder cancer in individuals with SCI was significantly greater than that of the US population (SMR = 70.6; 95% CI, 36.9--123.3). CONCLUSIONS: Bladder cancer risk and mortality are heightened in SCI compared with the general population. IDC is a significant independent risk factor for the increased risk of and mortality caused by bladder cancer in the SCI population.

Adolescent↗

PubMed2002

Modifiable risks of incident functional dependence in Hispanic and non-Hispanic white elders: the San Luis Valley Health and Aging Study.

PURPOSE: This study identified modifiable risks associated with incident functional dependence, compared their effects, and estimated the percent risk attributable to each factor, by ethnicity. DESIGN AND METHODS: The prospective study cohort comprised 751 rural Hispanic and non-Hispanic White elders from southern Colorado who reported no dependence in basic and instrumental activities of daily living (ADLs and IADLs) at baseline. Logistic regression modeled the effects of physical inactivity, nutritional risk, smoking, and falls on incident disability 22 months later, with and without adjustment for baseline ADL and IADL difficulty. Population attributable risk percentages assessed these modifiable risks by ethnicity. RESULTS: Each risk factor multiplied the likelihood of incident dependence by 1.4 or more, adjusted for covariates. Attributable risk percentages ranged from 8% to 32% depending on risk factor, ethnicity, and baseline ADL and IADL difficulty status. Attributable risk was generally greater among Hispanic elders, the result of higher prevalence of most of the risk factors. IMPLICATIONS: Interventions targeted at inadequate nutrition, inactivity, smoking, and preventable falls offer opportunities to reduce incident functional disability, especially among Hispanic elders.

Activities of Daily Living↗

PubMedDate not supplied

Adapting and implementing a long-term nutrition and physical activity curriculum to a rural, low-income, biethnic community.

This study adapted an urban-based school nutrition program for delivery in a rural community. Specific aims were to adapt the curriculum; expand it to include physical activity; determine effectiveness on students' attitudes, knowledge, and self-efficacy; and assess teachers' impressions. Three cohorts were established: 173 students taught by a resource teacher, 170 students taught by classroom teachers, and 187 students who did not receive the curriculum. Pre- and posttest surveys measured outcomes, and classroom teachers were observed and interviewed. The curriculum was shown to be effective in enhancing student outcomes for both the resource teacher and classroom teacher cohorts. Teachers reported that lessons needed to be simplified and that children enjoyed them. Findings support the transferability of an urban-based nutrition curriculum to a rural community and the need for students to receive health education annually.

Child↗