Biomedical subjects

S R Cummings

Publications and source records attributed to S R Cummings.

At least 163 records · Page 9Linked to original sources

PubMed1990

Appendicular bone density and age predict hip fracture in women. The Study of Osteoporotic Fractures Research Group.

To determine whether measurement of bone density predicts hip fracture in women, we prospectively studied 9703 nonblack women aged 65 years and older who had measurements of bone mineral density using single-photon absorptiometry in the calcaneus, distal radius, and proximal radius. During an average of 1.6 years of follow-up, 53 hip fractures occurred. The risk of hip fracture was inversely related to bone density at all three measurement sites. After adjusting for age, the relative risk of hip fracture was 1.66 for a decrease of 1 SD in the bone density at the calcaneus (95% confidence interval, 1.22 to 2.26), 1.55 (95% confidence interval, 1.13 to 2.11) at the distal radius, and 1.41 (95% confidence interval, 1.06 to 1.88) at the proximal radius. None of the three measurements was a significantly better predictor of hip fracture than the others. After adjusting for bone mineral density, the risk of hip fracture doubled for each 10-year increase in age (relative risk, 2.09; 95% confidence interval, 1.31 to 3.33). We conclude that decreased bone density in the appendicular skeleton is associated with an increased risk of hip fracture, but this accounts for only part of the age-related increase in risk of hip fracture among older women.

Age Factors↗

PubMed1990

Prevalence and determinants of estrogen replacement therapy in elderly women.

To better understand which women use estrogen replacement therapy, we examined the prevalence and determinants of estrogen replacement therapy in 9704 nonblack women, age greater than or equal to 65 years, who participated in the multicenter prospective Study of Osteoporotic Fractures. Overall, 13.7% of women reported current use of oral estrogen; 10.9% took estrogen alone and 2.8% took estrogen opposed by progestin. Four percent currently used parenteral estrogen compounds. Current use declined sharply with age from 17% at age 65 to 4% at age greater than or equal to 85. The primary determinant of estrogen replacement therapy was the type of menopause; the odds of using estrogen replacement therapy in current users compared with never users were approximately five times higher in women with a surgical menopause. Estrogen use was more common among women who had higher levels of education and were less obese. Furthermore, estrogen replacement therapy users were more likely to drink alcohol and to participate in sports and recreation. A diagnosis of osteoporosis was the major determinant of continued estrogen use, but only 24% of women with a diagnosis of osteoporosis used estrogen replacement therapy. We conclude that only a small proportion of elderly women in the United States use estrogen replacement therapy. Selection factors for use of estrogen are evident and may introduce bias in studies of estrogen and disease. In consideration of the distribution of these selection factors, estrogen users will tend to be at lower risk of coronary disease and possibly breast cancer but at greater risk for hip fractures.

Age Factors↗

PubMed1990

The future of hip fractures in the United States. Numbers, costs, and potential effects of postmenopausal estrogen.

Because of the increasing number of elderly people in the United States, the total number of hip fractures in persons 50 years and older will rise from 238,000 to 512,000 by the year 2040, with a concomitant increase in avoidable deaths, disability, and medical costs. The total annual cost of hip fractures (in 1984 dollars) will increase from approximately 7.2 billion dollars currently to 16 billion dollars in the year 2040. Universal use of estrogen therapy by postmenopausal white women may slow but not prevent this rise in hip fractures. New, effective, and widely applicable strategies to prevent hip fractures are urgently needed.

Aged↗

PubMed1990

Counseling medical patients about cigarette smoking: a comparison of the impact of training on nurse practitioners and physicians.

Health providers believe that eliminating smoking is an important health promotion goal, but physicians and nurse practitioners may differ in the implementation of that belief. To determine whether nurse practitioners or physicians were more likely to counsel smokers to quit smoking, 12 internal medicine nurse practitioners (100 percent female) and 40 internal medicine physicians (30 percent female) were studied at four San Francisco Bay-area Kaiser Permanente Medical Centers, both before and after training in smoking-cessation counseling. In addition, exit phone surveys of at least 15 smokers per participant were completed as soon as possible following an office visit to the participant (269 nurse practitioner patients; 948 physician patients). It was found that nurse practitioners discussed smoking with patients more often than did physicians (64 percent vs. 50 percent; p less than 0.001), asked patients more often whether they were interested in quitting (49 percent vs. 40 percent; p less than 0.01), distributed more smoking-cessation literature to patients (37 percent vs. 25 percent; p less than 0.001) and made more follow-up appointments about smoking (36 percent vs. 19 percent; p less than 0.001). These differences in counseling behavior between the two groups were not explained by differences in patient characteristics of the two groups. The authors concluded that, given the same training, nurse practitioners are more likely to counsel smokers about quitting than are physicians.

Adult↗

PubMed1989

Risk factors for recurrent nonsyncopal falls. A prospective study.

Falls are a major threat to the health of older persons. We evaluated potential risk factors for falls in 325 community-dwelling persons aged 60 years or older who had fallen during the previous year, then followed up weekly for 1 year to ascertain nonsyncopal falls and their consequences. Risk factors for having a single fall were few and relatively weak, but multiple falls were more predictable. In multivariate analyses, we found increased odds of two or more falls for persons who had difficulty standing up from a chair, difficulty performing a tandem walk, arthritis, Parkinson's disease, three or more falls during the previous year, and a fall with injury during the previous year, and for whites. The proportion of subjects with two or more falls per year increased from 0.10 for those with none or one of these risk factors to 0.69 for those with four or more risk factors. Among older persons with a history of a recent fall, the risk of multiple nonsyncopal falls can be predicted from a few simple questions and examinations.

Accidental Falls↗

PubMed1989

Training physicians in counseling about smoking cessation. A randomized trial of the "Quit for Life" program.

STUDY OBJECTIVE: To test whether physicians who receive a continuing education program ("Quit for Life") about how to counsel smokers to quit would counsel smokers more effectively and have higher rates of long-term smoking cessation among their patients who smoke. DESIGN: Randomized trial with blinded assessment of principal outcomes. SETTING: Four health maintenance organization medical centers in northern California. SUBJECTS: Eighty-one internists assigned by blinded randomization to receive training (40) or serve as controls (41). Consecutive samples of smokers visiting each physician (mean, 25.6 patients per experimental and 25.2 per control physician). INTERVENTIONS: Internists received 3 hours of training about how to help smokers quit. Physicians and their office staff also were given self-help booklets to distribute free to smokers and were urged to use a system of stickers on charts to remind physicians to counsel smokers about quitting. MEASUREMENTS AND MAIN RESULTS: On the basis of telephone interviews with patients after visiting the physician, we determined that internists who attended the Quit for Life program discussed smoking with more patients who smoked, spent more time counseling them about smoking, helped more patients set dates to quit smoking, gave out more self-help booklets, and made more follow-up appointments to discuss smoking than did internists in the control group. One year later, the rate of biochemically confirmed, long-term (greater than or equal to 9 months) abstinence from smoking was 1% higher among all patients of trained internists than among patients of controls (95% CI, -0.1% to +2.3%), and 2.2% (+0.2% to +4.3%) higher among the patients who most wanted to quit smoking. CONCLUSIONS: This continuing education program substantially changed the way physicians counseled smokers. As a result, a few more patients who wanted to quit smoking achieved long-term abstinence.

Attitude of Health Personnel↗

PubMed1989

The cost-effectiveness of counseling smokers to quit.

Cigarette smoking is the most important preventable cause of death in the United States. Surveys of patients, however, suggest that many physicians do not routinely counsel smokers to quit. Because physicians may not consider counseling against smoking to be as worthwhile as other medical practices, we examined its cost-effectiveness. We based our estimates of the effectiveness of physician counseling on published reports of randomized trials and our estimates of its cost on average charges for physician office visits. Our results indicate that the cost-effectiveness of brief advice during routine office visits ranges from $705 to $988 per year of life saved for men and from $1204 to $2058 for women. Follow-up visits about smoking appear to be similarly cost-effective. Physician counseling against smoking, therefore, is at least as cost-effective as several other preventive medical practices and should be a routine part of health care for patients who smoke.

Adult↗

PubMed1989

Smoking counseling and preventive medicine. A survey of internists in private practices and a health maintenance organization.

Physicians could help a large number of patients quit smoking by taking time to advise them about quitting, helping them plan a date to quit, giving them self-help materials, following up, and referring some to smoking cessation programs. To determine the attitudes and practices of internists concerning smoking cessation and selected preventive medical practices, we surveyed a random sample of internists in private practice and in a large health maintenance organization (Kaiser-Permanente Medical Group) in the San Francisco Bay area. Overall, internists consider counseling about smoking to be at least as worthwhile as many other practices, such as screening for breast cancer, and more worthwhile than periodic physical examinations. Despite these beliefs, 57% to 65% of internists reported that they spend two minutes or less counseling smokers during new patient visits. Many internists never use recommended strategies for counseling about smoking: 33% to 44% never help patients plan dates to quit, 68% to 75% never make follow-up appointments with patients primarily about smoking, and 27% to 48% never give smokers self-help pamphlets about quitting. Although they believe that counseling about smoking is worthwhile, internists are not doing as much as they could to help their patients quit.

Attitude of Health Personnel↗

PubMed1989

A hypothesis: the causes of hip fractures.

Neither age-related osteoporosis nor the increasing incidence of falls with age sufficiently explain the exponential increase in the incidence of hip fracture with aging. We propose that four conditions must be satisfied in order for a fall to cause a hip fracture: (a) the faller must be oriented to impact near the hip; (b) protective responses must fail; (c) local soft tissues must absorb less energy than necessary to prevent fracture, and (d) the residual energy of the fall applied to the proximal femur must exceed its strength. All of these events become more likely with aging and lead to an exponential rise in the risk of hip fracture with advancing age. This model also suggests that a combination of measurements of neuromuscular function and of bone strength may be the most accurate approach to assessing the risk of hip fracture.

Accidental Falls↗

PubMed1989

Physical performance measures in aging research.

Evaluation of physical functioning plays a valuable role in clinical geriatrics as well as in aging research. Physical functioning has generally been assessed through self- or proxy-report. An important addition to this form of assessment is the use of performance measures of physical function, in which individuals are asked to actually perform specific tasks and are evaluated using standardized criteria. Although there has been limited methodological work on physical performance instruments, this approach offers a number of potential advantages. Several performance assessments have been developed that correlate highly with other measures of health status and predict need for long-term care and mortality. It is suggested that more widespread use be made of physical performance assessments and that they be evaluated as measures of functioning in cross-national studies, as indicators of change in functioning over time, as endpoints in intervention studies, as tools for identifying persons functioning at high levels, and as sources of relevant information for the clinician.

Activities of Daily Living↗

PubMed1989

Dentists as smoking cessation counselors.

Dentists can help people quit smoking because they are experts in oral health, are accustomed to counseling about oral preventive health, and have broad exposure to the general populace. To determine dentists' counseling practices with regard to smoking cessation, a randomly selected sample of 82 dentists practicing in the San Francisco Bay Area were surveyed. Also 106 internists in the same region were surveyed. Whereas the dentists believed smoking is dangerous to health and considered counseling as an important part of their practice, only 17%, compared with 58% of the internists, frequently discussed quitting with their patients who smoke. The two groups also differed in the types of counseling they used. Dentists attributed their lack of counseling to poor insurance coverage, insufficient time, lack of training, and fear that patients might leave their practices if urged to quit. These issues must be addressed if dentists are to participate fully in helping their patients quit smoking.

Adult↗

PubMed1989

Lifetime risks of hip, Colles', or vertebral fracture and coronary heart disease among white postmenopausal women.

Lifetime risk is a useful way to estimate and compare the risk of various conditions. Hip fractures, Colles' fractures, and coronary heart disease, and breast and endometrial cancers are important conditions in postmenopausal women that might be influenced by the use of hormone replacement therapy. We used population-based data to estimate a woman's lifetime risk of suffering a hip, Colles', or vertebral fracture and her risk of dying of coronary heart disease. A 50-year-old white woman has a 16% risk of suffering a hip fracture, a 15% risk of suffering a Colles' fracture, and a 32% risk of suffering a vertebral fracture during her remaining lifetime. These risks exceed her risk of developing breast or endometrial cancer. She has a 31% risk of dying of coronary heart disease, which is about 10 times greater than her risk of dying of hip fractures or breast cancer. These lifetime risks provide a useful description of the comparative risks of conditions that might be influenced by postmenopausal hormone therapy.

Aged↗

PubMed1988

Internists and nicotine gum.

Nicotine gum may be a useful aid to help patients quit smoking. The effectiveness of the gum and incidence of side effects may depend on using the gum properly. To describe internists' current practices of prescribing nicotine gum and other drugs for smoking cessation, we surveyed randomly selected internists. Most internists prescribe nicotine gum to fewer than 25% of patients who try to quit smoking. Contrary to current recommendations, nearly half of internists would suggest gum to help patients cut down on smoking, and a majority would limit its use to less than three months. There is no evidence that sedatives are useful for smoking cessation, but one fourth of internists had recently prescribed them for that purpose. There is a widespread need for physician education about how to use nicotine gum more effectively.

Attitude of Health Personnel↗

PubMed1988

An examination of the association between vertebral deformities, physical disabilities and psychosocial problems.

In order to measure the clinical consequences of spinal osteoporosis, we correlated a number of physical and psychosocial dysfunctions with the degree of vertebral deformity in 204 women aged 55-75 yr. We employed 5 standardized questionnaire instruments: the physical dimension of the Sickness Impact Profile (SIP), an analog back pain scale, a 24-question instrument eliciting back-related disabilities, and assessments of self-esteem and mastery. Using these results as the dependent variables, we performed 5 separate stepwise regression analyses; independent variables were vertebral deformity score and 11 possible confounders. Using Pearson correlation coefficients, we found a high degree of correlation between each of the 5 primary outcome variables. Vertebral deformity score played a small but statistically significant role in the 3 models whose dependent variable was related to physical dysfunction, but it accounted for only 4-10% of the variance of these models. Mastery and self-esteem were related to overall poor health and attendant physical disabilities but not to vertebral deformity score. In this selected cohort of women, the occurrence of mild to moderate vertebral deformities caused little loss of physical function or function of psychosocial problems because of vertebral deformity. Although we were able to demonstrate a statistically significant handicap related to the total vertebral deformity score, several other clinical variables appeared to have a greater impact.

Aged↗

PubMed1988

Recovery of function after hip fracture. The role of social supports.

Previous studies have found that social support may reduce mortality after myocardial infarction and reduce overall mortality among the elderly. To determine whether social support also influences the recovery of function among patients who have had hip fractures and to describe other potential predictors of recovery after hip fracture, 111 patients with hip fractures were interviewed and examined before discharge from the hospital. The functional status of surviving patients was assessed again 6 months later. Patients who had a greater number of social supports had more complete recovery of their prefracture level of function (r = .21; P = .04). This association was strongest for patients over 60 years old (r = .31; P = .006); among these patients, this association remained statistically significant after adjustment for other significant (P less than .05) predictors of recovery: arm strength, mental status, and serum albumin. Additional studies should be done to test whether interventions to increase social supports can improve the recovery of function among elderly patients with hip fractures and other illnesses. In the meantime, health professionals should counsel elderly patients about the potential rehabilitative and preventive benefits of social supports.

Activities of Daily Living↗

PubMed1988

Forgetting falls. The limited accuracy of recall of falls in the elderly.

To determine how accurately elderly subjects recall recent falls, we studied 304 ambulatory men and women over the age of 60 years who completed a 12-month prospective study of risk factors for falling. We developed a system of weekly follow-up and home visits to record and confirm all falls. During the study, 179 participants suffered at least one fall that was confirmed by home visit. At the end of the study, all subjects were interviewed by telephone about whether they had suffered a fall during the preceding 3, 6, or 12 months. Depending on the time period of recall, 13% to 32% of those with confirmed falls did not recall falling during the specific period of time. Recall was better for the preceding 12 months than for 3 or 6 months. There were only weak correlations (r = 0.28 to 0.59) between the number of falls that were documented and the number that the subjects recalled during each of these periods. Those with lower scores on the Mini-Mental State Examination were more likely to forget falls. We conclude that elderly subjects often do not recall falls that occurred during specific periods of time over the preceding 3 to 12 months. Researchers and clinicians should consider using methods besides long-term recall for ascertaining and counting falls over specific periods of time.

Accidental Falls↗

PubMed1988

Optimum cutoff points for biochemical validation of smoking status.

Selection of cutoff points for tests to validate smoking cessation should take account of the prevalence of deception. When the prevalence of deception is relatively low, the cutoff points to validate quitting should be relatively high. Many studies have used cutoff points that are too low and may have underestimated cessation rates. We present a method for determining the best cutoff points that takes account of the prevalence of deception.

Blood Chemical Analysis↗

PubMed1987

Evaluation of two food frequency methods of measuring dietary calcium intake.

To assess the ability of food frequency methods to measure current dietary calcium intake in elderly women, the authors administered two types of food frequency instruments to 37 randomly selected women who attended two senior citizens centers in San Francisco, and they compared those responses to seven-day food records. A 34-item food frequency instrument (with portion sizes rated as small, medium, or large) correlated well (r = 0.76) with the estimated calcium intake from seven-day records. Limiting the instrument to the top 15, 10, or five foods that contribute to dietary calcium intake had little effect on this correlation (r = 076, 0.75, and 0.67, respectively). Rating all portions as "medium" reduced these correlations somewhat. An 18-item instrument, which asks respondents to rate portion sizes in ounces or cups, did not correlate as well with the seven-day records (r = 0.49). The authors conclude that brief food frequency instruments which rate portion sizes on a simple qualitative scale may be suitable for many clinical uses and adequate for some types of epidemiologic studies of calcium intake in elderly women.

Aged↗