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S Wing

Publications and source records attributed to S Wing.

33 records · Page 2Linked to original sources
PubMed1987

Interobserver agreement by auscultation in the presence of a third heart sound in patients with congestive heart failure.

Although the third heart sound (S3) is well recognized as an important sign in the evaluation of patients with congestive heart failure, the interobserver variability with its observation needs to be known before general applicability can be determined. Therefore, we determined the agreement among four trained observers on the presence of S3 in 81 hospitalized patients. Agreement between pairs of observers varied between 48 and 73 percent. The kappa statistic, which adjusts for agreement by chance alone, showed that agreement between various observer pairs was moderate (kappa = 0.40-0.50) at best and slight (kappa = 0.10-0.30) at worst. The rate of agreement did not appear to be affected by the time interval between measurements, by the sex of the patient or by a training effect over the time of the study. In conclusion, although S3 may be important as a clinical sign, clinicians cannot agree reliably about whether or not it is present.

Heart Auscultation↗
PubMed1987

The healthy worker effect. Selection of workers and work forces.

The favorable health status of employed populations in comparison to that of the general population is often called the "healthy worker effect," and most researchers feel that it results from the selection of healthy individuals during the hiring process. However, other mechanisms may also contribute to the healthy worker effect. In particular, the healthy worker effect may reflect the selection, for epidemiologic study, of relatively advantaged workforces in terms of socioeconomic status and health. Evidence of differential health by socioeconomic status within the workforce is reviewed, and its possible role in the healthy worker effect is discussed.

Employment↗
PubMed1986

Mini-plasminogen-like fragments of plasminogen in synovial fluid in acute inflammatory arthritis.

Neutrophil elastase digests plasminogen to yield a fragment, mini-plasminogen, which is activatable to a mini-plasmin capable of escaping the action of the primary plasmin inhibitor. Such a molecule may play a role in joint destruction, either directly or by activation of procollagenase to collagenase. Synovial fluid samples from 34 acute joint effusions were examined by lysine-Sepharose chromatography and fibrinolytic assay of the fall-through (non-lysine-binding) fractions in presence of urokinase. Fragments similar to mini-plasminogen were found in 20 of 23 inflammatory effusions (cell count greater than 0.5 X 10(3)/microliter) and in none of 11 non-inflammatory (traumatic and osteoarthritic) effusions (cell count less than 0.5 X 10(3)/microliter) (p less than 0.001). Analysis of four inflammatory fluids by gel filtration on Bio-Gel P 100 and enzyme-linked immunoassay for plasminogen antigen revealed plasminogen fragments with molecular weight similar to mini-plasminogen (34,000 daltons) in three, and larger plasminogen fragments (or complexes of mini-plasminogen with other synovial fluid macromolecules) in all four. Fibrinolytic activity was demonstrable in fractions containing plasminogen fragments after treatment with tissue type plasminogen activator. In contrast with non-inflammatory effusions, inflammatory joint fluids contain plasminogen fragments with the properties of mini-plasminogen, suggesting their possible role in inflammatory joint destruction.

Acute Disease↗
PubMed1986

Life-table methods for detecting age-risk factor interactions in long-term follow-up studies.

Methodological investigation has suggested that age-risk factor interactions should be more evident in age of experience life tables than in follow-up time tables due to the mixing of ages of experience over follow-up time in groups defined by age at initial examination. To illustrate the two approaches, age modification of the effect of total cholesterol on ischemic heart disease mortality in two long-term follow-up studies was investigated. Follow-up time life table analysis of 116 deaths over 20 years in one study was more consistent with a uniform relative risk due to cholesterol, while age of experience life table analysis was more consistent with a monotonic negative age interaction. In a second follow-up study (160 deaths over 24 years), there was no evidence of a monotonic negative age-cholesterol interaction by either method. It was concluded that age-specific life table analysis should be used when age-risk factor interactions are considered, but that both approaches yield almost identical results in absence of age interaction. The identification of the more appropriate life-table analysis should be ultimately guided by the nature of the age or time phenomena of scientific interest.

Actuarial Analysis↗
PubMed1986

Geographic variation in the onset of decline of ischemic heart disease mortality in the United States.

This report examines geographic variation in the onset of the decline of ischemic heart disease (IHD) mortality in white males aged 35-74 during the period 1968-78. Using a quadratic regression model, State Economic Areas (SEAs) were classified as experiencing onset of the decline in 1968 or earlier, 1969-72, or 1973 or later. In the United States as a whole, approximately one-third of SEAs experienced a late onset of the decline (after 1968). Metropolitan SEAs were in advance of non-metropolitan, and the Northeast and Pacific states showed earlier onset than the South and midsections of the country. The acceleration of the national decline after 1972 appears to be due to declines in areas in which rates had been increasing or in plateau until that time. Evidence about geographic variation in the onset of decline may provide clues about social and environmental factors responsible for the decline.

Adult↗
PubMed1985

The participant effect: mortality in a community-based study compared to vital statistics.

The 20-year mortality experience of the community-based Evans County Heart Study population is compared to local, regional and national vital statistics. Deficit mortality occurred in the study population at younger ages while at older ages mortality was similar to or greater than vital statistics. This was particularly true for white and nonwhite males, whose mortality patterns were statistically significantly different from Evans Co. vital statistics (P less than 0.005). Nonwhite/white mortality ratios in the study were close to those observed in local vital statistics, particularly for males. Sex mortality ratios in the study population were lower than in vital statistics due to a stronger participant effect (lower mortality) in males. Evans Co. was an area of particularly high mortality for whites in the period 1960-1980 compared to other parts of Georgia and the U.S. Results of this study are similar to other reports of participant effects in epidemiologic follow-up studies; implications for bias in estimates of population levels of disease and of disease/exposure relationships are discussed.

Adult↗
PubMed1985

The black/white mortality crossover: investigation in a community-based study.

The black/white mortality crossover at about age 75, a result of lower white mortality rates at younger ages and lower black rates at the oldest ages, has been observed in U.S. vital statistics since 1900. Though a persistant observation in such data, its validity has been challenged by questions about census enumeration and age reporting on death certificates. Analyses of 20 years experience of all-cause mortality in the community-based Evans County Study using a Weibull model of age specific mortality rates showed a statistically significant black/white mortality crossover for both men (at age 73) and women (at age 85). The finding of a crossover in this longitudinally followed population is significant because the age reporting for both survivors and age at death for nonsurvivors were obtained in the study protocol and did not rely on age reporting either in census data or on the death certificate. Differences in the age and sex patterns of mortality between two populations living in the same geographic region are relevant to questions about the etiology of the major age-related chronic diseases as well as to topics of current interest in health care policy.

Adult↗
PubMed1984

The role of medicine in the decline of hypertension-related mortality.

Mortality trends are often cited to justify public health priorities and to legitimate professional activities. For example, the decline of cardiovascular disease mortality in recent decades has been cited frequently as affirmation of the proper conduct and direction of medical and public health research. In this paper, the hypothesis that medical intervention is the major cause of hypertension-related mortality declines is reviewed. Evidence relevant to the "medical hypothesis," including mortality data and patterns of antihypertensive drug development and treatment, is presented. While it is clear that factors other than medical intervention must have played the major role in hypertension-related mortality trends for most of the period of the decline, much scientific literature increasingly promotes the view that medical intervention is the crucial factor in mortality trends. The role of the medical hypothesis in supporting status quo political and economic interests is discussed, and alternative explanations for mortality trends are considered.

Adult↗
PubMed1983

The contribution of hypertension to mortality in the US: 1968, 1977.

The contribution of hypertension to total mortality in the United States in 1968 and 1977 is assessed through multiple cause death rates for all mentions of hypertension and the death certificate prevalence of hypertension. Age-adjusted declines in the hypertension death rates were 32.8 per cent for non-White females, 30.4 per cent for non-White males, 30.3 per cent for White females, and 25.2 per cent for White males. Declines for younger non-Whites were the greatest, about 50 per cent, although their rates were more than twice the White rates in both years. Death certificate prevalence also declined for all four groups with the greatest (16.5 per cent) for non-White males and the least (10.4 per cent) for White males, who only showed declines at older ages. The age trajectory of death certificate prevalence reached a peak at ages 50-69 for non-Whites and ages 60-79 for Whites, with lower prevalence at the most advanced ages. Large declines in the contribution of hypertension to mortality observed in death certificate data are particularly striking in light of the probability that any bias would be toward better detection and reporting over the 10 years.

Adult↗
PubMed1982

Isolated systolic hypertension in Evans county--I. Prevalence and screening considerations.

Studies suggest that isolated hypertension involves pathophysiological change different from essential hypertension; while clinical trials of drug treatment of isolated systolic hypertension are underway, little is known of its descriptive epidemiology. This paper reports characteristics of isolated systolic hypertension in biracial Evans County, Georgia, 1967-69. Isolated systolic hypertension was rare below age 40, but the percent prevalence increased greatly at older ages. Defining isolated systolic hypertension as diastole blood pressure (DBP) less than 95 and systolic blood pressure (SBP) greater than 160, age-adjusted percent prevalence at ages 40 and above were 9.6, 10.6, 15.1, and 18.3 for white males, black males, white females, and black females respectively. Percent prevalence declined to 4.8, 6.3, 9.7, and 12.7 in the four race/sex groups when a DBP cutoff of 90 was used. Unlike essential hypertension, percent prevalence of isolated systolic hypertension varied more by sex than by race: it was 60-100% higher in females than in males and only 10--30% higher in blacks than in whites. Percent prevalence of isolated systolic hypertension for the second and third of three BP readings (one clinic visit) increased compared to the first reading, the reverse of what is usually found for essential hypertension. DBP variability was relatively greater than SBP variability and probably accounted for the changes in percent prevalence. These data support clinical studies indicating isolated systolic hypertension is a distinct syndrome. This condition, shown to be a risk factor for death and disease in other studies, was common at older ages and may increasingly become health problem as the population ages.

Adult↗
PubMed1981

Brain abscess.

Explore the source record for details and available documents.

Aged↗
PubMed1981

A multiple cause of death analysis of hypertension-related mortality in North Carolina, 1968-1977.

In this paper, records of all medical conditions on death certificates are used to evaluate hypertension-related mortality in North Carolina over the decade 1968-1977. Use of both an inclusive hypertension recode category and multiple cause data resulted in gains in information of over 750 per cent in all four race/sex groups compared to the commonly used underlying cause, hypertensive disease category. Race, sex and age specific 10-year trends in death rates for all mentions of hypertension are analyzed, with comparisons to underlying cause mortality from ischemic heart disease and stroke. Age-adjusted declines of 19 to 24 per cent between 1968 and 1977 were observed for all race/sex groups, although non-White declines occurred mainly at younger ages while White declines (especially White males) occurred mainly at older ages. The non-White excess of hypertension mentions (compared to Whites) increased for males and decreased for females. The decline in hypertension mentions, in spite of the increased awareness of hypertension as a public health problem which would make it more likely to be mentioned on death certificates, suggests that there was a real reduction in the contribution of hypertension to total mortality over the period.

Adult↗
PubMedDate not supplied

Recording of external radiation exposures at Oak Ridge National Laboratory: implications for epidemiological studies.

Accurate measurements of radiation exposure for individuals are critical to assessing radiation-mortality associations. This paper is based on a study of changes in recorded doses and in radiation monitoring programs at Oak Ridge National Laboratory, a U.S. Department of Energy facility where whole body external penetrating radiation exposures have been of primary epidemiological interest. External radiation monitoring data from 1943-1984 are analyzed for a group of white males (N = 8,318). The proportion of workers monitored for external radiation increased from about 50% in 1943 to over 80% in 1944 to above 98% after 1948. Mean radiation doses showed maxima in 1944 and 1957, followed by steady and long-term declines. Numerous changes in monitoring programs occurred during the study period, including changes in the types of dosimeters used, the frequency of reading dosimeters, methods of calculating doses, and practices of recording doses. Temporal patterns of doses in the lower range of the distribution showed some changes suggestive of changes in policies and practices for recording doses, which would influence dose values used in epidemiological studies. Reliable and accurate exposure measurements are especially important in studies of low level exposures due to small differences in outcomes between exposure groups. Evidence of changes in recorded doses due to monitoring and recording practices, rather than to actual changes in exposures in this well-monitored population, suggests the importance of comparable studies of other populations used for epidemiological studies of radiation-mortality associations.

Bias↗