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Biomedical subjects

T M Vogt

Publications and source records attributed to T M Vogt.

At least 37 records · Page 2Linked to original sources
PubMed1997

Broadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older women. A prospective study. Study of Osteoporotic Fractures Research Group.

BACKGROUND: Quantitative ultrasound of bone is a new radiation-free technique that measures bone mass and may assess bone quality. Retrospective studies have suggested that low-bone ultrasound of the calcaneus is associated with an increased risk for hip and other fractures in older women. OBJECTIVES: To establish the utility of calcaneal quantitative ultrasound of bone for the prediction of fractures and to compare quantitative ultrasound of bone with bone mineral densitometry by performing a prospective cohort study within the Study of Osteoporotic Fractures. SUBJECTS AND METHODS: We studied 6189 postmenopausal women older than 65 years of 4 US clinical centers. Broadband ultrasound attenuation (BUA), a measurement of the differential attenuation of sound waves transmitted through the calcaneus, and bone mineral density of the calcaneus and hip were measured. Subsequent hip and other nonspine fractures were documented during a mean follow-up of 2.0 years. RESULTS: In age- and clinic-adjusted analyses, each SD reduction in calcaneal BUA was associated with a doubling of the risk for hip fractures (relative risk [RR], 2.0; 95% confidence interval [CI], 1.5-2.7); a similar relationship was observed with bone mineral density of the calcaneus (RR, 2.2; 95% CI, 1.9-3.0) and femoral neck (RR, 2.6; 95% CI, 1.9-3.8). After adjustment for bone mineral density of the femoral neck, BUA was still associated with an increased risk for hip fracture (RR, 1.5; 95% CI, 1.0-2.1). Intertrochanteric fractures in particular were strongly associated with a low BUA measurement (RR, 3.3; 95% CI, 2.0-5.5). CONCLUSIONS: Broadband ultrasound attenuation predicts the occurrence of fractures in older women and is a useful diagnostic test for osteoporosis. The strength of the association between BUA and fracture is similar to that observed with bone mineral density.

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PubMed1996

Axial bone mass in older women. Study of Osteoporotic Fractures Research Group.

OBJECTIVE: To determine the anthropometric, historical, and lifestyle factors associated with bone mineral density (BMD) of the spine and proximal femur in older women. DESIGN: Cross-sectional analyses. SETTING: Four clinical centers in Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; and the Monongahela Valley, Pennsylvania. PARTICIPANTS: 7963 ambulatory, nonblack women 65 year of age or older. MEASUREMENTS: Medical history was obtained by questionnaire and interview, and physical and anthropometric data were obtained by examination. Lumbar spine and proximal femoral BMDs were measured using dual-energy x-ray absorptiometry. RESULTS: The multivariable models could predict 21% and 25% of the difference between participants in BMD at the femoral neck and lumbar spine, respectively. Weight was most highly associated with BMD. Postmenopausal estrogen use and other indicators of total estrogen exposure were strongly associated with increased BMD. Use of diuretics (both thiazide and nonthiazide), activity levels and muscle strength, alcohol intake, and dietary calcium intake were associated with higher BMD. A family history of osteoporotic fracture was strongly associated with low BMD. European ancestry and blond hair, childbirth or breast feeding, a history of hyperthyroidism, and progestin use were not associated with axial BMD. CONCLUSIONS: Weight is strongly associated with BMD. Estrogen exposure, physical activity, and calcium intake are also positively associated with BMD, whereas a family history of osteoporosis is associated with reduced BMD. These associations suggest ways to better identify risk for fracture.

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PubMed1996

Aspirin and NSAID use in older women: effect on bone mineral density and fracture risk. Study of Osteoporotic Fractures Research Group.

Prostaglandin inhibition by aspirin or nonsteroidal anti-inflammatory drug (NSAIDs) may inhibit bone loss and preserve bone mineral density (BMD) in vitro and in animal models. The effect of these agents on BMD and fracture risk in postmenopausal women in unknown. We assessed the risk factors for osteoporosis and the use of aspirin and NSAIDs in 7786 white women over age 65. Axial BMD was measured at the same time, and fractures were prospectively documented over the subsequent 4 years of follow-up. In age-adjusted analyses, daily use of aspirin or NSAIDs was associated with a 2.3-5.8% increase in BMD of the hip and spine. The relationship persisted even after adjustment for weight, a variety of medications, self-reported arthritis, and for radiographic findings of osteoarthritis, but the multiply adjusted increase in BMD was only 1.0-3.1%. Fracture risk was similar among daily users of aspirin and NSAIDs and nonusers. After adjustment for potential confounders, among daily aspirin users the relative risk of hip fracture was 1.1 (95% confidence interval [CI]: 0.7, 1.6), and among daily NSAID users the risk was 0.9 (CI: 0.6, 1.4). Considering all nonspine fractures together, the risk among aspirin users was 1.0 (CI: 0.8. 1.2), and among NSAID users the risk was also 1.0 (CI; 0.8, 1.2). Regular use of aspirin or NSAIDs may have a modest beneficial effect on BMD in postmenopausal women. This effect persists after adjustment for obesity and the presence of osteoarthritis. However, among women who take aspirin or NSAIDs regularly, there is no clinically significant protective effect on the subsequent risk of fractures.

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PubMed1996

Eighteen years of mammography experience in an HMO: 1975-1992.

OBJECTIVE: To describe the mammographic experience for the years 1975 to 1992 at Kaiser Permanente, Northwest Region (KPNW). SETTING: Large, group practices HMO. DESIGN: Clinical databases. PARTICIPANTS: KPNW women in various subgroups. MAIN OUTCOME MEASURES: Mammogram rates. RESULTS: The rate of mammography at KPNW was fairly low (2% to 5%) until 1983, when it began to rise rapidly, almost exclusively as a result of a great increase in screening examinations of otherwise normal women. By 1992 the annual rate of mammography had increased to 40.2% for all women over age 40, and 52.4% for women aged 50 to 69. Women aged 40 to 49 and those over 70 had rates 10% to 15% lower than women aged 50 to 69. Summary figures for all KPNW women hide the striking effect of duration of membership in this HMO. Women aged 50 to 69 who had been members for at least 2 years had mammography rates (at least one examination in that 2-year period) of 75% to 76%. Longer membership resulted in gradually higher rates. The annual mammogram rate for women with 4 years of membership was 58%. CONCLUSIONS: Though there may be significant personal barriers to regular mammography, the effect may be less important in the HMO setting. An efficient, organized system can effect high rates of mammographic screening. The longer a woman remains a member of such an organization the greater her likelihood of receiving regular screening mammograms.

Adult↗
PubMed1995

Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group.

BACKGROUND: Many risk factors for hip fractures have been suggested but have not been evaluated in a comprehensive prospective study. METHODS: We assessed potential risk factors, including bone mass, in 9516 white women 65 years of age or older who had had no previous hip fracture. We then followed these women at 4-month intervals for an average of 4.1 years to determine the frequency of hip fracture. All reports of hip fractures were validated by review of x-ray films. RESULTS: During the follow-up period, 192 women had first hip fractures not due to motor vehicle accidents. In multivariable age-adjusted analyses, a maternal history of hip fracture doubled the risk of hip fracture (relative risk, 2.0; 95 percent confidence interval, 1.4 to 2.9), and the increase in risk remained significant after adjustment for bone density. Women who had gained weight since the age of 25 had a lower risk. The risk was higher among women who had previous fractures of any type after the age of 50, were tall at the age of 25, rated their own health as fair or poor, had previous hyperthyroidism, had been treated with long-acting benzodiazepines or anticonvulsant drugs, ingested greater amounts of caffeine, or spent four hours a day or less on their feet. Examination findings associated with an increased risk included the inability to rise from a chair without using one's arms, poor depth perception, poor contrast sensitivity, and tachycardia at rest. Low calcaneal bone density was also an independent risk factor. The incidence of hip fracture ranged from 1.1 (95 percent confidence interval, 0.5 to 1.6) per 1,000 woman-years among women with no more than two risk factors and normal calcaneal bone density for their age to 27 (95 percent confidence interval, 20 to 34) per 1,000 woman-years among those with five or more risk factors and bone density in the lowest third for their age. CONCLUSIONS: Women with multiple risk factors and low bone density have an especially high risk of hip fracture. Maintaining body weight, walking for exercise, avoiding long-acting benzodiazepines, minimizing caffeine intake, and treating impaired visual function are among the steps that may decrease the risk.

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PubMed1995

Medical care utilization among older HMO members with and without hypertension.

OBJECTIVES: To compare hospital utilization, health status, and sociodemographic characteristics of older persons with and without hypertension and to examine the nature of the association of hypertension with medical care utilization. DESIGN: A retrospective, nonexperimental study. SETTING: A large health maintenance organization (HMO), located in the Portland, Oregon and Vancouver, Washington areas, that provides comprehensive, prepaid benefits to its members. PARTICIPANTS: Approximately 4200 older (> or = 65 years) members enrolled in the Social HMO Demonstration Project. MEASUREMENTS: The dependent variables were (1) whether a member was hospitalized (0 = no; 1 = yes) and (2) the number of hospitalizations during the 12-month period before the return of the Health Status Form, a mail questionnaire. The predictor variables were high blood pressure and other medical conditions, health status, and sociodemographic characteristics. Patients classified as hypertensive were those who self-reported high blood pressure and who received two or more dispensings for antihypertensive medications. RESULTS: Older hypertensives were more likely than older nonhypertensives to have been hospitalized (odds ratio (OR) = 1.14 (95% CI 1.01, 1.27)), self-report their health as only good or fair (P < .001), self-report IADL functional limitations (P < .001), and to be younger than nonhypertensives (P < .001). Utilization differences were similar after controlling for patients' age and gender. Factors independently associated with an increased likelihood of hospitalization were male gender (OR = 1.14 (1.00,1.31)), age (OR = 1.35 (1.00,1.81)), poor (OR = 1.32 (1.02,1.72)) or fair (OR = 1.20 (1.01,1.44)) self-rated health status, functional limitations in activities of daily living (OR = 1.74 (1.48,2.03), and self-reported heart trouble (OR = 1.50 (1.34,1.68)), stroke (OR = 1.37 (1.15,1.64)), or cancer (OR = 2.89 (1.72,4.84)). Factors independently associated with a decreased likelihood of hospitalization were excellent self-reported health (OR = 0.65 (0.47,0.90)), no physical impairments (OR = 0.59 (0.48,0.72)), and no circulation problems (OR = 0.85 (0.74,0.98)). CONCLUSIONS: Older hypertensive patients had poorer self-reported health, more functional limitations, used more hospital services, and were not as old as nonhypertensive older patients. To the extent that general health is improved by treatment of hypertension, appropriate treatment of high blood pressure may not only improve health, it may also reduce medical care utilization. Our findings offer further support for hypertension prevention, detection, and treatment programs designed to reduce or minimize hypertension's later medical complications and to reduce future utilization.

Activities of Daily Living↗
PubMed1994

Comparing health-related indicators of very old hypertensives and nonhypertensives in an HMO.

The purpose of this study was to determine if very old hypertensives (85 years of age and over) were sicker and in poorer health than very old nonhypertensives. The authors compared the frequency of comorbidities, medical care and drug use, self-reported functional and health status, and health-related behaviors of very old hypertensive and nonhypertensive health maintenance organization (HMO) enrollees. Very old male hypertensives were less healthy than very old male nonhypertensives, female hypertensives, and nonhypertensives. In contrast, very old female hypertensives were healthy or healthier than very old female nonhypertensives. Hypertension may be a more serious condition among the very old males than very old females, or treatment may be more efficacious (or prevalent) for very old female hypertensives. These relationships require further study to determine if treatment guidelines should differ by sex among very old hypertensives.

Activities of Daily Living↗
PubMed1993

Nurse-assisted counseling for smokers in primary care.

OBJECTIVE: Physician-delivered advice to stop smoking is effective, but time demands often reduce the number of smokers who receive assistance. We evaluated three nurse-assisted interventions designed to minimize physician burden and increase counseling in primary care settings. DESIGN: Randomized controlled trial with a 12-month follow-up. SETTING: Internal medicine and family practice offices in a health maintenance organization. PARTICIPANTS: Smokers (n = 3161) who were patients of participating physicians or other medical care providers (n = 60). INTERVENTION: Medical care providers delivered a 30-second stop-smoking prompt to 2707 smokers and referred them to an on-site nurse smoking counselor. The nurse randomly provided a two-page pamphlet (advice control) or one of three nurse-assisted interventions: 1) self-quit training; 2) referral to a group cessation program; or 3) a combination of self-quit training and referral. Each nurse-delivered intervention included a 10-minute video, written materials, and a follow-up phone call. RESULTS: Physicians delivered brief advice to 86% of identified smokers during the 1-year program. The proportion of participants reporting abstinence after both 3 and 12 months of follow-up nearly doubled (P = 0.01) for the nurse-assisted self-quit (7.1%), group-referral (7.6%), and combination (6.9%) interventions, compared to brief physician advice alone (3.9%) (P < 0.05). Saliva cotinine tests confirmed these effects (P < 0.004), although quit rates were lower (3.4%, 4.7%, 4.3%, and 2.3%, respectively) because roughly one half of quitters chose not to provide a saliva sample and were counted as smokers. CONCLUSION: Involving nurses in counseling smokers reduces physician burden, makes counseling more likely, and significantly increases cessation rates compared with brief physician advice alone.

Adult↗
PubMed1993

Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group.

Women with low bone density in the radius or calcaneus are at increased risk of hip fracture. To see whether bone density of the hip measured by dual X-ray absorptiometry is a better predictor of hip fracture than measurements of other bones, we assessed bone density at several sites in 8134 women aged 65 years or more. 65 women had hip fractures during a mean follow-up of 1.8 years. Each SD decrease in femoral neck bone density increased the age-adjusted risk of hip fracture 2.6 times (95% CL 1.9, 3.6). Women with bone density in the lowest quartile had an 8.5-fold greater risk of hip fracture than those in the highest quartile. Bone density of the femoral neck was a better predictor than measurements of the spine (p < 0.0001), radius (p < 0.002), and moderately better than the calcaneus (p = 0.10). Low hip bone density is a stronger predictor of hip fracture than bone density at other sites. Efforts to prevent hip fractures should focus on women with low hip bone density.

Absorptiometry, Photon↗
PubMed1993

A smoking-cessation intervention for hospital patients.

Many patients attempt to stop smoking during hospitalization, but most relapse after discharge. This study developed and evaluated a brief smoking-cessation and relapse-prevention program for hospitalized smokers. All hospitalized smokers (n = 1,119) were identified by questionnaire at hospital admission and then received either usual care or usual care plus a hospital-based smoking-cessation intervention regardless of interest in stopping smoking. Intervention components included a 20-minute bedside counseling session, a 12-minute videotape, a variety of self-help materials, and a follow-up telephone call. Special attention was given to techniques for preventing relapse after hospital discharge. Defining ex-smokers as those who reported no tobacco use at both 3- and 12-month follow-up assessments, and counting those lost to follow-up as smokers, the intervention increased the proportion of patients who quit smoking by one half (9.2% vs 13.5%, P < 0.05). These results demonstrate the efficacy of a brief in-hospital intervention and suggest that relapse-prevention efforts are needed to convert temporary cessation during hospitalization into long-term abstinence.

Adult↗
PubMed1992

The accuracy of self-report of fractures in elderly women: evidence from a prospective study.

The authors compared self-reports of non-spine fractures in a cohort of elderly white women with radiologic reports and medical records. Subjects (n = 9,704) were recruited between 1986 and 1988 in Baltimore, Pittsburgh, Minneapolis, and Portland, Oregon. Eleven percent (95% confidence interval 9-13%) of self-reports of fracture were false-positive (radiographs were negative) and a total of 20% (18-23%) could not be confirmed (radiographs were negative, uncertain, or not available). Report by proxy respondent was more accurate than self-report. There were no confirmed fractures in the medical records of a random sample of 283 participants who did not report a fracture. The percent of false-positives varied by the site of the injury and was low for self-reported fractures of the shoulder or upper arm (5%; 1-13%), wrist (8%; 4-11%), and hip (11%; 5-19%), but was high for hand or finger (20%; 12-30%), rib (23%; 15-32%), and face or skull (33%; 17-54%). Having a college education was associated with increased accuracy, while a history of falls and self-reported osteoporosis were associated with decreased accuracy. The authors conclude that elderly women overreport fractures, but that self-report is relatively accurate for several important osteoporotic fractures, including those of the hip, wrist, and humerus. Self-report of "any" fracture, rib, distal extremity, and head fracture, and fractures in women with a tendency to fall or with osteoporosis should be verified by a radiologic diagnosis.

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PubMed1992

Social networks as predictors of ischemic heart disease, cancer, stroke and hypertension: incidence, survival and mortality.

Three social network measures were obtained from a randomly sampled cohort of 2603 HMO members in 1970-71. Mortality and first incidence of ischemic heart disease, cancer, stroke, and hypertension were assessed over the next 15 years. Outcome data were adjusted for age, sex, smoking, SES, and baseline health status. Persons with histories of a given morbidity at or prior to baseline were excluded from the analyses of that morbidity. Social network measures, particularly network scope (a measure of the number of different domains in which a person has social contacts), were powerful predictors of 15-year mortality hazard, but weak predictors of incident disease. Only network scope predicted IHD incidence, and none of the other morbidities was predicted by the social network measures. However, social network measures were strong predictors of both cause-specific and all-cause mortality among persons who had incident cases of IHD, cancer, and stroke. These data suggest that social networks may be more effective in supporting recovery after illness has occurred than in preventing the incidence of new disease.

Adult↗
PubMed1992

Home blood pressure monitoring. Effect on use of medical services and medical care costs.

The objective of this study was to determine whether a hypertension management program in which patients monitor their own blood pressure (BP) at home can reduce costs without compromising BP control. The prospective, randomized, controlled 1-year clinical trial was conducted at four medical centers of the Kaiser Permanente Medical Care Program in the San Francisco Bay Area. Of 467 patients with uncomplicated hypertension who were referred by their physicians, 37 declined to participate in the study; 215 were randomly assigned to a Usual Care (UC) group and 215 to a Home BP group. Twenty-five UC patients and 15 Home BP patients did not return for year-end BP measurements. Patients in the UC group were referred back to their physicians. Patients in the Home BP group were trained to measure their own BP and return the readings by mail. Patients were given a standard procedure to follow in case of unusually high or low BP readings at home. The number and type of outpatient medical services used were obtained from patient medical records for the study year and the prior year. Costs of care for hypertension were calculated by assigning relative value units to each outpatient service. Trained technicians measured each patient's BP at entry into the study and 1 year later. Home BP patients made 1.2 fewer hypertension-related office visits than UC patients during the study year (95% confidence interval (CI): 0.8, 1.7). Mean adjusted cost for physician visits, telephone calls, and laboratory tests associated with hypertension care was $88.76 per patient per year in the Home BP group, 29% less than in the UC group (95% CI: $16.11, $54.74). The annualized cost of implementing the home BP system was approximately $28 per patient during the study year and would currently be approximately $15. After 1 year, BP control in men in the Home BP group was better than in men in the UC group; BP control was equally good in women in both groups. Management of uncomplicated hypertension based on periodic home BP reports can achieve BP control with fewer physician visits, resulting in substantial cost savings.

Adult↗
PubMed1992

Isolated systolic hypertension: lowering the risk of stroke in older patients. SHEP Cooperative Research Group.

The Systolic Hypertension in the Elderly Program (SHEP) was the first clinical trial to demonstrate the efficacy of low-dose antihypertensive medication in preventing stroke in older individuals with isolated systolic hypertension (ISH). The trial was multicentered, double-blind, randomized, placebo-controlled and involved 4,736 men and women, black and white, age 60 and over with ISH. Results showed a highly significant 36% reduction in nonfatal plus fatal stroke over 5 years in the group treated with active medication (low-dose chlorthalidone was step one), compared with the placebo group. Nonfatal plus fatal coronary disease and cardiovascular disease were also significantly reduced with antihypertensive medication, by 27% and 32% respectively, and total mortality was lower by 13%.

Aged↗
PubMed1991

Non-trauma mortality in elderly women with low bone mineral density. Study of Osteoporotic Fractures Research Group.

9704 ambulatory women aged 65 years or older were prospectively studied to determine whether low bone mineral density (osteopenia) was associated with mortality. Bone mineral density was measured at entry to the study by single-photon absorptiometry. 299 women died during a mean of 2.8 years' follow-up. Osteopenia was associated with increased non-trauma mortality, probably because it is a marker for several other adverse factors. Each standard deviation decrease in proximal radius bone mineral density (0.104 g/cm2) was associated with a 1.19-fold increase in mortality (95% confidence interval 1.04-1.36), adjusted for age and duration of follow-up. Diminished bone mineral density at the proximal radius was strongly associated with deaths from stroke (relative risk = 1.74; 95% CI 1.12-2.70), an association that was not confounded by history of previous stroke, hypertension, postmenopausal use of oestrogen, thiazide diuretic treatment, diabetes mellitus, and smoking. Most deaths in women with low bone mineral density are unrelated to the occurrence of fractures-an observation that should be taken into account when estimating the need for and cost-effectiveness of bone-density screening and fracture prevention programmes.

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