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Biomedical subjects

V M Hawthorne

Publications and source records attributed to V M Hawthorne.

At least 37 records · Page 2Linked to original sources
PubMed1991

The juvenile-onset, adolescent-onset and adult-onset obese.

As shown in more than 8000 proband-parent pairs derived from a total-community sample and followed in longitudinal fashion, the 5-year incidence of obesity (new cases per 5-year period) approximates 8 percent for the juvenile-onset, adolescent-onset and adult-onset obese alike. Parents of juvenile-onset (ages 5-9), adolescent-onset (10-19) and adult-onset obese (20-39) tend to be of above-average fatness level, +0.25Z scores, overall, regardless of the age at onset of obesity in their progeny. Except for the parents of the juvenile-onset obese, educational level of the parents tends to be below average for the sample as a whole. These new data acquired in longitudinal context and explored in retrospective-prospective fashion do not substantiate the notion that different onset ages of obesity indicate separate etiologies and different family constellations.

Adolescent↗
PubMed1990

Characteristics of individuals and long term reproducibility of dietary reports: the Tecumseh Diet Methodology Study.

Food frequency reports in 1967-1969 were compared to frequency reports of the same foods asked retrospectively in 1982-1983 and 1967-1969 for 1184 respondents aged 45-64 years in the Tecumseh Community Health Study. The kappa statistic for concordance of the retrospective and baseline reports was used as a summary measure of the individual's ability to reproduce his or her earlier diet report. Reproducibility was estimated for total diet, represented by 83 foods, and for 9 subsets of foods of epidemiologic interest. In bivariate and multivariate analyses, reproducibility was strongly related to stability of diet; those whose diets changed least over the 15-year period had greatest diet reproducibility. Greater total diet reproducibility was also found among men with higher education, among women of less than 110% desirable weight reporting no special diet and among women reporting no medications. Consistent with current models of memory, the retrospective report of diet was strongly related to the current report of diet. Agreement between the retrospective and baseline diet reports was greater than agreement between the current and baseline diet reports. This indicates that, as a proxy for past diet, the retrospective report of diet is superior to the current report. Similar relationships were found for the 9 subset of foods.

Body Weight↗
PubMed1990

A comparison of survival among dialytic therapies of choice: in-center hemodialysis versus continuous ambulatory peritoneal dialysis at home.

Analyses were performed on a series of 2,754 dialysis patients between the ages of 20 and 60 years whose end-stage renal disease (ESRD) therapy started in Michigan from 1980 through 1987 with the selection of either center hemodialysis (CH) or continuous ambulatory peritoneal dialysis (CAPD). The dialytic treatment at 6 months after first ESRD therapy was selected as the dialytic "treatment of choice" for each patient. Analyses of subsequent survival showed lower death rates for black patients than for white patients with hypertension (P less than 0.01) and diabetes (P less than 0.01). Death rates increased with patient age more dramatically among glomerulonephritis patients than among the other diagnostic groups (P less than 0.05). Females had significantly lower death rates than did males among diabetic patients (P less than 0.01). While no significant difference was found in average death rates between CH and CAPD (NS), there was a significant difference (P less than 0.05) in the trend in death rates. Death rates among CH patients increased significantly (P less than 0.001) during the study period, whereas death rates among CAPD patients have improved slightly (NS).

Adult↗
PubMed1990

Cigarette smoking and neuropathy in diabetic patients.

We studied whether lifetime cigarette smoking is associated with the presence of diabetic neuropathy. The research design consisted of a case-control study conducted from a referral-based diabetes clinic at a major medical center. The patients were a 65% sample (163 insulin-dependent diabetes mellitus [IDDM] and 166 non-insulin-dependent diabetes mellitus [NIDDM] patients) of all patients admitted during a 26-mo period. Neuropathy was diagnosed on the basis of signs and symptoms. Smoking history was obtained by mailed questionnaire (66% response rate). Diabetes duration, HbA1, age, sex, peripheral vascular disease, hypertension history, and lifetime alcohol consumption were measured as covariates. The prevalence of neuropathy was 49 and 38% in IDDM (n = 113) and NIDDM (n = 104) patients, respectively. In IDDM, but not NIDDM, current or ex-smokers were significantly more likely to have neuropathy than individuals who had never smoked (odds ratio 2.46, P = 0.02), and the prevalence of neuropathy increased with increasing number of pack-years smoked (P less than 0.001). After adjustment for covariates, IDDM patients smoking greater than or equal to 30 pack-yr were 3.32 times more likely to have neuropathy than patients smoking less than this amount (95% confidence interval 1.15-9.58, P = 0.026). Cigarette smoking was associated with the presence of neuropathy in this clinic-based population of IDDM patients. The hypothesis that cigarette smoking is associated with diabetic neuropathy should be investigated further, both prospectively and in a more representative population.

Adult↗
PubMed1989

Disparities in incidence of diabetic end-stage renal disease according to race and type of diabetes.

The incidence of end-stage renal disease in patients with diabetes mellitus is reportedly higher among blacks than among whites. This finding may be explained by the greater prevalence of diabetes among blacks. The relation of the type of diabetes to the risk of diabetic end-stage renal disease is largely unstudied. We addressed these issues in a study of all the black and white diabetic patients with end-stage renal disease (470 blacks and 861 whites) reported to the Michigan Kidney Registry who began treatment during 1974 through 1983. We also reviewed the medical records of a subpopulation of such patients (284 blacks and 310 whites) who were less than 65 years of age at the start of treatment for end-stage renal disease to determine what type of diabetes they had. In this study, we made use of national data on the prevalence of diabetes. We found that the incidence of diabetic end-stage renal disease was 2.6-fold higher (P less than or equal to 0.0001) among blacks after we adjusted for the higher prevalence of diabetes among blacks, with the excess risk occurring predominantly among blacks with non-insulin-dependent diabetes mellitus (NIDDM). Most black patients with diabetic end-stage renal disease had NIDDM (77 percent), whereas most white patients with diabetic end-stage renal disease had insulin-dependent diabetes mellitus (IDDM) (58 percent) (P less than or equal to 0.0005 for the difference between the races). For both races combined, the risk of diabetic end-stage renal disease during the 10-year period we studied was markedly greater for patients with IDDM (5.8 percent) than for those with NIDDM (0.5 percent). Our results indicate an increased risk of diabetic end-stage renal disease among blacks as compared with whites, particularly blacks with NIDDM. Although the risk of diabetic end-stage renal disease is higher in patients with IDDM, the majority of patients with diabetic end-stage renal disease in the population we studied had NIDDM.

Adolescent↗
PubMed1989

Passive smoking and cardiorespiratory health in a general population in the west of Scotland.

UNLABELLED: OBJECTIVE-To assess the risk of cardiorespiratory symptoms and mortality in non-smokers who were passively exposed to environmental smoke. DESIGN: Prospective study of cohort from general population first screened between 1972 and 1976 and followed up for an average of 11.5 years, with linkage of data from participants in the same household. SETTING: Renfrew and Paisely, adjacent burghs in urban west Scotland. SUBJECTS: 15,399 Men and women (80% of all those aged 45-64 resident in Renfrew or Paisley) comprised the original cohort; 7997 attended for multiphasic screening with a cohabitee. Passive smoking and control groups were defined on the basis of a lifelong non-smoking index case and whether the cohabitee had ever smoked or never smoked. MAIN OUTCOME MEASURE: Cardiorespiratory signs and symptoms and mortality. RESULTS: Each of the cardiorespiratory symptoms examined produced relative risks greater than 1.0 (though none were significant) for passive smokers compared with controls. Adjusted forced expiratory volume in one second was significantly lower in passive smokers than controls. All cause mortality was higher in passive smokers than controls (rate ratio 1.27 (95% confidence interval 0.95 to 1.70)), as were all causes of death related to smoking (rate ratio 1.30 (0.91 to 1.85] and mortality from lung cancer (rate ratio 2.41 (0.45 to 12.83)) and ischaemic heart disease (rate ratio 2.01 (1.21 to 3.35)). When passive smokers were divided into high and low exposure groups on the basis of the amount smoked by their cohabitees those highly exposed had higher rates of symptoms and death. CONCLUSION: Exposure to environmental tobacco smoke cannot be regarded as a safe involuntary habit.

Age Factors↗
PubMed1989

Plasma cholesterol, coronary heart disease, and cancer in the Renfrew and Paisley survey.

The relation between plasma cholesterol concentration and mortality from coronary heart disease, incidence of and mortality from cancer, and all cause mortality was studied in a general population aged 45-64 living in the west of Scotland. Seven thousand men (yielding 653 deaths from coronary heart disease, 630 new cases of cancer, and 463 deaths from cancer) and 8262 women (322 deaths from coronary heart disease, 554 new cases of cancer, and 395 deaths from cancer) were examined initially in 1972-6 and followed up for an average of 12 years. All cause mortality was not related to plasma cholesterol concentration. This was largely a consequence of a positive relation between cholesterol values and mortality from coronary heart disease being balanced by inverse relations between cholesterol and cancer and between cholesterol and other causes of death. These changes were highly significant for coronary heart disease and cancer in men and significant for coronary heart disease and other causes of death in women. The inverse association between cholesterol concentration and cancer in men was strongest for lung cancer, was not merely a function of the age at which a subject died, was present for the incidence of cancer as well as mortality from cancer, and persisted when new cases or deaths occurring within the first four years of follow up were excluded from the analysis.

Cause of Death↗
PubMed1989

Comparison of surrogate and subject reports of dietary practices, smoking habits and weight among married couples in the Tecumseh Diet Methodology Study.

Agreement between surrogate and subject reports of current food frequencies and other eating habits, smoking behavior and weight was assessed in 1982-1983 for 180 husbands and wives, aged 45 through 64 years. Agreement was measured by per cent exact agreement and weighted kappa for frequencies of 30 itemized foods or food groups, and for surrogate- and subject-based quintiles of frequencies of eight broad food groups and of vitamin A and C consumption indexes. Surrogate and subject mean frequencies were generally similar, but at the individual level of analysis, agreement varied widely. Agreement was greatest, among the food items and groups, for alcoholic beverages, and among the other items, for smoking status. Extreme misclassification by quintile was very small, but only 40% of persons self-classified in either extreme quintile were similarly classified by their spouses. This level of misclassification may result in the dilution of real relationships between diet and health.

Aged↗
PubMed1989

The charges for ESRD treatment of diabetics.

To evaluate the differential charges for treating end-stage renal disease (ESRD) associated with diabetes mellitus, Medicare billing data are analyzed. The charges of 244 patients in the Michigan Kidney Registry identified as having (ESRD) from diabetes are compared with charges of 902 nondiabetic patients. Average annual charges for ESRD treatment for diabetics are +29,671 (+/- 27,662) which are +4695 (+/- 1344) higher than charges for nondiabetics. The majority of the difference (84.3%) is attributable to higher inpatient hospital charges. Most of the remainder (14.5%) is attributable to higher physician and medical supply charges. Charges for treatment of diabetics are higher on all modalities of treatment, but differences are not significant among modalities.

Adult↗
PubMed1989

Independence in activities of daily living for end-stage renal disease patients: biomedical and demographic correlates.

Factors associated with physical well-being were examined in a population-based sample of adult end-stage renal disease (ESRD) patients in Michigan (n = 459). The dependent variables were two measures of physical functioning: (1) a ten-item measure of activities of daily living (ADL), and (2) the 45-item physical dysfunction dimension of the Sickness Impact Profile (SIP). Independent variables included four modalities of treatment (in-center hemodialysis, continuous ambulatory peritoneal dialysis [CAPD], related transplant, and cadaver transplant); primary cause of ESRD (eg, diabetes, glomerulonephritis); comorbidity (other illnesses besides primary cause of ESRD); and demographic characteristics (sex, race, age, marital status, education). ADL and SIP unadjusted mean scores differed significantly by category for each of the eight study factors (analysis of variance [ANOVA], P less than 0.0001), with the exception of sex for SIP means. The highest levels of dependency in ADL were reported by patients who were older, female, black, widowed, less educated, treated with in-center hemodialysis, had diabetes as the primary cause of ESRD, and/or reported more comorbidity. The partial effect of each factor on the dependent measures with adjustment for the seven other factors was assessed using analysis of covariance (ANCOVA). In the ADL analysis, sex, race, age, primary cause of kidney failure, and comorbidity were significant factors (probability values ranging from 0.05 for race to 0.0001 for sex, primary cause of ESRD, and comorbidity). The SIP physical dysfunction measure gave slightly different results. Race, age, primary cause of ESRD, comorbid status, and modality of treatment were significantly related to physical dysfunction (P less than 0.05 to P less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1989

Neoplasms in dialysis patients: a population-based study.

Cancer incidence was assessed in 4,161 end-stage renal disease (ESRD) patients on dialysis to determine whether there was any excess risk of cancer in this population. Records from the Michigan Kidney Registry (MKR) for 1973 to 1984 were linked to those of the Michigan Cancer Foundation's Metropolitan Detroit Cancer Surveillance System (MDCSS) to identify cases in the dialysis cohort. The expected number of cancers in the ESRD population was calculated using the race-, sex-, age- and calendar year-specific incidence rates of the tricounty metropolitan Detroit region of 4 million residents. The standardized incidence ratio (observed:expected) was significantly increased for all in situ tumors combined, as well as for invasive tumors of the kidney, the corpus uteri, and the prostate. The four-fold to five-fold excess (P less than 0.005) observed for renal and endometrial cancers, in addition to the significantly elevated (P less than 0.05) risk of prostate cancer indicates that patients maintained on dialysis should be evaluated for these tumors when they experience even minor symptoms. Population-based cancer and renal disease registries provide excellent opportunities for investigating etiologic hypotheses and future studies should incorporate potential risk factors when analyzing these data.

Adult↗
PubMed1989

Educational level, fatness, and fatness differences between husbands and wives.

In 1017 husband-wife pairs aged 20-49 y, both fatness and weight of the wives is inversely and linearly related to educational level whereas the husbands' summed skinfold measurements bear a curvilinear, parabolic relationship to years of schooling. Overall, fatness differences between husbands and wives diminish with increased education, and beyond 13 y of education husbands often exceed the subcutaneous fat thickness of their wives. When the education of one spouse is held constant at 9-12 y, women who marry up to men of greater education are systematically leaner and women who mary down are both fatter and heavier. These findings in spouse pairs sharing a common family income suggest that assortative mating with respect to educational level accounts for much of the socioeconomic effect in fatness including the fatness differences between women who marry down and those who marry up. These data also demonstrate that women are not fatter than men at all socioeconomic levels.

Adult↗
PubMed1989

Fatness and obesity of the parents of obese individuals.

As shown in 1419 pairings of obese probands with their parents drawn from a larger series of greater than 9000 proband-parent pairings, the fathers and mothers of obese probands are of increased fatness level (+0.27 Z scores) and more often obese than expected (odds ratio 1.50 overall). However, the tendency towards increased fatness and a greater prevalence of obesity among the parents of obese probands bears a curvilinear relationship to the age of the proband, being least when the probands are young, peaking when the sons and daughters are teen-agers, and declining thereafter. Parents of lean probands in turn tend to be lean themselves (averaging -0.25 Z scores) and least often obese when their progeny are teen-aged. As shown in a two-generational context, familial obesity is best demonstrated in adolescents and their parents, either reflecting years spent in common or a specific etiology for adolescent-onset obesity.

Adolescent↗
PubMed1989

Breathlessness, chronic bronchitis and reduced pulmonary function as predictors of cardiovascular disease mortality among men in England, Scotland and the United States.

Relationships between cardiovascular disease (CVD) mortality and breathlessness, a definition of chronic bronchitis, and pulmonary function are investigated among men in two employed populations (17,717 London civil servants and 4904 Scottish workers) and in two communities (844 men in Tecumseh, Michigan and 6859 men in Renfrew and Paisley Burghs, Scotland). Men are aged 40-64 years at entry in all studies except Renfrew-Paisley, where they are aged 45-64 years. Length of follow-up ranges from 6 to 16 years. Age and smoking habits were controlled for in all analyses. Chronic phlegm production is not significantly associated with CVD mortality, and 'chronic bronchitis' is significantly associated with mortality only in the employed populations. Low FEV1 is significantly associated with CVD mortality only in the Whitehall study; however, the rate ratios are above one in all studies. Breathlessness is significantly associated with CVD mortality in all studies. These associations between CVD mortality and 'chronic bronchitis', low FEV1, and breathlessness persist after also controlling for employment grade, systolic blood pressure, antihypertensive medication, ECG changes, plasma cholesterol level, body mass index and diabetes. Only the associations between breathlessness and mortality persist after further controlling for low FEV1 and myocardial ischaemia. The rate ratios between breathlessness and mortality are about two for all studies. It is concluded that in these populations, breathlessness is an independent and major predictor of CVD mortality.

Adult↗
PubMed1989

Discontinuation of dialysis therapy as a cause of death.

Discontinuation of life-sustaining dialysis therapy led to death in 282 of 5,208 patients who started therapy for end-stage renal disease (ESRD) in Michigan during 1980-1985 with a follow-up through 1986. Based on life table estimates at 60 months after initiation of therapy, 9.4% of patients overall died due to termination of dialysis, 11% of females versus 8% of males (p = 0.02), 0.1-3.4% for ages less than or equal to 49 years versus 56% for greater than 80 years, 12% for white versus 4% for black patients (p less than 0.001) and 16% for diabetic ESRD patients (higher than any other group, p less than 0.05). The Cox regression model confirms these significant findings for race, diabetes and age, and reveals a significant 60% increase in overall withdrawals for the years 1980-1985 (1.10/year, p less than 0.02). A separate analysis of discontinuation of dialysis as the percentage of all 2,564 dialysis deaths in prevalence cases for 1980-1984 revealed an overall ratio of 8.9% with a significant difference for ages less than or equal to 64 versus greater than or equal to 65 (p less than 0.001), race (p less than 0.001) but not for prior transplant failure or continuous ambulatory peritoneal dialysis therapy. Whereas the results for age and diabetes were expected, the significant increase of dialysis withdrawal over time and the racial difference are unexplained by information available at the Michigan Kidney Registry and indicate the need for exploration by further studies.

Actuarial Analysis↗