Search PubMed⌕ Search

Biomedical subjects

Vanessa A Diaz

Publications and source records attributed to Vanessa A Diaz.

16 recordsLinked to original sources
PubMed2006

Association of a polychlorinated dibenzo-p-dioxin, a polychlorinated biphenyl, and DDT with diabetes in the 1999-2002 National Health and Nutrition Examination Survey.

The association of a polychlorinated dibenzo-p-dioxin, a polychlorinated biphenyl, and p,p'-DDT with diabetes was evaluated using the 1999-2002 National Health and Nutrition Examination Survey. Persons 20 years old and older were included. Relationships with diagnosed diabetes, undiagnosed diabetes (glycohemoglobin (HbA1c) >6.1%), and total diabetes (diagnosed plus undiagnosed) were tested. When all three chemicals were evaluated together for total diabetes, the unweighted number of participants was 1830. All three compounds were significantly associated with diagnosed diabetes. PCB 126 and p,p'-DDT were significantly associated with undiagnosed diabetes. 1,2,3,6,7,8-hexachlorodibenzo-p-dioxin (HxCDD) was not associated with undiagnosed diabetes. When the three chemicals were included in a combined model for total diabetes, PCB 126>83.8pg/g lipid adjusted had an odds ratio of 2.57 (95% CI 1.33-4.95) compared to PCB 126 < or = 31.2pg/g lipid adjusted. Also significant in a combined model for total diabetes was p,p'-DDT 20.8-26.6ng/g lipid adjusted with an odds ratio of 2.52 (95% CI 1.26-5.02) and p,p'-DDT >26.6ng/g lipid adjusted with an odds ratio of 2.74 (95% CI 1.44-5.23) both compared to p,p'-DDT < or = 20.7ng/g lipid adjusted. HxCDD was not associated with total diabetes in a combined model. When participants with poor liver function and poor kidney function were removed from the analysis, the combined model for total diabetes produced similar results with PCB 126 and p,p'-DDT having been significantly associated, and HxCDD not having been associated. These findings add to the list of chemicals found to be associated with diabetes in the 1999-2002 National Health and Nutrition Examination Survey.

Adult↗
PubMed2006

Does fingernail polish affect pulse oximeter readings?

INTRODUCTION: Results from previous studies evaluating the effect of nail polish on oxygen saturation (SpO(2)) determined by pulse oximeter monitors are inconsistent. Establishing the effect of nail polish on SpO(2) is relevant to clinical practice, since removing nail polish requires clinical time and supplies. OBJECTIVE: The objective of this study was to determine if fingernail polish affects SpO(2) as measured by two different pulse oximeter machines. METHODS: Absorption spectra of 10 nail polish colors were obtained by spectrophotometry. Twenty-seven healthy volunteers with SpO(2)> or =95% participated. Using the Nellcor N20 and N595 pulse oximeters, the mean SpO(2) was measured on each of 10 nails with and without nail polish and using a side-to-side configuration. Means were compared using paired t-tests. RESULTS: Mean SpO(2) had a statistically significant decrease with brown and blue nail polish using both machines (p<0.05) but this was not clinically significant (<1% difference). Using the side-to-side configuration, the N595 oximeter had a statistically significant decrease in mean SpO(2) with red nail polish but again this was not clinically significant. CONCLUSION: Fingernail polish does not cause a clinically significant change in pulse oximeter readings in healthy people.

Adult↗
PubMed2006

Competing impact of excess weight versus cardiorespiratory fitness on cardiovascular risk.

Obesity is a risk factor for cardiovascular disease, whereas high cardiorespiratory fitness (CRF) is cardioprotective. This study evaluated the competing effect of weight and fitness on biomarkers of cardiovascular risk in a nationally representative sample of 2,112 adults (20 to 49 years of age; body mass index [BMI] > or =18.5 kg/m(2)) without previously diagnosed cardiovascular disease from the National Health and Nutrition Examination Survey 1999 to 2002. CRF levels were assigned using age- and gender-specific reference points of estimated maximal oxygen consumption calculated from submaximal graded exercise treadmill testing. CRF was also categorized by sample-specific tertiles of maximal oxygen consumption. Weight was categorized using BMI. Fasting insulin level >12.2 mU/L, C-reactive protein level > or =3.0 mg/L, and total cholesterol/high-density lipoprotein ratio (TC/HDL) >5 characterized increased cardiovascular risk. CRF and BMI were independently associated with increased fasting insulin and C-reactive protein (p <0.05). When patients with low, moderate, and high CRF were further stratified as normal, overweight, or obese, weight remained significantly associated with increased fasting insulin, C-reactive protein, and TC/HDL (p <0.001), but CRF did not. Logistic regressions evaluating increased fasting insulin, C-reactive protein, and TC/HDL demonstrated no significant differences in overweight/obese patients by CRF level after adjustment for other factors. Significant differences were present between normal-weight and overweight or obese patients regardless of fitness level. Analyses using tertiles of CRF yielded similar results. In conclusion, patients who are "fat but fit" require weight-loss interventions to improve their cardiovascular risk profiles. Future interventions should emphasize weight control, even for those with high CRF.

Adult↗
PubMed2006

Diabetes management in the USA and England: comparative analysis of national surveys.

OBJECTIVES: To compare diabetes management in adults between England and the United States, particularly focusing on the impact of a universal access health insurance system. DESIGN: Analysis of the nationally-representative surveys Health Survey of England, 2003 (unweighted n =14 057) and the National Health and Nutrition Examination Survey, 2001-2002 (unweighted n =5411). SETTING AND PARTICIPANTS: Adults 20-64 years of age; individuals >65. MAIN OUTCOME MEASURES: Glycaemic, lipid and blood pressure control and medication use among individuals with previously diagnosed diabetes. RESULTS: Among those aged 20-64 the prevalence of diagnosed diabetes was lower in England (2.7%) than in the USA (5.0%). The proportion with diabetes receiving treatment was similar for the two countries. However, the mean HbA1c in England was 7.6%: in the USA it was 7.5% for those with insurance and 8.6% for those without insurance. The proportion of individuals on ACE inhibitors in England was 39%: in USA it was 39% for those with insurance, and 14% for those without. CONCLUSIONS: Individuals in a healthcare system providing universal access have better managed diabetes than those in a market based system once one accounts for insurance.

Adult↗
PubMed2006

Practice patterns in sildenafil prescribing.

BACKGROUND: This study explores the incorporation of sildenafil into treatment of the common conditions of psychosexual and erectile dysfunction (ED). METHODS: The 2002 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey were analyzed for visits in which sildenafil was prescribed. Patient, visit, and provider characteristics for visits in which sildenafil was prescribed were compared between visits that documented a presenting complaint or diagnosis consistent with ED and those without documentation consistent with ED. RESULTS: Of visits by men 30 years or older receiving sildenafil, 50% had no documented presenting complaint or diagnosis consistent with ED. No significant differences were found between those prescribed sildenafil with or without a reason for visit or diagnosis of ED based on age, race, or payment type. Individuals with more visits in the last 12 months were significantly less likely to have a recorded diagnosis consistent with ED. Urologists documented ED significantly more often than family medicine, internal medicine, and other physicians. CONCLUSIONS: Sildenafil is being prescribed at a significant number of visits without documentation of a reason for visit or diagnosis consistent with psychosexual or erectile dysfunction.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2006

Multiple lipid scoring system for prediction of coronary heart disease risk: application to African Americans.

BACKGROUND: Clinicians often obtain a panel of lipids but then only use low-density-lipoprotein (LDL) cholesterol to make clinical decisions. We previously described the multiple lipid measure, a strategy that integrates information about seven lipid measures. Our current inquiry uses the multiple lipid measure to create a scoring system and validates that system in a second cohort. METHODS AND RESULTS: A scoring system that uses total cholesterol, high-density lipoprotein (HDL) cholesterol, LDL cholesterol and triglycerides was developed and tested. African-American participants of the Atherosclerosis Risk in Communities (ARIC) Study were used to validate the multiple lipid measure score. For nonsmokers, scores > or = 2 had a hazard ratio of 4.25 (95% CI 1.92-9.40) compared to reference scores of < or = -3 in adjusted survival analysis predicting incident coronary heart disease risk in the ARIC. The best conventional single lipid measure for nonsmokers was LDL cholesterol. Compared to LDL cholesterol <100 mg/dl, those with LDL cholesterol > or = 160 mg/dl had a hazard ratio of 2.31 (95% CI 1.13-4.75). For current smokers, the best conventional lipid measure was the total cholesterol/HDL cholesterol ratio, which was similar in predictive ability to the multiple lipid measure score. However, the multiple lipid measure score predicted an additional 10% of the cohort at risk compared to the total cholesterol/HDL cholesterol ratio. CONCLUSIONS: The use of the multiple lipid scoring system improves the assessment of incident coronary heart disease risk and may have utility for clinicians in integrating lipid values.

Black or African American↗
PubMed2005

Predicting coronary heart disease risk using multiple lipid measures.

Principal component analysis was used to summarize variations among 7 lipid measures included in the Framingham Offspring Study (n = 2,694). An overall measure combining information from the 7 lipids was compared with conventional lipid measures in adjusted survival analyses and was found to be a superior predictor of coronary heart disease risk.

Adult↗
PubMed2005

The association between weight fluctuation and mortality: results from a population-based cohort study.

Previous studies evaluating the association between weight fluctuation and mortality are limited and have conflicting results. This study will further evaluate the association between weight fluctuation and mortality in a nationally representative cohort by performing survival analysis of NHANES I and NHANES I Epidemiologic Follow-up Study (n = 8479; weighted sample = 68,200,905). This cohort was followed from 1971 to 1992 and categorized using weight change over five time points into stable non-obese, stable obese, weight gain, weight loss and weight fluctuation groups. All-cause mortality (ACM) and cardiovascular mortality (CM) were evaluated. Respondents with weight fluctuation had higher ACM (HR: 1.83, 95% CI: 1.25-2.69) and CM hazards ratios (HR: 1.86, 95% CI: 1.10-3.15) than the stable non-obese group, even after controlling for pre-existing disease, initial BMI and excluding those in poor health or incapacitated. Increased mortality was also seen in the weight loss group (ACM HR: 3.36, 95% CI: 2.47-4.55), (CM HR 4.22, 95% CI: 2.60-6.84). The stable obese group did not have increased ACM, but did have increased CM prior to the exclusion of those in poor health or incapacitated. (HR: 2.17, 95% CI: 1.10-4.28). Weight fluctuation is associated with a higher risk of all-cause and cardiovascular disease mortality in the US population, even after adjustment for pre-existing disease, initial BMI and the exclusion of those in poor health or incapacitated. Thus, health care providers should promote a commitment to maintaining weight loss to avoid weight fluctuation and consider patients' weight histories when assessing their risk status.

Adult↗
PubMed2005

Race and diet in the overweight: association with cardiovascular risk in a nationally representative sample.

OBJECTIVE: Because dietary differences may account for much of the racial and ethnic disparities in cardiovascular risk status, we evaluate the effect of race on cardiovascular risk after adjustment for dietary factors. METHODS: Prevalence of healthy diets in overweight U.S. adults (body mass index > or = 25 kg/m(2), age > or = 18 y) by race or ethnicity was determined by using 24-h dietary recalls from the National Health and Nutrition Examination Survey of 1999 to 2000. Dietary recalls included daily total calories, percentage of calories obtained from saturated fat, cholesterol, dietary fiber, and sodium and potassium intakes. Logistic regressions were used to evaluate the association between race/ethnicity, dietary factors, and cardiovascular risk markers (high levels of total cholesterol, C-reactive protein, systolic blood pressure, and diastolic blood pressure and low levels of high-density lipoprotein). RESULTS: The percentage of respondents who met healthy diet parameters ranged from 11.2 to 63.3. Non-Hispanic whites without diagnosed disease were less likely to have healthy diets than were African Americans or Hispanics, except with regard to cholesterol and fiber intake. After controlling for dietary factors, African American ethnicity was associated with a lower risk of hypercholesterolemia (odds ratio 0.587, 95% confidence interval 0.403 to 0.855), lower level of high-density lipoprotein (odds 0.440, 95% confidence interval 0.236 to 0.763), and a greater risk of high systolic blood pressure (odds ratio 2.383, 95% confidence interval 1.043 to 5.442) compared to whites. CONCLUSIONS: Differences in adherence to healthy diet parameters by race/ethnicity exist. However, after adjustment for diet and other modifiable factors, African Americans have a decreased risk of hypercholesterolemia and low level of high-density lipoprotein but an increased risk of systolic hypertension. Further research into the genetic basis for these differences is suggested.

Adult↗
PubMed2005

Prevalence of breastfeeding and acculturation in Hispanics: results from NHANES 1999-2000 study.

BACKGROUND: A more current estimate to evaluate ethnic and acculturation differences in breastfeeding is warranted, given the rapid growth of the Hispanic population in the United States and the proliferation of breastfeeding promotion programs. The study objective was to describe current national estimates of the prevalence of breastfeeding and evaluate differences in reasons not to breastfeed by acculturation status. METHODS: Secondary data analysis of the National Health and Nutrition Examination Survey (NHANES) 1999-2000 was performed on a nationally representative sample of non-Hispanic white women born in the U.S. and Hispanic women with at least one live birth. Acculturation status among Hispanics was assessed using a validated language scale, and prevalence of breastfeeding was based on maternal self-report. RESULTS: Prevalence of breastfeeding was higher in less acculturated Hispanic women (59.2%) than high acculturated Hispanic women (33.1%) and white women (45.1%). Less acculturated Hispanic women were more likely to cite their child's physical/medical condition as a reason not to breastfeed (53.1%), whereas whites and more acculturated Hispanics were more likely to cite their child preferred the bottle (57.5% and 49.8%, respectively). A logistic regression analysis revealed no significant differences in likelihood to breastfeed between non-Hispanic whites and Hispanics after controlling for education, age, and income. Higher acculturated women were less likely to breastfeed their children than low acculturated women (95% CI: 0.14-0.40) even after education, age, and income were taken into account. CONCLUSIONS: Acculturation differences in prevalence of breastfeeding and reasons not to breastfeed may be the result of attitudinal changes that occur due to acculturation. Further research into the acculturation process and its impact on breastfeeding may help to prevent the decline in breastfeeding that occurs as mothers become more acculturated. Meanwhile, patient education that addresses women's perceptions of the child's health condition and benefits of breastfeeding would be helpful.

Acculturation↗
PubMed2004

Undiagnosed obesity: implications for undiagnosed hypertension, diabetes, and hypercholesterolemia.

BACKGROUND AND OBJECTIVES: Since obesity is a risk factor for hypertension, diabetes, and hypercholesterolemia, health care providers should screen obese individuals for these common diseases. It is possible that obese adults are not receiving appropriate screening for these diseases. This study's objective was to describe the prevalence of undiagnosed obesity, diabetes, hypertension, and hypercholesterolemia, in a nationally representative sample of obese US adults, by patients' recollection of whether they had received such a diagnosis. METHODS: The prevalence of undiagnosed disease was obtained by identifying respondents in the 1999-2000 National Health and Nutrition Examination Survey (NHANES) who had findings consistent with a condition but who did not report being told they had that condition by a health care provider. RESULTS: The prevalence of undiagnosed obesity, diabetes, hypertension, and hypercholesterolemia in currently obese US adults is 22.9%, 11.3%, 16.1%, and 37.7%, respectively. Significant predictors of undiagnosed obesity include black race and younger age. In addition, obese adults with excellent self-reported general health condition and lower body mass index are less likely to have diagnosed obesity. CONCLUSIONS: Health care providers are missing valuable opportunities to address obesity and diagnose diabetes, hypercholesterolemia, and hypertension in obese adults. An emphasis on screening obese individuals for these diseases is needed to improve health promotion.

Adult↗
PubMedDate not supplied

Acculturation and diabetes among Hispanics: evidence from the 1999-2002 National Health and Nutrition Examination Survey.

OBJECTIVE: Hispanic individuals in the United States have a greater prevalence of diabetes mellitus than non-Hispanic white individuals; however, it is unclear whether Hispanics' risk of diabetes differs based on their level of acculturation. The purpose of our research was to examine acculturation among Hispanic Americans with respect to prevalence and control of diabetes. METHODS: We conducted an analysis of the National Health and Nutrition Examination Survey (NHANES), 1999-2002, a nationally representative sample of the noninstitutionalized U.S. population. We evaluated data on Hispanic adults (> or = 18 years of age, unweighted n=2,696), analyzing diagnosed diabetes, glycemic blood pressure and lipid control, and diabetes complications according to acculturation as measured by language and birth outside the United States. RESULTS: Hispanics with low acculturation were more likely to be without a routine place for health care, have no health insurance, and have low levels of education. In adjusted analyses, individuals with low acculturation, measured by language, were more likely to have diabetes (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.02, 3.54). Among individuals with diagnosed diabetes, no significant association was yielded between acculturation and diabetes control. However, individuals with low language acculturation were more likely to have the diabetes complication of peripheral neuropathy (OR 4.01, 95% CI 1.40, 11.48). CONCLUSIONS: Acculturation as measured through language is associated with diabetes and complications among Hispanics even after controlling for a variety of demographic characteristics including health insurance and education. The findings suggest that even within a "single" minority ethnic group, there are differences in disease prevalence and complications and access to health care.

Acculturation↗
PubMedDate not supplied

Changes in age at diagnosis of type 2 diabetes mellitus in the United States, 1988 to 2000.

PURPOSE: The prevalence of diabetes in the United States is increasing. There is also concern that diabetes may be occurring at a greater frequency in youth and in young adults. We describe US population trends in self-reported age at diagnosis of type 2 diabetes mellitus. METHODS: We undertook a secondary analysis of data from the National Health and Nutrition Examination Survey (NHANES) 1999-2000 and NHANES III (1988-1994). Both surveys are stratified, multistage probability samples targeting the civilian, noninstitutionalized US population, which allow calculation of population estimates. We included adults aged 20 years and older. We compared self-reported age at diagnosis of type 2 diabetes between the 2 survey periods. RESULTS: The mean age at diagnosis decreased from 52.0 to 46.0 years (P <.05). Racial and ethnic differences in age at diagnosis found in 1988 to 1994 are no longer found in 1999 to 2000. CONCLUSIONS: The age at diagnosis of type 2 diabetes mellitus has decreased with time. This finding likely represents a combination of changing diagnostic criteria, improved physician recognition of diabetes, and increased public awareness. Younger age at diagnosis may also reflect a true population trend of earlier onset of type 2 diabetes.

Age Factors↗
PubMedDate not supplied

Nasal carriage of Staphylococcus aureus and methicillin-resistant S aureus in the United States, 2001-2002.

PURPOSE: Staphylococcus aureus is a common cause of invasive infections, yet most assessments of prevalence are based on health care-based samples. We computed population-based estimates of nasal carriage of S aureus and risk factors for carriage, as well as population-based estimates of nasal carriage of methicillin-resistant S aureus (MRSA). METHODS: We used the National Health and Nutrition Examination Survey (NHANES) 2001-2002 to estimate carriage of S aureus and MRSA for the non-institutionalized US population including children and adults. RESULTS: An estimated 86.9 million persons (32.40% of the population) were colonized with S aureus. The prevalence of MRSA among S aureus isolates was 2.58%, for an estimated population carriage of MRSA of 0.84% or 2.2 million persons. Among individuals with S aureus isolates, individuals aged 65 years or older had the highest MRSA prevalence (8.28%). Among all the racial/ethnic groups studied, Hispanics had the highest prevalence of colonization with S aureus but, when colonized, were less likely to have MRSA. CONCLUSIONS: This first nationally representative assessment of carriage of S aureus indicates that nearly one third of the population is currently colonized by this organism. Although the prevalence of MRSA remains low, more than 2.2 million people carry this resistant organism; thus, vigilance in promoting appropriate microbial transmission protocols should remain a priority.

Adolescent↗