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Biomedical subjects

W M Vollmer

Publications and source records attributed to W M Vollmer.

At least 19 recordsLinked to original sources
PubMed1995

Use of an automated prescription database to identify individuals with asthma.

We used medication-dispensing information for 4 years (1/1/87 through 12/31/90) to examine the utilization of anti-asthma medications among 175,562 members of a large health maintenance organization. A total of 297,863 anti-asthma medications was dispensed during the study period, over one-half of which (55%) were beta-agonists, followed by aminophylline preparations (23%) and inhaled corticosteroids (13%). Next, we compared the predictive value of three algorithms for identifying individuals with asthma: (1) two or more beta-agonist dispensings, (2) both a beta-agonist and an inhaled corticosteroid dispensing, and (3) five or more total anti-asthma dispensings. We performed chart reviews for 40 subjects aged 5-45 years in each of these three groups and made a clinical judgment, based on all available information in the chart, as to whether each patient had asthma. Two levels of certainty were used: "any asthma" and "definite asthma." All 120 charts reviewed presented a clinical picture consistent with asthma. However, patients identified by the algorithm that included both a beta-agonist and an inhaled corticosteroid were more likely to meet our criteria for "definite" asthma and more likely to have moderate to severe asthma. These results demonstrate the feasibility of using an automated outpatient pharmacy database to identify patients with asthma.

Adolescent↗
PubMed1995

Rationale and design of the Dietary Approaches to Stop Hypertension trial (DASH). A multicenter controlled-feeding study of dietary patterns to lower blood pressure.

Epidemiologic studies have found that dietary patterns characterized by high intakes of certain minerals and fiber are associated with low blood pressure. Dietary Approaches to Stop Hypertension (DASH) is a multicenter, randomized, controlled-feeding trial designed to test the effects on blood pressure of two such dietary patterns consumed for 8 weeks. The two experimental diets will be compared with each other and with a control dietary pattern that is relatively low in potassium, magnesium, calcium, and fiber, and has a fat and protein profile mirroring current consumption. The first experimental diet, arguably termed "ideal," is high in fruits, vegetables, whole cereal products, low-fat dairy products, fish, chicken, and lean meats designed to be low in saturated fat and cholesterol; moderately high in protein; and high in minerals and fiber. The second experimental diet tests the effect of fruits and vegetables alone. Its potassium, magnesium, and dietary fiber content will be at the same high levels as the ideal dietary pattern, while its fat, protein, and calcium content will resemble that of the control dietary pattern. The study population will consist of 456 healthy men and women, aged 22 years or older, with systolic blood pressure less than 160 mm Hg and diastolic blood pressure 80 to 95 mm Hg. African-American and other minority groups will comprise 67% of the population. Participants will eat one of the three dietary patterns. The DASH trial has unique features. First, dietary patterns rather than single nutrients are being tested. Second, all food for the experimental diets is provided to the participants using a standardized multicenter protocol. Because the dietary patterns are constructed with commonly consumed food items, the results, if positive, may be conveniently implemented in dietary recommendations to the general public.

Adult↗
PubMed1995

Effects of cigarette smoking on lung function in four population samples in the People's Republic of China. The PRC-US Cardiovascular and Cardiopulmonary Epidemiology Research Group.

As part of an ongoing study of cardiopulmonary risk factors in the People's Republic of China, we conducted lung function tests and obtained information about smoking habits on 6,765 Chinese men and women 35 to 56 yr of age residing in or around Beijing in the north and in or around Guangzhou in the south. Within each region, separate urban and rural populations were recruited. This study examined the relationship between tobacco consumption (both manufactured cigarettes and leaf tobacco) and lung function in a subset of current smokers and never smokers who had acceptable lung function data. All methods were strictly standardized. Overall, tobacco smoking was associated with a statistically significant mean difference in FEV1 among men (-89 ml) and women (-52 ml) relative to never smokers after adjusting for age, height, and residence. Differences between smokers of cigarettes and smokers of leaf tobacco were not significant. Among the subset of smokers who smoked only cigarettes, this decrement increased with increasing duration of cigarette smoking, but it was small (-4 ml/yr of smoking for FEV1 for both men and women) in comparison with the effects of smoking reported from western countries. Although the smoking effect tended to increase with increasing dose, these differences were small and generally not statistically significant. The relatively small smoking effect in this study may result from differences between developed and developing countries in the cumulative dose of tobacco products. Alternative explanations or contributing factors such as racial differences in susceptibility and differences in the form and delivery of tobacco cannot be discounted.

Adult↗
PubMed1995

Effects of smoking and smoking cessation on longitudinal decline in pulmonary function.

Effects of cigarette smoking and smoking cessation on rate of FEV1 decline over 6 yr were examined in 4,451 Japanese-American men from the Honolulu Heart Program who were 45 to 68 yr of age at baseline (1965-1968). Within-person regression was used to calculate annual change in FEV1. Rates of FEV1 decline varied strongly with smoking status and increased significantly with age. Overall, men who continued to smoke experienced steeper rates of decline compared with men who never smoked (-33 ml/yr versus -22 ml/yr, respectively; p = 0.0001). Rates of decline for those who quit smoking during the first 2 yr (-32 ml/yr) were nearly the same as those who continued smoking (-34 ml/yr). After quitting, their rates of decline diminished to a level (-19 ml/yr) similar to that of men who had never smoked (-21 ml/yr). FEV1 decline in continuing smokers was significantly associated with duration of smoking, whereas associations with intensity and pack-years were of borderline significance. Among 216 men with impaired pulmonary function, those who quit smoking had significantly slower rates of FEV1 decline than did those who continued smoking. Potential reasons for quitting included respiratory conditions and stroke. These results extend previous reports of accelerated rates of FEV1 decline in the persons who continue to smoke, and they indicate that smoking cessation leads to less steep rates of decline in pulmonary function over a short period of time in middle-aged men, as well as in men with established pulmonary impairment.

Aging↗
PubMed1995

Body weight versus body fat distribution, adiposity, and frame size as predictors of bone density.

Weight is strongly associated with bone mineral density (BMD), but the mechanism of this effect is not well understood. Weight, height, hip-waist ratio, elbow breadth, adiposity, and BMD were measured in 6705 older women participating in the Study of Osteoporotic Fractures. Adiposity was measured by bioelectric impedance and BMD by single-photon (proximal and distal radius and calcaneus) and dual-energy x-ray absorptiometry (lumbar spine and proximal femur). Age-adjusted associations between weight and BMD were robust at all sites (R2 = 5.9-20.4%), but the addition of other anthropometric variables to the model only marginally improved the association. Adiposity explained a substantial fraction of the effect of weight on BMD, particularly at weight-bearing sites (36-62%). On the other hand, weight explained virtually all the variability of adiposity on BMD at weight-bearing sites (81-100%). At the radial measurement sites, adiposity had more substantial independent contributions. Weight did not seem to influence the relationship between BMD and age. In sum, at weight bearing-sites, the preponderance of the effect of weight on BMD is a direct result of mass effects rather than adiposity, whereas at non-weight-bearing sites, adiposity exerts more important effects, potentially mediated by metabolic factors.

Adipose Tissue↗
PubMed1992

Recruiting children and their families for clinical trials: a case study.

We describe the recruitment of 226 families for participation in a randomized trial examining the effectiveness of alternative strategies for the management of pediatric asthma. All families were members of a large health maintenance organization. Families of children identified through emergency room and hospital admission records were much more likely to participate in the study than were families of children identified only through outpatient prescription records. Specific details of the recruitment process are described.

Adolescent↗
PubMed1992

Diagnostic accuracy of asthma within a health maintenance organization.

Reported asthma morbidity and mortality are increasing in the U.S. We addressed one explanation, that the accuracy of the diagnosis of asthma is changing. The diagnosis of asthma was evaluated in 320 inpatient and outpatient records bearing the diagnosis of asthma for the periods 1970-73 and 1980-83 in a health maintenance organization (HMO). We determined whether or not our agreement with the chart diagnosis was a function of: sex, period of treatment, inpatient vs outpatient setting, whether or not asthma was the primary or secondary diagnosis, and patient age. The standard of comparison was an expert panel review in which asthma was divided into six categories. In both inpatient (97%) and outpatient settings (94%), the majority of charts examined exhibited a clinical picture consistent with asthma. The rate of the narrowly defined "definite asthma" category varied with respect to age, with the highest proportion in the under 20-year age group (74%) and the lowest (46%) in the over 60 age groups, probably because older individuals often have coexisting smoking related diseases. The increase in "definite asthma" among outpatients from the 1970s to the 1980s likely reflects increasing chart documentation among physicians, illustrating the need for clear, consistent chart documentation of signs and symptoms of asthma.

Adolescent↗
PubMed1992

Twenty year trends in hospital discharges for asthma among members of a health maintenance organization.

We examined trends in hospitalizations for asthma from 1967 to 1987 among members of a large health maintenance organization. During this time asthma discharges increased significantly among children, and especially among boys under the age of 5 years. Ninety-five percent of the increase in discharges among boys was explained by a corresponding increase in the number of boys who were hospitalized. Increased readmissions did not account for the rise. Changes in the International Classification of Diseases coding of asthma and diagnostic shift by physicians accounted for only part of the increase. A decline in hospitalizations since 1984 may reflect changes in the management of asthma in the emergency room and not a decline in severe asthma episodes.

Adolescent↗
PubMed1992

Antineoplastic drug handling protection after OSHA guidelines. Comparison by profession, handling activity, and work site.

Although Occupational Safety and Health Administration (OSHA) issued antineoplastic drug handling guidelines in 1986, literature reports indicated that use of protection in the early 1980s did not meet OSHA standards. This study investigated the use of protection by pharmacy and nursing staff in a national sample of facilities participating in the National Surgical Adjuvant Breast and Bowel Project collaborative clinical trials network of the National Cancer Institute. Extent of handling, handling activity, and use of protection are compared by work setting and profession. Use of protection by the study sample in 1988 to 1989 is compared with their past use, with use of protection in previous studies, and with OSHA guidelines. In general, pharmacists are better protected than are nurses, and hospital staff are better protected than staff in outpatient settings who also tend to handle more drugs. Although improving over time, protective garment use does not meet OSHA guidelines, particularly among nurses when administering agents or handling patient excreta.

Antineoplastic Agents↗
PubMed1991

Respiratory complications in critically ill medical patients with acute upper gastrointestinal bleeding.

STUDY OBJECTIVE: To determine types of respiratory complications encountered in critically ill patients with serious acute upper gastrointestinal (GI) bleeding, and to identify associated risk factors. DESIGN: Retrospective chart review. SETTING: A university hospital medical ICU. PATIENTS AND METHODS: We reviewed medical records of 86 patients admitted to the medical ICU over a 2 1/2-yr period of time, for 107 consecutive episodes of serious acute upper GI bleeding. Clinical features of patients who developed respiratory complications of pneumonia, witnessed aspiration of gastric contents, or who required intubation and mechanical ventilation for other reasons were compared with those features of patients without respiratory complications. MAIN RESULTS: Respiratory complications occurred during 23 (22%) serious upper GI bleeding episodes (mean transfusion requirement, 7 units of packed RBCs). Twelve patients developed pneumonia and all had evidence of advanced liver disease. Five patients were observed to aspirate gastric contents and six patients require intubation and mechanical ventilation for reasons other than pneumonia or aspiration. Esophageal sites of bleeding (esophagitis, esophageal ulcers and esophageal varices), advanced liver disease, age greater than 70 yrs, and an Acute Physiology and Chronic Health Evaluation (APACHE) II score greater than 13 appeared to be risk factors. Mortality rate was increased in patients with respiratory complications: 70% of patients with respiratory complications died, compared with 4% of those patients without such problems (p less than .001). CONCLUSIONS: Respiratory complications are common in critically ill medical patients with serious acute upper GI bleeding, and are associated with a poor outcome. Risk factors include advanced liver disease, esophageal site of bleeding, age greater than 70 yrs, and higher APACHE II score.

Acute Disease↗
PubMed1991

Pulmonary health risks among northwest loggers.

Spirometry, respiratory symptom questionnaires, and chest radiographs were obtained from 688 loggers in Oregon and Washington. These were compared against previously published National Institute for Occupational Safety and Health studies of nonexposed blue-collar workers to determine if these predictions fit our population. The loggers forced expiratory volume in 1 second and forced vital capacity values were significantly greater than predicted, and their forced expiratory volume in 1 second/forced vital capacity values were less than predicted. The only consistent difference in symptoms between the sample and reference populations was for recent chest illnesses, which were more prevalent in the loggers than in the reference population. The chest radiographs showed a small excess of pleural thickening that we believe is most likely due to chest trauma. We conclude that the National Institute for Occupational Safety and Health studies spirometry prediction equations may not be generalized to other blue-collar populations.

Aged↗
PubMed1991

Comparing sources of drug data about the elderly.

OBJECTIVE: This project assessed the extent of agreement between drug-taking data obtained from an in-home assessment and that obtained from an automated outpatient pharmacy system and from a mail questionnaire. DESIGN: The underlying assumption is that an in-home assessment provides the most complete information (criterion standard) about the prescription medications being taken. The drug data from the mail questionnaire and automated outpatient pharmacies were compared with that from the in-home assessment by use of t tests and measures of sensitivity, specificity, and positive predictive value. SETTING: Kaiser Permanente, Northwest Region, a prepaid group practice HMO. PARTICIPANTS: All elderly HMO members enrolled in the Social HMO demonstration project who had a comprehensive assessment within 30 days of returning a mail questionnaire between March 1986 and March 1988 (n = 83 frail elderly). MAIN OUTCOME MEASURES: The number of medications currently being taken and the number of different therapeutic classes of drugs being taken per elderly HMO member. MAIN RESULTS: The in-home assessment and the automated prescription system closely agreed on the number of different medications and the different therapeutic classes of prescription drugs being taken. The in-home assessment and mail questionnaire were in less agreement. Agreement was less for non-prescription drugs. CONCLUSIONS: An automated prescription system is an adequate source of information about the prescription drugs currently being taken by frail elderly HMO enrollees with a prepaid prescription drug benefit.

Aged↗
PubMed1990

Long-term reproducibility of tests of small airways function. Comparisons with spirometry.

We used a tracking index to measure the reproducibility of single breath nitrogen test variables (CV/VC, CC/TLC, delta N2/L) and spirometric variables (FEV1 and FEV1/FVC) and to compare the characteristics of individuals whose pulmonary function tracks well with those whose pulmonary function tracks poorly. Data were derived from two cohorts followed longitudinally over a 9-11 year period. All variables were adjusted for age, sex and height by expressing them as Z-scores. In all smoking groups and in both cohorts, the tracking index was highest for FEV1, indicating that this variable was the most reproducible over the period of follow-up; delta N2/L and FEV1/FVC had very similar but slightly lower tracking indices; CV/VC consistently had the lowest tracking indices. Tracking indices were generally higher in smokers than in nonsmokers. The reproducibility of CC/TLC increased over the period of follow-up whereas the FEV1 reproducibility remained constant. We found no significant difference between those with high tracking indices and those with low indices in terms of sex, smoking status, prevalence of respiratory symptoms, history of respiratory disease, and rate of decline of FEV1. We conclude that FEV1 is the most reproducible of the variables examined, both within and between individuals, and that poor tracking or reproducibility are not related to smoking or to the presence of respiratory symptoms or disease.

Adult↗
PubMed1989

Respiratory symptoms, lung function, and mortality in a screening center cohort.

Numerous studies have documented the effects of smoking and reduced pulmonary function on all-cause mortality. The effects of respiratory symptoms are less well studied. This paper examines the joint effects of respiratory symptoms, lung function, and smoking using 11-year mortality data on 698 subjects aged 25 years and older. Copies of death certificates were obtained for all 120 confirmed deaths, and cause of death was coded by a nosologist using the rules of the International Classification of Diseases, Ninth Revision. Symptoms of cough/phlegm, wheeze, and dyspnea were significantly associated with all-cause mortality in separate univariate analyses. On a cause-specific basis, these associations appeared to hold for chronic obstructive pulmonary disease, lung cancer, and vascular disease. Further analysis indicated that, for both smokers and nonsmokers, the presence of chronic cough and/or sputum production was related to mortality only in the presence of wheezing. In addition, among smokers, the presence of both cough/phlegm and wheeze. In addition, among smokers, the presence of both cough/phlegm and wheeze was significantly associated with mortality only among subjects with low initial lung function. Although the limited number of deaths and the nonrandom nature of the cohort limit the generalizability of our findings, it seems clear, based on these results and other published studies, that symptoms of cough, phlegm, and/or wheeze have important adverse health implications even in the absence of smoking and reduced lung function. More studies using common methodological approaches are needed.

Adult↗
PubMed1989

Community patterns of posttraumatic stress disorders.

This paper reports lifetime rates for posttraumatic stress disorder (PTSD) in two rural northwest communities. One community was affected by a major natural disaster, the eruption of Mt. St. Helens. Following an epidemiology study of this disaster, community-wide patterns of PTSD were identified. Disaster-related, combat, sexual assault, and all other types of PTSD are presented for men and women. Symptom patterns from these distinct PTSD stressors are compared along with concurrent psychiatric disorders. The findings are discussed with other studies that use a broader definition of disaster stress response syndromes. This comparison identifies a limitation of PTSD diagnostic criteria that may significantly underestimate community rates.

Adult↗
PubMed1988

Longitudinal versus cross-sectional estimation of lung function decline--further insights.

This paper explores the extent to which differences in longitudinal versus cross-sectional inference may be influenced by the choice of statistical models. Using lung function data on 524 working men, we first compare the goodness-of-fit and implication for longitudinal decline of a variety of cross-sectional models. We then compare the predicted longitudinal patterns from these models with those observed over a period of four years. In general, both approaches provide qualitatively, if not quantitatively, similar messages concerning the relative effects of smoking and age on lung function decline. Nonetheless, we acknowledge the existence of real selection and cohort effects. Although we recognize the utility of cross-sectional designs, we discourage quantitative comparisons between studies, especially longitudinal versus cross-sectional.

Adult↗