Albuminuria among Alaska Natives--findings from the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) study.

BACKGROUND: The prevalence and associated risk factors for albuminuria and low-grade albuminuria in Alaska Natives is not known. METHODS: Cross-sectional analysis of the Genetics of Coronary Artery Disease in Alaska Natives Study. We included 1,026 individuals, who represent 85% of the study participants for whom complete data were available. Risk factors examined were age, sex, education, diabetes, hypertension, obesity, lipids, C-reactive protein, angiotensin-converting enzyme inhibitor use, and smoking status. Urine albumin excretion was estimated by the albumin/creatinine ratio measured from a single random morning urine sample. Albuminuria was defined as an albumin/creatinine ratio of > or =30 mg/g. Low-grade albuminuria was defined as an albumin/creatinine ratio of 10 to <30 mg/g. RESULTS: The mean age was 42 years and over half were female. Diabetes prevalence was low at 3% and the prevalence of hypertension was 20%. The prevalence of albuminuria was 6%; the prevalence of low-grade albuminuria was 12%. Individuals with diabetes or hypertension were 3 times more likely to have albuminuria than those without these conditions [odd ratios: diabetes 3.0 (1.2-7.9) and hypertension 3.0 (1.2-7.3)]. CONCLUSIONS: The burden of albuminuria is low. Comprehensive programs and policies are important given the rise in diabetes and hypertension among Alaska Natives.

The association of restrained eating with weight change over time in a community-based sample of twins.

We investigated the association of restrained eating with BMI and weight gain while controlling for the influence of genes and shared environment. Participants were 1,587 twins enrolled in the University of Washington Twin Registry (UWTR). Restrained eating was assessed by the Herman and Polivy Restraint Scale. Height and weight were self-reported on two occasions. Analyses used generalized estimating equations or multiple linear regression techniques. Restraint Scale scores were positively associated with both BMI (adjusted beta = 0.39 kg/m(2); 95% confidence interval (CI) = 0.34-0.44; P < 0.001) and weight gain (adjusted beta = 0.33 pounds; 95% CI = 0.17-0.49; P < 0.001). High Restraint Scale scorers had an adjusted mean BMI of 27.9 kg/m(2) (95% CI = 27.4-28.4) as compared to intermediate (mean = 25.5 kg/m(2); 95% CI = 25.2-25.8) and low scorers (mean = 23.0 kg/m(2); 95% CI = 22.7-23.3). In within-pair analyses among 598 same-sex twin pairs, the adjusted association between Restraint Scale scores and BMI persisted even when genetic and shared environmental factors were controlled for (adjusted beta = 0.18; 95% CI = 0.12-0.24; P < 0.001), as did the association with weight gain (adjusted beta = 0.37; 95% CI = 0.13-0.61; P = 0.003). In stratified analyses, dizygotic (DZ) twins differed more in BMI for a given difference in the Restraint Scale score than monozygotic (MZ) twins, for whom genetics are 100% controlled (adjusted beta = 0.32; 95% CI = 0.20-0.44 vs. adjusted beta = 0.10; 95% CI = 0.04-0.16; P = 0.001 for test of interaction). These data demonstrate that observed relationships between BMI, weight gain, and restrained eating, as assessed by the Restraint Scale, have a strong environmental influence and are not solely due to shared genetic factors.

Decreased perfusion in the lateral wall of the left ventricle in PET/CT studies with 13N-ammonia: evaluation in healthy adults.

UNLABELLED: This study evaluated the causes of the frequently observed decreased myocardial perfusion in the lateral wall of the left ventricle in PET/CT studies with (13)N-ammonia in healthy adults. METHODS: Thirty-two adults who were undergoing PET/CT of the heart with (13)N-ammonia as part of a study of the effects of posttraumatic stress disorder in American Indians were included. Participants who had evidence of heart disease by a physician-administered questionnaire or by pharmacologic stress during the myocardial perfusion study were excluded. The ratio of counts in the lateral wall relative to the septum at stress and rest were compared with the degree of misalignment between the PET and CT images at the left border of the heart and at the right hemidiaphragm. RESULTS: No participant had evidence of heart disease. For the left heart border, 41% of participants showed misalignment at rest and 62% showed misalignment at stress. For the right hemidiaphragm, 28% showed misalignment at rest and 53% showed misalignment at stress. Among all participants, the decrease in lateral wall counts relative to the septum correlated with the degree of misalignment of the PET and CT images at the left heart border at rest using both average (P = 0.01) and maximum (P < 0.01) counts per pixel and at stress using maximum counts per pixel (P = 0.02) but not average counts per pixel (P = 0.14). There was also a correlation between the degree of misalignment of the PET and CT images at the left heart border and at the right hemidiaphragm at stress (P = 0.01) but not at rest (P = 0.09). The decreased counts in the lateral wall relative to the septum and the misalignment of the PET and CT images at the left heart border and at the right hemidiaphragm were all greater at stress than at rest (all P < 0.05). In those participants who had no misalignment of the PET and CT images at the left heart border, there was still a residual decrease in relative counts in the lateral wall at both stress and rest, using both average and maximum counts (all P < 0.05). CONCLUSION: Relative decreased counts in the lateral wall of the heart in PET/CT studies with (13)N-ammonia are commonly seen in healthy adults. The decreased counts in the lateral wall appear to be caused by an attenuation artifact from misalignment at the left border of the heart between the PET and CT images, possibly related to differences in respiratory motion during acquisition of the PET and CT images. In addition, there was a small, but significant, decrease in relative counts in the lateral wall even in participants without misalignment at the left heart border or at the right hemidiaphragm.

Relation between the level of American Indian and Alaska Native diabetes education program services and quality-of-care indicators.

OBJECTIVES: We examined the relation between the level of diabetes education program services in the Indian Health Service (IHS) and indicators of the quality of diabetes care to determine if more-comprehensive diabetes services were associated with better quality of diabetes care. METHODS: In this cross-sectional study, we used the IHS Integrated Diabetes Education Recognition Program to rank program services into 1 of 3 levels of comprehensiveness, ranging from lowest (developmental) to highest (integrated). We compared quality-of-care indicators among programs of differing levels with the 2001 IHS Diabetes Care and Outcomes Audit. Quality indicators included patients having recommended yearly examinations, education, and laboratory tests and achieving recommended levels of intermediate outcomes of care. RESULTS: Most of the 86 participating programs were classified at or below the developmental level; only 9 programs (11%) were ranked at higher levels. After adjusting for patient characteristics, program factors, and correlation of patients within programs, we associated programs that were more comprehensive with higher completion rates of yearly lipid and hemoglobin A1C tests (P < .05). CONCLUSIONS: System-wide improvements in diabetes education are associated with better diabetes care. The results can help inform the development of diabetes education programs.

Surgical morbidity and mortality among American Indian and Alaska Native veterans: a comparative analysis.

BACKGROUND: Few studies have examined surgical risk factors and outcomes in American Indians and Alaska Natives (AI/ANs). My colleagues and I sought to determine if prevalence of preoperative risk factors for morbidity and mortality differed between male AI/AN and Caucasian surgical patients, and to determine if AI/ANs had an increased risk of surgical morbidity or mortality. STUDY DESIGN: We obtained data from the Veterans Affairs National Surgical Quality Improvement Program on major, noncardiac, surgical procedures performed between 1991 and 2002 for all AI/AN men (n = 2,155) and a random sample of Caucasian men (n = 2,264), matched by facility. Chi-square and t-test analyses were used to assess differences in preoperative risk factors between the two groups. Logistic regression was used to determine whether AI/AN race was independently associated with 30-day morbidity (defined as 1 or more of 21 postoperative complications) or 30-day all cause mortality after adjustment for major risk factors. RESULTS: Prevalence of major preoperative risk factors for morbidity and mortality often differed between the groups. Compared with Caucasians, AI/AN race did not predict morbidity (adjusted odds ratio, 0.92; 95% CI, 0.75-1.13), but AI/ANs were at higher risk for 30-day all cause postoperative mortality (adjusted odds ratio, 1.56; 95% CI, 1.04-2.35). CONCLUSIONS: Our results add postoperative mortality to health disparities experienced by AI/ANs. Future research should be conducted to identify other factors that contribute to this disparity.

Cognitive processing in monozygotic twins discordant for chronic fatigue syndrome.

Twenty-one pairs of monozygotic twins discordant for chronic fatigue syndrome (CFS) and 21 matched healthy control (HC) subjects were assessed with 5 untimed tests and 5 timed tests from the computer-based NeuroCognitive Assessment Battery (R. K. Mahurin, 1993). Random effects regression showed no difference between CFS and healthy twins on any of the cognitive tests. Further, the twin groups did not differ from the HC group on any content-dependent measure. In contrast, both sets of twins performed worse than the HC group on all speed-dependent tests except Finger Tapping. Self-rated fatigue and dysphoric mood were only weakly correlated with cognitive performance. These data point toward a shared genetic trait related to information processing that is manifest in the CFS context. The findings have implications for differentiating genetic and acquired vulnerability in the symptomatic expression of the disorder. ((c) 2004 APA, all rights reserved)

A co-twin control study of physical function in elderly African America women.

OBJECTIVE: This study investigated variables associated with physical functioning limitations among elderly African American women, controlling for genetics and common family environment. METHOD: Activities of daily living limitations (ADL) and instrumental activities of daily living limitations (IADL) are examined in 180 pairs of African American elderly twins using a co-twin control design. The association of chronic disease, other physical problems, lifestyle, and demographic factors with both measures are investigated. RESULTS: Arthritis, hypertension, and more than 1 chronic disease are associated with ADL limitations and arthritis; diabetes, heart attack, and more than 1 chronic disease are associated with IADL limitations in univariate analyses. In multivariate analyses, a different set of additional variables is associated with the two measures. DISCUSSION: Among elderly African American women, physical functioning limitations are influenced by the presence of chronic diseases, other physical problems, lifestyle, and demographics. These associations are not due to genetics or common family environment effects.