Myocardial infarction site and mortality in diabetes.

Survival after a first myocardial infarction (MI) was examined in 54 diabetic and 270 nondiabetic subjects according to anatomic site of MI. Complete survival status information was obtained during a 12-yr follow-up. Compared with nondiabetic subjects, diabetics had a higher proportion of anterior site of MI below the age of 60 in both sexes. A significantly higher mortality was experienced in both sexes by patients with anterior MIs compared with other infarction sites (47% vs. 13% respectively, over 12 yr of follow-up). This excess fatality was differentially distributed by diabetic status. The 60-day mortality following admission with an anterior MI was significantly higher in diabetic (55%) than in nondiabetic subjects (31%). No differences in 60-day survival were found between diabetic and nondiabetic subjects with other infarction sites. Thus, anterior size and diabetic status each convey an increased risk of early postinfarct mortality. The findings from this study suggest that the presence of both is synergistic with regard to the 60-day mortality rate.

Isolated systolic hypertension in Evans county--I. Prevalence and screening considerations.

Studies suggest that isolated hypertension involves pathophysiological change different from essential hypertension; while clinical trials of drug treatment of isolated systolic hypertension are underway, little is known of its descriptive epidemiology. This paper reports characteristics of isolated systolic hypertension in biracial Evans County, Georgia, 1967-69. Isolated systolic hypertension was rare below age 40, but the percent prevalence increased greatly at older ages. Defining isolated systolic hypertension as diastole blood pressure (DBP) less than 95 and systolic blood pressure (SBP) greater than 160, age-adjusted percent prevalence at ages 40 and above were 9.6, 10.6, 15.1, and 18.3 for white males, black males, white females, and black females respectively. Percent prevalence declined to 4.8, 6.3, 9.7, and 12.7 in the four race/sex groups when a DBP cutoff of 90 was used. Unlike essential hypertension, percent prevalence of isolated systolic hypertension varied more by sex than by race: it was 60-100% higher in females than in males and only 10--30% higher in blacks than in whites. Percent prevalence of isolated systolic hypertension for the second and third of three BP readings (one clinic visit) increased compared to the first reading, the reverse of what is usually found for essential hypertension. DBP variability was relatively greater than SBP variability and probably accounted for the changes in percent prevalence. These data support clinical studies indicating isolated systolic hypertension is a distinct syndrome. This condition, shown to be a risk factor for death and disease in other studies, was common at older ages and may increasingly become health problem as the population ages.

Medical care use and hypertension.

We examined the relationship between the use of medical care and diastolic blood pressure (DBP) in 2,939 individuals residing in a rural Southern biracial community. The nonuse of medical care, defined as the absence of reported physician visits in the year preceding the survey, increased with higher levels of DBP among those not receiving antihypertensive treatment. Nearly one half of individuals with untreated DBP greater than or equal to 100 mm Hg had not seen a physician in the preceding year, whether aware of their hypertension or not. The association between nonuse of medical care and untreated diastolic hypertension could not be explained by demographic differences or differences in self-reported health. Despite the fact that all were referred for evaluation of their elevated blood pressure, only 28 per cent of moderate hypertensives (DBP greater than or equal to 100 mm Hg) visited their physician in the 3-month period following the survey. In contrast, 27 per cent of those with DBP less than or equal to 99 mm Hg visited their physician, although few were specifically referred.

Hypertension control in a rural biracial community: successes and failures of primary care.

Through a total community survey and a medical record review, we examined hypertension awareness, treatment, and control in a biracial rural community rich in primary care resources. The overall prevalence of hypertension among the 2,939 respondents was 20.5 per cent; 82 per cent of hypertensives were aware of their condition; 68 per cent were on treatment; and 55 per cent were under control. Comparison of data sources revealed discrepancies and misconceptions about diagnosis and treatment. Nearly one-third of the population reported a history of hypertension despite the fact that most of them were untreated and were normotensive. Conversely, one-third of "undetected" hypertensives had notation of the diagnosis in their medical records. Discontinuation of treatment accounted for over one-half of aware but untreated hypertension. Misconceptions about therapy contributed to failures of control in the treated group. These findings suggest that difficulties in the transmission of information about hypertension contribute importantly to failures of control.

Impact of medical training on ambulance dispatching.

This study was designed to assess the ability of trained individuals to screen calls for emergency medical services to allow for safer or more appropriate responses. The degree of urgency of calls, as judged by dispatchers and a panel of physicians, was compared to estimates of the severity of the patient's illness or injury. Physicians were more likely to designate calls as emergencies than were dispatchers. Neither physicians nor dispatchers were able to discriminate between the severely ill or injured and those without severe problems. The emergency medical technicians were better able to assess severity and degree of urgency than were physicians or dispatchers. A tentative conclusion is that rapid response by an emergency medical services system will be based upon the caller's description of the situation rather than medical assessment of patient condition.

Effectiveness of certified nurse-midwives. A prospective evaluation study.

A prospective evaluation study of the effectiveness of the services of certified nurse-midwives demonstrated that in a hospital setting the care of low-risk maternity patients provided by nurse-midwives was as effective as the provided by house staff physicians. A total of 438 low-risk maternity patients were studied. Selected outcomes pertaining to the prenatal period, labor and delivery, and early infancy demonstrated, with two exceptions, no significant differences. The two exceptions were: (1) overcompliance with appointment attendance was more common among the nurse-midwifery group of patients; (2) a higher rate of forceps delivery was reported among the house staff group of patients.