Echocardiographic contrast studies: initial experience.

Echocardiograms were obtained simultaneously with the standard indocyanine green injections performed during cardiac catheterization. When injected into cardiac chambers, indocyanine green produced a cloud of echoes that enabled us to visualize characteristic flow patterns in the presence of normal and abnormal cardiac hemodynamics. More than 300 echocardiographic contrast studies have been recorded in patients with various congenital and acquired cardiac defects. The patterns obtained were reproducible, sensitive, and specific.

Secundum atrial septal defect encountered in infancy.

From 1953 to 1972, approximately 170 patients less than 16 years old were seen at the Mayo Clinic for isolated secundum atrial septal defect. Thirteen of these patients were initially seen when they were less than 2 years old. Eleven of the patients had symptoms, and one of these died. Four patients failed to respond to medical management and underwent successful repair of their defects before they were 2 years old. Infants with isolated secundum atrial septal defect and significant symptoms are at an increased risk of death. Consideration should be given to early surgical closure of the defect in those infants who do not respond promptly and completely to medical therapy. Surgical repair in infancy can be accomplished with minimal risk and excellent early and long-term clinical results.

Prevalence of osteoporosis risk factors and treatment among women aged 50 years and older.

We conducted a cross-sectional, retrospective review to evaluate screening, diagnosis, and treatment of 389 women aged 50 years or older at risk for osteoporosis in a large primary care practice. Records randomly selected from a computerized database were reviewed for drug history, age, height, weight, and osteoporosis-related diagnoses, symptoms, and risk factors. Among the 389 women, 255 (65.5%) were receiving bone-preserving treatment (247 estrogen replacement exclusively). Most (70.4%) were white, with an average age of 61 years, and an average of 3.3 risk factors for osteoporosis. Risk factors were postmenopausal status 94%, age 65 years or older 53%, hysterectomy 39%, cigarette smoking 33%, and physical inactivity 30%. By logistic regression, the only positive predictor of antiresorptive therapy was hysterectomy (adjusted odds ratio [AOR] 2.52, 95% confidence interval [CI] 1.54-4.14). Negative predictors were physical inactivity (AOR 0.44, 95% CI 0.25-0.71), rheumatoid arthritis (AOR 0.31, 95% CI 0.12-0.79), and age 65 years and older (AOR 0.54, 95% CI 0.34-0.86). Controlling for age, women with four or more risk factors were 62% less likely to be receiving antiresorptive treatment (AOR 0.38, 95% CI 0.23-0.64) than those with fewer risk factors.

Association of gender with symptoms and complications in type II diabetes mellitus.

Females with Type II diabetes appear more likely than males to experience symptoms and vascular complications related to their disease.

Smokeless tobacco and osteoporosis: a new relationship?

Osteoporosis is a common disorder of bone predominantly affecting postmenopausal women in which bone mineral density declines making bone more likely to break. Although cigarette smoking is a well-established risk factor for osteoporosis, smokeless tobacco (ST) use has never been suggested or evaluated as a risk factor for this bone disorder. This would be important to consider since in certain regions of the world, ST use is more prevalent than cigarette smoking, particularly among women. This paper reviews the animal and human evidence lending support to this new hypothesis, as well as the epidemiology of ST use that underscores the potential impact this modifiable behavior might have on osteoporosis world wide.

Smoking status and psychosocial variables in type 1 diabetes mellitus.

While depression, anxiety, and negative affect are associated with smoking and smoking cessation outcomes in healthy individuals, these associations have not been established in smokers with chronic diseases such as diabetes mellitus, a condition which greatly increases cardiovascular disease risk. Other psychosocial variables such as stress and locus of control may also be associated with smoking but are seldom reported. We examined stress, affect, and locus of control by smoking status in patients with type 1 diabetes mellitus. Results indicated that current smokers reported significantly higher levels of perceived stress, a more negative affect, and higher powerful others locus of control compared with nonsmokers. These findings indicate that those patients who have diabetes and who smoke are at greater risk for depressive symptoms. This knowledge may aid clinicians in their attempts to help these patients quit smoking.

Association between smokeless tobacco use and breast cancer among Native-American women in North Carolina.

BACKGROUND: Cigarette smoking and smokeless tobacco use have been associated with the development of a variety of cancers. While cigarette smoking may be associated with breast cancer, smokeless tobacco use has never been evaluated as a breast cancer risk factor. This study explores such an association. METHODS: A complete census was carried out among Eastern Band Cherokee women aged 18 years and older, residing on tribal lands in western North Carolina. Self-reported alcohol, cigarette and smokeless tobacco use, demographic information, and personal history of breast cancer (stratified by age of onset < 55 years or > or = 55 years) were obtained by questionnaire. RESULTS: 1,070 out of 1,408 (76%) eligible women were interviewed. Current and former smokeless tobacco use was common (6% and 21%, respectively). Five cases of breast cancer were identified in women under the age of 55 years and 3 cases were found in women at > or = 55 years. Only the odds ratio (OR) for younger-onset breast cancer among ever-users of smokeless tobacco was significantly elevated (OR = 7.79, 95% CI = 1.05-66.0). While the ORs for younger onset breast cancer were elevated among ever-smokers or women reporting at least monthly alcohol use, these were not significant (OR 8.49, 95% CI = 0.09-200; and OR = 1.72, 95% CI = 0.19-15.2, respectively). No ORs were significantly elevated for breast cancer among older women. CONCLUSIONS: These preliminary data are the first to document an apparent relationship between smokeless tobacco use and breast cancer risk, but should be confirmed in other studies due to the small number of cases. The nearly 8-fold increase in risk suggests that smokeless tobacco is not a safe alternative to cigarette smoking.

Church-related correlates of tobacco use among Lumbee Indians in North Carolina.

BACKGROUND: Although minority populations suffer a disproportionately higher burden of tobacco-attributable morbidity and mortality, the church appears to be a promising avenue through which to pursue tobacco-cessation interventions in these communities. This report describes church-related correlates of tobacco use among the Lumbee Indians in North Carolina, a population with a high prevalence of tobacco use, strong ties to tobacco-related agriculture, and high levels of church participation. METHODS: A cross-sectional telephone survey of 400 adult Lumbee Indians was carried out in Pembroke, a town in Robeson County, NC. The questionnaire elicited information on tobacco use, demographic and social support information, knowledge and practices related to tobacco agriculture and traditional Native American tobacco use and church participation. RESULTS: Sixty-three percent of participants were church members and 82% said the church is "very important" to the Lumbee community. In bivariate analysis, church attendance over the past year correlated with age, education, gender, number of close friends and relatives, marital status and current smoking status. Church attendance was not related to current smokeless tobacco use or participation in tobacco-related agriculture. Current smokers who had not attended church in the past year smoked significantly more cigarettes per day than current smokers attending church more often. In logistic regression, participants attending church weekly or more often were 73% less likely to be current smokers (adjusted odds ratio [AOR] = 0.27, 95% confidence interval [CI] = 0.11-0.68). Among ever-smokers, participants having attended church infrequently in the past year were 79% less likely to have quit (AOR = 0.21, 95% CI = 0.07-0.65). Having participated in tobacco agriculture as a child predicted current Christian views on tobacco use. DISCUSSION: Tobacco use, common among Lumbee adults, correlates with a variety of demographic and social support variables. In addition, these data are the first to uncover a dose-response relationship between church attendance and number of cigarettes smoked per day by current smokers, and the relationship between childhood participation in tobacco agriculture and Christian views on tobacco use. Our results should be useful in designing a church-based tobacco-cessation intervention among Lumbee Indians.

Smoking and hormone-related disorders.

Through its antiestrogenic effect, cigarette smoking is linked to a variety of hormone-related disorders, both benign and malignant. Diseases that depend on this hormone for growth and development tend to be less common among smokers, such as endometrial cancer and uterine fibroids. Some normal, estrogen-dependent physiologic processes are affected by smoking, making osteoporosis and premature menopause more common among women who smoke. In other disorders, the link between sex hormone levels, cigarette smoking, and disease development is less clear.

Alcohol, tobacco and illicit drug use among women.

Although the prevalence of alcohol, tobacco, and illicit drug use among women is lower than that among men, women suffer unique adverse health effects from these substances. Furthermore, the use of these substances during pregnancy poses special risks to mother and fetus, including placental accidents, intrauterine growth retardation, congenital anomalies, and premature birth. Primary care clinicians should ask all women about their patterns of alcohol, tobacco, and illicit drug use and should offer targeted interventions to those using these products.

Osteoporosis in women.

Many preventive and treatment strategies are now available for osteoporosis, offering many women the opportunity to forego its many complications. Exercise with calcium and vitamin D supplements is recommended for most patients. Estrogens are a preferred treatment but not acceptable to many women. Alendronate, a bisphosphonate, recently became available to treat osteoporosis. Calcitonin, subcutaneous or intranasal, also can be useful.

Screening, health promotion, and prevention in women.

Many health promotion and disease prevention recommendations are specific to adult women. Given their strategic position within families, women often hold the responsibility for the health and well-being of all family members.

Body fat, fat distribution, and psychosocial factors among patients with Type 2 diabetes mellitus.

Diabetes, a risk factor for cardiovascular disease, requires lifestyle modifications (diet, exercise, weight loss). The relations between body mass index, waist-hip ratio (WHR), and psychosocial indicators, such as affect and stress, among 302 diabetic patients from a clinic and a neighborhood health center were analyzed. Data included stress and mood scale responses, body size (height, weight, and WHR) and potential confounders (physical activity, energy intake, and diabetes duration). In univariate analyses, body mass index was positively associated with stress and inversely associated with positive affect only in women. Multiple regression analyses indicated that stress was associated with body mass index and negative mood was associated with the WHR. The findings suggested that stress and affect may be important correlates of body fat among women with Type 2 diabetes, leading to more complications. Healthcare providers can help women with Type 2 diabetes lose weight and lower the risk of cardiovascular disease by recognizing and helping them deal with these psychosocial issues.

Uses and safety of acyclovir in pregnancy.

Acyclovir, an antiviral nucleoside analogue, is a widely used agent highly specific for herpes simplex and varicella-zoster viruses. Unintended exposure to acyclovir early in pregnancy, which is not uncommon, may cause excessive maternal and physician anxiety. This drug has not been studied prospectively in large numbers of pregnant women and lacks the Food and Drug Administration's approval for gestational use unless benefits clearly outweigh potential fetal harm. However, data published since acyclovir became available do not indicate increased adverse effects related to its use in pregnancy, especially if prescribed in selected situations, such as disseminated primary herpes simplex infections or maternal varicella pneumonia. This article reports the impact of inadvertent acyclovir exposure on a woman during the first trimester of pregnancy and reviews the literature on acyclovir's pharmacology, safety profile, and potential uses during pregnancy.

Prevalence and predictors of problem drinking among primary care diabetic patients.

BACKGROUND: Alcohol abuse among patients with diabetes mellitus is dangerous and complicates therapy, but its prevalence and the factors that predict it are unknown. This study examined the prevalence of problem drinking among a large number of primary care diabetic patients, exploring its relation to age, race, sex, psychological factors, and other health behaviors. METHODS: Volunteers with insulin-dependent diabetes mellitus and non-insulin-dependent diabetes mellitus were surveyed at three primary care practice sites. Patients completed a health risk appraisal designed to elicit alcohol use and other health practices, and two psychometric instruments: the Brief Encounter Psychosocial Instrument and the Affect Balance Scale. Fasting blood glucose and hemoglobin A1C levels were also determined. RESULTS: Of 395 diabetic patients, 32 (8.1%) had a drinking problem as defined by answering yes to the question "Have you ever had a drinking problem?" or reporting their last drink to be within 24 hours, or both. Patients with a drinking problem coped less well with psychological stress and had a more highly negative affect than those without a drinking problem. Depression, black race, and male sex were significantly associated with problem drinking (odds ratios = 8.42, 2.70, and 3.80, respectively). Problem drinking did not predict glycemic control but was associated with smoking and less frequent glucose monitoring. CONCLUSIONS: The prevalence of problem drinking among patients with diabetes mellitus appears lower than among other medical outpatient populations and is in keeping with the prevalence found in community surveys. While the lack of association between problem drinking and glycemic control in diabetic patients may be surprising, these data help define the characteristics of this subgroup of diabetic patients and highlight the need for family physicians to intensify alcohol screening efforts in this population.

Oral health behaviors in medical patients with diabetes mellitus.

PURPOSE: Periodontal disease is common among patients with noninsulin dependent diabetes mellitus (NIDDM) and insulin dependent diabetes mellitus (IDDM) and interferes with diabetic control. However, no study has examined predictors of oral health behavior among patients with diabetes in a medical setting. This study describes self-reported oral hygiene among primary care patients with IDDM and NIDDM, evaluating age, race, gender, psychosocial stress, family dysfunction, and other health predictors of preventive oral behaviors. METHODS: A written survey of oral health behaviors, psychological stress, and family function was conducted among 390 out of 473 possible primary care dentate patients with diabetes (IDDM=81; NIDDM=309). Fasting blood sugar and hemoglobin A1C also were obtained. Data were collected between January 1989 and June 1991, and analyzed using Mantel-Haenszel's chi-square and logistic regression. RESULTS: Patients with IDDM with severe family dysfunction were less likely to brush, floss, or visit a dentist regularly than those with better reported family function. Whites with NIDDM were more likely to practice these oral health behaviors than were blacks. Female gender correlated with flossing in the group of patients with IDDM, and with brushing in both groups. Patients with NIDDM who exercised were also more likely to visit the dentist annually. Age was positively associated with a history of periodontal disease in the group with IDDM. CONCLUSIONS: These data document for the first time the relationship between family dysfunction and oral health practices of patients with IDDM, and corroborate the known associations among white race, female gender, and oral hygiene. This information could be used to coordinate diabetic oral health promotion between primary care physicians and oral health professionals.