Copyright (c) 2009 All rights reserved. http://works.bepress.com/crawfords Recent documents in Sybil L. Crawford en-us Sun, 31 May 2009 04:38:11 PDT 3600 http://works.bepress.com/crawfords/54 http://works.bepress.com/crawfords/54 Thu, 27 Mar 2008 17:08:59 PDT OBJECTIVES: This study sought to determine whether blacks and whites with life-threatening cardiac events differ in likelihood of help seeking, types of help sought, or likelihood of reaching the hospital before death. DESIGN: Death certificates were used to identify all coronary heart disease-related deaths occurring in 1988-89 among 45- to 74-year-old, black and white, non-institutionalized residents of three contiguous inner-city districts in Boston, Massachusetts, USA. An informant was interviewed about the decedent's health status, access to care and pre-mortal help-seeking behaviors. RESULTS: Among the 232 decedents analyzed, there were no racial differences in the likelihood of help seeking. Among those who sought help, there were no racial differences in the likelihood of reaching the hospital. However, blacks were more likely than whites to engage in two specific help-seeking behaviors: calling the 911 emergency system, and trying to reach an emergency room. CONCLUSION: In an area where blacks and whites were similar with respect to socioeconomic status and access to care, race did not affect the likelihood of help seeking or the likelihood of succeeding in reaching the hospital before death. Susan M Frayne African Americans Aged Boston Coronary Disease Death Certificates European Continental Ancestry Group Female Hospitals Humans Likelihood Functions Male Middle Aged Outcome Assessment (Health Care) Patient Acceptance of Health Care Terminal Care Terminally Ill http://works.bepress.com/crawfords/53 http://works.bepress.com/crawfords/53 Thu, 27 Mar 2008 17:08:56 PDT We investigated the prevalence of angina (as determined by the Rose Questionnaire) in a random sample of African-American and white adults, aged 44 to 75 years, in three Boston (Mass) neighborhoods. Telephone interviews were completed by 2030 eligible subjects (response rate = 87.9%). A sample of 737 persons who had never been hospitalized for a heart attack also participated in a home visit. The prevalence of Rose angina was 7.0% in black women, 4.8% in white women, 5.0% in black men, and 5.7% in white men (P = .37). In both racial groups, respondents with diagnosed cardiovascular conditions, those taking cardiovascular medications, and those living alone were more likely to report angina than were other respondents. Blacks were more likely to report angina if they felt they were not getting needed medical care. Risk of angina declined with age among whites. In the home visit sample, the presence of major electrocardiogram abnormalities was also associated with angina. Rose angina appears to be influenced by similar risk factors in both blacks and whites. K W Smith Adult *African Americans African Continental Ancestry Group Aged Angina Pectoris Boston Electrocardiography European Continental Ancestry Group Female Humans Male Middle Aged Prevalence *Questionnaires Random Allocation Risk Factors Socioeconomic Factors http://works.bepress.com/crawfords/52 http://works.bepress.com/crawfords/52 Thu, 27 Mar 2008 17:08:52 PDT OBJECTIVES: Among the consequences of downsizing and cost containment in hospitals are major changes in the work life of nurses. As hospitals become smaller, patient acuity rises, and the job of nursing becomes more technical and difficult. This article examines the effects of changes in the hospital environment on nurses' job satisfaction and voluntary turnover between 1993 and 1994. METHODS: Data were collected in a longitudinal survey of 736 hospital nurses in one hospital to examine correlates of change in aspects of job satisfaction and predictors of leaving among nurses who terminated in that period. RESULTS: Unadjusted results showed decline in most aspects of satisfaction as measured by Hinshaw and Atwood's and Price and Mueller's scales. Multivariate analysis indicated that the most important determinants of low satisfaction were poor instrumental communication within the organization and too great a workload. Intent to leave was predicted by the perception of little promotional opportunity, high routinization, low decision latitude, and poor communication. Predictors of turnover were fewer years on the job, expressed intent to leave, and not enough time to do the job well. CONCLUSIONS: The authors conclude that although many aspects of job satisfaction are diminished, some factors predicting low satisfaction and turnover may be amenable to change by hospital administrators. Harriet Davidson Adult Communication Cost Control Employment Hospital Restructuring Humans *Job Satisfaction Longitudinal Studies Multivariate Analysis Nursing Administration Research Nursing Staff, Hospital Organizational Innovation *Personnel Turnover Workload http://works.bepress.com/crawfords/51 http://works.bepress.com/crawfords/51 Thu, 27 Mar 2008 17:08:48 PDT The dynamics of reproductive hormones that characterize the menopausal transition (perimenopause) are incompletely understood, particularly in non-Caucasian women. The Study of Women's Health across the Nation (SWAN) is a multiethnic cohort study of 3302 women at seven sites who were aged 42-52 yr at baseline. All participants are seen annually to assess a variety of endpoints. A subcohort of 848 women undergoes further investigation of their daily patterns of reproductive hormones in the Daily Hormone Study (DHS). DHS enrollees annually complete a daily collection of first morning voided urine for an entire menstrual cycle or up to 50 d (whichever comes first). Chemiluminescent assays measured urinary LH and FSH, as well as metabolites of estradiol [estrone conjugates (E1c)] and progesterone [pregnanediol glucuronide (Pdg)]. Cycles were assessed for evidence of luteal activity and day of luteal transition using previously developed algorithms. Midreproductive-aged women who underwent similar daily urinary analyses served as historical controls. Correlates of cycle features were identified. Eight hundred thirty-three cycles were evaluable and had complete data on covariates. Six hundred seventy-four (80.9%) cycles had evidence of luteal activity, and 159 (19.1%) did not. Women who were at least 49 yr old were less likely to have cycles with luteal activity and had more variable cycle length, higher total-cycle FSH, and lower total-cycle Pdg. Compared with heavier women, those with body mass index less than 25 kg/m2 had shorter cycles and higher total-cycle LH, FSH, and Pdg but not E1c. Chinese- and Japanese-American women had overall lower adjusted total-cycle E1c excretion. Smoking was not significantly associated with cycle length or hormones. When compared with cycles of younger control women, the cycles of the SWAN DHS participants had higher gonadotropins, lower total integrated Pdg, and E1c levels that were not different, which suggests that the ovary retains sensitivity to elevated FSH in the early menopausal transition. In this cross-sectional study of women over age 42 who are premenopausal or in the early menopausal transition, there were important differences in the characteristics of cycles related to age, body mass index, and ethnicity. Comparisons to younger women indirectly support the inhibin hypothesis, which proposes that the initiating event in the menopausal transition is the loss of inhibin negative feedback on FSH secondary to a diminished follicular reserve. Nanette Santoro Adult African Continental Ancestry Group Age Distribution Asian Continental Ancestry Group Body Constitution Cohort Studies Corpus Luteum Estrone European Continental Ancestry Group Female Follicle Stimulating Hormone Humans Longitudinal Studies Luteinizing Hormone Menopause Menstrual Cycle Middle Aged Pregnanediol United States Women's Health http://works.bepress.com/crawfords/50 http://works.bepress.com/crawfords/50 Thu, 27 Mar 2008 17:08:45 PDT OBJECTIVE: Results of past studies of menopause and weight are inconsistent, in part because of problems in study design and analyses, such as retrospective assessment of age at menopause and failure to control for confounding factors. To address such shortcomings, we conducted multivariate analyses on longitudinal data from a large, community-based sample of initially pre- and perimenopausal women who were making the transition through menopause. DESIGN: Data were from the second phase of the Massachusetts Women's Health Study, a cohort of 418 women aged 50-60 years in 1986. We assessed the relationship between menopause transition and weight, after accounting for previous weight; age; and the behavioral factors of smoking, exercise, and annual ethanol consumption. Menopause status was defined in terms of months of amenorrhea. The association of hormone replacement therapy and weight also was examined. RESULTS: Menopause transition was not consistently associated with increased weight, and use of hormone replacement therapy was not significantly related to weight. Behavioral factors--particularly exercise and ethanol consumption--were more strongly related to weight than was menopause transition. CONCLUSIONS: These results are consistent with findings from other studies that suggest that the weight increases experienced by middle-aged women in the United States are not a result of the menopause transition. Sybil L. Crawford Aging Estrogen Replacement Therapy Exercise Female Humans Linear Models Longitudinal Studies Massachusetts Menopause Middle Aged Smoking *Weight Gain Women's Health http://works.bepress.com/crawfords/49 http://works.bepress.com/crawfords/49 Thu, 27 Mar 2008 17:08:42 PDT BACKGROUND: In recent randomized trials, conjugated equine estrogens (CEE) with continuous medroxyprogesterone acetate provided no protection against coronary heart disease in postmenopausal women and may have increased cardiac risk. These trials did not address the role of unopposed estrogen for coronary protection. METHODS: A total of 10 739 women aged 50 to 79 years at baseline (mean age, 63.6 years) who had previously undergone hysterectomy were randomized to receive CEE, 0.625 mg/d, or placebo at 40 US clinical centers beginning in 1993. The trial was terminated early after 6.8 years of follow-up (planned duration, 8.5 years). This report includes final, centrally adjudicated results for the primary efficacy outcome (myocardial infarction or coronary death), secondary coronary outcomes, and subgroup analyses. RESULTS: During the active intervention period, 201 coronary events were confirmed among women assigned to receive CEE compared with 217 events among women assigned to receive placebo (hazard ratio, 0.95; nominal 95% confidence interval, 0.79-1.16). Among women aged 50 to 59 years at baseline, the hazard ratio for the primary outcome was 0.63 (nominal 95% confidence interval, 0.36-1.08). In that age group, coronary revascularization was less frequent among women assigned to receive CEE (hazard ratio, 0.55; nominal 95% confidence interval, 0.35-0.86), as were several composite outcomes, which included the primary outcome and coronary revascularization (hazard ratio, 0.66; nominal 95% confidence interval, 0.44-0.97). CONCLUSIONS: Conjugated equine estrogens provided no overall protection against myocardial infarction or coronary death in generally healthy postmenopausal women during a 7-year period of use. There was a suggestion of lower coronary heart disease risk with CEE among women 50 to 59 years of age at baseline. Judith Hsia Age Distribution Aged Blood Glucose C-Reactive Protein Cholesterol Estrogens Estrogens, Conjugated (USP) Female Follow-Up Studies *Hormone Replacement Therapy Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors Insulin Male Middle Aged Myocardial Infarction Myocardial Revascularization Postmenopause Proportional Hazards Models Triglycerides United States http://works.bepress.com/crawfords/48 http://works.bepress.com/crawfords/48 Thu, 27 Mar 2008 17:08:39 PDT OBJECTIVES. Latino adolescents in two urban New England areas were surveyed to assess risk of human immunodeficiency virus (HIV) transmission. METHODS. Probability of HIV infection during the previous 6 months was estimated from self-reported sexual contacts, condom usage rates, and number of partners. Teens were also asked to show condoms in their possession to the interviewer to validate self-reports of condom use. RESULTS. Overall, 8% of the 586 respondents were classified as high risk for HIV infection (estimated infection probability greater than .0001), 34% were at moderate risk, and the remaining 58% were classified as not at risk (no sexual activity or needle sharing). Teens who said they had purchased condoms or claimed to have used them recently were more likely than others to have condoms in their possession at the time of the interview. CONCLUSIONS. These estimates suggest that a small percentage of Latino adolescents may be at substantial risk for HIV infection over periods as short as 6 months, that self-reports of recent condom use are strongly related to condom possession, and that questionnaire items regarding condom use at last intercourse are poor surrogates for HIV risk. K. W. Smith Adolescent Adolescent Behavior Condoms Connecticut Female HIV Infections Hispanic Americans Humans Male Massachusetts Puerto Rico Regression Analysis Risk Factors Sexual Behavior *Urban Health http://works.bepress.com/crawfords/47 http://works.bepress.com/crawfords/47 Thu, 27 Mar 2008 17:08:36 PDT In many health-related studies, investigators wish to assess the strength of an association between 2 measured (continuous) variables. For example, the relation between high-sensitivity C-reactive protein (hs-CRP) and body mass index (BMI) may be of interest. Although BMI is often treated as a categorical variable, eg, underweight, normal, overweight, and obese, a noncategorized version is more detailed and thus may be more informative in terms of detecting associations. Correlation and regression are 2 relevant (and related) widely used approaches for determining the strength of an association between 2 variables. Correlation provides a unitless measure of association (usually linear), whereas regression provides a means of predicting one variable (dependent variable) from the other (predictor variable). This report summarizes correlation coefficients and least-squares regression, including intercept and slope coefficients. Sybil L. Crawford Least-Squares Analysis Linear Models *Regression Analysis Statistics http://works.bepress.com/crawfords/46 http://works.bepress.com/crawfords/46 Thu, 27 Mar 2008 17:08:33 PDT Researchers have previously emphasized the importance of kinship tie to explaining the pattern of care received by a disabled elder. For example, it has been argued that spouses are a distinct group of caregivers, i.e., they provide more care with less help from others and experience more stress. However, based on the theory of primary group structures and functions, this study hypothesized that coresidence rather than the kinship tie is more important in determining the pattern of caregiving. When spouses are compared to other coresiding caregivers, patterns of informal care and use of formal services are similar. Variance in amounts of informal care is explained by elder gender and frailty level rather than by caregiver relationship. Similarly, level of frailty was the only important predictor of use of formal services. S L Tennstedt Activities of Daily Living Adult Age Factors Aged Aged, 80 and over *Caregivers Community Health Services *Family Female Follow-Up Studies Forecasting *Frail Elderly Health Services for the Aged *Housing Humans Longitudinal Studies Male Marital Status Middle Aged Self Care Sex Factors Social Environment Social Support http://works.bepress.com/crawfords/45 http://works.bepress.com/crawfords/45 Thu, 27 Mar 2008 17:08:29 PDT Because evidence suggests lipoprotein (Lp(a)) may be an important cardiovascular risk factor in women, we evaluated whether reproductive hormones may influence Lp(a) concentrations and insulin resistance in a large multicenter study of women transitioning to postmenopause. Data were taken from the Study of Women's Health Across the Nation (SWAN), a prospective multiethnic study of menopausal transition (1,368 Caucasians, 808 African-Americans, 220 Chinese, 216 Hispanic, and 251 Japanese). Blood was assayed for Lp(a), follicle stimulating hormone, estradiol (E2), testosterone, and sex hormone binding globulin (free estradiol index and free androgen index), thyroid stimulating hormone, and glucose and insulin (to calculate insulin resistance). African-American women had twofold higher mean Lp(a) values than women of the other 4 race/ethnic groups, adjusted for body mass index (BMI). Lp(a) was modestly correlated with E2 (r = 0.10) in women without self-reported diagnosed heart disease but not in women with self-reported heart disease. Lp(a) was positively associated with log insulin resistance in women without self-reported heart disease but not in women with self-reported heart disease, an association that was not significant after adjusting for ethnicity, BMI, smoking, age, and site. Race/ethnicity, particularly being African-American, accounted for most of the explained Lp(a) variations. Lp(a) was very modestly associated (r = -0.04) with insulin resistance after adjusting for ethnicity and BMI, and this association was not modified by reproductive hormones, including androgens. MaryFran Sowers Adult *African Continental Ancestry Group *Asian Continental Ancestry Group Body Mass Index Cardiovascular Diseases China Climacteric Cross-Sectional Studies Estradiol *European Continental Ancestry Group Female Follicle Stimulating Hormone Hispanic Americans Humans *Insulin Resistance Japan Lipoprotein(a) Middle Aged Premenopause Prospective Studies Sex Hormone-Binding Globulin Testosterone Thyrotropin United States Women's Health