The OPTIMIZE patient- and family-centered, primary care-based deprescribing intervention for older adults with dementia or mild cognitive impairment and multiple chronic conditions: study protocol for a pragmatic cluster randomized controlled trial.

BACKGROUND: Most individuals with dementia or mild cognitive impairment (MCI) have multiple chronic conditions (MCC). The combination leads to multiple medications and complex medication regimens and is associated with increased risk for significant treatment burden, adverse drug events, cognitive changes, hospitalization, and mortality. Optimizing medications through deprescribing (the process of reducing or stopping the use of inappropriate medications or medications unlikely to be beneficial) may improve outcomes for MCC patients with dementia or MCI. METHODS: With input from patients, family members, and clinicians, we developed and piloted a patient-centered, pragmatic intervention (OPTIMIZE) to educate and activate patients, family members, and primary care clinicians about deprescribing as part of optimal medication management for older adults with dementia or MCI and MCC. The clinic-based intervention targets patients on 5 or more medications, their family members, and their primary care clinicians using a pragmatic, cluster-randomized design at Kaiser Permanente Colorado. The intervention has two components: a patient/ family component focused on education and activation about the potential value of deprescribing, and a clinician component focused on increasing clinician awareness about options and processes for deprescribing. Primary outcomes are total number of chronic medications and total number of potentially inappropriate medications (PIMs). We estimate that approximately 2400 patients across 9 clinics will receive the intervention. A comparable number of patients from 9 other clinics will serve as wait-list controls. We have > 80% power to detect an average decrease of - 0.70 (< 1 medication). Secondary outcomes include the number of PIM starts, dose reductions for selected PIMs (benzodiazepines, opiates, and antipsychotics), rates of adverse drug events (falls, hemorrhagic events, and hypoglycemic events), ability to perform activities of daily living, and skilled nursing facility, hospital, and emergency department admissions. DISCUSSION: The OPTIMIZE trial will examine whether a primary care-based, patient- and family-centered intervention educating patients, family members, and clinicians about deprescribing reduces numbers of chronic medications and PIMs for older adults with dementia or MCI and MCC. TRIAL REGISTRATION: NCT03984396. Registered on 13 June 2019.

Digital Communication Technology: Does Offering a Choice of Modality Improve Medication Adherence and Outcomes in a Persistent Asthma Population?

BACKGROUND: Use of digital communication technology has shown potential to improve asthma adherence and outcomes. Few studies have looked at patient preference around mode of medication reminders used to improve and maintain asthma medication adherence. OBJECTIVE: To determine if, in a population already receiving automated medication reminders, offering a choice for preferred mode of reminder (text, email, phone) would improve their adherence and asthma outcomes over a 1-year period. METHODS: This was a pragmatic, randomized controlled trial conducted at Kaiser Permanente Colorado involving 7522 adult patients with persistent asthma. Study patients were randomized to receive usual care or their choice of medication reminder. Differences between the 2 groups in both medication adherence and asthma outcomes were then assessed over the following year. RESULTS: Only 30% of those offered a choice of medication reminder modality responded by making a choice, with 52% preferring text messaging. There was less of a decrease in adherence rate over the 1-year period in those who made a choice regarding the mode of medication refill reminder. There was no difference in asthma outcomes between those who did make a choice compared with those who did not make a choice regarding the mode of medication refill reminder. CONCLUSION: In a patient population already receiving medication reminders, offering a choice about what type of technology-enabled asthma medication reminder patients wanted did not improve outcomes but did enable a subgroup to better maintain their medication adherence.

Depressive symptoms in Hispanic and non-Hispanic White rural elderly: the San Luis Valley Health and Aging Study.

Literature on depression in rural and Hispanic elderly adults is sparse. This report describes the prevalence of depressive symptoms in 1,151 community-dwelling, Hispanic and non-Hispanic White participants in the San Luis Valley Health and Aging Study, conducted in rural Colorado during 1993-1995. The prevalence and odds ratios of high depressive symptoms, defined as a Center for Epidemiologic Studies Depression Scale score of > or = 16, were calculated. The crude prevalence of high depressive symptoms was 11.4% (95% confidence interval: 9.6, 13.6). Female gender, chronic diseases, dissatisfaction with social support, living alone, and lower income and education were associated with depressive symptoms. There were no ethnic differences in the men. The age-adjusted odds ratio of depressive symptoms in Hispanic women compared with that of non-Hispanic White women was 2.11 (95% confidence interval: 1.32, 3.38). After adjustment for multiple sociodemographic and health risk factors, the odds ratio in Hispanic women was 2.12 (95% confidence interval: 1.19, 3.80). Higher depressive symptoms in Hispanic women varied by acculturation level. The odds ratio in the high acculturation stratum was 1.56 (95% confidence interval: 0.75, 3.27) and in the low acculturation stratum was 2.51 (95% confidence interval: 1.11, 5.70). A lower acculturation level may increase the risk for depression in older Hispanic women.

Percent body fat and lean mass explain the gender difference in leptin: analysis and interpretation of leptin in Hispanic and non-Hispanic white adults.

OBJECTIVE: To reassess the relationship between body fat and fasting leptin concentrations comparing plasma vs. serum assessments of leptin; ratios vs. regression adjustment for body composition; fat and lean mass vs. percent body fat; and gender-, ethnic-, and age-related variations. RESEARCH METHODS AND PROCEDURES: Subjects included 766 adults from the nondiabetic cohort of the San Luis Valley Diabetes Study examined at follow up (1997 to 1998). Body composition was determined by dual energy X-ray absorptiometry. Leptin concentrations were determined after an overnight fast. RESULTS: Fasting serum and plasma assessments of leptin were correlated with percent body fat to the same degree. Women had significantly higher serum leptin concentrations than men when leptin concentrations were divided by body mass index, fat mass in kilograms or percent body fat. The methodological problem inherent in interpreting these ratio measures is pictorially demonstrated. In regression analysis, fat mass alone did not explain the gender difference. However, lean body mass was inversely related to leptin concentrations (p < 0.0001) and explained 71% of the gender difference at a given fat mass. Percent body fat explained all of the gender difference in leptin concentrations in both Hispanics and non-Hispanic whites. Similar to findings about gender differences, ethnic- and age-related variations in the leptin-body fat association were minimized when percent body fat was employed as the body fat measure. DISCUSSION: Regression analysis and percent body fat measured with dual energy X-ray absorptiometry are recommended when assessing the relationship between leptin and body fat. Gender differences in leptin concentrations were accounted for by percent body fat in free living (no diet control), Hispanic and non-Hispanic white adults.

Methods and prevalence of ADL limitations in Hispanic and non-Hispanic white subjects in rural Colorado: the San Luis Valley Health and Aging Study.

PURPOSE: The Hispanic population in the United States is the fastest growing minority group, yet there is little understanding of the disability patterns that occur as this population ages. We conducted a cross-sectional study to define the prevalence of limitations of activities of daily living (ADL) and measures of observed function. METHODS: We censussed two rural counties in southern Colorado and selected a stratified sample of both Hispanic and non-Hispanic white (NHW) residents; 81.6% completed the protocol. RESULTS: Among the 1250 subjects aged 65 years and older, Hispanic elderly living in the community had greater ADL disability than NHW subjects, both for any difficulty (p = 0.006), and for needing assistance (p = 0.002). Hispanic persons were less likely to reside in nursing homes (3.4%) compared with NHW persons (9.3%). Hispanic elderly had excess prevalence of dependent ADL tasks (needs assistance or unable to do), (age, gender-adjusted odds ratio = 1.39, 95% CI = 1.01-1.92) in community dwelling and nursing home residents combined. There was no Hispanic excess of less severe difficulty compared with NHW persons, and there was a similar prevalence of limitation on observed functional tasks (timed walk, stooping, rising from a chair) in both groups. CONCLUSIONS: There was a modest Hispanic excess of reported dependent ADL limitation, and no excess of observed functional difficulties. Hispanics enter older age with much less income and education, yet they do not have a marked excess prevalence of limitations in activities of daily living when compared with NHW persons living in the same area.

Indicators of nutritional risk in a rural elderly Hispanic and non-Hispanic white population: San Luis Valley Health and Aging Study.

OBJECTIVE: To describe the prevalence of nutritional risk factors among elderly residents in a rural Hispanic and non-Hispanic white population. DESIGN: A geographically based survey of community-dwelling elderly adults. SUBJECTS/SETTING: From July 1993 to July 1995, all Hispanic persons older than 65 years and an age-stratified, random sample of 69% of non-Hispanic white persons, from 2 Colorado counties, were invited to participate in a study of functional impairment and disability (81% responded). After exclusion of 184 respondents who required a surrogate respondent and 8 with missing diet data, the study consisted of 1,006 subjects. Interviews included questions similar to the Nutrition screening Initiative checklist, a 21-item food frequency questionnaire, and anthropometric measures. STATISTICAL ANALYSES PERFORMED: Gender- and ethnicity-specific, age-adjusted prevalence for each risk factor was estimated by use of logistic regression. RESULTS: Hispanic participants were more likely than non-Hispanic whites to report inadequate intake of vegetables, problems with teeth or dentures that limited the kinds and amounts of food eaten, difficulty preparing meals, and lack of money needed to buy food. Hispanic women reported nutritional risk factors more often than Hispanic men, although anthropometric markers indicated that Hispanic men may be at higher risk of nutritional deficiency. APPLICATIONS/CONCLUSIONS: Hispanic men and women had a higher prevalence of nutritional risk factors than non-Hispanic whites. Intervention programs targeting rural, elderly Hispanics should aim to ensure that basic nutrition needs (access to food, help preparing meals, and adequate dental care) are being met. Community programs to increase activity levels and consumption of nutrient-dense foods are recommended.

Association of antibodies to beta2-glycoprotein 1 with pregnancy loss and pregnancy-induced hypertension: a prospective study in low-risk pregnancy.

OBJECTIVE: To determine whether higher levels of anti-beta2-glycoprotein 1 before 25 weeks' gestation are independently associated with either pregnancy loss or pregnancy-induced hypertension. METHODS: Serum samples for the immunoglobulin (Ig) G and IgM isotypes of anti-beta2-glycoprotein 1, anticardiolipin antibody, and antiphosphatidylserine were collected from 325 low-risk nulliparas who presented for prenatal care before 25 weeks' gestation. This cohort was followed prospectively for the development of pregnancy loss and pregnancy-induced hypertension. RESULTS: The adjusted odds ratios (OR) and 95% confidence intervals (CI) of elevated antiphospholipid antibody levels for pregnancy loss were: IgG anti-beta2-glycoprotein 1, OR 1.2 (CI 0.5, 2.8); IgG anticardiolipin antibody, OR 8.4 (CI 2.3, 31); and IgG antiphosphatidylserine, OR 5.2 (CI 1.4, 18.7). The relative risks of pregnancy loss for all IgG antiphospholipid antibodies were higher among women who had blood collected after 10 weeks' gestation compared with those studied before 10 weeks' gestation. However, there were only marginal differences in the attributable risks, suggesting that the impact of elevated levels of antiphospholipid antibodies might be similar in early and later stages of pregnancy. None of the antiphospholipid antibodies was associated with pregnancy-induced hypertension. CONCLUSION: In this study, elevated levels of IgG anticardiolipin and IgG antiphosphatidylserine antibodies were markers of pregnancy loss, but an elevated level of anti-beta2-glycoprotein was not a strong predictor of fetal loss.

Cognitive functioning and impairment among rural elderly Hispanics and non-Hispanic whites as assessed by the Mini-Mental State Examination.

We conducted a cross-sectional study to determine the distribution of cognitive functioning as measured by the Mini-Mental State Examination (MMSE) among a sample of Hispanic and non-Hispanic White (NHW) residents from two counties in rural, southern Colorado. Residents aged 60 years and older (N = 1,360) were administered the full MMSE, a sociodemographic and medical interview. Protocols were developed to administer the MMSE equitably in both ethnic groups. Younger Hispanics tended to be categorized as severely impaired more than similarly aged NHWs (OR at age 70 = 4.14), however, older Hispanics and NHWs performed similarly after adjusting for education and gender (OR at age 90 = 1.00). The use of a modified MMSE scale that removed the ethnic bias demonstrated that NHWs and Hispanics had similar levels of severe impairment after full adjustment (OR = 0.93). Given the widespread use of the MMSE, these findings indicate the need for further validation of this instrument.

The association of non-insulin-dependent diabetes mellitus with perceived quality of life in a biethnic population: the San Luis Valley Diabetes Study.

OBJECTIVES: This study evaluated the association between quality of life and non-insulin-dependent diabetes mellitus (NIDDM) status, and whether this association differs between Hispanics and non-Hispanic Whites. METHODS: Between 1986 and 1989, cross-sectional data on perceived quality of life (PQOL) were collected from 223 persons with NIDDM and 753 non-diabetic subjects. RESULTS: After adjustment, persons with NIDDM rated their PQOL significantly lower than did control subjects. The relationship of diabetes and PQOL did not differ by ethnicity. The number of complications of diabetes was not associated with lower PQOL scores. CONCLUSIONS: Control and treatment strategies should reflect an understanding of the impact that diabetes has on social functioning, leisure activities, and physical and mental health.

Higher instrumental activities of daily living disability in Hispanics compared with non-Hispanic whites in rural Colorado. The San Luis Valley Health and Aging Study.

This study examined Hispanic versus non-Hispanic white patterns of needing assistance with instrumental activities of daily living (IADL). The authors interviewed 798 Hispanic and 614 non-Hispanic white residents of rural Colorado, who were aged 60 years and older between 1993 and 1995. Seventy-five participants were nursing home residents at the time of the interview. Community-dwelling Hispanics were 1.6 times as likely as non-Hispanic whites to need assistance with at least one IADL task (95% confidence interval 1.25-2.13). A larger proportion of disabled non-Hispanic whites were in nursing homes but, after including nursing home residents, Hispanics remained significantly more likely to need assistance on at least one IADL task (odds ratio = 1.49, 95% confidence interval 1.16-1.93). Hispanics were also more likely to have difficulty on observed performance tasks. The Hispanic excess was not removed by adjusting for chronic disease, reported difficulty walking, or income. English language proficiency adjustment lowered the Hispanic excess, but adjusting for years of education or Mini-Mental State Examination scores more completely removed the ethnic differences. Higher education was protective for both Hispanic and non-Hispanic white elderly. Efforts to further investigate what facets or correlates of education are operating may offer useful insights into limiting IADL difficulties in future cohorts.

Improving power with repeated measures: diet and serum lipids.

The inability to detect associations between diet and serum cholesterol in cross-sectional population studies has been attributed to measurement error in diet assessments and between-subject variability in lipid concentrations. Current statistical methods can reduce the effects of measurement error and allow within-subject comparisons when replicate measures on individuals are available, even if the time between replicates is as long as 4 y and replicate data are not available for all subjects. Data from 928 nondiabetic participants of the San Luis Valley Diabetes Study with measures of 24-h dietary intake and fasting lipid concentrations at baseline, at a 4-y follow-up visit, or both were analyzed in a random-effects model that allowed for an unbalanced design. Sex was included as a non-time-varying covariate and age, body mass index, and energy intake were included as time-varying covariates. The findings when LDL cholesterol (mmol/L) was regressed on saturated fat intake (20 g/d) with all observations in a random-effects model (beta = 0.14, P = 0.0016) were compared with results with observations restricted to the first visit only (beta = 0.05, P = 0.52), a balanced design using averages across visits (beta = -0.12, P = 0.28), and a balanced design with random effects obtained by excluding subjects without two observations (beta = 0.12, P = 0.0092). Study power was greatest in the random-effects model using all observations and time-varying covariates. These findings highlight the importance of even a single replicate observation on a subsample of subjects. We recommend analyzing all data rather than averaging measures across visits or omitting observations to create a balanced design.

Executive cognitive abilities and functional status among community-dwelling older persons in the San Luis Valley Health and Aging Study.

OBJECTIVES: The purpose of this study was to evaluate the contribution of the executive cognitive functions to self-reported and observed performance of activities of daily living and instrumental activities of daily living. DESIGN: These data were collected as part of a cross-sectional survey of community-dwelling older persons, using statistical sampling, in a two-county area of southern Colorado. SETTING: Participants were interviewed and administered measures of general cognition, depression, executive functioning, and performance of self-care and instrumental activities, either in their homes or at the study clinic. PARTICIPANTS: A total of 1158 community-dwelling persons between the ages of 60 and 99 participated. Of these, 657 were female, 501 were male, 637 were Hispanic, and 521 were non-Hispanic whites. MEASUREMENTS: Subjects were administered the Mini-Mental State Exam (MMSE), a measure of executive functioning (the Behavioral Dyscontrol Scale), the Center for Epidemiologic Studies Depression scale (CES-D), and the Structured Assessment of Independent Living Skills (SAILS, a measure of observed performance of daily tasks). They also were interviewed regarding their reported ADL and IADL status using measures from the Longitudinal Study on Aging. RESULTS: Both general mental status and executive functioning demonstrated statistically significant univariate associations with all seven functional status measures (both self-report and observed performance). In a series of ordinary least squares regression models, executive functioning was a predictor for self-reported ADLs and observed performance of complex IADL tasks such as managing money and medications. Mental status did not predict self-reported functioning but was a predictor of observed performance. Depression was a significant variable for self-report measures but not for observed performance. Executive functioning and general mental status demonstrated some degree of independence from one another. CONCLUSION: Executive functioning is an important determinant of functional status for both self-reported and observed ADLs and IADLs and should be assessed routinely when evaluating the mental status and functional abilities of older people. These results replicate and extend previous research on executive functioning among older persons by examining these factors in a large bi-ethnic community sample.

Incidence and progression of diabetic retinopathy in Hispanics and non-Hispanic whites with type 2 diabetes. San Luis Valley Diabetes Study, Colorado.

OBJECTIVE: To learn if Hispanic people with type 2 diabetes have excess incidence and/or progression of diabetic retinopathy and to explore the association of risk factors with diabetic retinopathy. RESEARCH DESIGN AND METHODS: There were 244 subjects with type 2 diabetes (65.3% Hispanic) with at least one follow-up visit between 1984 and 1992 examined for the development of retinopathy over a median of 4.8 years (range 2.0-6.6 years). Stereo fundus photos were graded by the University of Wisconsin Reading Center. RESULTS: Of the 169 subjects without retinopathy at baseline, 47 developed some retinopathy, an incidence rate of 63.7 per 1,000 person-years (PY), or a 4-year cumulative incidence of 22.5%. The Hispanic incidence rate was 58.3/1,000 PY (95% CI: 39.4-83.3), which was lower than among non-Hispanic whites, 76.1/1,000 PY (44.3-121.9). Progression occurred in 24 of the 75 subjects with retinopathy at baseline, a 4-year cumulative rate of 24.1%. Logistic regression showed that insulin treatment was associated with higher risk of any retinopathy (odds ratio [OR] = 8.45, 2.65-26.97), and both systolic blood pressure (odds ratio [OR] = 1.58, 0.99-2.52) and total GHb (OR = 1.46, 0.99-2.17) nearly attained statistical significance. After adjustment for multiple potential risk factors, the Hispanic/non-Hispanic white OR was 0.66 (0.28-1.57). CONCLUSIONS: No excess risk for incident retinopathy was found among Hispanic compared with non-Hispanic white subjects in this population. These results are consistent with our previously reported prevalence data from the same population but differ from reports of excess prevalence among Texas Hispanics. No other Hispanic incidence data are available to assist in reconciling this difference.

Social network factors associated with perceived quality of life. The San Luis Valley Health and Aging Study.

Demographic and social network factors associations with perceived quality of life (PQOL) were examined in a sample of rural Hispanic and non-Hispanic White (NHW) elderly. A 20-item PQOL scale measured participants' satisfaction with multiple facets of their lives. Age, gender, marital status, and living alone were not associated with this outcome. Hispanic persons with higher incomes had consistently higher ratings of quality of life compared to NHWs. More education was associated with a higher PQOL rating only among NHWs. More close friends and relatives, visiting in homes, and participation in outside activities were all independently related to PQOL. Interaction tests showed that the impact of social networks was stronger in NHWs. These findings suggest that network size and contact are important social factors that can improve quality of life for both ethnic groups. However, differences may need to be examined when judging the magnitude of these associations and when planning interventions.

Incidence of distal symmetric (sensory) neuropathy in NIDDM. The San Luis Valley Diabetes Study.

OBJECTIVE: To determine the incidence and risk factors for distal symmetric sensory neuropathy (DSN) in people with NIDDM. RESEARCH DESIGN AND METHODS: Prospective follow-up was conducted from 1988 to 1992 on 231 people free of DSN during the baseline period 1984-1988 (mean follow-up, 4.7 years). Subjects with incident DSN (n = 66) were defined by any two of three criteria: 1) bilateral paresthesia in legs or feet; 2) bilateral decreased or absent ankle reflexes; and/or 3) bilateral decreased or absent cold temperature discrimination in feet. Of all 66 cases, 42 had one positive follow-up visit; 14 cases had 2 positive follow-up visits. RESULTS: The overall incidence rate of DSN was 6.1 per 100 person-years (95% CI, 4.7-7.8). The rate for Hispanics (n = 164) and non-Hispanic whites (n = 67), adjusted for age, sex, and NIDDM duration, was 5.3 per 100 person-years (95% CI, 3.9-7.0) and 5.0 per 100 person-years (95% CI, 2.8-8.1), respectively. Adjusting for age and sex, higher glycohemoglobin level and lower C-peptide secretion were associated with increased DSN but were no longer predictive after accounting for duration of diabetes. Logistic regression models found significantly increased risk of DSN for insulin treatment, current smoking, and history of myocardial infarction. Duration was related to DSN incidence until insulin treatment was included. Other risk factors, including height, weight, family history of diabetes, peripheral vascular disease, hypertension, urinary albumin, protein:creatinine ratio, retinopathy, and alcohol use, were not significantly related to incident DSN. CONCLUSIONS: Hispanic and non-Hispanic whites with NIDDM have similar risks of DSN. Current cigarette smoking and a history of myocardial infarction may represent independent risk factors for DSN in addition to glycemic control.

The prevalence of age-related maculopathy by geographic region and ethnicity. The Colorado-Wisconsin Study of Age-Related Maculopathy.

OBJECTIVES: To determine the prevalence of age-related maculopathy (ARM) in a biethnic population and to determine if there are ethnic and/or geographic differences in the prevalence of ARM. DESIGN: Prevalence data from 2 population-based studies, the San Luis Valley Diabetes Study (n = 1541, ages 21-74 years) and the Beaver Dam Eye Study (n = 3999, ages 43-74 years), were compared. SETTING: Southern Colorado and central Wisconsin. MAIN OUTCOME MEASURE: Color stereoscopic fundus photographs were graded for ARM using the Wisconsin Age-related Maculopathy Grading System. Similar questionnaire, laboratory, and clinical data on potential risk factors were available from both studies. RESULTS: Late-stage ARM was significantly less frequent among Hispanics than non-Hispanic whites (NHW) in Beaver Dam (odds ratio [OR] = 0.07; 95% confidence interval [CI] = 0.01-0.49; Hispanics vs Beaver Dam NHW). The prevalence of any ARM was significantly lower among San Luis Valley NHW (10.4%) than Beaver Dam NHW (14.3%) (OR = 0.67; 95% CI = 0.50-0.91). This prevalence difference was not explained by any of the risk factors examined (smoking, cardiovascular disease, diabetes, alcohol consumption, etc). The 2 NHW groups reported different European heritages. CONCLUSIONS: Late-stage ARM appeared to be rare among Hispanics but there was no ethnic difference in prevalence of any ARM. The 33% difference in risk among NHW by geographic location was not reduced when controlling for possible risk factors or confounders, suggesting that genetic heritage may be an important determinant of risk for ARM.

Mitochondrial versus nuclear admixture estimates demonstrate a past history of directional mating.

Six blood group antigens (ABO, RH, MNS, KK, KP, FY) and five plasma proteins (HP, GC, APOA4, FXIIIB, C1R) were typed in 790 individuals, and 12 mtDNA RFLP and deletion polymorphisms were typed in 657 individuals from the San Luis Valley, Colorado. The 790 nuclear typings were conducted on 399 Anglos and 391 Hispanics, while the 657 mitochondrial haplotypes were generated from 207 Anglos and 450 Hispanics. Chakraborty's ADMIX2 FORTRAN program was used to estimate the average Amerindian admixture using all nuclear loci simultaneously. Since there is no recombination in mtDNA, the sum of the frequencies of the Amerindian/Asian-specific mitochondrial haplotypes represents the level of Amerindian admixture. The nuclear estimates of Amerindian admixture were 33.15 +/- 2.41% for the Hispanics and 9.72 +/- 1.90% for the Anglos, while the strictly maternally inherited mtDNA estimates of Amerindian admixture were 85.11% for the Hispanics and 0.97% for the Anglos. This dramatic difference in estimated levels of admixture between the biparentally derived nuclear estimates and the uniparentally derived mtDNA estimates is indicative of past directional matings between Hispanic males and Amerindian females.

Self-rated health among Hispanic vs non-Hispanic white adults: the San Luis Valley Health and Aging Study.

OBJECTIVES: This study investigated whether objective health indicators explained lower self-rated health among Hispanics compared with non-Hispanic Whites. It also considered socioeconomic and cultural explanations. METHODS: Health ratings of 429 Hispanics and 583 non-Hispanic Whites aged 20 through 74 were analyzed with logistic regression. RESULTS: Illness indicators were found to be strongly correlated with self-rated health in both ethnic groups, but after such markers were controlled for, Hispanics remained 3.6 times more likely to report fair or poor health (95% confidence interval = 2.4, 5.3). Adjustment for socioeconomic factors accounted for a portion of Hispanics' lower health rating, but the strongest explanatory factor was acculturation. CONCLUSIONS: Because of cultural and economic influences on definitions of health, ethnic differences in self-assessed health may not accurately reflected patterns resulting from objective health measurements.

Population screening for glucose intolerant subjects using decision tree analyses.

The purpose of this study was to develop a method of screening for impaired glucose tolerance and previously undiagnosed NIDDM that could be used preliminary to the administration of an oral glucose tolerance test (OGTT) for final classification of glucose tolerance status. The purpose of a preliminary screening of this type would be to reduce the number of OGTT's needed to identify cases of IGT and NIDDM in the population. We used NIDDM risk indicators and decision tree analysis methods (CART software) to identify subgroups of the population at increased risk. We examined a population of Hispanic (n = 583) and non-Hispanic white (n = 768) subjects without a prior history of diabetes. Subjects were classified as normal, IGT or NIDDM (WHO criteria) based on results from a 75 g oral glucose tolerance test (OGTT). Sensitivity (SEN) and specificity (SPE) of the CART models were calculated using the OGTT as the 'gold standard.' Two approaches to screening were simulated. In the simultaneous approach all risk variables were entered into CART models at once. In the serial approach, risk variables were grouped according to degree of effort required for data collection, and were entered into CART models in stages. Fasting glucose, age and body mass index (BMI) were selected as risk variables by CART when simulating the simultaneous approach (SEN = 91%, SPE = 55%). In the serial approach, CART used age and BMI to eliminate 35% of the population from further screening, and then used fasting glucose, glycohemoglobin, age and BMI to classify the remaining higher risk subjects (SEN = 85%, SPE = 64%). These models suggest that screening for IGT and previously undiagnosed NIDDM can be based on measurement of relatively simple indicators, and yet maintain a level of both sensitivity and specificity acceptable for this type of preliminary screening.

Hypertension among rural Hispanics and non-Hispanic whites: the San Luis Valley Diabetes Study.

IN THE SAN LUIS VALLEY DIABETES STUDY (SLVDS) researchers studied hypertension morbidity and risk factors in 1788 Hispanics and non-Hispanic whites (NHW) from the rural San Luis Valley in Colorado. Hypertension was defined by The Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC-V) criteria. In this population-based study, the prevalence, incidence, and risk factors for hypertension did not differ significantly between non-diabetic Hispanics and NHW participants. Hypertension risk increased with age, heart rate, serum triglycerides, insulin area, and obesity (in young participants). Compared with the prevalence rates in non-diabetic participants, the rates were significantly higher in people with diabetes and increased with the duration of diabetes and central obesity. The risk of hypertension in diabetic Hispanics appeared to be somewhat lower than that in NHW diabetics.