Frank E. Speizer

Bio: Frank E. Speizer is an academic researcher from Brigham and Women's Hospital. The author has contributed to research in topics: Relative risk & Risk factor. The author has an hindex of 193, co-authored 636 publications receiving 135891 citations. Previous affiliations of Frank E. Speizer include Medical Research Council & Beth Israel Deaconess Medical Center.

Extended Work Shifts and the Risk of Motor Vehicle Crashes Among Interns

Abstract: It is not uncommon for interns in the United States to work extended shifts of 24 hours or longer. The marked increase in fatigue-related crashes and trucker deaths has been related to consecutive driving hours, prompting this survey of interns nationwide to detect any associations among work hours, extended shifts, and driving safety. A web-based survey was completed by 2737 interns, 80% of those receiving it. They completed 19,740 monthly reports of work hours, motor vehicle crashes, and near misses, as well as episodes of involuntary sleep. Participants were similar demographically to all interns matched through the National Resident Matching Program in 2002. Just over half the respondents were female. The mean age was 28 years. Nearly 80% were in medical specialties. The interns averaged 71 hours in the hospital each week and were awake for all but 3 hours. They spent an additional 4 hours weekly working or studying outside the hospital. Days off per month—including weekends, holidays, and allocated time off—averaged 6.5. The average number of extended work shifts per month was 4, and their average duration was 32 hours. In more than 85% of monthly surveys, the interns reported having worked extended shifts without night-float coverage. The longest time of continuous work averaged 28 hours. There were reports of 320 motor vehicle crashes, 133 of which were consequential (led to emergency treatment, caused at least $1000 in property damage, or prompted filing of a police report). The risk of a crash or near miss was significantly greater for interns commuting from work after an extended shift than after a nonextended shift. Every extended shift that was scheduled per month increased the monthly rate of motor vehicle crashes by 9% and increased crashes on the commute from work by 16%. The risk of falling asleep while driving or when stopped in traffic also rose significantly with the number of extended shifts per month. These findings indicate that interns commuting after an extended work shift are more than twice as likely to have a motor vehicle crash than those returning from a nonextended shift. This is a serious but preventable safety hazard for both the interns themselves and other motorists. Findings from other studies suggest that working an extended shift predisposes to failure of attention and to serious medical errors.

Postmenopausal Hormone Therapy and Mortality

Abstract: Background Postmenopausal hormone therapy has both benefits and hazards, including decreased risks of osteoporosis and cardiovascular disease and an increased risk of breast cancer. Methods We examined the relation between the use of postmenopausal hormones and mortality among participants in the Nurses' Health Study, who were 30 to 55 years of age at base line in 1976. Data were collected by biennial questionnaires beginning in 1976 and continuing through 1992. We documented 3637 deaths from 1976 to 1994. Each participant who died was matched with 10 controls alive at the time of her death. For each death, we defined the subject's hormone status according to the last biennial questionnaire before her death or before the diagnosis of the fatal disease; this reduced bias caused by the discontinuation of hormone use between the time of diagnosis of a potentially fatal disease and death. Results After adjustment for confounding variables, current hormone users had a lower risk of death (relative risk, 0.63; ...

Cumulative and reversible effects of lifetime smoking on simple tests of lung function in adults.

Abstract: Data from a random sample of 8,191 men and women from 6 U.S. cities are used to fit a model describing the effects of cumulative and current cigarette smoking on pulmonary function. The data show that smokers suffer an irreversible loss of FVC and FEV1, which is described by a linear function of their cumulative cigarette smoking as measured in pack-years. For a typical male 173 cm tall, the estimated loss of FEV1 is 7.4 ml for each pack-year smoked. For a typical woman, 161 cm tall, the estimated effect is 4.4 ml per pack-year. Current cigarette smoking adds an acute deficit over and above the cumulative effect of lifetime smoking. For any lifetime pack-years, exsmokers have higher levels of FEV1, 123 ml for a typical man, 107 ml for a typical woman, than do current smokers of a pack per day (p less than 0.001). A man who starts smoking one pack of cigarettes per day at 25 yr of age would at age 60, after 35 pack-years of exposure, have an expected FEV1 equal to that of a man 69.4 yr of age who had never smoked. If he stopped smoking at 60 yr of age, his expected level would increase to that of a 66.5-yr-old never-smoker. This model therefore estimates how much lung function is irreversibly lost by smoking, estimates how much could be regained with cessation of smoking, and predicts the future loss of lung function in both cases.

A prospective study of moderate alcohol drinking and risk of diabetes in women

Abstract: Several investigators have observed an association between alcohol consumption and elevated glucose levels, raising the possibility that alcohol may increase the risk of diabetes. This hypothesis was evaluated prospectively among 85,051 women participating in the Nurses' Health Study who were 34 to 59 years of age in 1980 and had no history of cancer, coronary heart disease, or diabetes. At baseline, participants completed an independently validated dietary questionnaire which included information on the consumption of beer, wine, and liquor. Incident cases of non-insulin-dependent diabetes were reported on follow-up questionnaires sent in 1982 and 1984 (98% response to at least one follow-up); 526 cases were confirmed by a supplementary questionnaire regarding symptoms, laboratory values, and treatment. The risk of diabetes decreased monotonically with increasing alcohol consumption (chi trend = -9.4, p less than 0.0001). Compared with nondrinkers, women consuming 5-14.9 g of alcohol per day (about 4-10 drinks per week) had an age-adjusted relative risk of diabetes of 0.4 (95% confidence interval (CI) 0.3-0.6); for 15 g or more per day, the relative risk was 0.3 (95% CI 0.2-0.4). However, a strong inverse association between alcohol drinking and body weight explained much of the apparent protective effect of alcohol. After simultaneous adjustment for Quetelet index (weight (kg)/height (m)2), family history of diabetes, total caloric intake, and age, the relative risk of diabetes for consumers of 5-14.9 g per day was 0.8 (95% CI 0.6-1.2), and for women who drank 15+ g per day, the relative risk was 0.6 (95% CI 0.3-0.9). These data provide no support for the hypothesis that moderate alcohol intake increases the risk of non-insulin-dependent diabetes.

The relationship of nonspecific bronchial responsiveness to respiratory symptoms in a random population sample

Abstract: The relationship of airway responsiveness to respiratory symptom prevalence has been studied in a cross-sectional analysis of a random subpopulation from a large-scale population study on chronic obstructive pulmonary disease (COPD) being conducted in the Netherlands. In 1,905 subjects with complete data on age, sex, area of residence, smoking habits, and respiratory symptom prevalence, airway responsiveness was assessed by a histamine challenge test. Subjects with a decrease in FEV1 of greater than or equal to 10% at a histamine concentration of less than or equal to 16 mg/ml were considered to be responders. Bronchial hyperresponsiveness appeared to be age dependent, with the proportion of responders increasing from 13% in those 14 to 24 yr of age to 40% in those 55 to 64 yr of age (p less than 0.001). Respiratory symptom outcomes included chronic cough, chronic phlegm, dyspnea, bronchitic episodes, persistent wheeze, and asthmatic attacks. Respiratory symptom prevalence rates were significantly higher in responders (p less than 0.001 for all symptoms). Cigarette smoking is known to be related to respiratory symptom prevalence and possibly to bronchial responsiveness. Because of these associations, we examined the relationship of bronchial responsiveness to respiratory symptoms within cigarette smoking categories. For all respiratory symptoms, it was found that, regardless of smoking category, responders were more likely to be symptomatic than were nonresponders. Odds ratios ranged from 1.7 for chronic cough to 4.4 for asthmatic attacks.(ABSTRACT TRUNCATED AT 250 WORDS)

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.

Abstract: Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is the fourth leading cause of chronic morbidity and mortality in the United States, and is projected to rank fifth in 2020 in burden of disease worldwide, according to a study published by the World Bank/World Health Organization. Yet, COPD remains relatively unknown or ignored by the public as well as public health and government officials. In 1998, in an effort to bring more attention to COPD, its management, and its prevention, a committed group of scientists encouraged the U.S. National Heart, Lung, and Blood Institute and the World Health Organization to form the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Among the important objectives of GOLD are to increase awareness of COPD and to help the millions of people who suffer from this disease and die prematurely of it or its complications. The first step in the GOLD program was to prepare a consensus report, Global Strategy for the Diagnosis, Management, and Prevention of COPD, published in 2001. The present, newly revised document follows the same format as the original consensus report, but has been updated to reflect the many publications on COPD that have appeared. GOLD national leaders, a network of international experts, have initiated investigations of the causes and prevalence of COPD in their countries, and developed innovative approaches for the dissemination and implementation of COPD management guidelines. We appreciate the enormous amount of work the GOLD national leaders have done on behalf of their patients with COPD. Despite the achievements in the 5 years since the GOLD report was originally published, considerable additional work is ahead of us if we are to control this major public health problem. The GOLD initiative will continue to bring COPD to the attention of governments, public health officials, health care workers, and the general public, but a concerted effort by all involved in health care will be necessary.

Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial

Abstract: Context Despite decades of accumulated observational evidence, the balance of risks and benefits for hormone use in healthy postmenopausal women remains uncertain Objective To assess the major health benefits and risks of the most commonly used combined hormone preparation in the United States Design Estrogen plus progestin component of the Women's Health Initiative, a randomized controlled primary prevention trial (planned duration, 85 years) in which 16608 postmenopausal women aged 50-79 years with an intact uterus at baseline were recruited by 40 US clinical centers in 1993-1998 Interventions Participants received conjugated equine estrogens, 0625 mg/d, plus medroxyprogesterone acetate, 25 mg/d, in 1 tablet (n = 8506) or placebo (n = 8102) Main outcomes measures The primary outcome was coronary heart disease (CHD) (nonfatal myocardial infarction and CHD death), with invasive breast cancer as the primary adverse outcome A global index summarizing the balance of risks and benefits included the 2 primary outcomes plus stroke, pulmonary embolism (PE), endometrial cancer, colorectal cancer, hip fracture, and death due to other causes Results On May 31, 2002, after a mean of 52 years of follow-up, the data and safety monitoring board recommended stopping the trial of estrogen plus progestin vs placebo because the test statistic for invasive breast cancer exceeded the stopping boundary for this adverse effect and the global index statistic supported risks exceeding benefits This report includes data on the major clinical outcomes through April 30, 2002 Estimated hazard ratios (HRs) (nominal 95% confidence intervals [CIs]) were as follows: CHD, 129 (102-163) with 286 cases; breast cancer, 126 (100-159) with 290 cases; stroke, 141 (107-185) with 212 cases; PE, 213 (139-325) with 101 cases; colorectal cancer, 063 (043-092) with 112 cases; endometrial cancer, 083 (047-147) with 47 cases; hip fracture, 066 (045-098) with 106 cases; and death due to other causes, 092 (074-114) with 331 cases Corresponding HRs (nominal 95% CIs) for composite outcomes were 122 (109-136) for total cardiovascular disease (arterial and venous disease), 103 (090-117) for total cancer, 076 (069-085) for combined fractures, 098 (082-118) for total mortality, and 115 (103-128) for the global index Absolute excess risks per 10 000 person-years attributable to estrogen plus progestin were 7 more CHD events, 8 more strokes, 8 more PEs, and 8 more invasive breast cancers, while absolute risk reductions per 10 000 person-years were 6 fewer colorectal cancers and 5 fewer hip fractures The absolute excess risk of events included in the global index was 19 per 10 000 person-years Conclusions Overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 52-year follow-up among healthy postmenopausal US women All-cause mortality was not affected during the trial The risk-benefit profile found in this trial is not consistent with the requirements for a viable intervention for primary prevention of chronic diseases, and the results indicate that this regimen should not be initiated or continued for primary prevention of CHD

2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

Abstract: ABCD : Appropriate Blood pressure Control in Diabetes ABI : ankle–brachial index ABPM : ambulatory blood pressure monitoring ACCESS : Acute Candesartan Cilexetil Therapy in Stroke Survival ACCOMPLISH : Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension ACCORD : Action to Control Cardiovascular Risk in Diabetes ACE : angiotensin-converting enzyme ACTIVE I : Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events ADVANCE : Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation AHEAD : Action for HEAlth in Diabetes ALLHAT : Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack ALTITUDE : ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints ANTIPAF : ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation APOLLO : A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People ARB : angiotensin receptor blocker ARIC : Atherosclerosis Risk In Communities ARR : aldosterone renin ratio ASCOT : Anglo-Scandinavian Cardiac Outcomes Trial ASCOT-LLA : Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm ASTRAL : Angioplasty and STenting for Renal Artery Lesions A-V : atrioventricular BB : beta-blocker BMI : body mass index BP : blood pressure BSA : body surface area CA : calcium antagonist CABG : coronary artery bypass graft CAPPP : CAPtopril Prevention Project CAPRAF : CAndesartan in the Prevention of Relapsing Atrial Fibrillation CHD : coronary heart disease CHHIPS : Controlling Hypertension and Hypertension Immediately Post-Stroke CKD : chronic kidney disease CKD-EPI : Chronic Kidney Disease—EPIdemiology collaboration CONVINCE : Controlled ONset Verapamil INvestigation of CV Endpoints CT : computed tomography CV : cardiovascular CVD : cardiovascular disease D : diuretic DASH : Dietary Approaches to Stop Hypertension DBP : diastolic blood pressure DCCT : Diabetes Control and Complications Study DIRECT : DIabetic REtinopathy Candesartan Trials DM : diabetes mellitus DPP-4 : dipeptidyl peptidase 4 EAS : European Atherosclerosis Society EASD : European Association for the Study of Diabetes ECG : electrocardiogram EF : ejection fraction eGFR : estimated glomerular filtration rate ELSA : European Lacidipine Study on Atherosclerosis ESC : European Society of Cardiology ESH : European Society of Hypertension ESRD : end-stage renal disease EXPLOR : Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination FDA : U.S. Food and Drug Administration FEVER : Felodipine EVent Reduction study GISSI-AF : Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation HbA1c : glycated haemoglobin HBPM : home blood pressure monitoring HOPE : Heart Outcomes Prevention Evaluation HOT : Hypertension Optimal Treatment HRT : hormone replacement therapy HT : hypertension HYVET : HYpertension in the Very Elderly Trial IMT : intima-media thickness I-PRESERVE : Irbesartan in Heart Failure with Preserved Systolic Function INTERHEART : Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries INVEST : INternational VErapamil SR/T Trandolapril ISH : Isolated systolic hypertension JNC : Joint National Committee JUPITER : Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin LAVi : left atrial volume index LIFE : Losartan Intervention For Endpoint Reduction in Hypertensives LV : left ventricle/left ventricular LVH : left ventricular hypertrophy LVM : left ventricular mass MDRD : Modification of Diet in Renal Disease MRFIT : Multiple Risk Factor Intervention Trial MRI : magnetic resonance imaging NORDIL : The Nordic Diltiazem Intervention study OC : oral contraceptive OD : organ damage ONTARGET : ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial PAD : peripheral artery disease PATHS : Prevention And Treatment of Hypertension Study PCI : percutaneous coronary intervention PPAR : peroxisome proliferator-activated receptor PREVEND : Prevention of REnal and Vascular ENdstage Disease PROFESS : Prevention Regimen for Effectively Avoiding Secondary Strokes PROGRESS : Perindopril Protection Against Recurrent Stroke Study PWV : pulse wave velocity QALY : Quality adjusted life years RAA : renin-angiotensin-aldosterone RAS : renin-angiotensin system RCT : randomized controlled trials RF : risk factor ROADMAP : Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention SBP : systolic blood pressure SCAST : Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke SCOPE : Study on COgnition and Prognosis in the Elderly SCORE : Systematic COronary Risk Evaluation SHEP : Systolic Hypertension in the Elderly Program STOP : Swedish Trials in Old Patients with Hypertension STOP-2 : The second Swedish Trial in Old Patients with Hypertension SYSTCHINA : SYSTolic Hypertension in the Elderly: Chinese trial SYSTEUR : SYSTolic Hypertension in Europe TIA : transient ischaemic attack TOHP : Trials Of Hypertension Prevention TRANSCEND : Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease UKPDS : United Kingdom Prospective Diabetes Study VADT : Veterans' Affairs Diabetes Trial VALUE : Valsartan Antihypertensive Long-term Use Evaluation WHO : World Health Organization ### 1.1 Principles The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …

Standardisation of spirometry

Abstract: [⇓][1] SERIES “ATS/ERS TASK FORCE: STANDARDISATION OF LUNG FUNCTION TESTING” Edited by V. Brusasco, R. Crapo and G. Viegi Number 2 in this Series [1]: #F13