John H. Summerson
Wake Forest University
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Featured researches published by John H. Summerson.
American Journal of Kidney Diseases | 1995
John H. Summerson; Ronny A. Bell; Joseph C. Konen
One hundred nine patients with essential hypertension and without either diabetes mellitus or clinical proteinuria were examined to investigate possible racial differences in urinary albumin excretion rates. The black hypertensive patients were found to have significantly higher urinary albumin excretion rates compared with the white patients; in addition, a significantly greater proportion of the black patients than the white patients (32% v 14%) had microalbuminuria, defined as a urinary albumin excretion rate greater than 30 micrograms/min. These differences could not be explained by age, blood pressure, body mass index, glycosylated hemoglobin, serum creatinine, duration of hypertension, or type of hypertension treatment. Hypertensive renal failure occurs six to 18 times more frequently in blacks than in whites; to our knowledge, these data are the first to indicate that microalbuminuria may be more prevalent during the course of hypertension in black patients and thus may be an early marker for end-organ damage susceptibility among hypertensive patients.
Behavioral Medicine | 1995
Ronny A. Bell; John H. Summerson; Joseph C. Konen
To determine whether racial differences exist in psychosocial variables among patients with non-insulin-dependent diabetes mellitus (NIDDM), the authors administered a series of questionnaires to 211 Black and White patients of the Wake Forest Family Medicine ambulatory care unit and the Reynolds Health Center, a community health center. In general, Blacks in the study population had higher levels of external locus of control, higher levels of stress, and lower levels of family functioning compared with Whites. These differences may account partially for the disparity of diabetes control and the consequences of diabetes among Blacks. Health professionals may benefit from understanding and addressing these psychosocial variables and may be more successful in implementing intervention programs in this population by tailoring programs to the psychosocial orientation of their population.
Addictive Behaviors | 2001
John G. Spangler; John H. Summerson; Ronny A. Bell; Joseph C. Konen
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.
Ethnicity & Health | 1999
Joseph C. Konen; John H. Summerson; Ronny A. Bell; Laura G. Curtis
OBJECTIVE To compare the frequency of common symptoms and complications between African- and white American adults with type 2 diabetes mellitus in a primary care setting, and to examine associations of these conditions with glycemic control. DESIGN Three hundred and four adults with type 2 diabetes participated in this cross-sectional analysis; 142 of whom were African-Americans. Patients were recruited from a family practice ambulatory care unit and a community health center. RESULTS Both male and female African-Americans had higher mean diastolic blood pressure and poorer metabolic control than their white counterparts. After adjustment for diabetes duration, glycosylated hemoglobin and diastolic blood pressure, African-American females were significantly more likely to experience constipation and hypertension but less likely to experience chest pain, claudication, peripheral neuropathy or have peripheral vascular disease. Among male subjects, African-Americans were significantly more likely to experience blurred vision and hypertension but less likely to have peripheral atherosclerotic disease. Poor glycemic control was more strongly associated with the occurrence of common diabetic symptoms in African-American subjects. CONCLUSIONS Both African- and white Americans with type 2 diabetes are likely to experience a wide variety of symptoms and vascular complications. African-American subjects appear more likely than whites to experience symptoms related to glycemic control but less likely to have, or experience symptoms and complications of, cardiovascular disease. That nearly half of these subjects seen in a primary care setting had microalbuminuria suggests that vascular complications are likely to be present in the majority of adults with type 2 diabetes, even in these currently asymptomatic. These findings may have implications for screening and preventive strategies for the treatment of this disease.
Behavioral Medicine | 1998
Ronny A. Bell; John H. Summerson; Spangler Jg; Joseph C. Konen
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.
Metabolism-clinical and Experimental | 1992
John H. Summerson; Joseph C. Konen; Mark Dignan
Racial differences in plasma lipid and lipoprotein levels were investigated in 145 patients with non-insulin-dependent diabetes mellitus (NIDDM). Black men had higher high-density lipoprotein (HDL) cholesterol levels, lower triglyceride levels, and an improved atherogenic index compared with white men. Premenopausal black women were also found to have higher HDL cholesterol levels, lower triglyceride levels, and a lower atherogenic index than their white counterparts. Adjustment for age, waist to hip ratio (WHR), hemoglobin A1c (HbA1c), and physical activity did not eliminate the significant differences found. There were no racial differences found regarding total and low-density lipoprotein (LDL) cholesterol. Metabolic control as measured by HbA1c was significantly correlated with the triglyceride level in black women. These data confirm that racial differences exist in plasma lipid levels among patients with NIDDM.
Clinical Trials | 2016
Thomas Ramsey; Joni K. Snyder; Laura Lovato; Christianne L. Roumie; Steven P Glasser; Nora M. Cosgrove; Christine Olney; Rocky Tang; Karen C. Johnson; Carolyn H. Still; Lisa H. Gren; Jeffery Childs; Osa L Crago; John H. Summerson; Sandy M Walsh; Letitia H. Perdue; Denise M Bankowski; David C. Goff
Background: The Systolic Blood Pressure Intervention Trial is a multicenter, randomized clinical trial of 9361 participants with hypertension who are ≥50 years old. The trial is designed to evaluate the effect of intensive systolic blood pressure control (systolic blood pressure goal <120 mm Hg) compared to standard control (systolic blood pressure goal <140 mm Hg) on cardiovascular events using commonly prescribed antihypertensive medications and lifestyle modification. Objective: To describe the recruitment strategies and lessons learned during recruitment of the Systolic Blood Pressure Intervention Trial cohort and five targeted participant subgroups: pre-existing cardiovascular disease, pre-existing chronic kidney disease, age ≥75 years, women, and minorities. Methods: In collaboration with the National Institutes of Health Project Office and Systolic Blood Pressure Intervention Trial Coordinating Center, five Clinical Center Networks oversaw clinical site selection, recruitment, and trial activities. Recruitment began on 8 November 2010 and ended on 15 March 2013 (about 28 months). Various recruitment strategies were used, including mass mailing, brochures, referrals from healthcare providers or friends, posters, newspaper ads, radio ads, and electronic medical record searches. Results: Recruitment was scheduled to last 24 months to enroll a target of 9250 participants; in just over 28 months, the trial enrolled 9361 participants. The trial screened 14,692 volunteers, with 33% of initial screens originating from the use of mass mailing lists. Screening results show that participants also responded to recruitment efforts through referral by Systolic Blood Pressure Intervention Trial staff, healthcare providers, or friends (45%); brochures or posters placed in clinic waiting areas (15%); and television, radio, newspaper, Internet ads, or toll-free numbers (8%). The overall recruitment yield (number randomized/number screened) was 64% (9361 randomized/14,692 screened), 77% for those with cardiovascular disease, 79% for those with chronic kidney disease, 70% for those aged ≥75 years, 55% for women, and 61% for minorities. As recruitment was observed to lag behind expectations, additional clinics were included and inclusion criteria were broadened, keeping event rates and trial power in mind. As overall recruitment improved, a greater focus on subgroup recruitment was implemented. Conclusion: Systolic Blood Pressure Intervention Trial met its overall projected recruitment goal using diverse, locally adapted enrollment strategies to specifically target persons with cardiovascular disease, chronic kidney disease, ≥75 years old, women, and minority subgroups. The trial exceeded its recruitment goal for minorities but found it a challenge to meet the competing demands of the targeted goals for recruiting into the remaining four subgroups. Important lessons include the imperative to monitor the recruitment process carefully, decide early to add new clinics or modify inclusion and exclusion criteria if recruitment lags, and consider limiting enrollment to subgroups only. We found benefit in using multiple recruitment sources simultaneously; mass mailing produced the largest number of participants, but referrals resulted in the greater randomization yield.
Womens Health Issues | 1999
John H. Summerson; John G. Spangler; Ronny A. Bell; Brent J. Shelton; Joseph C. Konen
Females with Type II diabetes appear more likely than males to experience symptoms and vascular complications related to their disease.
Journal of The American Board of Family Practice | 1997
John G. Spangler; Ronny A. Bell; John H. Summerson; Joseph C. Konen
Background: The excretion of small amounts of urinary protein, known as microalbuminuria, among patients with essential hypertension is associated with increased mortality from cardiovascular disease and, possibly, future renal decline. Correlates of microalbuminuria among primary care patients with essential hypertension, however, have not been well described. Methods: One hundred forty patients enrolled in a large family practice ambulatory care center who had essential hypertension but not diabetes participated in a screening project to document cardiovascular and renal diseases in this population. Patients underwent a brief physical examination and submitted blood and urine samples for analysis. Results: Twenty-five percent of patients had elevated urinary albumin excretion (UAE) rates, defined as greater than 30 μg/min. Patients with elevated UAE rates did not differ from patients without elevated UAE rates by age, race, sex, duration of hypertension, or type of antihypertensive medication used (if any). Although no patients had abnormally elevated g1ycosylated hemoglobin, after controlling for age and duration of hypertension, elevated UAE rates were significantly related to higher mean g1ycosylated hemoglobin levels (odds ratio [OR] = 3.06,95 percent confidence interval [CI] = 1.11 to 8.41) and to current smoking (OR = 3.14,95 percent CI = 1.09 to 9.04). Conclusions: These data are the first in a primary care population to show a threefold increase in risk for elevated UAE rates among patients with essential hypertension who currently smoke or who have above-average g1ycosylated hemoglobin levels. Although cross-sectional in nature, these data can also point toward subgroups of hypertensive patients who have a worse cardiovascular prognosis.
Ethnicity & Health | 1996
John H. Summerson; Ronny A. Bell; Joseph C. Konen
OBJECTIVE To determine possible racial differences in risk factors for coronary heart disease (CHD) in black and white patients with noninsulin-dependent diabetes mellitus (NIDDM). METHODS Study of risk factors for coronary heart disease among 308 subjects who met the WHO criteria for NIDDM. RESULTS Both black and white patients were found to have a high prevalence of hypertension, obesity, low high density lipoprotein (HDL) cholesterol, low leisure-time physical activity levels, and an atherogenic dietary profile. Black males were more likely to have hypertension, reported a greater intake of dietary cholesterol, and had lower triglycerides, higher HDL cholesterol levels, a lower CHOL/HDL ratio, and a lower waist to hip ratio (WHR) than white males. Black females had higher mean arterial and diastolic blood pressures, had lower triglycerides, higher HDL cholesterol, a lower CHOL/HDL ratio, a higher subscapular/triceps ratio and lower reported leisure-time energy expenditure compared to white females. There were no racial differences found for obesity level. CONCLUSION Our results indicate that racial differences in CHD risk factors exist among black and white patients with NIDDM. The complex genetic, sociocultural and environmental interactions involving CHD risk factors that contribute to the development of CHD may eventually provide clues to the etiology of the disease.