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oai:open-archive.highwire.org:amjepid:133/9/8392015-05-11HighWireOUPamjepid:133:9
Risk Factors for Ectopic Pregnancy: A Case-Control Study in France, with Special Focus on Infectious Factors
Coste, Joël
Job-Spira, Nadine
Fernandez, Hervé
Papiemik, Emile
Spira, Alfred
ORIGINAL CONTRIBUTIONS
A case-control study was conducted in 1988 in seven Paris area maternity hospitals to evaluate the role of several risk factors, particularly infectious factors, in ectopic pregnancy. A total of 279 cases and 279 controls were compared for sociodemographic characteristics, cigarette smoking, sexual, reproductive and surgical histories, and conditions of conception Pelvic inflammatory disease confirmed by celioscopy (odds ratio (OR) = 5.5, 95% confidence interval (CI) 2.1–13.9) and <it>Chlamydia trachomatis</it> seropositivity (OR = 3.9, 95% Cl 2.3–6.7) appeared to be important risk factors for ectopic pregnancy Other risk factors found to be associated with an increased risk of ectopic pregnancy were dose-related cigarette smoking at the time of conception (ORs 13 to 2.5), appendectomy (OR = 1.6, 95% CI 1.1–2.5), prior tubal surgery (OR = 5.1, 95% Cl 1.7–15.4), induced conception cycle (OR = 3.2, 95% Cl 1.1–9 3), and prior ectopic pregnancy (OR = 13.3, 95% Cl 4.5–39.2). However, some of the latter risk factors, i e, prior tubal surgery, prior ectopic pregnancy, and perhaps appendectomy, may be considered to be the results of pelvic inflammatory disease and sexually transmitted diseases Maternal age, panty, prior induced abortion, and prior spontaneous abortion were not associated with ectopic pregnancy. Use of intrauterine device, progestagen micropill, and also combined estroprogestative pill at the time of conception were associated with a better prevention of intrauterine pregnancy than of ectopic pregnancy. These findings confirm the importance of several previously reported nsk factors of ectopic pregnancy: sexually transmitted diseases, cigarette smoking, and prior ectopic pregnancy. They also identified new risk factors, appendectomy and induced conception cycle, and revealed that the combined estroprogestative pill does not prevent ectopic pregnancy as effectively as it does intrauterine pregnancy. <it>Am J Epidemiol</it> 1991; 133: 839–49.
Oxford University Press
1991-05-01 00:00:00.0
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Changes in the Prevalence and Incidence of Diabetes Mellitus in Finnish Adults, 1970-1987
Laakso, Markku
Reunanen, Antti
Klaukka, Timo
Aromaa, Arpo
Maatela, Jouni
Pyöälä, Kalevi
ORIGINAL CONTRIBUTIONS
Prevalence and incidence of known diabetes mellitus in Finnish subjects aged 30 years or over in 1970–1987 were investigated using a nationwide register of drug recipients and four population surveys. On the basis of the drug-register data, the prevalence of drug-treated diabetes in men increased from 1.5% in 1970 to 2.8% in 1987. In women, the prevalence increased from 2.1% in 1970 to 3.0% in 1979 and declined thereafter slightly to 2.7% in 1987. The increase in the prevalence of drugtreated diabetes was mainly due to the increase of diabetes in the age groups 60 years and older. The prevalence of all known diabetic subjects in the population studies increased from 2.1% in the health examination survey of 1966–1972 (<it>n</it> = 38, 676) to 3.5% in the interview survey of 1976 (<it>n</it> = 10, 657) and to 4.5% in the health examination survey of 1979–1980 (<it>n</it> = 7, 217) but decreased to 3.3% in the interview survey in 1987 (<it>n</it> = 9, 522). The increased prevalence of obesity in men and better survival may be important factors contributing to the increasing prevalence rates of diabetes in Finnish subjects aged 30 years and over. <it>Am J Epidemlol</it> 1991; 133: 850–7.
Oxford University Press
1991-05-01 00:00:00.0
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oai:open-archive.highwire.org:amjepid:133/9/8582015-05-11HighWireOUPamjepid:133:9
Which Measure Of Body Fat Distribution is Best for Epidemiologic Research?
Mueller, William H.
Wear, Mary L.
Hanis, Craig L.
Emerson, James B.
Barton, Sara A.
Hewett-Emmett, David
Schull, William J.
ORIGINAL CONTRIBUTIONS
Multivariate associations were sought between risk factor levels (total cholesterol, high density lipoprotein (HDL) cholesterol, triglycendes, glucose, and systolic and diastolic blood pressures) and two sets of anthropometnc variables (four circumferences and six skinfolds) to select a set of anthropometric indicators of body fat distribution that correlate most highly with nsk of disease. Subjects were men (<it>n</it> = 285) and women (<it>n</it> = 672) from a study of gallbladder disease in a Mexican American population in Starr County, Texas, 1985–1986. The canonical correlations showed that circumferences (0.49–0.61) and skinfolds (0.42–0.60) were equally well correlated to nsk factor levels independently of sex and age. Weights from the canonical analyses suggest that measurements at or above the waist and on the lower limb (thigh) are most heavily loaded toward risk (waist = highest nsk; thigh = lowest risk). The simplest and most reliable index of body fat distribution for both sexes is the ratio of waist to thigh circumferences. The more commonly used waist/hip ratio proved more valid in women, but not in men Simple skinfold indices of body fat distribution were more poorly correlated to risk factor levels than the corresponding circumference ratios. In women, body mass index and waist circumference by themselves did as well as body fat distribution indices in explaining variation in risk factors, suggesting the involvement of visceral fat in the body fat/body fat distribution disease relation. <it>Am J Epidemiol</it> 1991; 133: 858–69.
Oxford University Press
1991-05-01 00:00:00.0
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Which Measure of Body Fat Distribution is Best for Epidemiologic Research Among Adolescents?
Sangi, Haleh
Mueller, Wiliam H
ORIGINAL CONTRIBUTIONS
Body fat distribution is a cardiovascular health risk factor in adults. The development of body fat distribution patterns in childhood remains to be explored and the appropriate index and relations of body fat distribution to cardiovascular risk factors in children is not clear. Data are available from the US Health Examination Survey (1966–1970), which included measurements of skinfold thickness, body and limb circumferences, biologic maturity, and nsk factors (blood pressure, total cholesterol). Using canonical correlation analysis, the relation between sets of anthropometnc variables and risk factors was explored, controlling for age, race, sex, and maturity stage. The relation of vanous body fat distribution and fatness indices used in adult studies to the risk factors was also explored using stepwise regression and partial correlation analyses. The first canonical correlations were significant between risk factors and both sets of anthropometric variables (skinfolds, 0.36–0.46; circumferences, 0.39–0.54). However, neither method revealed a clear cut pattern suggesting a role of centralized fatness. Rather, body fatness or size appeared to be the major correlate with risk factors in both races (black, white) and sexes and in each maturity status group. In the stepwise regression analysis, a body fatness or “size” variable (e.g., body mass index, hip circumference) invariably entered on step one. Only among the sexually mature did body fat distribution indices enter on the second step in a consistent manner. No one index seemed “better”, although indices based on skinfold measures entered more often than the waist/hip ratio. <it>Am J Epidemiol</it> 1991; 133: 870–83.
Oxford University Press
1991-05-01 00:00:00.0
TEXT
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oai:open-archive.highwire.org:amjepid:133/9/8842015-05-11HighWireOUPamjepid:133:9
Tracking of Serum Lipids and Lipoproteins from Childhood to Adulthood: The Bogalusa Heart Study
Webber, Larry S.
Srinivasan, Sathanur R.
Wattigney, Wendy A.
Berenson, Gerald S.
ORIGINAL CONTRIBUTIONS
Serum lipids (total cholesterol and tnglycerides) and lipoprotein cholesterol fractions (low density lipoprotein (LDL) cholesterol, very low density lipoprotein (VLDL) cholesterol, and high density lipoprotein (HDL) cholesterol) have been measured approximately every 3 years on children and young adults since 1973–1974 in Bogalusa, Louisiana, a community of approximately 22,000 individuals, one-third of whom are black and two-thirds of whom are white. A total of 1,586 children were examined both at baseline (1973–1974) and at the most recent survey (1984–1986), providing 12 years of follow-up. The decreases in levels noted during puberty for total cholesterol and LDL cholesterol, primarily for boys, were followed by a nse until age 26 years. HDL cholesterol levels, particularly for white boys, continued to drop after age 14 years, yielding increasingly high LDL cholesterol/HDL cholesterol ratios. Tracking, as measured by both correlation coefficients and persistence at extreme quartiles, was evident for all of the lipids and lipoproteins. The 12-year correlation coefficients were greatest for LDL cholesterol and no trend in the magnitude of the correlation coefficients with age was noted. Tracking for HDL cholesterol was better after age 9 years, particularly for white males. Approximately 50% of those children who had total cholesterol levels or LDL cholesterol levels above the 75th percentile at baseline remained elevated 12 years later. For HDL cholesterol, a trend with age was noted for white boys: 42% of those aged 9–14 years in the lowermost quartile persisted in this rank 12 years later. The best predictor of follow-up lipid or lipoprotein level was baseline level. The next best predictor was increase in weight as defined by weight/height3, an index of obesity. That serum lipid and lipoprotein levels continue to track from childhood into young adulthood points to the necessity of measurement early in life and, where indicated, the introduction of preventive and interventional programs aimed at developing healthy lifestyles. <it>Am J Epidemiol</it> 1991; 133: 884–99.
Oxford University Press
1991-05-01 00:00:00.0
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Labor and Delivery Events and Risk of Sudden Infant Death Syndrome (SIDS)
Buck, Germaine M.
Michalek, Arthur M.
Kramer, Andrew A.
Batt, Ronald E.
ORIGINAL CONTRIBUTIONS
The purpose of this study was to assess whether labor and delivery events were nsk factors for sudden infant death syndrome (SIDS). A nested case-control design was used. From the 1974 cohort of live births for Upstate New York (exclusive of New York City), resident mothers (<it>n</it> = 132,948), SIDS cases, and living controls were selected. Data were abstracted from hospital delivery and vital records for 148 autopsied cases and 355 frequency-matched controls With the use of unconditional logistic regression, no increase in SIDS risk was observed for artificial rupture of membranes, medication use dunng labor, induction/augmentation of labor, or anesthesia for delivery. An increased risk of SIDS was observed for labor 16 hours or more (odds ratio (OR) = 2.6, 95% confidence interval (Cl) 1.1–6.5) and vaginal breech delivery (OR = 7.2, 95% Cl 0.7–72.2). Significant inverse trends were observed for Apgar scores and nsk of SIDS. <it>Am J Epidemiol</it> 1991; 133: 900–6.
Oxford University Press
1991-05-01 00:00:00.0
TEXT
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oai:open-archive.highwire.org:amjepid:133/9/9072015-05-11HighWireOUPamjepid:133:9
Health and Social Predictors of Mortality in an Elderly Chinese Cohort
Ho, Suzanne C.
ORIGINAL CONTRIBUTIONS
A total of 1,054 Hong Kong Chinese subjects aged 70 years or over were recruited into a cohort study to investigate the relation between social support and health outcomes. More than 30 social, health, and behavioral charactenstics were recorded as baseline information when the study began in 1985. Mortality data were obtained dunng a 2-year follow-up. Logistic regression analyses were used to determine the roles of these variables in predicting mortality. The mortality patterns of Hong Kong and of the studied cohort closely resemble that of Western developed countnes with cancer, heart disease, and cerebrovascular diseases as the leading causes of death. Besides sex and place of residence (whether living in the community or in homes for the elderly), the independent predictors of mortality included five baseline variables: being single or widowed, limited ability in activities of daily living, smoking habit, low body mass index, and poor self-evaluated health status. Subjects with at least three of these predictors had a relative risk of 3.9 (95% confidence interval 2 4–6.2) compared with those with zero to two of these characteristics <it>Am J Epidemiol</it> 1991; 133: 907–21
Oxford University Press
1991-05-01 00:00:00.0
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In-Vivo and Post-Mortem Gallstones: Support for Validity of the "Epidemiologic Necropsy" Screening Technique
Simonovis, Nelson J. F.
Wells, Carolyn K
Feinstein, Alvan R.
ORIGINAL CONTRIBUTIONS
This research was done to evaluate the “epidemiologic necropsy” procedure as a “screening” technique for disease that has been clinically unsuspected or inactive during life. The post-mortem occurrence rates of gallstones in necropsies at Yale-New Haven Hospital were compared and found reasonably similar to the analogous rates of gallstones detected in-vivo via ultrasonographic screening of large general populations. Because the authors could not find an appropriate in-vivo screening study done in the United States, they used data mainly from screening studies in Copenhagen, Denmark, and Rome and Sirmione, Italy. Two additional ultrasonographic screening studies have been done in Norway and in populations of Hispanic Americans Previous disparities between post-mortem and in-vivo screening results probably arose because of failure to stratify for age and sex, to remove patients with cholecystectomy from the analysis, or to account for small-size stones that would be detected at necropsy but not with ultrasonography The current results help confirm the value of the epidemiologic necropsy procedure in estimating the size of the substantial reservoir of undetected disease that does not appear in the customary tabulations of “vital statistics.” <it>Am J Epidemiol</it> 1991; 133: 922–31
Oxford University Press
1991-05-01 00:00:00.0
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oai:open-archive.highwire.org:amjepid:133/9/9322015-05-11HighWireOUPamjepid:133:9
Clustering of Residence of Multiple Sclerosis Patients at Age 13 to 20 Years in Hordaland, Norway
Riise, Trond
Grønning, Mant
Klauber, Melville R
Barrett-Connor, Elizabeth
Nyland, Harald
Albrektsen, Grethe
ORIGINAL CONTRIBUTIONS
Geographic and temporal variation and migration studies point to an exogenous agent in the etiology of multiple sclerosis. If infectious etiology is involved, space-time clustering would also be expected. The authors analyzed 381 patients with a clinical onset of multiple sclerosis between 1953 and 1987 in the county of Hordaland, Norway Patients within the same birth cohort had lived significantly closer to each other than would be expected during ages 13–20 years, with peak clustenng at age 18 years (<it>p</it> = 0.002) Clustering was also shown between patients in pairs comprised of one individual with initial remittent disease and the other with chronic progressive course of disease, suggesting a similar etiology for both clinical patterns. Clustering between cases with widely divergent dates of clinical onset provides evidence of marked variation in latency No similar clustering was observed in age-, sex-, and area-matched hospital controls without multiple sclerosis, and no clustering was found among the cases when using fixed number of years before onset. These results are compatible with a common infectious agent, such as the Epstein-Barr virus, acquired in adolescence in genetically vulnerable persons who are also not protected by an infection acquired before this age of susceptibility. Susceptibility could be related to the route of transmission or to other age-related covariates or it may be hormonally mediated. <it>Am J Epidemiol</it> 1991; 133: 932–9.
Oxford University Press
1991-05-01 00:00:00.0
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Reassessment of the Association between Guillain-Barre Syndrome and Receipt of Swine Influenza Vaccine in 1976-1977: Results of a Two-State Study
Safranek, Thomas J.
Lawrence, Dale N.
Kuriand, Leonard T.
Culver, David H.
Wiederholt, Wigbert C.
Hayner, Norman S.
Osterholm, Michael T.
O'Brien, Peter
Hughes, James M.
Expert Neurology Group,
ORIGINAL CONTRIBUTIONS
Although the original Centers for Disease Control study of the relation between A/ New Jersey/8/76 (swine flu) vaccine and Guillain-Barré syndrome (polyradiculoneuritis) demonstrated a statistical association and suggested a causal relation between the two events, controversy has persisted. To reassess this association, the authors obtained medical records of all previously reported adult patients with Guillain-Barré syndrome in Michigan and Minnesota from October 1, 1976 through January 31, 1977. To identify previously unreported hospitalized cases with onset of symptoms during this period, the authors surveyed medical care facilities. A group of expert neurologists formulated diagnostic criteria for Guillain-Barré syndrome and then reviewed the clinical records in a blinded fashion. Of the 98 adult patents from the original Centers for Disease Control study eligible for consideration, three were found to have been misclassified by date of onset and were excluded. Of the remaining 95, the 28 (29%) who did not meet the diagnostic criteria were equally distributed between the vaccinated group (18 of 60, 30%) and the unvaccinated group (10 of 35, 29%). In addition to the 67 remaining cases who met the diagnostic criteria, six previously unreported cases (three of whom had been vaccinated) were found and included in this analysis. The relative nsk of developing Guillain-Barre syndrome in the vaccinated population of these two states dunng the 6 weeks following vaccination was 7.10, comparable to the relative nsk of 7.60 found in the onginal study. These findings suggest that there was an increased risk of developing Guillain-Barré syndrome dunng the 6 weeks following vaccination in adults. The excess cases of Guillain-Barré syndrome dunng the first 6 weeks attributed to the vaccine was 8.6 per million vaccinees in Michigan and 9.7 per million vaccines in Minnesota No increase in relative nsk for Guillain-Barrié syndrome was noted beyond 6 weeks after vaccination. <it>Am J Epidemiol</it> 1991; 133: 940–51
Oxford University Press
1991-05-01 00:00:00.0
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Guillain-Barre Syndrome and Influenza Vaccination in the US Army, 1980-1988
Roscelli, John D.
Bass, James W.
Pang, Lorrin
ORIGINAL CONTRIBUTIONS
An increased incidence of Guillain-Barré syndrome (polyradiculoneuritis) occurred in individuals who received the A/New Jersey (swine) influenza vaccine in 1976–1977. A retrospective study encompassing the years 1980–1988 was conducted to determine if the US Army's mass influenza vaccination program has been associated with an increased incidence of Guillain-Barré syndrome in active duty soldiers dunng the study years. No temporally related increase in Guillain-Barrié syndrome was found dunng the study years. <it>Am J Epidemiol</it> 1991; 133.952–5.
Oxford University Press
1991-05-01 00:00:00.0
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BOOK REVIEW
Armenian, Haroutune K.
BOOK REVIEW
Oxford University Press
1991-05-01 00:00:00.0
TEXT
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RE "INTERPREGNANCY INTERVAL AND RISK OF PRETERM LABOR"
Mavalankar, Dileep V.
Gray, R. H.
LETTERS TO THE EDITOR
Oxford University Press
1991-05-01 00:00:00.0
TEXT
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THE AUTHORS REPLY
Lang, Janet M.
Lieberman, Ellice
Ryan, Kenneth J.
Monson, Richard R.
LETTERS TO THE EDITOR
Oxford University Press
1991-05-01 00:00:00.0
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RE. "COSTS AND STATISTICAL POWER ASSOCIATED WITH FIVE METHODS OF COLLECTING OCCUPATION EXPOSURE INFORMATION FOR POPULATION-BASED CASE-CONTROL STUDIES"
Flegal, Katherine M.
LETTERS TO THE EDITOR
Oxford University Press
1991-05-01 00:00:00.0
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THE AUTHORS REPLY
Dewar, Ron
Siemiatycki, Jack
LETTERS TO THE EDITOR
Oxford University Press
1991-05-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/133/9/961
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RE. "INTERPRETATION AND CHOICE OF EFFECT MEASURES IN EPIDEMIOLOGIC ANALYSES"
Levin, Bruce
LETTERS TO THE EDITOR
Oxford University Press
1991-05-01 00:00:00.0
TEXT
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THE AUTHOR REPLIES
Greenland, Sander
LETTERS TO THE EDITOR
Oxford University Press
1991-05-01 00:00:00.0
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ERRATUM
ERRATUM
The <it>Journal</it> has been notified of a typographical error in the paper by Lassauzet et al., “Factors Associated with Transmission of Bovine Leukemia Virus by Contact in Cows on a California Dairy” (<it>Am J Epidemiol</it> 1991; 133: 164–76). The error occurs in table 1 (p. 169) in the last entry of the final column, where the range for the percent of cows in first lactation in nonlactating pens should be 0.11–0.50, <it>not</it> 0.11–0.30, as printed.
Oxford University Press
1991-05-01 00:00:00.0
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