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oai:open-archive.highwire.org:amjepid:136/4/3772015-05-11HighWireOUPamjepid:136:4
Birth Defects in Norway by Levels of External and Food-based Exposure to Radiation from Chernobyl
Lie, Rolv Terje
Irgens, Lorentz M.
Skjærven, Rolv
Reitan, Jon B.
Strand, Per
Strand, Terje
ORIGINAL CONTRIBUTIONS
In Norway, external doses of radiation resulting from fallout from the Chernobyl nuclear accident were estimated from detailed measurements, including soil deposition patterns. Internal doses were estimated from measurements of radioactive cesium in meat and milk supplies. The doses were calculated as average monthly doses for each of 454 municipalities durIng 36 consecutIve months after the accident In sprIng 1986. Prospectively collected data on all newborns listed in the Medical Birth Registry of Norway who were conceived in the period May 1983–April 1989 were used to assess possible dose-response relations between estimated external and food-based exposures and congenital malformations and some other conditions. A positive association was observed between total radiation dose (external plus food-based) and hydrocephaly, while a negative association was observed for Down's syndrome. However, an important conclusion of the study was that no associations were found for conditions previously reported to be associated with radiation, i.e., small head circumference, congenital cataracts, anencephaly, spina biflda, and low birth weight. Potential sources of bias, including exposure misclassification and incomplete ascertainment of cases, are discussed.
Oxford University Press
1992-08-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/136/4/377
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:136/4/3892015-05-11HighWireOUPamjepid:136:4
Mortality among Workers Exposed to Polychlorinated Biphenyls
Sinks, Thomas
Steele, Gragory
Smith, Alexander B.
Watkins, Kathy
Shults, Ruth A.
ORIGINAL CONTRIBUTIONS
On the basis of evidence from animal studies, polychlotinated biphenyls (PCBs) are considered potentially carcinogenic to humans. However, the results of studies in human populations exposed to PCBs have been inconsistent. The authors conducted a retrospective cohort analysis (1957–1986) comparing the mortality of 3,588 electrical capacitor manufacturing workers with known exposure to PCBs with age-, sex-, and calendar time-specific mortality rates for all whites in the United States. Proportional hazards modeling was also performed to examine the association between cumulative PCB exposure and site-specifIc cancer mortality. All-cause mortality (192 deaths observed, 283.3 expected) and total cancer mortality (54 deaths observed, 63.7 expected) were lower than expected. More deaths were observed than expected for malignant melanoma (8 observed, <2.0 expected) and cancer of the brain and nervous system (5 observed, 2.8 expected). The average estimated cumulative dose for the cases of brain cancer (22.9 units) was greater than for other workers (12.9 units), but the 95% confidence intervals around this difference were broad. The risk of malignant melanoma was not related to cumulative PCB exposure. These results provide some evidence of an association between employment at this plant and malignant melanoma and cancer of the brain. The possibility that the results are due to chance, bias, or confounding cannot be excluded.
Oxford University Press
1992-08-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/136/4/389
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:136/4/3992015-05-11HighWireOUPamjepid:136:4
Influence of Paternal Characteristics on the Risk of Low Birth Weight
Parker, Jennifer D.
Schoendorf, Kenneth
ORIGINAL CONTRIBUTIONS
The combined effects of maternal and paternal factors on the risk of delivering low birth weight (<2,500 g) and very low birth weight (<1,500 g) infants were examined among married parents. Using 1984–1988 natality data compiled by the National Center for Health Statistics, the authors found paternal education and race to have independent effects on the risks of low birth weight and very low birth weight after adjustment for maternal charactenstics. The odds of low and very low birth weight decreased with increasing paternal education. Adjustment for paternal education decreased the effect of maternal education on the risks of low and very low birth weight. Additionally, the examination of paternal race led to the identification of a subgroup of married black women with lower nsks of low and very low birth weight than married black mothers overall. These data suggest that paternal characteristics should be used, in addition to maternal characteristics, to describe the risks of low and very low birth weight.
Oxford University Press
1992-08-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/136/4/399
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:136/4/4082015-05-11HighWireOUPamjepid:136:4
Reproductive Factors and Risk of Myocardial Infarction
Palmer, Julie R.
Rosenberg, Lynn
Shapiro, Samuel
ORIGINAL CONTRIBUTIONS
The relation of reproductive factors to risk of myocardial infarction in women aged 45–69 years was examined in a case-control interview study carried out in Massachusetts from 1986 to 1990. Each of 858 cases of first myocardial infarction was age-matched with a control from the same precinct of residence. Conditional logistic regression was used to control the matching factors and the major known and suspected risk factors for coronary heart disease. For parous women compared with nulliparous women, the estimated relative risk of myocardial infarction was 1.8 (95% confidence interval (Cl) 1 .0–3.3). Among parous women, the relative risk estimate for five or more births relative to fewer births was 1.4 (95% Cl 1.0–2.0); the estimate for a first birth before age 20 relative to a later age at first birth was 1.7 (95% Cl 1.1–2.6). The greatest increase in risk was observed for women who had both an early age at first birth and five or more children. However, confounding by factors related to socioeconomic status may have contributed to the results. Compared with women who had a natural menopause at age 50 or older, women who reached the menopause before age 45 were at increased risk regardless of type of menopause: The estimated relative risks were 2.1 (95% Cl 1.3–3.2), 1 .7 (95% Cl 1.0–2.7), and 1 .7 (95% Cl 1 .0– 2.8) for early natural menopause, bilateral oophorectomy, and hysterectomy with retention of one or both ovaries, respectively. These results suggest that early cessation of ovulatory function, whether due to natural causes or to surgery, increases the risk of myocardial infarction. Age at menarche was not related to myocardial infarction risk.
Oxford University Press
1992-08-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/136/4/408
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:136/4/4172015-05-11HighWireOUPamjepid:136:4
Ingested Arsenic, Keratoses, and Bladder Cancer
Cuzick, Jack
Sasieni, Peter
Evans, Susan
ORIGINAL CONTRIBUTIONS
A cohort of 478 patients treated with Fowler's solution (potassium arsenite) in Lancashire, England, during the penod 1945–1969 and previously followed until January 1, 1980, was followed for an additional 11 years. A significant excess of bladder cancer mortality occurred (observed/expected ratio = 5/1.6; <it>p</it> = 0.05). No excess was found for other causes of death. In a subcohort of 142 patients examined for signs of arsenicism around 1970, all 11 subsequent cancer deaths occurred in those with signs of arsenicism (<it>p</it> = 0.0009).
Oxford University Press
1992-08-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/136/4/417
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:136/4/4222015-05-11HighWireOUPamjepid:136:4
Reduced Cancer Morbidity and Mortality in a Prospective Cohort of Women with Distal Forearm Fractures
Olsson, Håkan
Hâgglund, Gunnar
ORIGINAL CONTRIBUTIONS
At the Department of Orthopedics of University Hospital, Lund, Sweden, cancer incidence and overall and cause-specific mortality were studied in a prospective cohort of 677 women who had experienced a fracture of the distal forearm in 1974 or 1975. The women were followed through population-based population, cancer, and death registries in southern Sweden. There was a significant reduction In overall cancer incidence (66 cases observed vs. 90.21 expected), breast cancer incidence (11 cases observed vs. 20.31 cases expected), and incidence of tumors of the female genital tract (5 cases observed vs. 11.84 expected). Overall mortality was also reduced (146 cases observed vs. 191.69 cases expected), and rates of death from circulatory disease (79 cases observed vs. 111.49 expected) and malignant tumors (30 cases observed vs. 40.41 expected) were both tower than expected.
Oxford University Press
1992-08-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/136/4/422
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:136/4/4282015-05-11HighWireOUPamjepid:136:4
Blood Pressure and Twenty-year Mortality in the City of Bergen, Norway
Selmer, Randi
ORIGINAL CONTRIBUTIONS
A blood pressure survey was carried out in 1963 in the city of Bergen, Norway. The relation between 20-year mortality and blood pressure in 52,064 participants aged 30–89 years at examination was analyzed. Increased blood pressure was related to increased mortality from coronary heart disease, stroke, and all causes in all age groups except the oldest, where a more irregular pattern was present. The relative risks decreased with age at screening, while the absolute increase in mortality with increasing blood pressure was greatest in persons aged 60–69 or 70–79 years at screening. A log-linear relation between systolic blood pressure and coronary heart disease and stroke mortality was seen in both men and women. An upturn in total mortality at low systolic blood pressures was suggested in the groups aged 60 years or more at screening. An upturn, or leveling off, was also seen at low diastolic blood pressures for total deaths and stroke deaths in both men and women.
Oxford University Press
1992-08-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/136/4/428
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:136/4/4412015-05-11HighWireOUPamjepid:136:4
Serum Lipoprotein(a) Levels in Racially Different Populations
Cobbaert, Christa
Kesteloot, Hugo
ORIGINAL CONTRIBUTIONS
Lipoproteln(a) is an atherogenic lipoprotein which has been studied predominantly in white populations. Serum lipoproteln(a), serum lipids, and apolipoproteins A-I and B were quantified in 1991 in a total of 300 sex-matched samples derived from five different ethnic groups. Three population samples of Asian origin (Tibet, Korea, and China), one population sample of West African origin (Nigeria), and one Western population sample (Belgium) were included. All serum samples had been collected in the past (3–11 years previously) and had been stored at Y−807�C since then. Thirty serum samples from males and 30 serum samples from females were analyzed from each ethnic group. Overall median lipoprotein(a) levels in Koreans, Chinese, Tibetans, Nigerians, and Belgians were 99, 89, 49, 134, and 80 mg/liter, respectively. Lipoprotein(a) frequency distributions were highly skewed to the right in all populations, with the Nigerian distribution showing less skewness than the Asian and Western plots. All distributions became nearly gaussian after logarithmic transformation. No statistical difference was found between the mean log lipoprotein(a) values of the sexes (4.43 � 1.01 mg/liter (standard deviation) in men; 4.44 � 1 .08 mg/liter in women). Pearson correlation analysis of both sexes combined revealed no statistically significant correlation (at the <it>p</it> < 0.01 level) of log lipoprotein(a) with age, height, weight, body mass index, cholesterol, high density lipoprotein cholesterol, apolipoprotein A-I, or apolipoprotein B within any of the population groups studied or after pooling of all population groups.
Oxford University Press
1992-08-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/136/4/441
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:136/4/4502015-05-11HighWireOUPamjepid:136:4
The increase in Blood Pressure with Age and Body Mass Index is Overestimated by Conventional Sphygmomanometry
Staessen, J.
O'Brien, E.
Atkins, N.
Bulpitt, C. J.
Cox, J.
Fagard, R.
O'Malley, K.
Thijs, L.
Amery, A.
ORIGINAL CONTRIBUTIONS
This cross-sectional study investigated whether the technique of blood pressure measurement used (conventional sphygmomanometry vs. ambulatory monitoring) affects the relation between blood pressure and both age and body mass index. Two independent data sets were analyzed. The first comprised 328 subjects (48% men) drawn from the population of a small Belgian town, and the second comprised 776 Irish bank employees (51% men). Age ranged from 17 years to 81 years, and body mass index (weight (kg)/height (m)2 ranged from 16.6 to 40.2. Twenty-four-hour ambulatory blood pressure was lower than blood pressure measured by a nurse in both the Belgian population sample (118/71 mmHg vs. 122/73 mmHg) and the Irish employees (118/72 mmHg vs. 119/76 mmHg). When blood pressure was measured by an observer, the well-established relations between systolic and diastolic blood pressure and both age and body mass index were evident. When the analyses were repeated using 24-hour measurements, the increment (cross-sectionally assessed) in blood pressure with age was weaker, especially in young and middle-aged subjects (20–60 years), while the increase in blood pressure with body mass index was also reduced. The within-subject differences between the conventional and ambulatory blood pressure measurements increased with older age and greater body mass index. Several other relations with blood pressure as the response variable may require revision in light of the present findings.
Oxford University Press
1992-08-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/136/4/450
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:136/4/4602015-05-11HighWireOUPamjepid:136:4
The Risk Approach to Intervention in Severe Malnutrition in Rural Bangladesh
Henry, Fitzroy
Briend, André
Fauveav, Vincent
Huttly, Sharon R. A.
Yunus, Mohammed
Chakraborty, Jyotsnarnoy
ORIGINAL CONTRIBUTIONS
To determine whether clinical marasmus occurs in small groups of children from easily recognizable high-risk households, the authors conducted a case-control study to identify risk indicators that may be used in targeted interventions. Cases were children whose mid-upper arm circumference measured less than 110 mm, and controls were children matched for age and sex with arm circumferences greater than 120 mm. Between June 1988 and June 1989, 164 such pairs of children aged 1-4 years were studied in Matlab, Bangladesh. Conditional logistic regression analysis showed an increased risk of marasmus among children from families with other children under 5 years of age (odds ratio = 2.80, 95% confidence interval 1.56–5.02) and children who consumed formula foods (odds ratio = 18.81, 95% confidence interval 4.15–85). Higher maternal education was associated with reduced risk of marasmus. Further examination of these risk indicators suggests that the resources saved through targeting fewer households will be negated by missing many children with marasmus. The authors conclude that the application of targeted interventions against marasmus, using the risk approach, is unlikely to be efficient.
Oxford University Press
1992-08-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/136/4/460
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:136/4/4642015-05-11HighWireOUPamjepid:136:4
Efficiency Loss from Categorizing Quantitative Exposures into Qualitative Exposures in Case-Control Studies
Zhao, Lue Ping
Kolonel, Laurence N.
ORIGINAL CONTRIBUTIONS
In the analysis of data from case-control studies, quantitative exposure variables are frequently categorized into qualitative exposure variables, such as quarters. The qualitative exposure variables may be scalar variables that take the median values of each quantile interval, or they may be vectors of indicator variables that represent each quantile interval. In a qualitative analysis, the scalar variables may be used to test the dose-response relation, while the indicator variables may be used to estimate odds ratios for each higher quantile interval versus the lowest. Qualitative analysis, implicitly and explicitly documented by many epidemiologists and biostatisticians, has several desirable advantages (induding simple interpretation and robustness in the presence of a misspedfled model or outlier values). In a quantitative analysis, the quantitative exposure variables may be directly regressed to test the dose-response relation, as well as to estimate odds ratios of interest. As this paper demonstrates, quantitative analysis is generally more efficient than qualitative analysis. Through a Monte Carlo simulation study, the authors estimated the loss of efficiency that results from categorizing a quantitative exposure variable by quartiles in case-control studies with a total of 200 cases and 200 controls. In the analysis of the dose-response relation, this loss is about 30% or more; the percentage may reach about 50% when the odds ratio for the fourth quartile interval versus the lowest is around 4. In estimating odds ratios, the loss of efficiency for the second, third, and fourth quartile intervals versus the lowest is around 90%, 75%, and 40%, respectively. The authors consider the pros and cons of each analytic approach, and they recommend that 1) qualitative analysis be used initially to estimate the odds ratios for each higher quantile interval versus the lowest to examine the dose-response relation and determine the appropriateness of the assumed underlying model; and 2) quantitative analysis be used to test the dose-response relation under a plausible log odds ratio model.
Oxford University Press
1992-08-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/136/4/464
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:136/4/4752015-05-11HighWireOUPamjepid:136:4
A Multistate Outbreak of Sporotrichosis associated with Sphagnum Moss
Coles, F. Bruce
Schuchat, Anne
Hibbs, Jonathan R.
Kondracki, Stanley F.
Salkin, Ira F.
Dixon, Dennis M.
Chang, Hwa Gen
Duncan, Rory A.
Hurd, Nancy J.
Morse, Dale L.
ORIGINAL CONTRIBUTIONS
In the spring of 1988, the largest documented US outbreak of cutaneous sporotrichosis to date occurred, with 84 cases among persons from 15 states who were exposed to Wisconsin-grown sphagnum moss used in packing evergreen tree seedlings. In New York State, 13 cases occurred among 109 forestry workers. All 13 cases occurred among 76 workers who had handled evergreen seedlings and moss (attack rate = 17%). For those exposed to evergreens and moss, the risk of infection increased as worktime exposure to moss increased (attack rates: <10 hours, 8%; 10–19 hours, 12%; >19 hours, 33%). While environmental samples of moss from the Wisconsin supplier were negative, <it>Sporothrix schenckii</it> was cultured from multiple samples of the sphagnum moss obtained from one of six Pennsylvania tree nurseries, representing the nursery that was identified as the source for 79 (94%) of the moss-associated cases. Differences in tree-handling procedures at this nursery—including the use of 1- to 3- year-old moss to pack seedlings, use of a pond water source to wet the moss, use of an organic polymer gel on the seedling root system, and underground storage and longer storage of moss-packed seedlings before shipping—suggested possible explanations for the assodatlon. Efforts to prevent sporotrichosis among persons handling evergreen seedlings should include the use of alternate types of packing material (e.g., cedar wood chips or shredded paper) and protective clothing such as gloves and longsleeved shirts.
Oxford University Press
1992-08-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/136/4/475
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:136/4/4882015-05-11HighWireOUPamjepid:136:4
Interspecies Transmission and Reassortment of Influenza A Viruses in Pigs and Turkeys in the United States
Wright, Stephen M.
Kawaoka, Yoshihiro
Sharp, Gerold B.
Senne, Dennis A.
Webster, Robert G.
ORIGINAL CONTRIBUTIONS
Genetic reassortrnent between influenza A viruses in humans and in animals and birds has been implicated in the appearance of new pandemics of human influenza. To determine whether such reassortment has occurred in the United States, the authors compared the genetic origins of gene segments of 73 swine influenza virus isolates (1976–1990), representing 11 states, and 11 turkey virus isolates (1980–1989), representing eight states. The host origin of gene segments encoding the internal proteins of H1 N1 swine and turkey influenza viruses was identified by developing a dot-blot assay. All gene segments of swine influenza viruses were characteristic of influenza virus genes from that species, indicating that pigs may not be frequent participants in interspecies genetic exchange and reassortrnent of influenza viruses in the United States. In contrast, 73% of the turkey influenza virus isolates contained genes of swine origin. One turkey isolate was a reassortant having three genes characteristic of avian influenza virus and three of swine origin. These findings document a high degree of genetic exchange and reassortment of influenza A viruses in domestic turkeys in the United States. The molecular biologic techniques used by the authors should aid future epidemiologic studies of influenza pandemics.
Oxford University Press
1992-08-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/136/4/488
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:136/4/4982015-05-11HighWireOUPamjepid:136:4
RE. "COMPLETENESS OF THE DISCHARGE DIAGNOSES AS A MEASURE OF BIRTH DEFECTS RECORDED IN THE HOSPITAL BIRTH RECORD"
Stone, David H.
LETTERS TO THE EDITOR
Oxford University Press
1992-08-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/136/4/498
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:136/4/499-a2015-05-11HighWireOUPamjepid:136:4
RE: "DECLINE IN INCIDENCE OF EPIDEMIC GLUCOSE INTOLERANCE IN NAURUANS: IMPLICATIONS FOR THE 'THRIFTY GENOTYPE'"
Bradley, Patrick J.
LETTERS TO THE EDITOR
Oxford University Press
1992-08-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/136/4/499-a
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:136/4/4992015-05-11HighWireOUPamjepid:136:4
THE AUTHORS REPLY
Calle, Eugenia E.
Khoury, Muin J.
LETTERS TO THE EDITOR
Oxford University Press
1992-08-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/136/4/499
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:136/4/501-a2015-05-11HighWireOUPamjepid:136:4
THE AUTHORS REPLY
Starfield, Barbara
Shapiro, Samuel
LETTERS TO THE EDITOR
Oxford University Press
1992-08-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/136/4/501-a
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:136/4/5012015-05-11HighWireOUPamjepid:136:4
RE: "RACE, FAMILY INCOME, AND LOW BIRTH WEIGHT"
Krieger, Nancey
Rowley, Diane L.
LETTERS TO THE EDITOR
Oxford University Press
1992-08-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/136/4/501
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Copyright (C) 1992, Oxford University Press