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oai:open-archive.highwire.org:amjepid:137/9/10012015-05-11HighWireOUPamjepid:137:9
Population-Based Study of Survival after Osteoporotic Fractures
Cooper, Cyrus
Atkinson, Elizabeth J.
Jacobsen, Steven J.
OFallon, W. Michael
Melton, L. Joseph
ORIGINAL CONTRIBUTIONS
Vertebral fractures are the most frequent of the fractures associated with osteoporosis, yet little is known of their impact on health in the United States. To aid in this understanding, the authors examined the survival rate of 335 residents of Rochester, Minnesota, who had an initial radiologic diagnosis of vertebral fracture between 1985 and 1989. Seventy-six died during 809 person-years of follow-up. The overall survival rate was worse than expected, and diverged steadily from expected values throughout the course of the study. At 5 years after diagnosis, the estimated survival was 61% compared with an expected value of 76% (relative survival = 0.81, 95% confidence interval (Cl) 0.70–0.92). The 5-year relative survival after a hip fracture in Rochester was a comparable 0.82 (95% Cl 0.77–0.87), but there was a much greater excess of deaths within the first 6 months as compared with patients with vertebral fractures. The 5-year relative survival rate after a distal forearm fracture was 1.00 (95% Cl 0.95–1.05). Clinically diagnosed vertebral fractures are rarely fatal, and the reduced survival seen subsequently could relate to comorbid conditions. Nonetheless, the excess mortality should be accounted for in assessing the public health impact of osteoporosis.
Oxford University Press
1993-05-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/137/9/1001
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Copyright (C) 1993, Oxford University Press
oai:open-archive.highwire.org:amjepid:137/9/10062015-05-11HighWireOUPamjepid:137:9
Decrements in Neurobehavioral Performance Associated with Mixed Exposure to Organic and Inorganic Lead
Schwartz, Brian S.
Bolla, Karen I.
Stewart, Walter
Ford, D. Patrick
Agnew, Jacqueline
Frumkin, Howard
ORIGINAL CONTRIBUTIONS
In 1990, 222 current employees of a chemical facility in the eastern United States that manufactured tetraethyl lead were administered a neurobehavioral test battery, tests of olfactory function and peripheral vibration threshold, and questionnaires that assessed neuropsychiatric symptoms. A cumulative variable of exposure to inorganic and organic lead was derived from 12 years of personal industrial hygiene sampling data and an occupational history interview that assessed work in each of 29 exposure zones in the lead area. The range of assigned exposure intensities in these 29 zones was 4-119 μg/m3 for organic lead and 1-56 μg/m3 for inorganic lead. Cumulative lead exposure and exposure duration were defined as categorical variables (four groups) in multiple linear regression models. The adjusted mean differences in neurobehavioral test scores were estimated by comparing the average scores of the moderate, high, and highest exposure groups with the low exposure (reference) group. After adjustment for premorbid intellectual ability, age, race, and alcohol consumption, neurobehavioral test scores were poorer as measures of both cumulative lead exposure and exposure duration increased; many of the associations evidenced dose-response relations. Associations were observed in most cognitive and functional domains tested, but were most common in two domains: manual dexterity and verbal memory/learning. On the affected neuropsychologic measures, the groups with the highest exposure averaged scores 5–22% lower than those of the reference groups. Overall, the data revealed generally consistent and coherent associations between two measures of lead exposure and poorer neurobehavioral test performance.
Oxford University Press
1993-05-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/137/9/1006
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Copyright (C) 1993, Oxford University Press
oai:open-archive.highwire.org:amjepid:137/9/10222015-05-11HighWireOUPamjepid:137:9
Modeling Age- and Time-Specific Incidence from Seroprevalence: Toxoplasmosis
Ades, A. E.
Nokes, D. J.
ORIGINAL CONTRIBUTIONS
New forms of catalytic epidemic models were developed to estimate the incidence of primary toxoplasmosis infection from age- and time-specific seroprevalence data collected from persons aged 0–100 years in South Yorkshire, England, 1969–1990. Piecewise constant and exponential polynomial functions were used to assess the way in which incidence depended on age and time, and to guide the choice of parametric models suitable for prediction. Incidence estimates were biased unless both age- and time-dependence were allowed for. New findings on the epidemiology of this infection emerged. Incidence appears to have fallen sixfold between 1915 and 1970, but has remained stable for the last 20 years. There is a marked peak in incidence in childhood. The incidence throughout the childbearing period is currently estimated to be 0.07 or less per 100 susceptible persons per year. However, these predictions were highly sensitive to assumptions about incidence in childhood, and the 95% confidence limits for a range of models were between 0.003 and 0.32% per year. Age- and time-specific seroprevalence data can be collected inexpensively on a mass population basis, and, with appropriate incidence modeling, may prove to be a powerful method for the study of infectious disease and for incidence prediction.
Oxford University Press
1993-05-01 00:00:00.0
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http://aje.oxfordjournals.org/cgi/content/short/137/9/1022
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Copyright (C) 1993, Oxford University Press
oai:open-archive.highwire.org:amjepid:137/9/1035-a2015-05-11HighWireOUPamjepid:137:9
THE AUTHORS REPLY
Grady, Deborah
Ernster, Virginia
LETTERS TO THE EDITOR
Oxford University Press
1993-05-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/137/9/1035-a
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Copyright (C) 1993, Oxford University Press
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RE: "INCREASED MORTALITY FROM BRAIN TUMORS: A COMBINED OUTCOME OF DIAGNOSTIC TECHNOLOGY AND CHANGE OF ATTITUDE TOWARD THE ELDERLY"
Mao, Yang
Desmeules, Marie
LETTERS TO THE EDITOR
Oxford University Press
1993-05-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/137/9/1035-b
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Copyright (C) 1993, Oxford University Press
oai:open-archive.highwire.org:amjepid:137/9/10352015-05-11HighWireOUPamjepid:137:9
RE: "DOES CIGARETTE SMOKING MAKE YOU UGLY AND OLD?"
Chapman, Simon
LETTERS TO THE EDITOR
Oxford University Press
1993-05-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/137/9/1035
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Copyright (C) 1993, Oxford University Press
oai:open-archive.highwire.org:amjepid:137/9/10362015-05-11HighWireOUPamjepid:137:9
THE AUTHORS REPLY
Modan, Baruch
Wagener, Diane K.
Feldman, Jacob J.
Rosenberg, Harry M.
Feinleib, Manning
LETTERS TO THE EDITOR
Oxford University Press
1993-05-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/137/9/1036
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Copyright (C) 1993, Oxford University Press
oai:open-archive.highwire.org:amjepid:137/9/9312015-05-11HighWireOUPamjepid:137:9
Relation of Caffeine Intake during Pregnancy to Intrauterine Growth Retardation and Preterm Birth
Fortier, Isabel
Marcoux, Sylvie
Beaulac-Baillargeon, Louise
ORIGINAL CONTRIBUTIONS
Whether caffeine intake during pregnancy is related to intrauterine growth retardation, low birth weight, and preterm birth remains unclear. The purpose of this population-based study is to assess these associations and to evaluate the interaction between caffeine intake and smoking. The study participants (<it>n</it> = 7,025) were women who lived in Quebec City, Canada, and the surrounding area who gave birth between January 1989 and October 1989 to a singleton liveborn neonate. Information on gestational age at delivery, caffeine intake (coffee, tea, chocolate, and colas) during pregnancy, and several potential confounders was obtained by telephone a few weeks after delivery. Birth weight was abstracted from the birth certificate. Caffeine consumption was associated with an increased risk of intrauterine growth retardation (birth weight less than the 10th percentile for sex and gestational age). For women whose average daily caffeine consumption was 0–10, 11–150, 151–300, or >300 mg, the adjusted odds ratios for delivering a newborn with growth retardation were 1.00, 1.28 (95% confidence interval (Cl) 1.04–1.59), 1.42 (95– Cl 1.07–1.87), and 1.57 (95% Cl 1.05–2.33), respectively. Caffeine intake, however, was not related to preterm delivery or low birth weight. We conclude that caffeine intake during pregnancy is a risk factor for intrauterine growth retardation.
Oxford University Press
1993-05-01 00:00:00.0
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http://aje.oxfordjournals.org/cgi/content/short/137/9/931
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Copyright (C) 1993, Oxford University Press
oai:open-archive.highwire.org:amjepid:137/9/9412015-05-11HighWireOUPamjepid:137:9
Effects on Birth Weight of Alcohol and Caffeine Consumption during Pregnancy
Larroque, Beatrice
Kaminski, Monique
Lelong, Nathalie
Subtil, Damien
Dehaene, Philippe
ORIGINAL CONTRIBUTIONS
The aim of this study was to investigate the effect of alcohol and caffeine consumption on birth weight and the possible interaction of these substances with smoking. The sample included 628 women who were interviewed at their first visit to the maternity hospital of Roubaix, France, in 1985–1986. A significant reduction in birth weight was found to be associated with an average daily alcohol consumption of three drinks or more after gestational age, infant sex, maternal age, parity, weight, and height, and cigarette smoking had been controlled for. There was no interaction between smoking and alcohol consumption on birth weight, but a significant relation between alcohol consumption and birth weight was observed among nonsmokers as well as heavy smokers. The relation observed between caffeine and birth weight disappeared after adjustment for smoking. Our results indicate that alcohol reduces birth weight, but do not support the hypothesis of an interaction between smoking and alcohol consumption.
Oxford University Press
1993-05-01 00:00:00.0
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http://aje.oxfordjournals.org/cgi/content/short/137/9/941
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Invited Commentary: Caffeine and Birth Outcomes
Shiono, Patricia H.
Klebanoff, Mark A.
ORIGINAL CONTRIBUTIONS
Oxford University Press
1993-05-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/137/9/951
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oai:open-archive.highwire.org:amjepid:137/9/9552015-05-11HighWireOUPamjepid:137:9
Marcoux et al. Reply to "Invited Commentary: Caffeine and Birth Outcomes"
Marcoux, Sylvie
Fortier, Isabel
Beaulac-Baillargeon, Louise
ORIGINAL CONTRIBUTIONS
Oxford University Press
1993-05-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/137/9/955
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Copyright (C) 1993, Oxford University Press
oai:open-archive.highwire.org:amjepid:137/9/9572015-05-11HighWireOUPamjepid:137:9
Larroque et al. Reply to "Invited Commentary: Caffeine and Birth Outcomes"
Larroque, Beatrice
Kaminski, Monique
Lelong, Nathalie
Subtil, Damien
Dehaene, Philippe
ORIGINAL CONTRIBUTIONS
Oxford University Press
1993-05-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/137/9/957
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Copyright (C) 1993, Oxford University Press
oai:open-archive.highwire.org:amjepid:137/9/9592015-05-11HighWireOUPamjepid:137:9
How Good a Marker Is Insulin Level for Insulin Resistance?
Laakso, Markku
ORIGINAL CONTRIBUTIONS
Epidemiologic studies have correlated fasting and postload insulin levels with the risk of coronary heart disease, assuming that insulin levels are reliable markers of insulin resistance. However, this assumption has not been systematically studied. The author measured insulin response to an oral glucose load and quantitated insulin resistance using the euglycemic hyperinsulinemic clamp technique to evaluate the correlation between insulin level and the degree of insulin resistance in individuals with varying degrees of glucose tolerance. Subjects were randomly selected from previous population studies done in 1987–1989 at the Department of Medicine of the University of Kuopio in east Finland. Altogether, 50 subjects with normal glucose tolerance, 28 with impaired glucose tolerance, and 54 with non-insulin-dependent diabetes mellitus were studied. Correlations of insulin resistance (whole-body glucose uptake in clamp studies) with fasting or postload insulin levels were remarkably consistent, ranging from −0.58 to −0.74 (<it>p</it> < 0.01) in subjects with normoglycemia. In contrast, corresponding correlations were substantially weaker in subjects with impaired glucose tolerance and non-insulin-dependent diabetes. Among these subjects, only the fasting insulin level correlated significantly with insulin resistance (−0.47, <it>p</it> < 0.05 and −0.48, <it>p</it> < 0.01, respectively). The authors conclude that in population studies, only the fasting insulin level should be used as a marker of insulin resistance, particularly in subjects with abnormal glucose tolerance.
Oxford University Press
1993-05-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/137/9/959
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Copyright (C) 1993, Oxford University Press
oai:open-archive.highwire.org:amjepid:137/9/9662015-05-11HighWireOUPamjepid:137:9
Inverse Association between Serum Total Cholesterol and Cancer Mortality in Dutch Civil Servants
Schuit, Albertine J.
Van Dijk, Carolina E. M. J.
Dekker, Jacqueline M.
Schouten, Evert G.
Kok, Frans J.
ORIGINAL CONTRIBUTIONS
The association between serum total cholesterol and cancer mortality was investigated in a 28−year follow−up study of 3,091 Dutch civil servants aged 40–65 years and their spouses. After adjustment for age, body mass index, and smoking, an inverse association between serum total cholesterol and all−cancer mortality was observed in men during the first 15 years of follow−up, excluding the first 2 years: The multivariate rate ratio of those in the lowest cholesterol quintile compared with those in the highest quintile was 2.1 (95% confidence interval (Cl) 1.1–4.0); this association was accounted for mainly by gastrointestinal cancers (RR = 4.2, 95% Cl 1.4–12.9). For follow−up years 16–28, the multivariate rate ratio for all−cancer mortality was 0.8 (95% Cl 0.5–1.4). In women, no consistent association between serum total cholesterol and cancer was observed. After the first 5 years of follow−up were excluded, the significant inverse association in men still persisted. These results suggest that in this study population, low serum cholesterol seems not to be attributable to undetected cancer, but might be a risk factor for cancer mortality in men.
Oxford University Press
1993-05-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/137/9/966
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Copyright (C) 1993, Oxford University Press
oai:open-archive.highwire.org:amjepid:137/9/9772015-05-11HighWireOUPamjepid:137:9
Incidence of Community-Acquired Pneumonia in the Population of Four Municipalities in Eastern Finland
Jokinen, C.
Heiskanen, L.
Juvonen, H.
Kallinen, S.
Karkola, K.
Korppi, M.
Kurki, S.
Rönnberg, PR.
Seppä, A.
Soimakallio, S.
Stén, M.
Tanska, S.
Tarkiainen, A.
Tukiainen, H.
Pyörälä, K.
Mäkelä, P. H.
ORIGINAL CONTRIBUTIONS
Between September 1, 1981, and August 31, 1982, all patients with suspected or confirmed pneumonia among the 46,979 inhabitants of four municipalities in the province of Kuopio, Finland, were reported to a pneumonia register by their attending physicians. In addition, two study pathologists reported all cases of pneumonia found at autopsy, and two permanent registers were checked for retrospective identification of patients. Chest radiographs were obtained from 97% of all patients. The final diagnosis was based on radiologic or autopsy criteria. A total 546 patients (323 mates and 223 females) had community—acquired pneumonia; of these, 37% were less than 15 years of age, and 31% were 60 years of age or older. Nineteen percent of the patients had defined chronic conditions, and 42% were admitted to hospital. The case fatality rate was 4%. The overall incidence of community—acquired pneumonia per 1,000 inhabitants per year was 11.6 (13.9 in males, 9.4 in females). The age—specific incidence per 1,000 inhabitants per year was as follows: age <5 years, 36.0; age 5–14 years, 16.2; age 15–59 years, 6.0; age 60–74 years, 15.4; and age >75 years, 34.2.
Oxford University Press
1993-05-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/137/9/977
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Copyright (C) 1993, Oxford University Press
oai:open-archive.highwire.org:amjepid:137/9/9892015-05-11HighWireOUPamjepid:137:9
Correlates of the Rate of Decline of CD4+ Lymphocytes among Injection Drug Users Infected with the Human Immunodeficiency Virus
Alcabes, Philip
Schoenbaum, Ellie E.
Klein, Robert S.
ORIGINAL CONTRIBUTIONS
Changes in the level of CD4-bearing T-lymphocytes in injection drug users infected with the human immunodeficiency virus were evaluated in a sample of 318 subjects enrolled from a methadone program in the Bronx, New York, from 1985 through 1989. Follow-up continued through 1990. The percentage of CD4+ T-lymphocytes (CD4%) was used to maximize the stability of measurements. The rate of decline of the CD4% was determined using a random-effects assumption, and predictors of rate of decline were evaluated using an autoregressive model. The rate of CD4% decline was approximately 1.2 CD4% lost per 6 months, with a higher rate in recent seroconverters (2.2 CD4% lost). The most important predictors of decline of the CD4% in autoregressive models were current pyogenic bacterial infection (CD4% reduced by 2.75, 95% confidence interval (Cl) 0.42–5.08), current report of a second constitutional symptom (CD4% reduced by 2.16, 95% Cl 0.03–4.29), and history of bacterial infection (CD4% reduced by 1.49, 95% Cl 0.09–2.89; proportion of prior CD4% lost increased by 0.14, 95% Cl 0.01–0.27). Oral thrush was not related to an accelerated rate of CD4% decline.
Oxford University Press
1993-05-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/137/9/989
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Copyright (C) 1993, Oxford University Press
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Re: "Does cigarette smoking make you ugly and old?"
Chapman, S
LETTERS TO THE EDITOR
Oxford University Press
1993-05-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/137/9/1035a
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Copyright (C) 1993, Oxford University Press
oai:open-archive.highwire.org:amjepid:137/9/1035b1993-05-01HighWireOUPamjepid:137:9
Re: "Increased mortality from brain tumors: a combined outcome of diagnostic technology and change of attitude toward the elderly"
Mao, Y
Desmeules, M
LETTERS TO THE EDITOR
Oxford University Press
1993-05-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/137/9/1035b
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Copyright (C) 1993, Oxford University Press