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Invited Commentary on "Epidemiology of Smallpox in West Pakistan III. Outbreak Detection and Interlocality Transmission"
Henderson, Donald A.
ARTICLES
Oxford University Press
1995-03-15 00:00:00.0
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oai:open-archive.highwire.org:amjepid:141/6/4902015-05-11HighWireOUPamjepid:141:6
EPIDEMIOLOGY OF SMALLPOX IN WEST PAKISTAN III. OUTBREAK DETECTION AND INTERLOCALITY TRANSMISSION
THOMAS, DAVID B.
MACK, THOMAS M.
ALI, ASGHAR
KHAN, M. MUZAFFAR
HISTORICAL PAPER
Thomas, D. B. (Johns Hopkins Univ. School of Hygiene and Public Health, Baltimore, Md. 21205), T. M. Mack, A. Ali and M. M. Khan. Epidemiology of smallpox in West Pakistan. III. Outbreak detection and interlocality transmission. <it>Am I Epideimiol</it> 95: 178–189, 1972.—During one year, 121 outbreaks of variola major were detected in 99 of the 1717 localities within a rural area of West Pakistan with a total population of approximately 1.2 million. Only 19% of the outbreaks, representing 36% of the 1040 investigated cases, were officially reported, although potential strengths in the government surveillance system were also identified. Persistence of smallpox within the area depended on introductions from the outside, and more than one-half of all outbreaks of known source could be ultimately traced to cities. Within the study area, outbreaks with the largest numbers of cases and those in the larger communities were the ones from which smallpox was most frequently transported. The frequency with which variola was introduced into localities was directly related to population size and to the presence of medical care facilities. Trips between localities by infected individuals were extremely rare events. They were made most often during the late fail and winter, primarily during the incubation period of the disease, and did not differ in purpose, means or destination from journeys unassociated with smallpox. Individuals at relatively high risk of becoming introducers included the unvaccinated (primarily children under five), the unschooled and those not native to the area. Vaccination priorities based on these findings could increase the efficiency of smallpox eradication efforts.
Oxford University Press
1995-03-15 00:00:00.0
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Copyright (C) 1995, Oxford University Press
oai:open-archive.highwire.org:amjepid:141/6/5022015-05-11HighWireOUPamjepid:141:6
Medical Practice-based Influenza Surveillance: Viral Prevalence and Assessment of Morbidity
Monto, Arnold S.
Ohmit, Suzanne E.
Margulies, Janice A.
Talsma, AkkeNeel
ORIGINAL CONTRIBUTIONS
Regular surveillance of influenza virus activity and associated illness is necessary to monitor changes in circulating strains. As part of a demonstration project, medical practices in a seven-county area in southern lower Michigan were recruited as sentinel surveillance sites. The practices were asked to collect specimens for virus isolation and/or data on age-specific frequency of respiratory illnesses that met a case definition. Data were used to establish periods of influenza virus activity for vaccine effectiveness determinations. Over three study periods, 1989–1992, there were documented outhreaks of influenza type A(H3N2), type A(H1N1), and type B. The incidence of influenza-like illness increased during these outbreaks, with variation in age-specific frequency from year to year. Recovery of virus was not affected during the winter season by long delays in specimen receipt by the laboratory. Results indicated that medical practices can be successfully recruited as surveillance sites to provide information on the timing, etiology, and intensity of acute respiratory illness. <it>Am J Epldemiol</it> 1995;141:502–6.
Oxford University Press
1995-03-15 00:00:00.0
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oai:open-archive.highwire.org:amjepid:141/6/5072015-05-11HighWireOUPamjepid:141:6
Plasma Lipid Levels and Psychologic Characteristics in Men
Freedman, David S.
Byers, Tim
Barrett, Drue H.
Stroup, Nancy E.
Eaker, Elaine
Monroe-Blum, Heather
ORIGINAL CONTRIBUTIONS
Results of several studies suggest that either a reduction in the serum level of total cholesterol level or a persistently low cholesterol level may be associated with an increase in violent deaths. Although there are several possible explanations for these observations, it has been suggested that the cholesterol level could Influence various behaviors. We therefore examined the cross-sectional relation of several psychologic characteristics, assessed by the Diagnostic Interview Schedule and the Minnesota Multiphasic Personality Inventory, to levels of total cholesterol, high-density lipoprotein cholesterol, and triglycerides among 3,490 men aged 31–45 years who were examined in 1985–1986. (All men had served in the US Army between 1965 and 1971). Compared with that of other men, the mean total cholesterol level was 5 mg/dl higher among 697 men diagnosed with generalized anxiety disorder (possibly because of increased catecholamine levels) and 7 mg/dl lower among 325 men with antisocial personality disorder (<it>p</it> < 0.01 for each association). These differences could not be attributed to education, relative weight, cigarette smoking, use of various medications, or other potential confounders. In contrast, cholesterol levels were not significantly associated with major depression or hostility; levels of high-density lipoprotein cholesterol and triglycerides were not related to any diagnosis. If the serum level of total cholesterol is found to be predictive of antisocial personality disorder in longitudinal analyses, this association may have implications for cholesterol-lowering recommendations. <it>Am J Epidemiol</it> 1995;141:507–17.
Oxford University Press
1995-03-15 00:00:00.0
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oai:open-archive.highwire.org:amjepid:141/6/5182015-05-11HighWireOUPamjepid:141:6
Invited Commentary: Low Blood Cholesterol, Nonillness Mortality, and Other Nonatherosclerotic Disease Mortality: A Search for Causes and Confounders
Jacobs, David R.
Muldoon, Matthew F.
Rastam, Lennart
ORIGINAL CONTRIBUTIONS
Oxford University Press
1995-03-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/141/6/518
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Copyright (C) 1995, Oxford University Press
oai:open-archive.highwire.org:amjepid:141/6/5232015-05-11HighWireOUPamjepid:141:6
Case-Control Study of Bladder Cancer and Arsenic in Drinking Water
Bates, Michael N.
Smith, Allan H.
Cantor, Kenneth P.
ORIGINAL CONTRIBUTIONS
Mortality from several cancers, including bladder cancer, is elevated in a Taiwanese population exposed to high levels of arsenic in drinking water. Data from the Utah respondents to the National Bladder Cancer Study conducted in 1978 were used to evaluate these associations in a US population exposed to measurable, but much lower, levels of drinking water arsenic. Two indices of cumulative arsenic exposure were used, one representing total cumulative exposure (index 1) and the other, intake concentration (index 2). Overall, there was no association of bladder cancer with either measure; however, among smokers, but not among nonsmokers, positive trends in risk were found for exposures estimated for decade-long time periods, especially in the 30- to 39-year period prior to diagnosis. Exposures were in the range 0.5–160 μg/liter (mean, 5.0 μg/liter). The data raise the possibility that smoking potentiates the effect of arsenic on risk of bladder cancer. However, the risk estimates obtained are much higher than predicted on the basis of the results of the Talwanese studies, raising concerns about bias or the role of chance. Confirmatory studies are needed. <it>Am J Epidemiol</it> 1995;141:523–30.
Oxford University Press
1995-03-15 00:00:00.0
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Copyright (C) 1995, Oxford University Press
oai:open-archive.highwire.org:amjepid:141/6/5312015-05-11HighWireOUPamjepid:141:6
Nitrous Oxide and Spontaneous Abortion in Female Dental Assistants
Rowland, Andrew S.
Baird, Donna D.
Shore, David L.
Weinberg, Clarice R.
Savitz, David A.
Wilcox, Allen J.
ORIGINAL CONTRIBUTIONS
The relation between anesthetic gas exposure and spontaneous abortion remains unresolved. We examined the effect of nitrous oxide on spontaneous abortion among female dental assistants. Questionnaires were sent to 7,000 dental assistants aged 18–39 years who were registered in California in 1987; 4,856 (69%) responded. Analysis was based on 1,465 respondents whose most recent pregnancy was conceived while working full time. Women were asked how many hours a week they worked with nitrous oxide during this pregnancy and whether the excess gas was scavenged (vented). Relative risk of spontaneous abortion (through week 20) was calculated using a person-week model. This allowed women with current pregnancies (13%) or induced abortions (10%) to be included for appropriate time periods of risk. A total of 101 pregnancies (7%) ended as spontaneous abortions. An elevation in risk of spontaneous abortion was seen among women who worked with nitrous oxide for 3 or more hours per week in offices not using scavenging equipment (relative risk = 2.6, 95% confidence interval 1.3–5.0, adjusted for age, smoking, and number of amalgams prepared per week), but not among those using nitrous oxide in offices with scavenging equipment. This relation changed little when analyses were restricted to confirmed pregnancies or examined for several types of potential bias. Scavenging equipment appears to be important in protecting the reproductive health of women working with nitrous oxide. <it>Am J Epidemiol</it> 1995;141:531–8.
Oxford University Press
1995-03-15 00:00:00.0
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oai:open-archive.highwire.org:amjepid:141/6/5392015-05-11HighWireOUPamjepid:141:6
Nonsteroidal Anti-inflammatory Drugs and the Incidence of Hospitalizations for Peptic Ulcer Disease in Elderly Persons
Smalley, Walter E.
Ray, Wayne A.
Daugherty, James R.
Griffin, Marie R.
ORIGINAL CONTRIBUTIONS
To determine the incidence rate of serious ulcer disease among users and nonusers of nonsteroidal anti-inflammatory drugs (NSAIDs), a retrospective cohort study was done on 103,954 elderly Tennessee Medicaid recipients with 209,068 person-years of follow-up from 1984 to 1986. There were 1,371 patients hospitalized with peptic ulcer disease or upper gastrointestinal hemorrhage identified by Medicaid hospital claims and verified by review of the medical record. Ulcer hospitalization rates by NSAID exposure category, duration of use, and daily dose were determined. The rates of ulcer hospitalization among nonusers and current users of NSAIDs were 4.2 and 16.7 per 1,000 person-years, respectively, an excess rate among current users of 12.5 (95% confidence interval (Cl) 11.4–13.6) per 1,000 person-years. Among new users, the ulcer hospitalization rates were 26.3 per 1000 person-years during the first 30 days of use and 20.9 per 1,000 person-years over the next 31–180 days, representing excess ulcer hospitalization rates of 22.1 (95% Cl 18.6–25.6) and 16.7 (95% Cl 13.1–20.1) per 1,000 person-years, respectively. For long-term users (180 days or more of continuous NSAID use), the ulcer hospitalization rate remained elevated at 15.3, an excess of 12.0 (95% Cl 10.3–13.6) hospitalizations per 1,000 person-years. The excess hospitalization rates per 1,000 person-years increased with increasing dose from 6.0 (95% Cl 4.0–8.0) for the lowest dose category to 17.8 (95% Cl 15.5–20.1) for the highest. The excess rate of ulcer hospitalization for elderly NSAID users is high. These drugs should be used with caution in elderly persons, and alternatives to NSAID therapy should be strongly considered. <it>Am J Epidemiol</it> 1995;141:539–45.
Oxford University Press
1995-03-15 00:00:00.0
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oai:open-archive.highwire.org:amjepid:141/6/5462015-05-11HighWireOUPamjepid:141:6
Effects of Urban Air Pollutants on Emergency Visits for Childhood Asthma in Mexico City
Romieu, Isabelle
Meneses, Fernando
Sienra-Monge, Juan Jose L.
Huerta, Jose
Velasco, Silvia Ruiz
White, Mary C.
Etzel, Ruth A.
Hemandez-Avila, Mauricio
ORIGINAL CONTRIBUTIONS
The metropolitan area of Mexico City, Mexico, has serious air pollution problems. Although air contaminants may contribute to clinical asthma, there are at present no data on the relation between air pollution exposure and childhood asthma in Mexico City. The authors reviewed data on emergency visits from January to June 1990 at one major pediatric hospital in Mexico City. They used a Poisson regression model to study the relation between the number of daily emergency visits for asthma and air pollutant levels. The levels of ozone and sulfur dioxide exposure were significantly associated with the number of emergency visits for asthma. After adjustment for potential confounding factors, the multivariate regression model predicted that an increase of 50 ppb In the 1-hour maximum ozone level would lead to a 43% increase in the number of emergency visits for asthma on the following day. Exposure to high ozone levels (>110 ppb) for 2 consecutive days increased the number of asthma-related emergency visits by 68 percent. The results of this study suggest that ozone exposure is positively associated with the number of children's emergency visits for asthma in Mexico City. <it>Am J Epidemiol</it> 1995;141:546–53.
Oxford University Press
1995-03-15 00:00:00.0
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oai:open-archive.highwire.org:amjepid:141/6/5542015-05-11HighWireOUPamjepid:141:6
Age, Period, and Cohort Effects on Pulmonary Function in a 24-Year Longitudinal Study
Xu, Xiping
Laird, Nan
Dockery, Douglas W.
Schouten, Jan P.
Rijcken, Bert
Weiss, Scott T.
ORIGINAL CONTRIBUTIONS
This paper proposes the use of two-factor models (age-period and age-cohort models) to estimate age, period, and cohort effects on pulmonary function by using the data collected in a 24-year longitudinal study in the Netherlands from 1965 to 1990. The analysis included 18,363 pulmonary function measurements on 6,148 subjects aged 20–54 years at the initial visit. The subjects were grouped into four birth cohorts (before 1923, 1923–1934, 1935–1946, and after 1946) and four survey periods (1965–1972, 1973–1978, 1979–1984, and 1985–1990). In the age-cohort model, the decrement in forced expiratory volume in 1 second (FEV<inf>1</inf> associated with a yearly increase in age was 28.3 ± 3.7 ml/year for a man 176 cm tall and 16.0 ± 1.9 ml/year for a woman 163 cm tall. The estimated acceleration of decline with aging was significant for both men (β=−0.212; standard error = 0.079 ml) and women (β = −0.346; standard error = 0.058 ml). Compared with that of the cohort born before 1923, the average level of FEV<inf>1</inf>, was estimated to increase by 156,277, and 379 ml, respectively, for the three younger cohorts in men (<it>p</it> = 0.01) and by 133, 213, and 328 ml for the three younger cohorts in women (<it>p</it> < 0.01). In the age-period model, the estimated linear age effect on FEV<inf>1</inf> was 36.2 ± 4.2 ml/year for a man and 30.5 ± 2.3 ml/year for a woman. The age quadratic term was significant for women, but not for men. Average FEV<inf>1</inf> was estimated to be increased by 141, 169, and 250 ml, respectively, for the periods 1973–1978, 1979–1984, and 1985–1990 in men and by 131, 138, and 219 ml in women. These period effects were significant for both men and women. In summary, this study applied the two-factor models to estimate cross-sectional and longitudinal effects of aging on FEV<inf>1</inf>, and demonstrated significant period and cohort effects, which could be attributed in part to changes in air pollutants, respiratory infections, vaccinations, types of cigarettes, diet, and lifestyles over time. <it>Am J Epidemiol</it> 1995;141:554–66.
Oxford University Press
1995-03-15 00:00:00.0
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oai:open-archive.highwire.org:amjepid:141/6/5672015-05-11HighWireOUPamjepid:141:6
Use of Capture-Recapture to Estimate the Prevalence of Opiate Addiction in Barcelona, Spain, 1989
Domingo-Salvany, Antònia
Hartnoll, Richard L.
Maguire, Andrew
Suelves, J. M.
Antó, J. M.
ORIGINAL CONTRIBUTIONS
It is difficult to obtain accurate prevalence estimates of opiate addiction with direct methods. The capture-recapture method has been used to estimate the prevalence of hidden populations, including opiate addicts. In this study, we applied capture-recapture, including log-linear modeling, to estimate the prevalence of opiate addicts in Barcelona, Spain. Anonymous identification data from three 1989 sources (hospital emergency rooms, treatment admissions, and heroin overdose deaths) in Barcelona were used to obtain population samples. For prevalence estimation, two strategies were followed: 1) emergency room data only, divided into trimesters; and 2) all three sources used simultaneously. Estimates based only on emergency room data were lower than estimates obtained by the simultaneous analysis of all three data sources; the latter estimates gave narrower confidence intervals (6,324–7,414 addicts), giving a prevalence for Barcelona in 1989 of between 8.5 and 9.9 opiate addicts per 1,000 residents aged 15–44 years. The estimated prevalence varied by sex and age group and was highest in males aged 15–29 years (between 17.1 and 21.2). At least 42% had contacted one or more of the services studied, although only one in seven had been admitted for treatment during 1989. Capture-recapture is the election method for prevalence estimation when direct methods are not feasible. <it>Am J Epidemiol</it> 1995;141:567–74.
Oxford University Press
1995-03-15 00:00:00.0
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oai:open-archive.highwire.org:amjepid:141/6/5752015-05-11HighWireOUPamjepid:141:6
Reliability of the Youth Risk Behavior Survey Questionnaire
Brener, Nancy D.
Collins, Janet L.
Kann, Laura
Warren, Charles W.
Williams, Barbara I.
ORIGINAL CONTRIBUTIONS
The Centers for Disease Control and Prevention's Youth Risk Behavior Survey (YRBS) has been used on a biennial basis since 1990 to measure health risk behaviors of high school students nationwide. The YRBS measures behaviors related to intentional and unintentional injury, tobacco use, alcohol and other drug use, sexual activity, diet, and physical activity. The authors present the results from a test-retest reliability study of the YRBS, conducted by administering the YRBS questionnaire to 1,679 students in grades 7 through 12 on two occasions 14 days apart. The authors computed a kappa statistic for each of 53 self-report items and compared group prevalence estimates across the two testing occasions. Kappas ranged from 14.5% to 91.1%; 71.7% of the items were rated as having usub or higher reliability (kappa = 61-100%). No significant differences were found between the prevalence estimates at time 1 and time 2. Responses of seventh grade students were less consistent than those of students in higher grades, indicating that the YRBS is best suited for students in grade 8 and above. Except for a few suspect items, students appeared to report personal health risk behaviors reliably over time. Reliability and validity issues in health behavior assessment also are discussed. <it>Am J Epidemiol</it> 1995;141:575–80.
Oxford University Press
1995-03-15 00:00:00.0
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RE: "CONCENTRATION OF INDOOR PARTICULATE MATTER AS A DETERMINANT OF RESPIRATORY HEALTH IN CHILDREN"
Sterling, Theodor D.
Rosenbaum, Wilfred L.
Weinkam, James J.
LETTERS TO THE EDITOR
Oxford University Press
1995-03-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/141/6/581
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oai:open-archive.highwire.org:amjepid:141/6/5822015-05-11HighWireOUPamjepid:141:6
THREE OF THE AUTHORS REPLY
Neas, Lucas M.
Dockery, Douglas W.
Speizer, Frank E.
LETTERS TO THE EDITOR
Oxford University Press
1995-03-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/141/6/582
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Copyright (C) 1995, Oxford University Press