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Invited Commentary on "Observations on a Mumps Epidemic in a 'Virgin' Population"
Nelson, Kenrad E.
ARTICLES
Oxford University Press
1995-08-01 00:00:00.0
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http://aje.oxfordjournals.org/cgi/content/short/142/3/231
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Copyright (C) 1995, Oxford University Press
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OBSERVATIONS ON A MUMPS EPIDEMIC IN A "VIRGIN" POPULATION
PHILIP, R. N.
REINHARD, K. R.
LACKMAN, D. B.
HISTORICAL PAPER
Oxford University Press
1995-08-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/142/3/233
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oai:open-archive.highwire.org:amjepid:142/3/2542015-05-11HighWireOUPamjepid:142:3
Coronary Heart Disease Prevalence and Its Relation to Risk Factors in American Indians: The Strong Heart Study
Howard, Barbara V.
Lee, Elisa T.
Cowan, Linda D.
Fabsitz, Richard R.
Howard, Wm. James
Oopik, Arvo J.
Robbins, David C.
Savage, Peter J.
Yeh, Jeunliang L.
Welty, Thomas K.
ORIGINAL CONTRIBUTIONS
Although coronary heart disease (CHD) is currently the leading cause of death among American Indians, information on the prevalence of CHD and its association with known cardiovascular risk factors is limited. The Strong Heart Study was initiated in 1988 to quantify cardiovascular disease and its risk factors among three geographically diverse groups of American Indians. Members of 13 Indian communities in Arizona, Oklahoma, and South and North Dakota between 45 and 74 years of age underwent a physical examination that included medical history; an electrocardiogram; anthropometric and blood pressure measurements; an oral glucose tolerance test; and measurements of fasting plasma lipoproteins, fibrinogen, insulin, hemoglobin A1<inf>C</inf>, and urinary albumin. Prevalence rates of definite myocardial infarction and definite CHD were higher in men than in women at all three centers (<it>p</it> < 0.0001) and higher in those with diabetes mellitus (<it>p</it> = 0.002 in men and <it>p</it> = 0.0003 in women). Diabetes was associated with relatively higher prevalence rates of myocardial infarction (diabetic: nondiabetic prevalence ratio = 3.8 vs. 1.9) and CHD (prevalence ratio = 4.6 vs. 1.8) in women than in men. Prevalence rates of heart disease were lowest in the communities in Arizona; prevalence rates were similar in Oklahoma and South Dakota/North Dakota and were two- to threefold higher than those in Arizona. By logistic regression, prevalent CHD among American Indians was significantly and independently related to age, diabetes, hypertension, albuminuria, percentage of body fat, smoking, high concentrations of plasma insulin, and low concentrations of high density lipoprotein cholesterol. In contrast to reports from other non-Indian populations, diabetes was the strongest risk factor. The lower prevalence of CHD among Indians in Arizona is distinctive in view of their higher rates of diabetes, obesity, hypertension, and albuminuria, but it may be partly related to their low frequency of smoking and their low concentrations of total and low density lipoprotein cholesterol. These findings from the initial Strong Heart Study examination emphasize the importance of diabetes and its associated variables as risk factors for CHD in Native American populations.
Oxford University Press
1995-08-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/142/3/254
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oai:open-archive.highwire.org:amjepid:142/3/2692015-05-11HighWireOUPamjepid:142:3
Cardiovascular Disease Risk Factors among American Indians: The Strong Heart Study
Welty, Thomas K.
Lee, Elisa T.
Yeh, Jeunliang
Cowan, Linda D.
Go, Oscar
Fabsitz, Richard R.
Le, Ngoc-Anh
Oopik, Arvo J.
Robbins, David C.
Howard, Barbara V.
ORIGINAL CONTRIBUTIONS
The Strong Heart Study, a study of cardiovascular disease among American Indians, was conducted to determine cardiovascular disease rates and the prevalence of risk factors among members of 13 tribal groups in South Dakota/North Dakota (SD/ND), southeastern Oklahoma, and Arizona. From 1989 to 1992, 4,549 tribal members aged 45–74 years (62% of eligible participants) were surveyed and examined for cardiovascular disease and its risk factors. Mean total cholesterol concentrations were over 20 mg/dl lower among the men and 27 mg/dl lower among the women than national mean levels for the same age groups. Cholesterol levels varied by tribal group; Arizona Indians had mean levels more than 20 mg/dl lower than those of SD/ND Indians. The prevalence of hypercholesterolemia was almost twice as high among SD/ND Indians as among Arizona Indians, but the rates for all three groups were much lower than total US rates (all races). Mean levels of high density lipoprotein cholesterol were lower among Indian men and women than in the US population as a whole. The prevalence of hypertension among Arizona and Oklahoma Indians was higher than that for the entire United States. SD/ND Indians had significantly lower mean blood pressures and prevalence rates of hypertension than Oklahoma and Arizona Indians and the United States as a whole. The prevalence of cigarette smoking was higher for all Indian groups except Arizona women in comparison with US rates. Smoking rates were highest in SD/ND and lowest in Arizona. Indian smokers smoked fewer cigarettes per day than the average US smoker. Arizona Indians had the highest prevalence of diabetes mellitus; over 60% of those participants were diabetic. In Oklahoma and SD/ND, one third of the men and over 40% of the women were diabetic. In addition, 13–20% of the participants had impaired glucose tolerance. Proteinuria was also a common problem; almost half of the Arizona Indians had micro- or macroalbuminuria, and 20% of Oklahoma and SD/ND Indians had significant proteinuria. The prevalence of obesity was high in all three groups, with Arizona Indians having the highest rates and the highest mean body mass indices. The prevalence of current alcohol use was lower among Indians than in the nation as a whole, but binge drinking was common among those who used alcohol. These results indicate that cardiovascular disease risk factors vary significantly among tribal groups. Prevention programs tailored toward decreasing the prevalence of risk factors are recommended for long-term reduction of cardiovascular disease rates in American Indian communities.
Oxford University Press
1995-08-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/142/3/269
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oai:open-archive.highwire.org:amjepid:142/3/2882015-05-11HighWireOUPamjepid:142:3
Uric Acid and Coronary Heart Disease Risk: Evidence for a Role of Uric Acid in the Obesity-Insulin Resistance Syndrome: The Normative Aging Study
Lee, Jerry
Sparrow, David
Vokonas, Pantel S.
Landsberg, Lewis
Weiss, Scott T.
ORIGINAL CONTRIBUTIONS
Various epidemiologic studies have linked an increase in serum uric acid level to an increased risk of coronary heart disease. The reasons for this finding are unclear. The authors examined the influence of a number of cardiovascular disease risk factors on serum uric acid level in 886 middle-aged and older men participating in the Normative Aging Study. The men were examined between 1987 and 1991. In a multivariate regression model predicting serum uric acid level, uric acid was positively associated with body mass index (weight (kg)/height (m)2; β = 0.041 mg/dl per kg/m2, <it>р</it> = 0.003), abdomen : hip circumference ratio (β = 1.88 mg/dl per cm/cm, <it>р</it> = 0.048), log alcohol intake (β = 0.150 μg/dl per g/week, <it>р</it> = 0.0001), and log postcarbohydrate insulin level (β = 0.157 mg/dl per log(μlU/ml), <it>р</it> = 0.005). Serum uric acid level was negatively associated with age (β = -0.012 mg/dl per year of age, <it>р</it> = 0.017) and log physical activity (β = -0.152 mg/dl per kcal/week, <it>р</it> = 0.0001). The data suggest that serum uric acid may be involved in the obesity-insulin resistance syndrome, which in turn may explain the relation of serum uric acid to coronary atherosclerosis.
Oxford University Press
1995-08-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/142/3/288
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oai:open-archive.highwire.org:amjepid:142/3/2952015-05-11HighWireOUPamjepid:142:3
The Contribution of Urinary Cations to the Blood Pressure Differences Associated with Migration
Klag, Michael J.
He, Jiang
Coresh, Josef
Whelton, Paul K.
Chen, Jun-Yun
Mo, Jing-Ping
Qian, Ming-Chu
Mo, Pei-Sheng
He, Guan-Qing
ORIGINAL CONTRIBUTIONS
People living in unacculturated societies have a low average blood pressure and little rise in blood pressure with age. In a community-based survey in southwestern China, the authors assessed the contribution of urinary cation excretion to differences in blood pressure between an unacculturated group (Yi farmers) and migrants to an urban environment, as well as urban controls from a different ethnic group (Han). In March 1989, blood pressure and overnight urinary electrolyte levels were measured on 3 consecutive days in 313 Yi farmers, 265 Yi migrants, and 253 urban Han residents, all male. Of the urinary electrolytes, a higher sodium: potassium ratio best explained the higher blood pressure in the migrants. Yi farmers had lower systolic (106.7 mmHg vs. 114.8 mmHg, respectively) and diastolic (66.2 mmHg vs. 71.3 mmHg, respectively) blood pressures than Yi migrants. However, even after adjustment for age, body mass index, alcohol intake, and urinary sodium, potassium, calcium, and magnesium excretion, Yi farmers continued to have lower average blood pressures than Yi migrants. In pooled analyses of all three groups, urinary sodium and calcium were positively related and urinary potassium and magnesium were inversely related to blood pressure. Migration is associated with a higher blood pressure that is only partially explained by higher levels of adiposity and alcohol and sodium intake and lower levels of potassium and magnesium intake.
Oxford University Press
1995-08-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/142/3/295
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oai:open-archive.highwire.org:amjepid:142/3/3042015-05-11HighWireOUPamjepid:142:3
Prognostic Factors for All-Cause Mortality among Hemophiliacs Infected with Human Immunodeficiency Virus
Diamondstone, Laura S.
Blakley, Sally A.
Rice, Janet C.
Clark, Rebecca A.
Goedert, James J.
ORIGINAL CONTRIBUTIONS
To identify the prognostic significance of hemophilia- and virus-related factors, the authors undertook a survival analysis among 644 human immunodeficiency virus (HIV)-infected subjects enrolled in the Multicenter Hemophilia Cohort Study between 1985 and 1993. Acquired immunodeficiency syndrome (AIDS) was the leading cause of death, followed by hemorrhage and hepatic disease. Adverse prognostic factors included older age and CD4-positive lymphocyte values below 14 percent either at entry (age-adjusted mortality rate ratio (RR) = 6.4, 95% confidence interval (Cl) 3.4-12.1) or after entry (time-dependent RR = 4.2, 95% Cl 2.6-6.7); indeterminate antibody responses to hepatitis C virus (RR = 3.0, 95% Cl 1.8-5.0); and inhibitory antibodies to factor VIII concentrates (RR = 1.8, 95% Cl 1.1-3.1). Indeterminate hepatitis C virus status was associated with mortality from hepatic disease but not with AIDS mortality. Factors that were not prognostic included duration of HIV infection, hepatitis B virus infection, and other hemophilia variables. These findings suggest that fatal liver disease among coinfected subjects with an indeterminate hepatitis C virus status is probably related to an insufficient humoral response secondary to HIV immune dysfunction and that the risk of death among HIV-infected subjects is best evaluated with age and duration of low CD4 percentage.
Oxford University Press
1995-08-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/142/3/304
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oai:open-archive.highwire.org:amjepid:142/3/3142015-05-11HighWireOUPamjepid:142:3
Temporal Trends in Human Immunodeficiency Virus Seroprevalence and Sexual Behavior at the San Francisco Municipal Sexually Transmitted Disease Clinic, 1989-1992
Schwarcz, Sandra K.
Kellogg, Timothy A.
Kohn, Robert P.
Katz, Mitchell H.
Lemp, George F.
Bolan, Gail A.
ORIGINAL CONTRIBUTIONS
The authors analyzed temporal trends in human immunodeficiency virus (HIV) infection among men and women who visited the San Francisco municipal sexually transmitted disease clinic between 1989 and 1992, using blinded HIV seroprevalence data. Temporal changes in sexual behavior were evaluated by abstracting self-reported information on sexual behaviors from a random sample of charts of men who visited the clinic between 1990 and 1992. From 1989 to 1992, HIV seropositivity declined from 2.0% to 1.0% among women (<it>p</it> = 0.06) and from 18.9% to 12.0% (<it>p</it> < 0.001) among men. The percentage of patients who reported having anal intercourse in the previous year did not change significantly during the study period. The percentage of male patients who reported having vaginal intercourse during the previous year decreased from 82.9% to 78.6% (<it>p</it> < 0.05), and the percentage of male patients who reported engaging in receptive oral sex during the previous year increased from 24.0% to 41.6% (<it>p</it> < 0.001). The percentage of male patients who reported that they always used condoms increased from 31.8% to 49.2% for anal sex, from 8.7% to 19.5% for vaginal sex, and from 1.4% to 6.3% for oral sex (<it>p</it> < 0.05). Among patients visiting the sexually transmitted disease clinic, there was a steady and significant decline in HIV seroprevalence. The decline in HIV seroprevalence was accompanied by a significant trend toward safer sexual practices. However, by the end of the study period, less than half of the patients reported using condoms all of the time, which suggests that there is a need to expand behavioral interventions to focus on high-risk persons.
Oxford University Press
1995-08-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/142/3/314
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Copyright (C) 1995, Oxford University Press
oai:open-archive.highwire.org:amjepid:142/3/3232015-05-11HighWireOUPamjepid:142:3
The Multicenter AIDS Cohort Study: Retention after 91/2 Years
Dudley, Janice
Jin, Shelia
Hoover, Donald
Metz, Sharon
Thackeray, Robert
Chmiel, Joan
ORIGINAL CONTRIBUTIONS
In a longitudinal, multicenter study of 4,954 men at risk for human immunodeficiency virus infection and acquired immunodeficiency syndrome, data from the first 9.5 years of follow-up (April 1984 through Septembe 1993) were used to determine differences between those who remained in the study and those who dropped out. Demographic variables (age, race, education, employment, and study center), health status (human immunodeficiency virus type 1 serostatus and depression), and behavioral characteristics (alcohol drinking, drug use, and anal-receptive intercourse) were analyzed. Strategies for promoting retention included having frequent contact with participants, generating trust, keeping participants well-informed, utilizing multiple resources for follow-up, and providing flexible methods of participation. After 9.5 years of follow-up, vital status was known for 4,385 (88.5%) of the participants. Results from multiple logistic regression showed that race, age, education, and smoking were each significantly associated with nonparticipation (<it>p</it> < 0.001). A high level of retention was maintained in this well-educated and highly motivated cohort of homosexual/bisexual men. Extensive follow-up methods may improve case-finding. Nonwhite race, younger age, less education, and smoking were important predictors of dropping out. These findings identify specific groups for targeting follow-up efforts to reduce potential bias due to dropout.
Oxford University Press
1995-08-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/142/3/323
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Seroepidemiology of Hepatitis B Virus in a Population of Injecting Drug Users: Association with Drug Injection Patterns
Levine, Orin S.
Vlahov, David
Koehler, Jane
Cohn, Sylvia
Spronk, Adrian M.
Nelson, Kenrad E.
ORIGINAL CONTRIBUTIONS
To investigate the epidemiology of hepatitis B virus (HBV) infection among injecting drug users, the authors assessed the prevalence of HBV seromarkers among 2,558 injecting drug users recruited through street outreach in Baltimore, Maryland, in 1988–1989. Eighty percent of the drug users had at least one HBV seromarker. HBV seropositivity was associated with increasing age, duration of injecting drug use, African-American ethnicity, injecting drugs at least once daily, and sharing needles or visiting “shooting galleries” during the previous 11 years, but not with high-risk sexual behaviors or a history of sexually transmitted disease. This finding is possibly due to the relative inefficiency of sexual transmission as compared with parenteral transmission in injecting drug users. In addition, HBV seropositivity was strongly associated with seropositivity for hepatitis C virus and human immunodeficiency virus. The authors conclude that HBV transmission among injecting drug users occurs primarily through the sharing of contaminated drug injecting equipment rather than through sexual relations, and that efforts to prevent HBV infection must target injecting drug users early in their injecting careers.
Oxford University Press
1995-08-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/142/3/331
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oai:open-archive.highwire.org:amjepid:142/3/3422015-05-11HighWireOUPamjepid:142:3
Misclassification of Nutrient and Energy Intake from Use of Closed-ended Questions in Epidemiologic Research
Tylavsky, Frances A.
Sharp, Gerald B.
ORIGINAL CONTRIBUTIONS
The authors investigated the effect of collecting food frequency intake data using questionnaires that record response intervals rather than exact frequencies of consumption. Measures of energy and 24 nutrients were calculated using both types of frequency data for subjects' mean intakes, rank classifications and group mean values. Frequency data obtained between 1987 and 1989 using the open-ended Health Habits and History Questionnaire (HHHQ) developed by Block and associates at the National Cancer Institute were recoded into the interval response formats used by the computer-scannable version of the HHHQ and into the format used in the food frequency questionnaire developed by Willett for the Nurses' Health Study and other studies. Compared with the open-ended HHHQ, for otherwise identical data sets, the closed-ended HHHQ and Willett response categories produced significantly different (<it>p</it> < 0.05) measures of intake on the individual level for 18 (72%) (HHHQ) and 16 (64%) (Willett) of the 25 nutrient and energy measures studied, and they ranked 13-53% (HHHQ) and 16-52% (Willett) of subjects in different quintiles for the various measures. Use of food frequency questionnaires with closed-ended response categories causes nondifferential misclassification that could bias study results. To reduce such misclassification in epidemiologic studies, the authors recommend that food frequency questionnaires obtain exact frequencies of intake for measurement of diet exposure, and they describe an open-ended questionnaire layout which does so and also permits computer scanning of data. <it>Am J Epidemiol</it> 1995;142:342–52.
Oxford University Press
1995-08-01 00:00:00.0
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http://aje.oxfordjournals.org/cgi/content/short/142/3/342
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Cost-Efficient Design of a Diet Validation Study
Stram, Daniel O.
Longnecker, Matthew P.
Shames, Lisa
Kolonel, Laurence N.
Wilkens, Lynne R.
Pike, Malcolm C.
Henderson, Brian E.
ORIGINAL CONTRIBUTIONS
Validation studies of food frequency questionnaires (FFQs) describe the extent to which the FFQ reflects true diet and the relation between measured and true diet (calibration). Calibration data can be used to estimate the relation between disease and diet that would have been observed in the absence of error due to the FFQ. In this paper, the authors consider the optimal design of a validation study when the goal is precise calibration of an FFQ. The authors posed the following question: Under the constraint of a fixed total cost for a validation study, what is the optimal choice of number of subjects (<it>n</it>) and number of days (<it>m</it>) of diet records (or 24-hour recalls) per subject? The optimal <it>n</it> and <it>m</it> were found to depend upon 1) the ratio between the costs of the initial and subsequent 1 -day diet records and 2) the ratio of the variance in day-to-day nutrient intake to the variance in true diet for a fixed FFQ value. Data for the two ratios and optimal values of <it>n</it> and <it>m</it> are given under a variety of realistic scenarios. The authors conclude that in most settings the optimal study design will rarely require more than four or five 1-day diet records per subject.
Oxford University Press
1995-08-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/142/3/353
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Computer Simulation Analysis of Sartwell's Incubation Period Model for Diseases with Uncertain Etiology: The Effect of Competing Risk
Yi, Qilong
Glickman, Lawrence T.
ORIGINAL CONTRIBUTIONS
Computer simulation was applied to Sartwell's model to examine the impact of competing risks of death on the underlying assumptions and the power to reject both uniform and normal incubation period distributions. Exponential and nonparametric survival functions were imposed onto lognormal, uniform, and normal distributions to create random samples reflecting competing risk. These random samples were evaluated with the Shapiro-Wilk's test to determine the proportion for which the lognormal distribution was rejected. The simulations indicated that competing causes of death do not significantly alter the lognormal distribution of incubation periods. In only approximately 5% of the samples drawn from a lognormal distribution was a lognormal hypothesis rejected with a goodness-of-fit test when sample size varied from 20 to 500. There was generally good power (>80%) to reject a lognormal distribution if the random samples were generated from a uniform distribution of incubation times, but not when they were generated from a normal distribution, particularly with increasing ages at disease onset. Varying the standard deviation did not significantly change the simulation results if the random samples came from a lognormal or uniform distribution. These conclusions were further supported by application of Sartwell's model to published data on the ages of onset for several chronic diseases.
Oxford University Press
1995-08-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/142/3/363
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ERRATA
ERRATUM
Dr. David Williamson has informed the Journal of an error in the headings of two tables that appeared in the article he coauthored for the June 15th issue (1). In tables 4 and 5, the heading in the top right-hand corner should read “Diabetes-related mortality,” not “Diabetes-related cancer.” The Journal regrets this error.
Oxford University Press
1995-08-01 00:00:00.0
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http://aje.oxfordjournals.org/cgi/content/short/142/3/369
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