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Biomedical subjects

J F Annegers

Publications and source records attributed to J F Annegers.

At least 73 records · Page 4Linked to original sources
PubMed1993

Incidence and risk factors for Bell's palsy in Laredo, Texas: 1974-1982.

Incidence rates of Bell's palsy in the predominantly Mexican-American population of Laredo, Texas, USA, are higher than those reported elsewhere, reaching 23.5 per 100,000 among males and 32.7 per 100,000 among females. During childbearing years (15-44) the risk of Bell's palsy was greater for women than for men (incidence density ratio 2.0; 95% confidence interval 1.3-3.1). No evidence for seasonality or epidemicity was obtained. Using prevalence estimates from community surveys in south Texas or the Hispanic Health and Nutrition Survey, standardized prevalence ratios (SPR) calculated for hypertension revealed a 10 or 20% increased risk for women and a 50 or 60% increased risk for men. SPRs calculated for diabetes among men with Bell's palsy were twice that expected, while risks of 60% or 90% were noted for women. The increased incidence of Bell's palsy observed in Laredo appears to be due to the high prevalence of diabetes in Mexican-Americans and, to a lesser extent, uncontrolled hypertension.

Adolescent↗
PubMed1993

Effect of perceived barriers on compliance with antihypertensive medication.

Noncompliance with antihypertensive medication remains an obstacle to the management of hypertension, and despite research efforts over the past decade, the predictors of noncompliance remain unclear. According to values expectancy theory, individuals rationally choose noncompliance when the barriers or costs of treatment outweigh the expected benefits. Noncompliance, therefore, is likely to occur when net costs of treatment are high. Using a cross-sectional study design among subjects (n = 197) attending a specialized clinic for hypertension, we measured "net barriers" (costs), self-reported compliance, and possible determinants of noncompliance, including socio-demographics, the medical regimen, and locus of control. The effect of each quartile of the net barriers score (none, low, moderate, and high) on compliance, controlling for potential effect modifiers, was assessed using logistic regression modeling. Noncompliance (47%) was associated with younger age, higher salt use, longer duration of treatment, and higher levels of net barriers, but duration of treatment modified the effect of net barriers. Among subjects in short-term treatment, noncompliance increased with severity of net barriers suggesting a dose-response effect. In contrast, patients in long-term treatment showed no dose-response effect but a consistent association between noncompliance and levels of net barriers. Subjects at greater risk for noncompliance, however, were those who reported high net barriers, regardless of duration of treatment. Net barriers accounted for 50% of the noncompliance and appeared most important for patients who were younger or in the early stages of treatment. Implications for health care providers are discussed.

Adult↗
PubMed1991

Incidence and prevalence of amyotrophic lateral sclerosis in Harris County, Texas, 1985-1988.

The incidence of amyotrophic lateral sclerosis was determined in Harris County, Texas, for the period 1985 through 1988. Amyotrophic lateral sclerosis cases were ascertained from four sources: area neurologists, hospitals, death certificates, and the Muscular Dystrophy Association. The age-adjusted incidences of 1.27 per 100,000 person-years in males and 1.03 per 100,000 person-years in females were lower than recent rates in the northern US, Canadian, and northern European studies but higher than rates in southern European studies. Comparisons with other recent incidence studies show less uniformity in occurrence of amyotrophic lateral sclerosis, in both the overall rates and in the age- and sex-specific patterns, than was suggested by mortality studies. The incidence of amyotrophic lateral sclerosis among blacks and whites was similar. Hispanic males had incidences similar to white males, although a deficit of female Hispanic cases was found in Harris County. The prevalence of amyotrophic lateral sclerosis peaked in the 65- to 74-year age group at 33 per 100,000 population among males and 19 per 100,000 population for females.

Adolescent↗
PubMed1991

Occurrence of other reproductive failures among women with recurrent spontaneous abortion.

We have previously reported an association between recurrent spontaneous abortion and ectopic pregnancy. We now report that not only ectopic pregnancy, but also other reproductive failures including hydatidiform moles, preterm births, and stillbirths are also associated with recurrent spontaneous abortion. The obstetrical histories of 455 women who had experienced two or more consecutive spontaneous abortions were studied for the occurrence of term births, preterm births, stillbirths, spontaneous abortions, ectopic pregnancies, and hydatidiform moles. The observed frequencies of these reproductive outcomes were compared with the expected frequencies of 920 term births, 80 preterm births, five stillbirths, 150 spontaneous abortions, 14.5 ectopic pregnancies and 0.5 molar pregnancies per 1,000 livebirths. The 455 women had experienced 1,968 pregnancies of which 184 were term births, 30 were preterm births, 16 were stillbirths, 1,669 were spontaneous abortions, 63 were ectopic pregnancies, and six were molar pregnancies. The ratio of observed to expected values was term births 0.1, preterm births 1.6, stillbirths 14.0, spontaneous abortion 6.6, ectopic pregnancy 2.6, and molar pregnancy 7.1. The gravid specific proportions of reproductive outcomes were constant suggesting comorbidity or common cause(s). The commonality that links these types of reproductive failure will provide insight into the mechanisms of reproductive wastage.

Abortion, Habitual↗
PubMed1991

Brain injury and neurologic sequelae: a cohort study of dementia, parkinsonism, and amyotrophic lateral sclerosis.

We reviewed the medical records of 821 Olmsted County residents who had suffered head trauma with presumed brain injury between 1935 and 1974 and were more than 40 years old at the time of their last medical assessment. These patients were followed over 15,000 person-years for dementia and other degenerative neurologic diseases. The standardized morbidity ratio (SMR) for dementia was 1.06, and the SMR for dementia of the Alzheimer type was 1.00. These values are not significantly elevated and are inconsistent with studies that suggest that head trauma is a risk factor for Alzheimer's disease. In addition, the SMRs for parkinsonism (1.04), Parkinson's disease (0.94), and amyotrophic lateral sclerosis (1.05) were not significantly elevated, providing no evidence that head trauma is a risk factor for these disorders. However, these latter results are based on smaller total case numbers.

Alzheimer Disease↗
PubMed1990

Recurrence of febrile convulsions in a population-based cohort.

The risk of recurrence after an initial febrile seizure was 25% in a population-based cohort of 639 children followed from their first febrile seizure. Prognostic factors were an increasing risk of recurrence with younger age at first febrile seizure, a first degree relative with febrile seizures and complex features of the first febrile seizure. The effect of complex features was modified by age at first febrile seizure and family history in that complex features alone did not increase risk of recurrence but further increased the risk for children under 18 months at first seizure and/or with a positive family history. The prognostic factors for all febrile convulsions recurrences were also prognostic for having subsequent complex febrile convulsions. Children with none of the prognostic factors had only a 3% risk of a future complex febrile seizure while children under 18 months at first febrile convulsion and a positive family history or complex features had about a 20% risk of a subsequent complex febrile seizure.

Child, Preschool↗
PubMed1990

Prenatal exposure to ionizing radiation and subsequent development of seizures.

Seizures are a frequent sequela of impaired brain development and can be expected to affect more children with radiation-related brain damage than children without such damage. This report deals with the incidence and type of seizures among survivors prenatally exposed to the atomic bombing of Hiroshima and Nagasaki, and their association with specific stages of prenatal development at the time of irradiation. Fetal radiation dose was assumed to be equal to the dose to the maternal uterus. Seizures here include all references in the clinical record to "seizure," "epilepsy," or "convulsion." Histories of seizures were obtained at biennial routine clinical examinations starting at about the age of 2 years. These clinical records were used to classify seizures as febrile or unprovoked (without precipitating cause). No seizures were ascertained among subjects exposed 0-7 weeks after fertilization at doses higher than 0.10 Gy. The incidence of seizures was highest with irradiation at the eighth through the 15th week after fertilization among subjects with doses exceeding 0.10 Gy and was linearly related to the level of fetal exposure. This obtains for all seizures without regard to the presence of fever or precipitating causes, and for unprovoked seizures. When the 22 cases of severe mental retardation were excluded, the increase in seizures was only suggestively significant and only for unprovoked seizures. After exposure at later stages of development, there was no increase in recorded seizures.

Adolescent↗
PubMed1990

Seizure recurrence after a 1st unprovoked seizure: an extended follow-up.

We followed 208 patients identified on the day of their 1st unprovoked seizure for a mean duration of 4 years. Seizures recurred in 64. Recurrence risks were estimated to be 14%, 29%, and 34% at 1, 3, and 5 years following the 1st episode. A history of previous neurologic insult (remote symptomatic) was associated with a 2.5-fold increased risk of recurrence. Among idiopathic cases, a sibling with epilepsy, a generalized spike and wave EEG, or a history of acute symptomatic seizure increased risk for recurrence. Among remote symptomatic cases, status epilepticus, a prior acute symptomatic seizure, or Todd's paresis increased risk. Depending upon clinical features, recurrence risk at 5 years following a 1st seizure ranged from 23% to 80%. Treatment with anticonvulsant medication was not associated with a decrease in recurrence risks.

Analysis of Variance↗
PubMed1990

Occupational physical activity and other risk factors for preterm birth among US Army primigravidas.

We examined the relation of occupational physical activity to the risk of preterm birth among US Army active-duty primigravidas between 1981 and 1984 using 604 cases (preterm deliveries; less than or equal to 37 weeks gestation) and 6,070 controls (term and post-term deliveries). Women employed in the highest physical activity levels had increased odds of preterm delivery ranging from 1.69 to 1.75. The relation was not changed by adjustment for the effects of age, marital status, socioeconomic status, or education. Missing data suggest cautious interpretation.

Adult↗
PubMed1989

Chromosome sensitivity to bleomycin-induced mutagenesis, an independent risk factor for upper aerodigestive tract cancers.

Defective DNA repair capability, measured by enumerating mutagen-induced chromosomal lesions, might explain variable host susceptibility to the action of environmental carcinogens. We compared sensitivity to bleomycin-induced chromosome damage in 75 patients (53 men and 22 women) with previously untreated upper aerodigestive tract malignancies with that in 62 healthy control subjects. Data on tobacco and alcohol use were derived from a detailed, self-administered cancer risk factor questionnaire. Forty-five patients and 13 controls were sensitive to bleomycin-induced mutagenesis (average breaks/cell greater than 0.8). Differential susceptibility was detected in patients categorized by primary tumor location. Odds ratios for chromosome sensitivity were significantly elevated for all sites (odds ratio = 10.3 for pharyngeal cancers, 8.0 for laryngeal cancers, and 3.8 for oral cavity cancers). On logistic regression analysis, chromosome sensitivity remained a strong and independent risk factor after adjustment for potential confounding from age, sex, and tobacco and alcohol use (odds ratio = 4.3, 95% confidence limits = 2.0, 10.2). Despite the small study size and design constraints, the strength of the association with chromosome sensitivity even after adjustment for potential confounders is impressive and suggests a promising avenue for further research. The preventive implications of a valid marker for carcinogen sensitivity are manifold.

Alcohol Drinking↗
PubMed1989

Epilepsy and clefting disorders: lack of evidence of a familial association.

Offspring of women with epilepsy who are taking anticonvulsant medications have an increased incidence of clefting abnormalities. However, there is disagreement as to the extent to which this increase is due to a teratogenic effect of anticonvulsant medications or to a familial association of epilepsy and clefting. Some investigators suggested, but were unable to demonstrate adequately, that clefting and epilepsy associate together in families. In order to address this issue, individuals with a clefting disorder and their relatives were ascertained to determine whether clefting and epilepsy aggregate together in families. The incidence of epilepsy was not increased over that in the general population with a standardized morbidity ratio (SMR) for epilepsy of 0.9 (95% CI 0.2-2.6) for first-degree relatives (excluding parents) and 0.0 for second-degree relatives. The SMRs ranged from 0.7-2.2 for the individual relative types (parents 1.5, sibs 0.7, children 2.2) and were also not increased. These results do not support suggestions that clefting and epilepsy segregate together in families.

Anticonvulsants↗
PubMed1989

The Rochester Coronary Heart Disease Project: effect of cigarette smoking, hypertension, diabetes, and steroidal estrogen use on coronary heart disease among 40- to 59-year-old women, 1960 through 1982.

A population-based case-control study of coronary heart disease (CHD) risk in young women attributable to cigarette smoking, hypertension, diabetes, and steroidal estrogen use was conducted among residents of Rochester, Minnesota. All newly diagnosed cases of CHD (sudden unexpected death [SUD], N = 18; myocardial infarction [MI], N = 90; and angina, N = 133) among female Rochester residents 40 to 59 years of age during the years 1960 through 1982 were identified, and two community control subjects were matched for age and duration of community medical record. The overall adjusted odds ratio (OR) for the association between steroidal estrogen use and definite CHD (MI and SUD) was 0.6 (95% confidence interval [CI] = 0.2 to 1.3). Smoking (OR = 5.1; 95% CI = 2.3 to 11.6), hypertension (OR = 4.8; 95% CI = 2.3 to 10.2), and diabetes (OR = 8.4; 95% CI = 1.6 to 44.5) were strong risk factors for CHD events. If considered causal, cigarette smoking accounted for 64% of all MIs and SUDs in the community, hypertension accounted for 45%, and diabetes accounted for 13%. Although steroidal estrogen exposure reduced CHD among these women by 14%, giving steroidal estrogens to all women in this age group might reduce the population rates of MI by as much as 45%.

Adult↗