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S J Jacobsen

Publications and source records attributed to S J Jacobsen.

At least 37 records · Page 2Linked to original sources
PubMed2001

Incidence of reading disability in a population-based birth cohort, 1976-1982, Rochester, Minn.

OBJECTIVE: To report the incidence of reading disability among school-aged children. SUBJECTS AND METHODS: In this population-based, retrospective birth cohort study, subjects included all 5718 children born between 1976 and 1982 who remained in Rochester, Minn, after the age of 5 years. Based on records from all public and nonpublic schools, medical facilities, and private tutorial services and on results of all individually administered IQ and achievement tests, extensive medical, educational, and socioeconomic information were abstracted. Reading disability was established with use of research criteria based on 4 formulas (2 regression-based discrepancy, 1 non-regression-based discrepancy, and 1 low achievement). RESULTS: Cumulative incidence rates of reading disability varied from 5.3% to 11.8% depending on the formula used. Boys were 2 to 3 times more likely to be affected than girls, regardless of the identification methods applied. CONCLUSIONS: In this population-based birth cohort, reading disability was common among school-aged children and significantly more frequent among boys than girls, regardless of definition.

Adolescent↗
PubMed2000

Prostate-specific antigen levels in young white and black men 20 to 45 years old.

OBJECTIVES: To determine the prostate-specific antigen (PSA) levels and PSA change over time in young white and black men 20 to 45 years old. METHODS: The Department of Defense Serum Repository, a serum bank that stores all residual serum from the military human immunodeficiency virus screening program at -25 degrees C, was sampled to obtain a total of 588 black and 588 white subjects 20 to 45 years old. This was a retrospective study with only demographic data available on the studied subjects. The samples used for this study were collected between June 24, 1988 and June 12, 1996. Individuals with a history of prostate disease were excluded by query of a centralized Department of Defense diagnosis database. Three serum specimens evenly distributed over a mean of 6 years were selected for each individual to determine the free and total PSA levels and PSA velocity. The Hybritech Tandem-E PSA assay was used for the total PSA measurement, and the Hybritech Tandem-R assay was used for the free PSA measurement. RESULTS: The baseline serum PSA levels differed by race (P = 0.04). The median (25th, 75th percentile) baseline serum PSA levels for black men 20 to 29, 30 to 39, and 40 to 45 were 0.38 ng/mL (0.26, 0.61), 0.45 ng/mL (0.32, 0. 67), and 0.52 ng/mL (0.37, 0.73), respectively. The median baseline serum PSA levels for the same decade groups in white men were 0.38 ng/mL (0.27, 0.57), 0.45 ng/mL (0.28, 0.68), and 0.40 ng/mL (0.26, 0. 64), respectively. The PSA velocity was higher in white men than in black men (mean 2.8%/yr and 1.6%/yr, respectively, P = 0.032). CONCLUSIONS: These results suggest that although black men 20 to 45 years old have higher baseline serum PSA levels than white men of the same age, the PSA velocity is greater in young white than in young black men. Additional work is needed to determine the clinical significance of these findings.

Adult↗
PubMed2000

Digital rectal examination and prostate-specific antigen abnormalities at the time of prostate biopsy and biopsy outcomes, 1980 to 1997.

OBJECTIVES: To assess the temporal trends in the prevalence of pre-biopsy abnormalities in digital rectal examination (DRE) findings, serum prostate-specific antigen (PSA) levels, and cancer detection rates by abnormality in all men from the community who had a prostate biopsy. METHODS: All Olmsted County, Minnesota residents who had their first prostate biopsy performed between January 1980 and December 1997 were identified (n = 1729). The complete medical records of these men were reviewed to determine the clinical findings at the time of the biopsy and the biopsy outcome. RESULTS: The prevalence of an abnormal DRE decreased from 69% in 1980 to 1986 to 45% in 1993 to 1997 (P <0.001). The prevalence of an isolated elevated PSA level (normal DRE) increased from 28% in 1987 to 1992 to 42% in 1993 to 1997 (P <0.001). In men diagnosed with cancer, 55% had an abnormal DRE in 1993 to 1997 (P <0.001). Prostate cancer was detected in 471 (37%) of 1280 men with an abnormal DRE or elevated PSA level noted within 6 weeks of the biopsy. The positive predictive value for prostate cancer was 61% (229 of 373) in men with an abnormal DRE and elevated PSA, 34% (166 of 494) in men with an elevated PSA only, and 18% (60 of 327) in men with an abnormal DRE only. CONCLUSIONS: The prevalence of an abnormal DRE at the time of biopsy has declined and that of an isolated elevated PSA has increased. However, nearly 40% of men with abnormalities in both PSA and DRE at the time of biopsy had a negative biopsy for prostate cancer. An increase in both the sensitivity and specificity of screening tests may further enhance the early detection of prostate cancer and potentially decrease the high negative biopsy rate.

Aged↗
PubMed2000

Prognostic value of treadmill exercise testing in elderly persons.

BACKGROUND: Recent exercise testing guidelines recognized a gap in knowledge about the prognostic value of treadmill exercise testing in elderly persons. OBJECTIVE: To test the hypothesis that treadmill exercise testing has equal prognostic value among elderly (> or =65 years of age) and younger (<65 years of age) persons and to examine the incremental value of this testing over clinical data. DESIGN: Inception cohort with a median follow-up of 6 years. SETTING: Olmsted County, Minnesota. PATIENTS: All elderly (n = 514) and younger (n = 2593) residents of Olmsted County who underwent treadmill exercise testing between 1987 and 1989. MEASUREMENTS: Overall mortality and cardiac events (cardiac death, nonfatal myocardial infarction, and congestive heart failure). RESULTS: Compared with younger patients, elderly patients had more comorbid conditions, achieved a lower workload (6.0 and 10.7 metabolic equivalents; P < 0.001), and had a greater likelihood of a positive exercise electrocardiogram (28% and 9%; P < 0.001). With median follow-up of 6 years, overall survival (63% and 92%; P < 0.001) and cardiac event-free survival (66% and 95%; P < 0.001) were worse among elderly persons than among younger persons. Workload was the only treadmill exercise testing variable associated with all-cause mortality in both age groups, and the strength of association was similar. Workload and angina with exercise testing were associated with cardiac events in both age groups, whereas a positive exercise electrocardiogram was associated with cardiac events only in younger persons (P < 0.05 for all comparisons). After adjustment for clinical variables, workload was the only additional treadmill exercise testing variable that was predictive of death (P < 0.001) and cardiac events (P < 0.05); the strength of the association was similar in both age groups. Each 1-metabolic equivalent increase in exercise capacity was associated with a 14% and 18% reduction in cardiac events among younger and elderly persons, respectively. CONCLUSIONS: In elderly persons, treadmill exercise testing provided prognostic information that is incremental to clinical data. After adjustment for clinical factors, work-load was the only treadmill exercise testing variable that was strongly associated with outcome, and its prognostic effect was of the same magnitude in elderly and younger persons.

Age Factors↗
PubMed2000

Sex differences in evaluation and outcome of unstable angina.

CONTEXT: The existence of sex bias in the delivery of cardiac care is controversial, and little is known about the association between sex and delivery of care and outcomes at an early point in the diagnostic sequence, such as when patients present for the evaluation of chest pain. OBJECTIVE: To test the hypothesis that female sex is negatively associated with care delivered to and outcomes of persons diagnosed as having unstable angina. DESIGN: Inception population-based cohort study with an average of 6 years of follow-up. SETTING: Emergency departments (EDs) in Olmsted County, Minnesota. PATIENTS: A total of 2271 Olmsted County residents (1306 men and 965 women) who presented to the ED for the first time with symptoms meeting criteria for unstable angina between 1985 and 1992. MAIN OUTCOME MEASURES: Use of cardiac procedures within 90 days of ED visit, overall mortality, and cardiac events (cardiac death, nonfatal myocardial infarction, nonfatal cardiac arrest, and congestive heart failure), compared by sex and Agency for Health Care Policy and Research cardiovascular risk category (low, intermediate, or high). RESULTS: Women were older (P<.001), more likely to have a history of hypertension (P = .001), and less likely to present with typical angina (P = .004) than men. Men were more likely than women to undergo noninvasive cardiac tests (relative risk [RR], 1.27; 95% confidence interval [CI], 1.14-1.40) as well as invasive cardiac procedures (RR, 1.72; 95% CI, 1.51-1.97). After adjustment, male sex was associated with a 24% increase in the use of cardiac procedures. Survival of both men and women in the high and intermediate risk categories was significantly lower than expected per the general population (P<.001). Women had a worse outcome than men, but after multivariate adjustment, male sex was associated with a trend toward an increase in the risk of death (RR, 1.23; 95% CI, 0.99-1.54) and significantly associated with increased risk of cardiac events (RR, 1.21; 95% CI, 1.03-1.42). CONCLUSIONS: Our population-based data indicate that after an ED visit for symptoms of unstable angina, the use of cardiac procedures was lower in women, but after taking into account baseline characteristics, men experienced worse outcomes.

Aged↗
PubMed2000

Epidemiology of prostatitis.

Prostatitis is the third most important condition of the prostate. Problems in the diagnosis and classification of this condition, however, have hindered epidemiologic research. Consequently, our understanding of the incidence of prostatitis and factors that increase its probability is limited. Recent studies suggest that the prevalence of prostatitis is 5% to 9% among unselected men in the community. Based on estimates from national data, approximately 2 million men in the United States seek treatment for prostatitis each year. A number of recent studies suggest that genetic, behavioral, and environmental factors; age; inflammatory mediators; and oxidative stress may be risk factors for prostatitis. However, findings from most of these studies may at best be considered preliminary because of problems with small sample sizes or lack of generalizability. Nonetheless, these studies suggest hypotheses that should be tested in well-designed population-based studies.

Age Factors↗
PubMed2000

Cardiology services after stress testing: are there sex differences? A population-based study.

To test the hypothesis that, in a population-based cohort of persons undergoing stress tests, female sex was negatively associated with the use of cardiology visits in persons with no documented coronary artery disease (CAD) but that this association did not exist when CAD was established. Sex differences in the use of invasive cardiac procedures have been clearly documented, but data on physician encounters, an integral part of care, are lacking. A population-based cohort consisting of all Olmsted County, Minnesota residents who underwent an initial stress test in 1987, 1988, and 1989 in Olmsted County was examined. Medical records were reviewed for baseline characteristics including CAD diagnosis status, test results, and cardiology visits in the year following the stress test. Regression models were constructed to determine whether sex is independently associated with the probability of a visit. In the year after stress testing, there was no difference between the sexes in the use of inpatient (OR for female sex 0.88, 95% CI 0.62-0.97, P = 0.365) and outpatient/consultative (OR for female sex 1.24, 95% CI 0.95-1.61, P = 0.6) cardiology visits. Women were, however, less likely to receive preventive cardiology visits (OR for female sex 0.77, 95% CI 0.62-0.97, P = 0.02). This was largely related to less use of preventive visits among older women with documented coronary artery disease (CAD). In the absence of documented CAD, when the stress test was positive, women were less likely to receive preventive visits. In this geographically defined population within one year after an initial stress test, there was no sex difference in the use of in-patient or out-patient visits but women were less likely to receive preventive cardiology visits in the year after stress testing. Further studies are needed to understand the reasons for and impact of these care patterns.

Adult↗
PubMed2000

Validation of death certificate diagnosis of out-of-hospital coronary heart disease deaths in Olmsted County, Minnesota.

OBJECTIVE: To evaluate the validity of death certificate diagnosis of out-of-hospital (OOH) coronary heart disease (CHD) and sudden cardiac death (SCD) in Olmsted County, Minnesota, between 1981 and 1994. METHODS: In this review of the medical records, autopsy reports, and coroner's files, OOH deaths with heart disease as the underlying cause of death on the death certificate were classified into CHD (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] codes 410-414) and non-CHD (other ICD-9-CM heart disease codes) deaths. A 10% random sample (n = 174) of these death certificates was reviewed by physicians, and published validation criteria were applied to classify these deaths into validated CHD or non-CHD categories. Sudden cardiac death was defined as validated CHD that occurred at an OOH location with less than 24 hours between symptom onset and death. RESULTS: The death certificate definition of OOH CHD death (ICD-9-CM codes 410-414) had high sensitivity and positive predictive value of 91% and 96%, respectively. The specificity and the negative predictive value were slightly lower at 86% and 72%, respectively. The sensitivity of death certificate diagnosis of CHD for validated SCD was 89%, and the positive predictive value was 77%. Using a more restrictive definition of SCD, that is, less than 1 hour between the onset of symptoms and death, the positive predictive value of CHD codes for SCD was lower at 52%. CONCLUSIONS: In Olmsted County, the positive predictive values of death certificate diagnosis for OOH CHD and SCD are high. Relying on death certificate diagnoses results in about 5% underestimation of the true CHD rates, whereas their use as a surrogate for SCD yields a 16% overestimation of the true SCD rates.

Autopsy↗
PubMed2000

Longitudinal changes in peak urinary flow rates in a community based cohort.

PURPOSE: We describe longitudinal changes in peak urinary flow rates in community dwelling men in Olmsted County, Minnesota. MATERIALS AND METHODS: A cohort of 2,115 men 40 years old or older was randomly selected from the Olmsted County, Minnesota population. Peak urinary flow rates and the American Urological Association symptom index were assessed in all men at baseline and biennially, and in a 25% random subsample prostate volume was determined by transrectal ultrasonography. The annualized percentage change in peak urinary flow rate (slope) was assessed for 492 men in the subsample during 6 years of followup. RESULTS: Median peak urinary flow rate slope was -2.1% per year (25th percentile -4.0, 75th percentile -0.6). Peak urinary flow rate declined more rapidly with decreasing baseline rate, and increasing baseline age, prostate volume and symptom severity (all p = 0.001). When the variables were simultaneously adjusted for each other, a rapid decline (negative slope 4.5% or greater per year) was more likely in men 70 years old or older (odds ratio 46.4, 95% confidence intervals 16.8, 127.7) and those with a rate less than 10 ml. per second (42.0, 14.1, 125.3) at baseline compared to those 40 to 49 years old and those with a rate of 15 ml. or greater, respectively. Prostate volume and symptom severity were not statistically significant predictors of a rapid decline in peak urinary flow rate when variables were considered simultaneously. CONCLUSIONS: Despite variability in measurement of peak urinary flow rate, a consistent decline was observed when measured longitudinally in a community based cohort. Furthermore, this decline was associated with impairments in other physiological and anatomical measures of lower urinary tract function in an unselected cohort of men.

Adult↗
PubMed2000

Positive and negative biopsies in the pre-prostate specific antigen and prostate specific antigen eras, 1980 to 1997.

PURPOSE: We assess temporal trends in prostate biopsy incidence, utilization and cancer yield in the community before and after the introduction of serum prostate specific antigen (PSA) to the community medical practice MATERIALS AND METHODS: Study subjects comprised all Olmsted County men with a first prostate biopsy performed between January 1, 1980 and December 31, 1997. Medical records of all study subjects (1,729) were reviewed for clinical information from the first and all subsequent biopsies. RESULTS: Annual age adjusted prostate biopsy incidence increased from 113/100, 000 (95% confidence interval 76, 150) in 1980 to 487/100,000 (421, 554) in 1992 and decreased to 264/100,000 (219, 309) in 1997. For men 50 to 59 years old biopsy incidence increased 400% from 137/100, 000 in 1980 to 1986 to 686/100,000 in 1993 to 1997. Overall, there were 93/100,000 more negative biopsies and 49/100,000 more positive biopsies in 1993 to 1997 than in 1980 to 1986. The overall cancer yield of 36% was essentially unchanged across periods (p = 0.6). However, by age cancer yield decreased from 29% to 21% (1980 to 1986 versus 1993 to 1997) for men 50 to 59 years old but increased from 38% to 45% for those 70 to 79 years old. CONCLUSIONS: Overall cancer yield from prostate biopsies has changed little during the last 15 years. Increased cancer yield for men 70 years old or older has been offset by the decreased yield in younger men. Attention must now be given to diagnostic techniques which might reduce the incidence of negative biopsies and improve cancer yield in younger men.

Aged↗
PubMed1999

A population-based study of school scoliosis screening.

CONTEXT: Although school-based screening programs for adolescent idiopathic scoliosis are mandated in 26 states in the United States, few program outcomes data exist regarding the effectiveness of such programs. OBJECTIVE: To determine the effectiveness of a community-based school scoliosis screening program. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of children who attended kindergarten or first grade at public or private schools in Rochester, Minn, during 1979-1982. Children were followed up until age 19 years or until they left the school district. MAIN OUTCOME MEASURES: Number of children diagnosed and treated for scoliosis, based on results from scoliosis screenings performed annually in grades 5 through 9, linked to community medical records data; performance characteristics of the screening program. RESULTS: Of the 2242 children screened, 92 (4.1 %) were referred for further evaluation. Of these, 68 (74%) had documented medical or chiropractic evaluation of scoliosis. School screening identified 5 of the 9 children treated for scoliosis but resulted in referrals for another 87 children who were not treated. The cumulative incidence of diagnosed scoliosis in this population was 1.8% (95% confidence interval [CI], 1.2%-2.3%) for curves of more than 10 degrees, 1.0% (95% CI, 0.6%-1.5%) for curves of at least 20 degrees, and 0.4% (95% CI, 0.1 %-0.6%) for curves of 40 degrees or more; 0.4% (0.5% of girls and 0.3% of boys) were treated for scoliosis. The positive predictive value of the school screening program for the identification of treated scoliosis was 0.05 (95% CI, 0.048-0.052), with 448 children needed to screen to identify 1 child who subsequently received treatment. The percent positive agreement across consecutive years of screening varied from 7% to 30%. CONCLUSION: In this population, school scoliosis screening identified some children who went on to receive treatment but referred many more who did not. These data should be considered in making decisions regarding school scoliosis screening.

Adolescent↗
PubMed1999

Blood transfusion and risk of non-Hodgkin's lymphoma.

A few epidemiologic studies have suggested that blood transfusion may be a risk factor for non-Hodgkin's lymphoma. The authors tested this hypothesis in a population-based, case-control study, using pathologically verified non-Hodgkin's lymphoma cases and transfusion documented via medical records. In 221 age- and sex-matched case-control pairs from Olmsted County, Minnesota, in 1975-1993, the authors observed an odds ratio of 0.84 (95% confidence interval 0.50-1.41) for history of transfusion and non-Hodgkin's lymphoma. There also was no apparent association between transfusion and non-Hodgkin's lymphoma in any subgroup analysis. Results do not support the hypothesis that blood transfusion contributes to the occurrence of non-Hodgkin's lymphoma.

Adult↗
PubMed1999

Biased tests of association: comparisons of allele frequencies when departing from Hardy-Weinberg proportions.

Association studies of genetic markers or candidate genes with disease are often conducted using the traditional case-control design. Cases and controls are sampled from genetically unrelated subjects, and allele frequencies compared between cases and controls using Pearson's chi-square statistic. An assumption of this analysis method is that the two alleles within each subject are statistically independent, at least when no association exists. This is equivalent to assuming that the frequencies of the genotypes in the general population comply with Hardy-Weinberg Equilibrium proportions, which may not always be the case. However, deviations from Hardy-Weinberg Equilibrium can inflate the chance of a false-positive association. These results demonstrate that when comparing the frequencies of two alleles between cases and controls, the chance of a false-positive association can be substantially increased if homozygotes for the putative high-risk allele are more common in the general population than predicted by Hardy-Weinberg Equilibrium. In contrast, Pearson's chi-square statistic can be conservative if the frequency of homozygotes for the high-risk allele is less than that predicted. A statistically valid method that corrects for deviations from Hardy-Weinberg Equilibrium is presented, so that the chance of a false-positive association is not greater than the acceptable level.

Alleles↗
PubMed1999

Measles antibody seroprevalence rates among immunized Inuit, Innu and Caucasian subjects.

Measles antibody seroprevalence was compared in Innu, Inuit, and Caucasian peoples of northern Newfoundland, Canada, who were immunized with a single dose of M-M-R-II (Merck Research Laboratories) vaccine. Healthy, volunteer schoolchildren (n = 606) were enrolled. Measles antibody was measured with a whole virus measles-specific IgG EIA. Native (Innu and Inuit) schoolchildren (n = 253) had a significantly higher seropositive rate (83%) after a single dose of measles vaccine compared to Caucasian (n = 353) children (76%; p = 0.025), and higher mean antibody levels after immunization compared to Caucasian children (1.74 EIA units, vs. 1.63; p = 0.06). Caucasian children were more likely to have been immunized after age 15 months (20.6% vs. 9.6%; p = 0.001). There was no significant difference in the mean time interval between immunization and blood sampling for natives versus Caucasian (8.0 years vs. 7.95 years; p = 0.49). After adjustment for time from immunization and age at immunization, there remained a marginally significant racial difference in seropositivity (OR = 1.65, 95% CI 0.96, 2.83, p = 0.068). The unadjusted odds ratio for seropositivity (comparing natives vs. non-natives, combining negative and equivocal results) was 1.66 (95% CI 1.06-2.59, p = 0.018). The higher measles-seropositive rate found among native compared to non-native Canadian children suggests that genetic and/or environmental factor(s) affect circulating antibody levels following immunization. The determination of these sources of variability may lead to the development of more efficacious vaccines or delivery strategies.

Adolescent↗
PubMed1999

Congestive heart failure in the community: trends in incidence and survival in a 10-year period.

OBJECTIVE: To compare the incidence of congestive heart failure and the survival in patients with congestive heart failure in Rochester, Minn, in 1981 with that observed in 1991. METHODS: Population-based, descriptive epidemiological study with ecological and individual level comparisons over time. Olmsted County, Minnesota, where the Rochester Epidemiology Project provides passive surveillance of the population for health outcomes. All 248 patients fulfilled the Framingham criteria, 107 patients presenting with the new onset of congestive heart failure in 1981 and 141 patients in 1991. The community inpatient and outpatient medical records of all incident cases were reviewed to evaluate the presenting characteristics of patients at diagnosis. RESULTS: The incidence of congestive heart failure after adjustment for age and sex to the US population was not significantly different in the 1991 cohort compared with that in 1981 (3.0 per 1000 person-years; 95% confidence interval, 2.5-3.5 vs 2.8 per 1000 person-years; 95% confidence interval, 2.2-3.3; P = .55). The survival of patients with new diagnosis of congestive heart failure was similar in the 2 cohorts (P = .53). Survival adjusted for age, sex, and New York Heart Association functional class was not significantly different in patients with congestive heart failure in 1981 and 1991 (relative risk, 0.907; P = .55). CONCLUSIONS: These data suggest that recent advances in management of cardiovascular disease, as used in the community, had not yet impacted incidence or survival of patients with congestive heart failure in the community during the 10-year study period. This highlights the need to continue efforts to ensure that advances in diagnosis and therapy are incorporated into the care of patients with congestive heart failure in the community.

Age Distribution↗
PubMed1999

Population-based incidence and survival figures in essential thrombocythemia and agnogenic myeloid metaplasia: an Olmsted County Study, 1976-1995.

To provide basic information about occurrence and outcome of essential thrombocythemia (ET) and agnogenic myeloid metaplasia (AMM), we used the Rochester Epidemiology Project medical record linkage system for residents of Olmsted County, Minnesota. We identified all residents who were diagnosed with ET or AMM from 1976 to 1995. Community inpatient and outpatient medical records were reviewed to verify the diagnosis of ET or AMM, and patients were followed passively through their medical records to determine the outcome after diagnosis. We identified 39 cases of ET and 21 of AMM, with age- and sex-adjusted incidence rates of 2.53 and 1.46 cases/100,000 population annually, respectively. The respective median ages at diagnosis were 72 and 67 years. The female-to-male ratios were 1.8 and 1.6 for ET and AMM, respectively, and when adjusted for age, there was no difference in risk. The median follow-up period was 62.9 months for ET and 33.2 months for AMM. Five- and 10-year survivals were 74.4% and 61.3%, respectively, for ET and were significantly lower than expected for age-matched controls (P = 0.012). Prognosis was worse for AMM, with a median progression time of 7 months and a 3-year survival of 52.4%. This was significantly worse than for age-matched controls (P < 0.001). This study provides population-based incidence and comparative survival figures in ET and AMM.

Adolescent↗
PubMed1999

Contribution of weather to the seasonality of distal forearm fractures: a population-based study in Rochester, Minnesota.

Distal forearm fractures due to falls were more frequent in the winter (p < 0.0001) among Rochester men and women 35 years of age or older in 1952-89. The winter excess was partially explained by a greater relative risk of distal forearm fractures on days with freezing rain (1.65; 95% CI 1.28-2.13) or snow (1.42; 95% CI 1.17-1.74) among women under 65 years of age and on days with freezing rain (1.63; 95% CI 1.23-2.17) among older women. The greater seasonality of forearm compared with hip fractures is explained by the fact that more of them occur out-of-doors. However, residual effects of season after adjusting for daily weather conditions suggest that other factors may play a role.

Accidental Falls↗