Biomedical subjects

W H Giles

Publications and source records attributed to W H Giles.

At least 37 records · Page 2Linked to original sources

PubMed1999

Adverse childhood experiences and smoking during adolescence and adulthood.

CONTEXT: In recent years, smoking among adolescents has increased and the decline of adult smoking has slowed to nearly a halt; new insights into tobacco dependency are needed to correct this situation. Long-term use of nicotine has been linked with self-medicating efforts to cope with negative emotional, neurobiological, and social effects of adverse childhood experiences. OBJECTIVE: To assess the relationship between adverse childhood experiences and 5 smoking behaviors. DESIGN: The ACE Study, a retrospective cohort survey including smoking and exposure to 8 categories of adverse childhood experiences (emotional, physical, and sexual abuse; a battered mother; parental separation or divorce; and growing up with a substance-abusing, mentally ill, or incarcerated household member), conducted from August to November 1995 and January to March 1996. SETTING: A primary care clinic for adult members of a large health maintenance organization in San Diego, Calif. PARTICIPANTS: A total of 9215 adults (4958 women and 4257 men with mean [SD] ages of 55.3 [15.7] and 58.1 [14.5] years, respectively) who responded to a survey questionnaire, which was mailed to all patients 1 week after a clinic visit. MAIN OUTCOME MEASURES: Smoking initiation by age 14 years or after age 18 years, and status as ever, current, or heavy smoker. RESULTS: At least 1 of 8 categories of adverse childhood experiences was reported by 63% of respondents. After adjusting for age, sex, race, and education, each category showed an increased risk for each smoking behavior, and these risks were comparable for each category of adverse childhood experiences. Compared with those reporting no adverse childhood experiences, persons reporting 5 or more categories had substantially higher risks of early smoking initiation (odds ratio [OR], 5.4; 95% confidence interval [CI], 4.1-7.1), ever smoking (OR, 3.1; 95% CI, 2.6-3.8), current smoking (OR, 2.1; 95% CI, 1.6-2.7), and heavy smoking (OR, 2.8; 95% CI, 1.9-4.2). Each relationship between smoking behavior and the number of adverse childhood experiences was strong and graded (P<.001). For any given number of adverse childhood experiences, recent problems with depressed affect were more common among smokers than among nonsmokers. CONCLUSIONS: Smoking was strongly associated with adverse childhood experiences. Primary prevention of adverse childhood experiences and improved treatment of exposed children could reduce smoking among both adolescents and adults.

Adolescent↗

PubMed1999

Racial differences in the incidence of intracerebral hemorrhage: effects of blood pressure and education.

OBJECTIVE: To determine the relative risk (RR) of intracerebral hemorrhage (ICH) among African Americans compared with that among whites. METHODS: Data from the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study were used to determine the incidence of ICH (n = 78) in 10,851 whites and 1,802 African Americans during a 20-year follow-up period. Cox proportional hazards analyses were used to determine the RR of ICH among African Americans compared with that among whites. RESULTS: The estimated annual incidence of ICH was 50 per 100,000 among African Americans and 28 per 100,000 among whites. The age- and sex-adjusted RR for ICH among African Americans was 1.9 (95% confidence interval [CI], 1.1 to 3.2). With the addition of systolic blood pressure and educational attainment to the Cox proportional hazards model, the RR decreased to 1.6 (95% CI, 0.9 to 2.7). The adjustment for additional cerebrovascular disease risk factors did not change this risk estimate appreciably. CONCLUSIONS: Compared with whites, African Americans have a twofold increased risk for ICH. Most of this risk may be explained by differences in educational attainment and systolic blood pressure. Unless additional efforts are undertaken to reduce racial differences in the prevalence of stroke risk factors, mainly systolic blood pressure and socioeconomic status, the African American-white disparities in the risk for ICH will likely continue.

Adult↗

PubMed1999

Heart failure survival among older adults in the United States: a poor prognosis for an emerging epidemic in the Medicare population.

OBJECTIVE: To describe the 6-year probability of survival for older adults after their first hospitalization for heart failure. SETTING: National Medicare hospital claims records for 1984 through 1986 and Medicare enrollment records from 1986 through 1992. DESIGN: We identified a national cohort of 170 239 (9% black patients) Medicare patients, 67 years or older, with no evidence of heart failure in 1984 or 1985, who were hospitalized and discharged for the first time in 1986 with a principal diagnosis of heart failure. For groups defined by race, sex, age, Medicaid eligibility, and comorbid conditions, we compared the probability of survival with Cox proportional hazards regression. RESULTS: Only 19% of black men, 16% of white men, 25% of black women, and 23% of white women survived 6 years. One third died within the first year. Men had lower median survival and 38% greater risk of mortality than did women (P<.05). White men had 10% greater risk of mortality than did black men (P<.05). Medicaid eligibility (white adults only) and diabetes were associated with increased mortality (P<.05). CONCLUSIONS: The prognosis for older adults with heart failure underscores the importance of prevention strategies and early detection and treatment modalities that can prevent, improve, or reverse myocardial dysfunction, particularly for the growing number of adults who are at increased risk for developing heart failure because of hypertension, diabetes, or myocardial infarction.

Black or African American↗

PubMed1999

Distribution and correlates of elevated total homocyst(e)ine: the Stroke Prevention in Young Women Study.

PURPOSE: To determine the distribution and correlates of elevated total homocyst(e)ine (tHcy) concentration in a population of premenopausal black and white women. METHODS: Data from the Stroke Prevention in Young Women Study (N = 304), a population-based study of risk factors for stroke in women aged 15-44 years of age, were used to determine the distribution and correlates of elevated tHcy in black (N = 103) and white women (N = 201). RESULTS: The mean tHcy level for the population was 6.58 micromol/L (range 2.89-26.5 micromol/L). Mean tHcy levels increased with age, cholesterol level, alcohol intake, and number of cigarettes smoked (all: p < 0.05). There were no race differences (mean tHcy 6.72 micromol/L among blacks and 6.51 micromol/L among whites; p = 0.4346). Regular use of multivitamins and increasing education was associated with significant reductions in tHcy concentration. Approximately 13% of the sample had elevated tHcy levels, defined as a tHcy concentration > or = 10.0 micromol/L. Multivariate-adjusted correlates of elevated tHcy included education > 12 vs. < or = 12 (odds ratio [OR] = 0.4, 95% confidence interval [CI] = 0.2-0.8); smoking > or = 20 cigarettes/day vs. nonsmokers (OR = 2.8, 95% CI = 1.1-7.3); and the regular use of multivitamins (OR = 0.4, 95% CI = 0.2-0.9). CONCLUSIONS: These results suggest that a substantial proportion of healthy young premenopausal women have tHcy levels that increase their risk for vascular disease. A number of potentially modifiable behavioral and environmental factors appear to be significantly related to elevated tHcy levels in young women.

Adolescent↗

PubMed1999

Hospitalization of patients with heart failure: National Hospital Discharge Survey, 1985 to 1995.

BACKGROUND: In the United States, heart failure has emerged as the leading first-listed diagnosis among hospitalized older adults. METHODS: The number and prevalence of hospitalizations, procedure use, and discharge outcomes for men and women aged >/=35 years hospitalized with heart failure were estimated from National Hospital Discharge Survey data for the years 1985 through 1995. RESULTS: In 10 years, the number of hospitalizations increased from 577,000 to 871,000 for a first-listed diagnosis and from 1.7 to 2.6 million for any diagnosis of heart failure. Almost 78% of men and 85% of women hospitalized with heart failure were aged >/=65 years. Among persons hospitalized with any diagnosis of heart failure, in-hospital mortality rate decreased from 1985 to 1995 whereas prevalence of discharge to long-term care increased. In 1995, 67% of male patients were discharged home, 12% were discharged to long-term care, and 8% died during hospitalization; the corresponding values for female patients were 58%, 21%, and 8%. Men had twice the prevalence of invasive cardiac procedures as did women during hospitalization. CONCLUSIONS: The growing burden of heart failure can be expected to increase during the next decade unless innovative interventions and primary and secondary prevention strategies are implemented.

Adult↗

PubMed1999

Homocyst(e)ine and risk of cerebral infarction in a biracial population : the stroke prevention in young women study.

BACKGROUND AND PURPOSE: Genetic enzyme variation and vitamin intake are important determinants of blood homocyst(e)ine levels. The prevalence of common genetic polymorphisms influencing homocyst(e)ine levels varies by race, and vitamin intake varies by socioeconomic status. Therefore, we examined the effect of vitamin intake, race, and socioeconomic status on the association of homocyst(e)ine with stroke risk. METHODS: All 59 hospitals in the greater Baltimore-Washington area participated in a population-based case-control study of stroke in young women. One hundred sixty-seven cases of first ischemic stroke among women aged 15 to 44 years were compared with 328 controls identified by random-digit dialing from the same region. Risk factor data were collected by standardized interview and nonfasting phlebotomy. Plasma homocyst(e)ine was measured by high-performance liquid chromatography and electrochemical detection. RESULTS: Blacks and whites did not differ in median homocyst(e)ine levels, nor did race modify the association between homocyst(e)ine and stroke. After adjustment for cigarettes per day, poverty status, and regular vitamin use, a plasma homocyst(e)ine level of >/=7.3 micromol/L was associated with an odds ratio for stroke of 1.6 (95% CI, 1.1 to 2.5). CONCLUSIONS: The association between elevated homocyst(e)ine and stroke was independent not only of traditional vascular risk factors but also of vitamin use and poverty status. The degree of homocyst(e)ine elevation associated with an increased stroke risk in young women is lower than that previously reported for middle-aged men and the elderly and was highly prevalent, being present in one third of the control group.

Adolescent↗

PubMed1998

Serum folate and risk for coronary heart disease: results from a cohort of US adults.

PURPOSE: To assess the role of serum folate in the risk for coronary heart disease in a national cohort of US adults. METHODS: Data from the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study (N = 1921) were used to determine whether a low serum folate concentration was associated with an increased risk for incident coronary heart disease (N = 284). The Cox proportional hazards model adjusted for age, sex, race, education, serum cholesterol, systolic blood pressure, body mass index, cigarette smoking, and alcohol consumption. RESULTS: The association between folate and risk for coronary heart disease differed by age group (p = 0.03). Among persons aged 35-55 years, the relative risk for heart disease was 2.4 (95% confidence interval (CI), 1.1-5.2) for persons in the lowest quartile (< or = 9.9 nmol/L) when compared with those in the highest quartile (> or = 21.8 nmol/L). However, among persons > or = 55 years the relative risk was 0.5 (95% CI, 0.3-0.8) for comparisons of the lowest versus highest quartiles. CONCLUSIONS: If the age differences in the risk for heart disease are confirmed, randomized clinical trials assessing the role of folic acid for the prevention of heart disease may need to include young adults in order to demonstrate benefits related to folate supplementation.

Adult↗

PubMed1998

Prevalence of multiple cardiovascular disease risk factors among women in the United States, 1992 and 1995: the Behavioral Risk Factor Surveillance System.

We sought to examine the prevalence of self-reported multiple cardiovascular disease (CVD) risk factors (hypertension, high blood cholesterol, diabetes, overweight, and current smoking) among women in 1992 and 1995 in the United States using data from the Behavioral Risk Factor Surveillance System. In 1992, 37.5%, 34.4%, and 28.1% of women had zero, one, and two or more of the five risk factors, respectively. In 1995, the respective estimates were 35.5%, 34.3%, and 30%. In both years, the prevalence of two or more risk factors increased with age, decreased with educational level, was higher among black women (lowest among Hispanic women and women of other ethnic groups), and higher among women reporting cost as a barrier to healthcare. The percentage of women with two or more risk factors was higher in 1995 than in 1992 for 35 of 48 states, being statistically significant for 7 states. The percentage of women with at least two risk factors was not significantly lower in 1995 than in 1992 for any state. A higher percentage of women reported having multiple CVD risk factors in 1995 compared with 1992. A multifactorial approach to primary prevention and risk factor reduction should be encouraged to help reduce the prevalence and burden of CVD among women.

Adolescent↗

PubMed1998

Serum folate and chronic disease risk: findings from a cohort of United States adults.

BACKGROUND: Previous studies have suggested that folate may provide protection against various chronic conditions. METHODS: We examined the effect of serum folate concentration on mortality and chronic disease incidence in a nationally representative sample of 3059 adults of the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study who were first examined from 1971 through 1975 and who were followed for about 19 years through 1992. Proportional hazards regression was used to estimate hazard ratios for the lowest quintile of serum folate compared with the highest quintile for selected causes of death and disease incidence. RESULTS: The hazards ratio for all-cause mortality was 1.18 (95% CI: 0.91-1.52); for mortality for diseases of the circulatory system, 1.31 (95% CI: 0.82-2.12); and for cancer mortality, 0.99 (95% CI: 0.46-2.11). The hazard ratio for incidence of diseases of the circulatory system was 1.04 (95% CI: 0.86-1.26); and for cancer incidence, 1.00 (95% CI: 0.61-1.66). The hazards ratio for all-cause mortality was 1.26 (95% CI: 1.01-1.57) for participants with a serum folate of <9.3 nmol/l compared with other participants. CONCLUSIONS: Low levels of serum folate may be associated with mortality from all-causes and cardiovascular disease. However, the study lacked power to adequately examine the association between folate and disease-specific endpoints. Additional studies, using serum and other measures of folate nutritional status, are needed to examine the relationship between folate nutrition and other more specifically defined health outcomes.

Adolescent↗

PubMed1998

Total homocyst(e)ine concentration and the likelihood of nonfatal stroke: results from the Third National Health and Nutrition Examination Survey, 1988-1994.

BACKGROUND AND PURPOSE: Elevated serum total homocyst(e)ine [H(e)] is an independent risk factor for stroke. Few studies, however, have examined this association in blacks. METHODS: Data from the Third National Health and Nutrition Examination Survey (n=4534), a nationally representative sample of US adults, were used to examine the relationship between H(e) and a physician diagnosis of stroke (n=185) in both black and white adults. Multivariate-adjusted logistic regression analyses were used to examine this relationship. RESULTS: Serum vitamin B12 and folate concentrations were significantly lower among participants in the highest H(e) quartile (>/=12.1 micromol/L) than among participants in the lowest quartile (</=7.4 micromol/L). Those in the highest quartile were older, had higher mean cholesterol and blood pressure levels, and were more likely to smoke and to have completed <12 years of education. After adjustment for age, the odds ratio (OR) for stroke was 2.9 (95% confidence interval [CI], 1.4 to 5.7; highest versus lowest quartile). Adjustment for gender, race/ethnicity, education, systolic blood pressure, cholesterol, diabetes mellitus, and smoking reduced the magnitude of the association (OR, 2.3; 95% CI, 1.2 to 4. 6). The association between H(e) and stroke did not differ by race [P=0.265 for race-H(e) interaction term]. The multivariate adjusted OR for the highest quartile versus the lowest was 2.5 (1.1 to 5.5) among whites and 1.4 (0.4 to 4.7) among blacks. CONCLUSIONS: In this nationally representative sample of US adults, H(e) concentration was independently associated with an increased likelihood of nonfatal stroke. This association was present in both black and white adults.

Aged↗

PubMed1998

Platelet glycoprotein receptor IIIa polymorphism P1A2 and ischemic stroke risk: the Stroke Prevention in Young Women Study.

BACKGROUND AND PURPOSE: Platelet glycoprotein IIb/IIa (GpIIb-IIIa), a membrane receptor for fibrinogen and von Willebrand factor, has been implicated in the pathogenesis of acute coronary syndromes but has not been previously investigated in relation to stroke in young adults. METHODS: We used a population-based case-control design to examine the association of the GpIIIa polymorphism P1A2 with stroke in young women. Subjects were 65 cerebral infarction cases (18 patients with and 47 without an identified probable etiology) 15 to 44 years of age from the Baltimore-Washington region and 122 controls frequency matched by age from the same geographic area. A face-to-face interview for vascular disease risk factors and a blood sample for the P1A2 allele and serum cholesterol were obtained from each participant. Logistic regression was used to estimate the odds ratio for one or more P1A2 alleles after adjustment for other risk factors. RESULTS: Among cases and controls, the prevalence rates of one or more P1A2 alleles were 21% and 22% among blacks and 36% and 28% among whites, respectively. This genotype was significantly associated with hypertension only in black control subjects but otherwise not with any of the established vascular risk factors. The adjusted odds ratio for cerebral infarction of one or more P1A2 alleles was 1.1 (confidence interval [CI], 0.6 to 2.3) overall, 0.5 (CI, 0.1 to 7.1) among blacks, and 1.4 (CI, 0.5 to 3.7) among whites. For the cases with an identified probable etiology, the corresponding odds ratios were 3.0 (CI, 0.9 to 10.4) overall, 0.7 (CI, 0.1 to 7.1) among blacks, and 12.8 (CI, 1.2 to 135.0) among whites. CONCLUSIONS: No association was found between the P1A2 polymorphism of GpIIIa and young women with stroke. However, subgroup analyses showed that the P1A2 polymorphism of GpIIIa appeared to be associated with stroke risk among white women, particularly those with a clinically identified probable etiology for their stroke. Further work with an emphasis on stroke subtypes and with multiracial populations is warranted.

Adolescent↗

PubMed1998

Impaired glucose tolerance and the likelihood of nonfatal stroke and myocardial infarction: the Third National Health and Nutrition Examination Survey.

BACKGROUND AND PURPOSE: Although diabetes mellitus (DM) is known to increase the risk of cardiovascular disease (CVD), the effect of impaired glucose tolerance (IGT) on the risk remains unclear. We determined whether IGT was associated with an increased likelihood for stroke and myocardial infarction in a nationally representative sample of US adults. METHODS: We evaluated the association between IGT (defined as a fasting glucose level of < 140 mg/dL and a plasma glucose level of between 140 and 200 mg/dL 2 hours after administration of 75 grams of an oral glucose load) and DM (defined as the current use of insulin or an oral hypoglycemic medication, a fasting plasma glucose level of > 140 mg/dL, or a plasma glucose level of > 200 mg/dL 2 hours after administration of an oral glucose load) with a self-reported physician diagnosis of stroke and myocardial infarction in 6547 adults aged 40 to 74 years participating in the Third National Health and Nutrition Examination Survey. Multivariate logistic regression analyses were used to investigate these relationships. RESULTS: IGT and DM were observed in 1494 and 1532 adults, respectively. After adjustment for differences in age, gender, race/ethnicity, education, hypertension, cholesterol, body mass index, and cigarette smoking, IGT was not associated with stroke (odds ratio [OR], 0.9; 95% confidence interval [CI], 0.5 to 1.6) or myocardial infarction (OR, 1.1; 95% CI, 0.7 to 1.6). DM was associated with both stroke (OR, 1.6; 95% CI, 1.0 to 2.6) and myocardial infarction (OR, 1.9; 95% CI, 1.3 to 2.8). CONCLUSIONS: In contrast to DM, IGT was not associated with an increased likelihood of prevalent nonfatal stroke or myocardial infarction.

Adult↗

PubMed1998

Thermolabile methylenetetrahydrofolate reductase polymorphism (C677T) and total homocysteine concentration among African-American and white women.

A polymorphism associated with a thermolabile variant (C677T) of the enzyme methylenetetrahydrofolate reductase has been associated with both elevated total homocysteine (tHcy) levels and risk for cardiovascular disease. Data from the Stroke Prevention in Young Women Study were used to determine the prevalence of the C677T genotype and to assess whether environmental factors modified the association between genotype and tHcy concentration. The C677T genotype prevalence was 80% -/-, 20% +/-, and 0% +/+ among 46 African-American women; and 39% -/-, 53% +/-, and 8% +/+ among 77 white women (P < 0.01). There was a trend toward higher tHcy levels in African-American women with the +/- genotype when compared with the -/- genotype (6.9 mumol/L vs 5.3 mumol/L respectively, p = 0.10); no association was found among the white women (6.0 mumol/L, -/-; 4.5 mumol/L, +/-; and 6.2 mumol/L, +/+; p = 0.67). Among African American women, those who smoked and were +/- genotype had the highest tHcy levels (8.0 mumol/L); while among white women, those who smoked and were -/- had the highest tHcy levels (8.1 mumol/L). Despite being hampered by a limited sample size, the thermolabile allele is significantly less common among African-American than white women. The association between genotype and tHcy concentration is influenced by smoking and multivitamin use.

Adolescent↗

PubMed1997

Number of pregnancies and risk for stroke and stroke subtypes.

OBJECTIVE: To examine the effect of the number of pregnancies on the subsequent risk for stroke and stroke subtypes. DESIGN: Prospective cohort study. PARTICIPANTS: National cohort of 3852 women aged 45 to 74 years who participated in the first National Health and Nutrition Examination Survey Epidemiology Follow-up Study. MAIN OUTCOME MEASURES: Stroke, cerebral infarction, and intracerebral hemorrhage during a 20-year follow-up period. RESULTS: After adjusting for differences in age, women with 6 or more pregnancies were at an increased risk for any type of stroke (relative risk [RR] = 1.7; 95% confidence interval [CI], 1.2-2.3) and cerebral infarction (RR = 1.6; 95% CI, 1.2-2.3). Adjustment for stroke risk factors explained some but not all of the risk associated with pregnancy (RR = 1.3; 95% CI, 0.9-1.9 for all stroke, and RR = 1.3; 95% CI, 0.9-1.9 for cerebral infarction). The rate of intracerebral hemorrhage was 3-fold higher among women who had been pregnant when compared with nulligravida women; however, this finding did not reach statistical significance possibly because of the small number of intracerebral hemorrhages (n = 33). CONCLUSION: The number of pregnancies may influence the risk for stroke, particularly cerebral infarction, in women.

Aged↗

PubMed1997

Social class and race disparities in premature stroke mortality among men in North Carolina.

The purpose of this work was to examine the association between social class and premature stroke mortality among blacks and whites. For black men and white men in North Carolina, aged 35-54 years, mortality data from vital statistics files and population data from Census Public Use Microdata Sample files were matched according to social class for the years 1984-1993. Four categories of social class were defined based upon a two-dimensional classification scheme of occupations. For each category of social class, race-specific age-adjusted stroke mortality rates were calculated, and race-specific prevalences of income, wealth, education, unemployment, and disability were estimated. Women were excluded because comparable information on social class was not available from the mortality and population data sources. For both black men and white men, the highest rates of premature stroke mortality were observed among the lowest social classes. The rate ratios (RR) between the lowest and highest social class were 2.8 for black men and 2.3 for white men. Within each social class, black men had substantially higher rates of premature stroke mortality than white men (black-to-white RR ranged from 4.0 to 4.9). Among both black men and white men, the highest social class consistently had the most favorable levels of income, wealth, education, and employment. The inverse association between social class and stroke mortality for both black men and white men supports the need for stroke prevention efforts that address the structural inequalities in economic and social conditions.

Adult↗

PubMed1997

Major depression and all-cause mortality among white adults in the United States.

PURPOSE: Depression is the most common psychiatric illness affecting adults. Despite the importance of a potential link between major depression and mortality, research has been surprisingly sparse. METHODS: Information on 57,897 white adults aged 25 years and older who were included in the mental health supplement of the 1989 National Health Interview Survey was linked with the National Death Index to examine the relationship of major depression to mortality. Death status was obtained through December 1991. Sex-specific hazard rate ratios for mortality were calculated by Cox proportional hazards regression and Poisson regression to adjust for potential confounders (age, education, marital status, body mass index, and whether the target subject or a family member completed the survey about the subject). RESULTS: Major depression was reported for 223 (0.8%) of 27,345 men and 392 (1.3%) of 30,552 women. During the 2.5-year follow-up, death certificate data were obtained for 848 (3.1%) men and 651 (2.1%) women. The adjusted hazard rate ratios for all-cause mortality associated with major depression were 3.1 (95% confidence interval; 2.0-4.9) for men and 1.7 (95% confidence interval; 0.9-3.1) for women. CONCLUSIONS: These results suggest that major depression increases risk of all-cause mortality, particularly among men. Further research is needed to explain the mechanism.

Adult↗

PubMed1997

Effect of body mass index on activity limitation and mortality among older women: the National Health Interview Survey, 1986-1990.

We assessed the impact of body mass on the association between activity limitations due to chronic conditions and mortality among 24,612 noninstitutionalized white or African American women aged > or = 65 years who participated in a National Health Interview Survey between 1986 and 1990. We found that more African American women had activity limitations than white women (59% vs 46%, respectively). The difference by race was greatest (19% vs 10%) for the most severe limitation (unable to perform the major activity). For women aged 65-69, the major activity was working or keeping house; for those aged > or = 70, it was the ability to live independently. For white women in all three categories of body mass index (BMI) and for African American women with BMI 15%-85%, the risk of dying was significantly higher for those unable to perform the major activity than for those with no limitations, controlling for the effects of education, marital status, and perceived health. The findings confirm the established link between low BMI and mortality and between activity limitations and mortality. Additionally, the findings further suggest that activity limitations linked to chronic conditions increase the risk of death within each stratum of BMI after adjusting for potential confounders.

Activities of Daily Living↗

PubMed1997

Pharmacologic and dietary therapies in epilepsy: conventional treatments and recent advances.

A number of treatment options are currently available for the medical management of epilepsy. Conventional antiepileptic drugs (AEDs) include phenytoin, carbamazepine, valproic acid, ethosuximide, barbiturates, and benzodiazepines. Although these drugs control seizures, they may also cause blood dyscrasias, sedation, and cognitive impairment. Felbamate, gabapentin, lamotrigine, and vigabatrin are new AEDs believed to cause fewer side effects than conventional medications. Felbamate, however, has been linked with substantially increased incidence of aplastic anemia, and the other new AEDs have been studied for relatively short periods of time. Ketogenic diets, comprised of foods high in fat and low in protein and carbohydrate content, have been reported to improve seizure control. However, these diets are widely acknowledged to be unpalatable, making sustained compliance with dietary restrictions difficult. To promote long-term control of seizures, physicians must consider the side effects of therapeutic interventions for epilepsy, as well as their anticonvulsant efficacy.

Acetates↗