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PubMed2005

Racial misclassification and disparities in cardiovascular disease among American Indians and Alaska Natives.

BACKGROUND: National vital event data suggest that cardiovascular disease (CVD) mortality rates are lower for American Indians and Alaska Natives (AIAN) than for the general US population, but these data are disproportionately flawed for AIAN because of racial misclassification. METHODS AND RESULTS: Vital event data adjusted for racial misclassification and published by the Indian Health Service were used to compare trends in CVD mortality from 1989 to 1991 to 1996 to 1998 between AIAN, US all-races, and US white populations. Without misclassification accounted for, AIAN initially had the lowest mortality rates from major CVD, but by the end of the study, their rates were the highest. Adjustment for misclassification revealed an early and rapidly growing disparity between CVD mortality rates among AIAN compared with rates in the US all-races and white populations. By 1996 to 1998, the age- and misclassification-adjusted number of CVD deaths per 100,000 among AIAN was 195.9 compared with age-adjusted rates of 166.1 and 159.1 for US all races and whites, respectively. The annual percent change in CVD mortality for AIAN was 0.5 compared with -1.8 in the other groups. Regardless of racial misclassification, the most striking and widening disparities were found for middle-aged AIAN, but CVD mortality among AIAN > or =65 years of age was lower than in the other populations. CONCLUSIONS: A previously underrecognized disparity in CVD mortality exists for AIAN, particularly among middle-aged adults. Moreover, these disparities are increasing. Efforts to reduce CVD mortality in AIAN must begin before the onset of middle age.

Age Factors↗
PubMed1985

Lipoprotein predictors of the severity of coronary artery disease in men and women.

In this study we examined the relationships between levels of several components of plasma lipoproteins and severity of coronary artery disease in 65 men and 42 women who underwent coronary arteriography for suspected coronary disease. Severity of coronary atherosclerosis was scored as the extent of disease seen at arteriography. Univariate analyses of the relationships between the plasma lipoprotein parameters and score for severity of atherosclerosis revealed a marked difference between men and women. In men, the score for severity of atherosclerosis was strongly related to the low-density lipoprotein (LDL) cholesterol and apolipoprotein B concentrations, whereas in women it was related to the triglyceride concentrations in plasma intermediate-density lipoprotein (IDL) and LDL and to the cholesterol and apolipoprotein B concentrations in IDL. The significance of these correlations was not negated by possible confounding factors such as alcohol intake, diabetes, and treatment with thiazides and beta-adrenergic blockers. Stepwise regression analyses of data adjusted for weight and age indicated that 22% of the variation in the score for severity of atherosclerosis could be accounted for by levels of LDL cholesterol in men. No other lipoprotein parameter could account for any further variation. In contrast, cholesterol did not account for any variation in the score for severity of atherosclerosis in women, whereas plasma triglyceride accounted for 16% of the observed variation in this group. No relationships were found between score for severity of atherosclerosis and high-density lipoprotein cholesterol or plasma apolipoprotein A-I concentrations in either group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Alcohol consumption and insulin concentrations. Role of insulin in associations of alcohol intake with high-density lipoprotein cholesterol and triglycerides.

BACKGROUND: The relation between alcohol intake and insulin levels may explain, in part, the reported associations of alcohol with cardiovascular disease risk factors, including high-density lipoprotein (HDL) cholesterol, triglycerides, blood pressure, and glucose levels, each of which has been recognized as a component of the insulin resistance syndrome. METHODS AND RESULTS: Subjects included nondiabetic participants of the Kaiser Permanente Women Twins Study (1989 through 1990). Usual alcohol intake was assessed as part of a food frequency questionnaire. For women from twin pairs in which both twins drank (n = 338), an increment of 12 g of alcohol per day (about one drink) was associated with an 8% lower 2-hour post-glucose-load insulin (P < .01) in a multiple regression analysis for twin data, adjusted for age, body mass index, waist-to-hip ratio, total caloric intake, and family history of diabetes. With genetic influences removed by matched analysis of the subset of 98 monozygotic twin pairs, an intrapair difference of 12 g of alcohol per day was associated with a 12.4% intrapair decrement in postload insulin (P < .01). Inverse associations were also seen for fasting insulin. Alcohol consumption was inversely associated with postload glucose but not with fasting glucose in unmatched (P = .05) and matched (P = .005) analyses. A significant positive association of alcohol intake with high-density lipoprotein cholesterol and an inverse relation of alcohol intake with triglycerides were each independent of insulin levels (P < or = .02 in the matched models). Neither systolic nor diastolic blood pressures were related to alcohol consumption in this sample, perhaps because of the rather low level of alcohol intake in the study population (median, 4 g/d). CONCLUSIONS: Within the range of light to moderate drinking habits, alcohol consumption was inversely related to fasting and postload insulin levels. This relation did not explain associations of alcohol intake with lipid levels and may instead reflect an additional mechanism by which moderate alcohol consumption impacts cardiovascular disease risk.

Adult↗
PubMed1987

Progress in the battle against hypertension. Changes in blood pressure levels in the United States from 1960 to 1980.

Intensive efforts by practicing physicians and public health workers to identify and treat persons with hypertension have been underway for many years. In this report, changes in blood pressure levels in the United States are assessed based on nationally representative health (and nutrition) examination surveys conducted by the National Center for Health Statistics in 1960 to 1962, 1971 to 1974, and 1976 to 1980. Analysis of age-adjusted data for adults aged 18 to 74 years (including those on antihypertensive medication) indicates that between the first and third surveys for whites and blacks, respectively, mean systolic blood pressure declined 5 and 10 mm Hg; the proportion of persons with systolic blood pressure of 140 mm Hg or higher fell 18 and 31%; the proportion with undiagnosed hypertension decreased 17 and 59%; and the proportion taking antihypertensive medications rose 71 and 31%. These differences between the first and third surveys were all statistically significant (p less than 0.05 or better). Changes in diastolic blood pressure levels were generally not significant among race-sex groups. The proportion of persons with definite hypertension (i.e., systolic blood pressure greater than or equal to 160 mm Hg, and/or diastolic blood pressure greater than or equal to 95 mm Hg, and/or taking antihypertensive medication) declined among blacks but rose slightly among whites. Study results are consistent with the recent decline in cardiovascular disease mortality.

Adolescent↗
PubMed1992

Bizarre delusions and DSM-III-R schizophrenia.

OBJECTIVE: Bizarre delusions are assigned greater weight relative to other delusions in the DSM-III-R diagnosis of schizophrenia. The decision to emphasize bizarre delusions was based largely on historical tradition rather than empirical evidence. This study examined 1) the extent to which a history of bizarre delusions contributes to the diagnosis of schizophrenia and 2) whether schizophrenic patients with bizarre delusions constitute a clinically distinguishable subgroup. METHOD: Two hundred fourteen consecutively admitted psychotic inpatients were assessed for bizarre delusions according to the DSM-III-R criteria. Clinical and demographic correlates of bizarre delusions were examined in subsets of patients diagnosed as schizophrenic according to DSM-III-R who also received CT scans and neuropsychological testing. RESULTS: With the base prevalence rate for schizophrenia of 0.71, bizarre delusions had a sensitivity of 0.79, a specificity of 0.56, and a positive predictive power of 0.82 for the diagnosis of schizophrenia (N = 152) relative to other psychotic disorders (N = 62). Clinical, neurobehavioral, CT scan, and premorbid adjustment data on the schizophrenic patients indicated that beyond manifesting more severe positive symptoms, patients with bizarre delusions did not otherwise constitute a clinically distinguishable subgroup. CONCLUSIONS: The data suggest that criterion A for the diagnosis of schizophrenia in DSM-IV could be improved by removing the special emphasis that was placed on bizarre delusions in DSM-III-R.

Adolescent↗
PubMed2007

Associations of myostatin gene polymorphisms with performance and mortality traits in broiler chickens.

Myostatin is a negative regulator of skeletal muscle growth. We evaluated effects of myostatin polymorphisms in three elite commercial broiler chicken lines on mortality, growth, feed conversion efficiency, ultrasound breast depth, breast percentage, eviscerated carcass weight, leg defects, blood oxygen level, and hen antibody titer to infectious bursal disease virus vaccine. Progeny mean data adjusted for fixed and mate effects and DNA from 100 sires per line were used. Single nucleotide polymorphisms (SNPs) of the myostatin gene segregating in these lines were identified by designing specific primers, amplifying individual DNA in each line by polymerase chain reaction, cloning, sequencing and aligning the corresponding products. Individual sires were genotyped for five identified SNPs which contributed to eight haplotypes. Frequencies of SNP alleles and haplotypes differed between lines. Using the allele substitution effect model, the myostatin SNPs were found to have significant (P < 0.031) associations with growth, mortality, blood oxygen and hen antibody titer to infectious bursal disease virus vaccine, although the associations were not often consistent across lines. These results suggest that the myostatin gene has pleiotropic effects on broiler performance.

Animals↗
PubMed2003

Social self-efficacy and behavior problems in maltreated and nonmaltreated children.

Investigated the relations among child maltreatment, children's social self-efficacy, and behavioral adjustment. Data were collected on 305 maltreated and 195 non-maltreated children from low-income families (ages 5 to 12 years) who were assessed on perceived social self-efficacy and evaluated by camp counselors on internalizing and externalizing symptomatology. Younger (< 8 years) maltreated children exhibited inflated levels of perceived self-efficacy in confictual peer interactions compared to younger nonmaltreated children. Younger maltreated children with higher levels of social self-efficacy showed significantly less internalizing behaviors compared to younger maltreated children with lower levels of social self-efficacy. For older children (> 8 years), regardless of maltreatment status, higher levels of perceived social self-efficacy in conflict situations were related to lower levels of internalizing symptomatology. The results are discussed as suggestive of the role of children's social self-efficacy as a protective factor in the link between maltreatment and internalizing symptomatology.

Adaptation, Psychological↗
PubMed2000

The effects of internal radiation exposure on cancer mortality in nuclear workers at Rocketdyne/Atomics International.

We examined the effects of chronic exposure to radionuclides, primarily uranium and mixed-fission products, on cancer mortality in a retrospective cohort study of workers enrolled in the radiation-monitoring program of a nuclear research and development facility. Between 1950 and 1994, 2,297 workers were monitored for internal radiation exposures, and 441 workers died, 134 (30.4%) of them from cancer as the underlying cause. We calculated internal lung-dose estimates based on urinalysis and whole-body and lung counts reported for individual workers. We examined cancer mortality of workers exposed at different cumulative lung-dose levels using complete risk-set analysis for cohort data, adjusting for age, pay type, time since first radiation monitored, and external radiation. In addition, we examined the potential for confounding due to chemical exposures and smoking, explored whether external radiation exposure modifies the effects of internal exposure, and estimated effects after excluding exposures likely to have been unrelated to disease onset. Dose-response relations were observed for death from hemato- and lymphopoietic cancers and from upper aerodigestive tract cancers, adjusting for age, time since first monitored, pay type, and external (gamma) radiation dose. No association was found for other cancers, including cancers of the lung. Despite the small number of exposed deaths from specific cancer types and possible bias due to measurement error and confounding, the positive findings and strong dose-response gradients observed suggest carcinogenic effects of internal radiation to the upper aerodigestive tract and the blood and lymph system in this occupational cohort. However, causal inferences require replication of our results in other populations or confirmation with an extended follow-up of this cohort.

California↗
PubMed1996

Health effects of acid aerosols on North American children: respiratory symptoms.

We examined the respiratory health effects of exposure to acidic air pollution among 13,369 white children 8 to 12 years old from 24 communities in the United States and Canada between 1988 and 1991. Each child's parent or guardian completed a questionnaire. Air quality and meteorology were measured in each community for a 1-year period. We used a two-stage logistic regression model to analyze the data, adjusting for the potential confounding effects of sex, history of allergies, parental asthma, parental education, and current smoking in the home. Children living in the community with the highest levels of particle strong acidity were significantly more likely [odds ratio (OR) = 1.66; 95% confidence interval (CI) 1.11-2.48] to report at least one episode of bronchitis in the past year compared to children living in the least-polluted community. Fine particulate sulfate was also associated with higher reporting of bronchitis (OR = 1.65; 95% CI 1.12-2.42). No other respiratory symptoms were significantly higher in association with any of the air pollutants of interest. No sensitive subgroups were identified. Reported bronchitis, but neither asthma, wheeze, cough, nor phlegm, were associated with levels of particle strong acidity for these children living in a nonurban environment.

Aerosols↗
PubMed1996

Exposure to polycyclic aromatic hydrocarbons among Dutch children.

We determined the urinary 1-hydroxypyrene (1-HP) concentration and the creatinine-adjusted 1-HP concentration in 644 randomly selected Dutch children, aged 1-6 years and living in five areas with roughly different levels of polycyclic aromatic hydrocarbons (PAHs) in soil and ambient air. The presence of other factors that might influence the exposure to PAHs was studied using a questionnaire. To evaluate the reliability of a single urinary 1-HP determination, measurements were repeated after 3 weeks for approximately 200 children. The mean urinary 1-HP content of the total study population was 2.06 nmol/l. This varied from 1.58 nmol/l in the reference area (Flevoland) to 2.71 nmol/l in the valley of the Geul. Only indoor sources of PAHs showed a small, positive association with urinary 1-HP. The urinary 1-HP concentrations of children from the valley of the Geul were higher (p < 0.01) and those of children from a suburb of Amsterdam were lower (p < 0.01) than those of children from the reference area. The possible ambient environment-related differences were probably too small to be detected in the variations of the intake of PAHs from the daily diet. The reliability of a single 1-HP measurement was low. Similar results were obtained with the creatinine-adjusted data. In one neighborhood built on coal-mine tailings, the urinary 1-HP content in children was weakly but positively associated with the PAH content in the upper soil layer of the garden of their homes. However, this association was not found for the children from the other neighborhood built on coal-mine tailings and with similar PAH levels in soil.

Air Pollutants↗
PubMed2002

Mode of inheritance of hand osteoarthritis in ethnically homogeneous pedigrees.

The aim of the present study was to investigate the extent and mode of inheritance of hand osteoarthritis (OA) using a large sample of ethnically homogeneous pedigrees. Two types of segregation analysis (SA) models were examined. Type I models used the data adjusted for potential significant covariates, particularly age and sex, prior to genetic analysis. Type 11 models incorporated effects of the potential covariates into major gene penetrance functions, permitting an account of the genotype covariate-specific effect on study variables. The results of this study strongly supported the hypothesis of a major gene effect and additional multifactorial component. The best-fitting model was the Mendelian one with an additive type of inheritance. The estimates obtained using the standard three-factor variance decomposition analysis suggest that age (72.8%) and major gene (14.5%) are the main sources of interindividual differences in the development of hand OA. The contribution of the putative major gene on age- and sex-adjusted OA phenotype variation was 55% in the present study.

Adult↗
PubMed2002

Four-year gain in bone mineral in girls with and without past forearm fractures: a DXA study. Dual energy X-ray absorptiometry.

We have previously shown that girls with a recent distal forearm fracture have weaker skeletons than girls who have never fractured. This could be a transient or persistent phenomenon. The present study was undertaken to determine whether the bone mineral content (BMC) of girls with previous distal forearm fractures remains lower 4 years postfracture or if catch-up gain has occurred. We report baseline and follow-up dual energy X-ray absorptiometry (DXA) results for 163 girls: 81 girls from the original control group who remained free of fracture (group 1) and 82 girls from the original group with distal forearm fractures (group 2). In data adjusted for bone area, height, weight, and pubertal status, group 2 girls had 3.5-8.5% less BMC at the total body, lumbar spine, ultradistal radius, and hip trochanter than group 1 at baseline, and 2.4-5.7% less BMC at these sites at follow-up. Even girls from group 2 who did not experience another fracture after baseline (n = 58) did not display greater BMC at follow-up compared with baseline values at any site, indicating that the decreased BMC at the time of fracture had persisted. In group 2, the relative gain in BMC after adjusting for the initial BMC and current bone area, height, weight, and pubertal stage was less than or similar to, but not greater than that of group 1 (ratio [95% CI]: total body, 0.985 [0.972-0.998]; lumbar spine, 0.961 [0.935-0.987]; ultradistal radius, 0.968 [0.939-0.998]; hip trochanter, 0.955 [0.923-0.988]; femoral neck, 0.981 [0.956-1.007]; and 33% radius 0.999 [0.977-1.021]). These findings indicate that girls with distal forearm fractures do not improve their gain of BMC. We conclude that girls who have sustained a distal forearm fracture maintain their lower BMC at most sites for at least 4 years.

Absorptiometry, Photon↗
PubMed1997

Does light-to-moderate alcohol consumption during pregnancy increase the risk for renal anomalies among offspring?

OBJECTIVE: To determine the association between light-to-moderate prenatal alcohol exposure and congenital renal anomalies. METHODS: Data from the population-based Atlanta Birth Defects Case-Control Study were used to examine the association between selected renal anomalies and self-reported maternal alcohol consumption during the period from 1 month before through 3 months after conception. Case infants were ascertained by a population-based birth defects registry with active case ascertainment; the case group consisted of 158 infants, born during 1968 through 1980 to metropolitan Atlanta residents, in whom these renal anomalies had been diagnosed. Two control groups were used. One had 3029 infants without birth defects, and the other had 4633 infants with birth defects exclusive of the urinary tract who were born during the same period. RESULTS: Overall, there was a moderate association between renal anomalies and moderate prenatal alcohol exposure (odds ratio, 1.5; 95% confidence interval, 1.0 to 2.3). When the renal anomalies were subclassified, moderate prenatal alcohol exposure was significantly associated only with renal agenesis or hypoplasia (odds ratio, 2.5; 95% confidence interval, 1.2 to 5.1), and within this group only infants with bilateral defects and other major anomalies in addition to renal agenesis or hypoplasia had significantly elevated risks. There were no significant associations between reported light consumption and any category of the selected renal anomalies. No conclusions could be reached for reported heavy consumption because of sparse data. Adjustments for potential confounding factors did not alter these results. CONCLUSION: This study suggests that moderate alcohol consumption during pregnancy may increase a woman's risk of giving birth to a child with renal agenesis or hypoplasia.

Abnormalities, Multiple↗
PubMed2007

[Prevalence and factors associated with hospital admissions in a population-based study in a southern Brazilian city].

This cross-sectional study investigates the use of health services and associated factors in individuals > or = 14 years of age in Canoas, Rio Grande do Sul, Brazil. 1,954 persons were interviewed in 40 census tracts. One-year prevalence of hospital admissions was 9.4%. Adjusted data analysis showed that hospitalization was associated with: age > or = 60 years (RP = 4.14; 95% CI: 2.07-8.25), physician visit in the previous two months (RP = 2.79; 95%CI: 2.03-3.83), and > or = 2 stressful life events (RP = 1.83; 95%CI: 1.19-2.80). Individual income of > or = 2.10 times the prevailing minimum wage was associated with decreased likelihood of hospitalization (RP = 0.60; 95% CI: 0.41-0.87). Prevalence of hospital admissions was consistent with other studies. Higher prevalence of hospitalization in lower-income groups may indicate decreased access to primary health care. Other possible factors are higher morbidity and severity of diseases among lower-income groups. Future research should focus on the relationship between morbidity and stressful life events.

Adolescent↗
PubMed1992

Trends in prevalences of behavioral risk factors: recent Hawaiian experience.

Recent time trends were studied for the prevalences of behavioral risk factors in Hawaii during the 5-year period from 1986 through 1990. The presence of linear time trend was analyzed by the multiple logistic regression method on weighted data, adjusting for confounding factors. The risk factors studied were seatbelt nonuse, lack of exercise, obesity, hypertension, smoking, acute drinking, chronic drinking, and driving while intoxicated. Seatbelt nonuse showed a significant decline, from 8.6% to 4.8%, with a mean annual decrease of 0.9 percentage point. Lack of exercise and obesity increased steadily, from 48.0% to 62.4% and from 16.7% to 21.6%, respectively, with respective annual mean increases of 3.3 and 1.4 percentage points.

Chronic Disease↗
PubMed2006

Trends in semen parameters in the northeast of Scotland.

The data on trends in semen quality are conflicting and sensitive to geographical variations. Although previous British surveys on semen quality indicate a decline, the northeast of Scotland has never been included in these surveys. This is an area with low out migration rates where andrology services for a population of 500 000 are centralized within a single laboratory, thus providing a unique opportunity to study population-based trends in semen quality over time. We investigated trends in semen parameters between 1994-2005, in a cohort of 4832 men attending for routine semen analysis at the Aberdeen Fertility Centre who had a sperm density of greater than 20 million per mL. The main outcome measures were trends in sperm density, sperm motility and motile density in the first semen sample. Linear regression and time series analysis were used to examine trends over time in the semen parameters. The mean and standard deviation (SD) age of all men (n=5204) in the study was 34(6) years. The median (inter quartile range) for sperm density and motile density for the study population were 61 (40-91) million/mL and 99 (47-181) million. The mean (SD) sperm motility was 49 (19)%. Among 4832 men (with sperm count >20 million per mL), data adjusted for age and period of abstinence showed a decreasing trend for sperm density over time, R2=0.45 (P=.017). There was no such trend in sperm motility and motile density. However, this trend has to be interpreted with caution due to fluctuations in semen parameters, population bias and the retrospective nature of the analysis.

Adolescent↗
PubMed1993

How socioeconomic status affects birth and death rates in rural Kerala, India: results of a health study.

Data relating to birth and death were collected from throughout the state of Kerala, India, in a health survey conducted by the Kerala Sastra Sahitya Parishad, a voluntary organization. In this study, the authors analyze birth and death rates as calculated from the sample of 9,940 households (57,665 persons), with respect to other variables such as region, religion, and socioeconomic status. In order to study the effect of socioeconomic factors on birth and death rates, a socioeconomic status rating (SES rating) was developed, taking into account such factors as income, education, housing conditions, and land ownership. Socioeconomic status was found to have a definite influence on birth and death rates, with higher socioeconomic status resulting in lower birth and death rates. This effect was independent of such confounding variables as age structure of the population, religion, and region. The higher risk of mortality among the poorer households can partly be explained by the material deprivation: the higher birth rates could be the result of poorer educational attainments.

Adolescent↗
PubMed1998

Mental rotation: a task for the assessment of visuospatial skills of children.

7 girls and 5 boys, ranging in age from 7 to 12 years, participated in the pilot testing of a mental rotation task developed for use in a comprehensive test battery of visuoperceptual abilities. Two asymmetric, three-dimensional objects were constructed from wood strips such that one object was the mirror-image of the other. Black and white photographs were taken of these objects in various spatial orientations along a horizontal plane. 16 photographs depicted the object right-side-up and in 16 the object was upside-down (rotated 180 degrees in the vertical plane). These photographs were presented to the children who were asked to match each with the corresponding object. Analysis indicated correct judgements of the right-side-up images occurred more frequently than the upside-down images (t11 = 4.73, p < .001). Using these data, adjustments were made to the task instructions to provide greater clarity for the young participants.

Child↗