摘要:

The role of hormones in ischemic heart disease is of considerable interest, but limited data are available pertaining to risk factors associated with endogenous hormones. We examined the association between menstrual and reproductive factors and ischemic heart disease in a cohort of 867 white, college-educated women who prospectively recorded menstrual cycle-data for at least 5 years from their early 20s through their menopause. Ischemic heart disease history was obtained from a self-administered (N = 714) or proxy-administered (N = 153) questionnaire completed at a mean age of 73 years. The analysis included 44,899 person-years of follow-up and 45 cases of myocardial infarction, angioplasty, heart bypass surgery, or ischemic heart disease-related mortality. Ischemic heart disease risk decreased with increasing age at menarche (age-adjusted RR 0.76 per year, 95% CI = 0.60–0.95). Considering menstrual cycle characteristics ages 28–32, there was little overall association with length, variability, or bleeding duration. Ischemic heart disease risk increased with later age at first birth (age-adjusted RR 2.90 for ages 33–43 compared with 25–29) and later age at last birth (age-adjusted RR 3.79 for ages ≥40 compared with 35–39), but there was little association with high parity. (Epidemiology 1999;10:255–259)

ISSN:1044-3983    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

There have been relatively few epidemiological studies to verify the information obtained from study participants on the use of menopausal hormone replacement therapy. We conducted this study as part of a case-control study of diet, hormone use, and endometrial cancer in Toronto, Ontario, Canada, 1994–1998. We compared records from 653 subjects, 30–79 years of age, with reports from their physicians on ever/never use of hormone replacement therapy and duration, type, and dose of hormone replacement therapy. A total of 88% of the interview records were in agreement with physician reports for ever/never use of hormone replacement therapy. The overall kappa value for ever/never use agreement was 0.76 (range = 0.71–0.81), and the intraclass correlation coefficient was 0.64 (range = 0.57–0.70) for duration of hormone replacement therapy use, indicating good agreement; similar correlations were seen among cases and controls for overall use, as well as estrogen- or progestogen-alone use. Concordance for brand codes was observed for about 43% of the subjects. This study suggests that information obtained by interview in case-control studies provides a reasonable measure of ever use of hormone replacement therapy and duration of use. Interviews, however, do not represent a reliable source of information on brands and dosage of hormone replacement therapy preparations. (Epidemiology 1999;10:260–263)

ISSN:1044-3983    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

More than 50% of infants with Down syndrome have associated defects that cause considerable morbidity and mortality. We evaluated the hypothesis that the trisomic genome interacts with environmental factors to increase the risk for specific associated defects. We evaluated risk factors present during early pregnancy in a multiracial population of 687 infants with Down syndrome. Mother's cigarette smoking was associated with the grouped cardiac defects [odds ratio (OR) = 2.0; 95% confidence interval (CI) = 1.2–3.2). When adjusted for other cardiac defects and maternal race, the following specific defects were associated with smoking: atrioventricular canal (OR = 2.3; 95% CI = 1.2–4.5), tetralogy of Fallot (OR = 4.6; 95% CI = 1.2–17.0), and atrial septal defects without ventricular septal defect (OR = 2.2; 95% CI = 1.1–4.3). Hirschsprung disease was associated with mother's daily consumption of more than three cups of coffee (OR = 6.02; 95% CI = 1.2–29.7) and with mother's fever (OR = 3.4; 95% CI = 0.7–16.4), but the number of cases was small. Use of alcohol was not associated with any defect. Mother's race, age, parity, income, or education did not confound the associations. Results suggest that environmental factors can modify the occurrence of associated anomalies in the embryo with Down syndrome. (Epidemiology 1999;10:264–270)

ISSN:1044-3983    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

We use here the Swedish Family-Cancer Database to analyze the time trends in childhood leukemia and brain cancer between 1960 and 1994 and the effect of parental age on childhood leukemia and brain cancer of some 1500 cases each. The database includes all persons born in Sweden after 1940 with their biological parents, over 6 million individuals, whose cancers were retrieved from the Swedish Cancer Registry from years 1958–1994. Incidence in cancer increased from 1960 to 1994; low grade astrocytoma accounted for most of the increase, whereas high grade astrocytoma has not increased in incidence. There has been a moderate increase in leukemia to about 1980. We found a parental age effect for both leukemia and brain cancer, with the former (of about 50% excess in those over 35 years) being mediated by maternal age and the latter (of about 25% excess) by paternal age. Accumulation of chromosomal aberrations and mutations during the maturation of germ cells is a likely mechanism for these findings. They can help to explain partially the secular trends of these malignancies and the excess risks in offspring of the well educated. (Epidemiology 1999;10:271–275)

ISSN:1044-3983    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Diagnostic research and diagnostic practice frequently do not cohere. Studies commonly evaluate whether a single test discriminates between disease presence and absence, whereas in practice a test is always judged in the context of other information. This study illustrates drawbacks of single-test evaluation and discusses principles of diagnostic research. We used data on 140 patients suspected of pulmonary embolism who had an inconclusive ventilation-perfusion lung scan. We evaluated three tests: partial pressure of oxygen in arterial blood (PaO2), x-ray film of the thorax, and leg ultrasound. On the basis of single-test evaluations, ultrasound was most informative. Given a prior probability of 0.27, it had a much better combination of positive and negative predictive value (0.71 and 0.21, respectively) relative to thorax x-ray (0.33 and 0.11) and PaO2(0.35 and 0.27). The combination of positive and negative likelihood ratio was also more promising for ultrasound (7.3 and 0.7) than for thorax x-ray (1.3 and 0.3) and PaO2(1.3 and 0.9). As the tests are always performed after the history and physical, we judged their added value using multivariable logistic modeling with receiver operating characteristic (ROC) analyses. The ROC areas of the model, including history and physical, with additional PaO2, thorax x-ray, or ultrasound, were 0.75, 0.77, 0.81, and 0.81, respectively, which indicated similar added value of thorax x-ray and ultrasound. Application of the models to patient subgroups also yielded added predictive value for thorax x-ray film. Thus, the results of single-test evaluations may he very misleading. As no diagnosis is based on one test, single-test evaluations have limited value in diagnostic research and only have relevance in the context of screening and the initial phase of test development. Diagnostic research should always apply an approach of constructing, extending, and validating diagnostic models in agreement with routine clinical work-up using logistic regression analyses, (Epidemiology 1999;10:276–281)

ISSN:1044-3983    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

We identified maternal demographic, behavioral, and medical history factors that predict bacteriuria (that is, symptomatic and asymptomatic urinary tract infection) at prenatal care initiation. We applied logistic regression modeling to data from all prenatal care recipients who delivered during 1990–1993 and resided in selected North Carolina counties (N = 8037), omitting those with diabetes mellitus, human immunodeficiency virus, or structural urologic abnormalities. The two strongest predictors of bacteriuria at prenatal care initiation were an antepartum urinary tract infection prior to prenatal care initiation (for whites, adjusted prevalence odds ratio (POR) = 2.5, 95% CI 0.6–9.8; for blacks, POR = 8.8, 95% CI 3.8–20.3) and a pre-pregnancy history of urinary tract infection (POR = 2.1, 95% CI 1.4–3.2). For white women only, education beyond high school and age ≥30 years were inversely associated (POR ≤ 0.6). Sickle cell hemoglobin nearly doubled the prevalence odds for bacteriuria among African-Americans (POR = 1.9, 95% CI 1.0–3.5), whereas African-Americans with normal hemoglobin had reduced prevalence odds compared with whites (POR = 0.6, 95% CI 0.4–0.9). This study suggests predictors not considered before, including race controlling for sickle cell disease or trait and antepartum urinary tract infections prior to prenatal care. (Epidemiology 1999;10:282–287)

ISSN:1044-3983    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Senile cataract may be a marker of generalized tissue aging. We examined this hypothesis using population-based linked health data. We hypothesized that any such association would diminish with increased use of cataract surgery. Mortality rates of those 50–95 years of age undergoing cataract surgery in British Columbia during either 1985 or 1989 were compared with the provincial population of comparable age who did not undergo cataract surgery during the study period. The 1985 cohort included 8,262 patients undergoing surgery and a comparison population of 804,303, and the 1989 cohort included 11,952 patients and a comparison population of 839,393. Using Cox regression, for the 1985 cohort, the hazard ratios for dying during follow-up were 3.2 for males 50–54.9 years of age [95% confidence limits (CL) = 2.0, 5.0] and 3.3 for females (95% CL = 1.9, 5.7). Hazard ratios for older age groups decreased with age. We also fit an additive risk model that produced excess mortalities that were less age dependent. In the 1985 analysis, these ranged from +7.1 per 1,000 (95% CL = +0.44, +13.76) to +20.3 (95% CL = +13.24, +27.36) for males and −17.5 (95% CL = −28.28, −6.72) to +2.0 (95% CL = −2.12, + 6.12) for females. Findings for the 1989 analyses were similar, indicating that the association between cataracts and generalized aging remained constant despite a large increase in the use of cataract surgery. (Epidemiology 1999;10:288–293)

ISSN:1044-3983    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

We assessed the role of ventilation rate in homes in the development of bronchial obstruction during the first 2 years of life. We conducted a matched case-control study based on a cohort of 3,754 newborns in Oslo in 1992–93 that was followed for 2 years. The case series comprised 172 children with bronchial obstruction, and the control series was one-to-one matched for date of birth. Ventilation rate and other building characteristics were measured/collected in home visits, and questionnaires were used to obtain additional information. We found that the risk of bronchial obstruction was not directly associated with the ventilation rate in liters per second and per person (ventilation rate quartiles: 6.9, 11.5 and 17.6 l/s, p [liter/second and person]) in the homes (odds ratio; OR 0.98, 95% confidence interval (CI) 0.96–1.01). The odds ratios of bronchial obstruction were higher in the low air change group (air change rate ≤0.5 h-1) than in the high air change group owing to exposure to environmental tobacco smoke (low 1.8; 95% CI: 0.35–9.66; high 1.5; 95% CI: 0.74–3.20), dampness problems (low 9.6; 95% CI: 1.05–87.4; high 2.3; 95% CI: 0.83–6.39), and the presence of textile wall paper (low 3.7; 95% CI: 0.62–21.5; high 1.7; 95% CI 0.72–3.94) and plasticizer-containing surfaces (low 12.6; 95% CI: 1.00–159; high 2.6; 95% CI: 1.02–6.58). Our results are consistent with the hypothesis that low ventilation rates strengthen the effects of indoor air pollutants. (Epidemiology 1999;10:294–299)

ISSN:1044-3983    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Herbicides, chlorophenols, and other occupational exposures are suspected risk factors for soft-tissue sarcoma, but the epidemiologic evidence is inconsistent. Given that soft-tissue sarcomas represent a heterogeneous mix of cancer subtypes and that these subtypes have different disease patterns by race, sex, and age at diagnosis, studying all soft-tissue sarcomas combined may mask subtype-specific associations. Using the Selected Cancers Study, a large population-based case-control study of sarcoma conducted among U.S. men aged 30 to 60 in 1984 to 1988, we explored the occupational risk factors for soft-tissue sarcoma subtypes and skeletal sarcoma. The analysis included 251 living sarcoma cases (48 dermatofibrosarcoma protuberans, 32 malignant fibrohistiocytic sarcoma, 67 leiomyosarcoma, 53 liposarcoma, and 51 skeletal sarcoma) and 1908 living controls. Exact conditional logistic regression models suggested patterns of subtype specificity for occupational exposures. Self-reported herbicide use was associated with malignant fibrohistiocytic sarcoma (OR = 2.9, 95% CI = 1.1–7.3). We found elevated risks for chlorophenol exposure and cutting oil exposure and malignant fibrohistiocytic sarcoma and leiomyosarcoma. We found no occupational risk factor for liposarcoma. Polytomous regression models identified different odds ratios across subtypes for plywood exposure and exposure to wood and saw dust. Although exploratory, this analysis suggests that occupational risk factors for sarcoma are not uniform across subtypes. (Epidemiology 1999;10:300–306)

ISSN:1044-3983    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

An increased risk of intracerehral hemorrhage among heavy consumers of alcohol has been demonstrated in several epidemiologic studies. The effect of moderate or intermediate intakes is, however, unclear. Although several studies provide evidence for a protective effect, this conclusion may he spurious, resulting from the inclusion, within the zero intake (reference) group, of past drinkers who have recently abstained for health reasons. The present study describes the relation between alcohol consumption and intracerebral hemorrhage among 331 case-control pairs recruited in Melbourne, Australia. Heavy drinking was associated with an increased risk of intracerebral hemorrhage (odds ratio (OR) 3.4, 95% confidence interval (CI) = 1.4–8.4). The odds ratio of intracerebral hemorrhage with moderate drinking, when compared with never drinkers, was 0.7, (95% CI = 0.4–1.2) and was 0.6 (95% CI = 0.4–1.0) when compared with nondrinkers (never drinkers plus past drinkers). Wine drinkers were apparently protected from intracerebral hemorrhage (OR 0.5, 95% CI = 0.2–0.9). These results are consistent with the possibility that moderate drinking may confer protection from intracerebral hemorrhage, but this protection may he less than that previously reported. (Epidemiology 1999;10:307–3 12)

ISSN:1044-3983    

出版商:OVID    

年代:1999

数据来源: OVID