ISSN:1044-3983    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1044-3983    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1044-3983    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1044-3983    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The association of cocaine and amphetamine use with hemorrhagic and ischemic stroke is based almost solely on data from case series. The limited number of epidemiologic studies of stroke and use of cocaine and/or amphetamine have been done in settings that serve mostly the poor and/or minorities. This case-control study was conducted in the defined population comprising members of Kaiser Permanente of Northern and Southern California. We attempted to identify all incident strokes in women ages 15–44 years during a 3-year period using hospital admission and discharge records, emergency department logs, and payment requests for out-of-plan hospitalizations. We selected controls, matched on age and facility of usual care, at random from healthy members of the health plan. We obtained information in face-to-face interviews. There were 347 confirmed stroke cases and 1,021 controls. The univariate matched odds ratio for stroke in women who admitted to using cocaine and/or amphetamine was 8.5 (95% confidence interval = 3.6–20.0). After further adjustment for potential confounders, the odds ratio in women who reported using cocaine and/or amphetamine was 7.0 (95% confidence interval = 2.8–17.9). The use of cocaine and/or amphetamine is a strong risk factor for stroke in this socioeconomically heterogeneous, insured urban population. (Epidemiology 1998; 9:596–600)

ISSN:1044-3983    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We studied the relation between pregnancy and Guillain-Barré syndrome in the Swedish female population ages 15–49 years during the period 1978–1993. Person-based information from the national Hospital In-patient Registry on patients discharged with a diagnosis of Guillain-Barré syndrome was linked to data on pregnancy and delivery from the Swedish Medical Birth Registry. We validated coded Guillain-Barré syndrome diagnoses and the time periods of clinical onset for patients hospitalized with Guillain-Barré syndrome during pregnancy or during the first 90-day postpartum period. We compared the incidence of Guillain-Barré syndrome in women in different exposure categories related to pregnancy with that in women neither pregnant nor in the 90-day postpartum period. Poisson regression analysis yielded age-adjusted rate ratios of 0.89 [95% confidence interval (CI) = 0.52–1.53] for pregnant women, 1.37 (95% CI = 0.64–2.91) for women during the first 90 days, and 2.93 (95% CI = 1.20–7.11) during the first 30 days after delivery. Our results indicate that the risk of Guillain-Barré syndrome increases after delivery, particularly during the first 2 weeks postpartum. (Epidemiology 1998; 9:601–604)

ISSN:1044-3983    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This article illustrates the use of time-homogeneous Markov models with covariaties to estimate the AIDS incubation period distribution from prevalent cohorts and to evaluate the effect of factors such as gender, age, human immunodeficiency virus (HIV) transmission category, and antiretroviral therapy on disease progression. We applied this methodology to the analysis of data from a cohort of 3,027 patients enrolled from a hospital-based surveillance system of HIV infection in the Bordeaux University Hospital and four secondary public hospitals in southwestern France. A total of 998 individuals (33%) progressed to AIDS during a median follow-up period of 34 months. Based on a progressive three-state Markov model, the estimated mean and median incubation periods were 9.1 years [95% confidence interval (CI) = 8.7–9.6] and 7.5 years (95% CI = 7.2–7.9), respectively Our analyses showed a similar disease progression in men and women; we observed a more rapid progression for older subjects compared with younger ones and for homosexual men compared with heterosexuals, intravenous drug users, and transfusion recipients, who had similar disease progression rates after adjusting for age. The use of antiretroviral therapy appeared to slow disease progression. Moreover, the results indicated that a combination therapy of zidovudine with another antiretroviral drug may be more efficient than zidovudine monotherapy. (Epidemiology 1998; 9: 605–612)

ISSN:1044-3983    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We evaluated changes over time in rates of progression to AIDS, mortality, and distribution of AIDS-defining illnesses in 524 human immunodeficiency virus (HIV)-seropositive injection drug users enrolled between 1986 and 1995 in a prospective study of HIV infection in the Bronx, NY, At enrollment participants attended a hospital-affiliated methadone maintenance program with on-site primary care. Using the 1993 clinical definition of AIDS, we found that the hazard ratio (HR) of progression to AIDS declined for enrollees over time in comparison with the referent group of persons enrolled in 1986–1987. For program enrollees in 1988–1989, the HR was 1.0 [95% confidence interval (CI) = 0.6–1.6]; for enrollees in 1990–1991, the HR was 0.3 (95% CI = 0.1–0.9); for enrollees in 1992–1993, the HR was 0.5 (95% CI = 0.3–0.9); and for enrollees in 1994–1995, the HR was 0.2 (95% CI = 0.1–0.7), cm-initial-CD4+cell counts and age. Never theless, the greater AIDS-free time of later study entrants was not associated with reduced mortality. The study provides evidence that drug users with access to primary care likely benefited from improved management of HIV disease in prolonging AIDS-free time but, through 1996, did not experience greater survival. (Epidemiology 1998; 9:613–617)

ISSN:1044-3983    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Few environmental risk factors for Alzheimer's disease have been identified. This lack of information may reflect the fact that salient factors affect most of the population in developed countries. Furthermore, the critical period of exposure may be earlier than hitherto suspected, during the first years of life, as the brain differentiates and develops. Exposure to lead at levels lower than those associated with evident toxicity causes mild intellectual impairment in childhood. I hypothesize that this may be one of the childhood exposures that also confers an additional risk for the onset of Alzheimer's disease. (Epidemiology 1998; 9:618–621)

ISSN:1044-3983    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We used a case-crossover design to evaluate short-term effects of several exposures on the risk of childhood accident. One hundred fifty-six hospitalized children with injuries responded to an interviewer-administered questionnaire that included, among other variables, information concerning transient exposures that had terminated within 26 hours before the occurrence of the accident. We considered the 2-hour interval preceding the accident as the likely effect period and made within-individual comparisons between this period and the remaining 2-hour intervals during which the child was awake. We used conditional logistic regression analyses to evaluate the effect of the transient exposures on the occurrence of childhood accidents. We present univariate and multivariate analyses adjusting for possible within-person confounding by exposure to more than one exposure simultaneously and for clock time. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were as follows: for strenuous physical activity, OR = 24.2, 95% CI = 10.8–54.4; for intellectual exertion, OR = 9.0, 95% CI = 1.9–25.8; for involvement in family quarrels, OR = 2.6, 95% CI = 0.4–16.9; for school examination, OR = 3.8, 95% CI = 1.5–9.4; and for a pleasing event, OR = 3.4, 95% CI = 1.5–8.2. Other transient exposures were not associated with increased accident risk. Comparison of the overall frequency of reported transient events between the first of the control intervals (3rd and th hours before the accident) and the 2-hour interval covering the th and th hours before the accident suggested that information bias may have led to slight overreporting of transient exposures during the period most proximal to the accident; this bias, however, was too small to explain the marked risk elevations associated with the indicated transient exposures. We conclude that several transient exposures are important component causes in the occurrence of childhood accidents. (Epidemiology 1998; 9:622–625)

ISSN:1044-3983    

出版商:OVID    

年代:1998

数据来源: OVID