American journal of epidemiology
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Comparative Study
Obesity and the risk of newly diagnosed asthma in school-age children.
To determine the relation between obesity and new-onset asthma among school-age children, the authors examined longitudinal data from 3,792 participants in the Children's Health Study (Southern California) who were asthma-free at enrollment. New cases of physician-diagnosed asthma, height, weight, lung function, and risk factors for asthma were assessed annually at five school visits between 1993 and 1998. Incidence rates were calculated, and proportional hazards regression models were fitted to estimate the adjusted relative risks of new-onset asthma associated with percentile of body mass index (weight (kg)/height (m)(2)) and indicators of overweight (>85th body mass index percentile) and obesity (>95th body mass index percentile). ⋯ Boys had an increased risk associated with being overweight (RR = 2.06, 95% 1.33, 3.18) in comparison with girls (RR = 1.25, 95% CI: 0.83, 1.88). The effect of being overweight was greater in nonallergic children (RR = 1.77, 95% CI: 1.26, 2.49) than in allergic children (RR = 1.16, 95% CI: 0.63, 2.15). The authors conclude that being overweight is associated with an increased risk of new-onset asthma in boys and in nonallergic children.
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Comparative Study
Changes in functional status attributable to hip fracture: a comparison of hip fracture patients to community-dwelling aged.
Disability attributable to hip fracture regarding activities of daily living was evaluated by comparing 594 hip fracture patients entering eight hospitals in Baltimore, Maryland, in 1990-1991 with community-dwelling aged from the Established Populations for Epidemiologic Studies of the Elderly (EPESE) cohort matched on age, sex, and walking ability. Subjects were assessed at baseline (prefracture report for patients), 12 months, and 24 months. ⋯ Likewise, hip fracture patients experienced more disability regarding transferring (38-39% vs. 10-18%; attributable disability, approximately 22 cases per 100 persons) and grooming (17-19% vs. 7-15%; attributable disability, approximately six cases per 100 persons). Thus, results showed that hip fracture patients had substantially more activities of daily living disability than that explained by aging over 24 months.
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Trends in out-of-hospital coronary heart disease (CHD) death, a surrogate for sudden cardiac death (SCD), are important for understanding the decline in CHD mortality. Little is known about out-of-hospital CHD death without prior CHD diagnosis, the definition of unexpected SCD. The authors analyzed secular trends in CHD death and unexpected SCD over a 20-year period (1979-1998) to examine the association between prior CHD and SCD and to test the hypothesis that in-hospital deaths declined more than SCDs. ⋯ The relative odds of prior CHD were higher among persons with SCD than among controls, but there was a modest decline in the magnitude of the association. Thus, during the past 20 years, the decline was greater for in-hospital CHD deaths than for SCDs. Since approximately half of the SCDs were unexpected and rates of these deaths declined less over time than rates of SCD with prior CHD, primary prevention is becoming increasingly more important in sustaining the decline in CHD mortality.
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Epidemiologists respond to the information needs of health professionals. Although medical professionals are routine users of epidemiologic information, use within medical specialties varies remarkably. To explore the variation in use of epidemiologic information across clinical medical specialties, the authors examined the scientific literature by analyzing patterns of citation of specific journal articles to and by the American Journal of Epidemiology (AJE). ⋯ Few citations to and by AJE were found in publications specializing in dermatology, gastroenterology, orthopedics, allergy, anesthesiology, surgery, rheumatology, and other areas. Trend patterns of citations between clinical and epidemiologic literature indicated that citations to the fields of cardiovascular disease and cancer are increasing, whereas citations regarding pediatrics have remained stable. This analysis suggests an increasing interchange of information between epidemiologists and clinicians specializing in certain fields, uncovering potential research opportunities for epidemiologists.
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By using a population-based cohort of the general Dutch population, the authors studied whether an excessively negative orientation toward pain (pain catastrophizing) and fear of movement/(re)injury (kinesiophobia) are important in the etiology of chronic low back pain and associated disability, as clinical studies have suggested. A total of 1,845 of the 2,338 inhabitants (without severe disease) aged 25-64 years who participated in a 1998 population-based questionnaire survey on musculoskeletal pain were sent a second questionnaire after 6 months; 1,571 (85 percent) participated. For subjects with low back pain at baseline, a high level of pain catastrophizing predicted low back pain at follow-up (odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.0, 2.8) and chronic low back pain (OR = 1.7, 95% CI: 1.0, 2.3), in particular severe low back pain (OR = 3.0, 95% CI: 1.7, 5.2) and low back pain with disability (OR = 3.0, 95% CI: 1.7, 5.4). ⋯ The significant associations remained after adjustment for pain duration, pain severity, or disability at baseline. For those without low back pain at baseline, a high level of pain catastrophizing or kinesiophobia predicted low back pain with disability during follow-up. These cognitive and emotional factors should be considered when prevention programs are developed for chronic low back pain and related disability.