Annals of epidemiology
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Annals of epidemiology · Jul 2007
Comparative StudyRisk-adjusted mortality rates of elderly veterans with hip fractures.
The goal of this research was to estimate 12-month survival rates for a large sample of elderly veterans after hip fracture with a risk-adjusted model and to compare the results of men to those of women. ⋯ One in 3 elderly male veterans who sustain a hip fracture dies within 1 year. Our work represents the first large study of hip fractures with a predominantly male sample and confirms that men have a higher mortality risk than women, as reported by previous researchers who used smaller samples that were mostly female. Fracture patients with metastatic cancer, renal failure, lymphoma, weight loss, and liver disease have higher mortality risks. The adverse outcomes associated with hip fracture argue for clinical intervention strategies, such as gait and balance testing, and osteoporosis diagnosis that may prevent fractures in both genders.
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Annals of epidemiology · May 2007
Secondhand smoke exposure, pulmonary function, and cardiovascular mortality.
Cardiovascular disease and obstructive lung disease are leading global causes of death. Despite this, the impact of secondhand smoke (SHS) exposure on pulmonary function and cardiovascular disease remains uncertain. Our goal was to elucidate the association between baseline SHS exposure and the risk of lung function decline and cardiovascular mortality over a period of nearly a decade. ⋯ Lifetime SHS exposure appears to result in a greater decline in lung function and risk of cardiovascular mortality, taking into account confounders and the mediating effect of FEV1 and baseline cardiovascular disease.
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Annals of epidemiology · Mar 2007
Plausible and implausible parameters for mathematical modeling of nominal heterosexual HIV transmission.
Several mathematical models simulate a HIV/AIDS epidemic by using the assumption that heterosexual transmission is the major or sole transmission mode. The validity of these models has been unclear. To understand the validity of these models, empirical estimates for relevant model parameters are needed that can be compared with parameters used in mathematical models. ⋯ Existing models of nominal heterosexual HIV transmission for sub-Saharan Africa rely on assumptions inconsistent with empirical evidence. Simulations have not accurately portrayed the epidemiological situation in sub-Saharan Africa, and conclusions drawn from these models should be interpreted with great caution. To realistically simulate HIV spread in sub-Saharan Africa's general population nominally due to heterosexual HIV transmission, parameter values should be based on the most accurate data.
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Annals of epidemiology · Feb 2007
Effect measure modification and confounding of severe head injury mortality by age and multiple organ injury severity.
The study aim is to assess confounding and effect measure modification of the relationship between head injury severity (measured using the Glasgow Coma Scale [GCS]) and mortality by age and multiple organ injury (measured using the Injury Severity Score [ISS]). Head injury-related mortality is affected by head injury severity, as well as age and multiple organ injury. However, little is known about the effect modification of these relationships. ⋯ The relationship of head injury severity and mortality is modified and confounded by age and ISS. GCS is a better predictor of death in younger patients.
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Annals of epidemiology · Jan 2007
Ecstasy and gateway drugs: initiating the use of ecstasy and other drugs.
The main purposes of this study are to examine whether and to what extent ecstasy use serves as a gateway to the use of such hard drugs as cocaine, heroin, and methamphetamine and compare ages of onset of alcohol and marijuana use and subsequent use of cocaine, heroin, and methamphetamine among young adult ecstasy users. ⋯ The sequential progression of drug use proposed in the gateway literature is not immutable. Researchers must take into account the changing popularity of drugs over time, such as the emergence of ecstasy use, when identifying patterns of drug-use onset.