Journal of chronic diseases
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In order to assess the validity of self-reports of physical conditions, symptoms, and ailments, the nine-year mortality experience of a random population sample of 4590 adults, aged 35-94, in Alameda County, California, was examined. Consistently, increased risks of death from any cause and from ischemic heart disease were found for several self-reports. Multiple logistic analyses of deaths from ischemic heart disease showed that the best predictors for men were reports of "high blood pressure," "heart trouble," and "shortness of breath" and for women were "heart trouble," "swollen ankles," and "chest pain." The strength and consistency of the relationships between these self-reports and risk of death from all causes and from ischemic heart disease argues for the validity of such reports as measures of underlying disease state.
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Established indices of relative body weight are reviewed and critically evaluated in terms of five criteria: (1) high correlation with obesity, (2) a conceptual interpretation, (3) universality, (4) simplicity of computation, and (5) zero correlation with height. Regression procedures are used to create standard weight charts which are distributed similarly to the body weight of 13,645 Americans, provided by the National Health Survey (NHS), and which have an arithmetic mean equal to the mean of the Metropolitan Life Insurance ( MLI ) table of desirable weights. A similar method is used to create a standard weight table based on body mass index (BMI). Finally, standard body weight charts which are uncorrelated with sex, age, and/or body frame are developed and discussed in terms of their usefulness.
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Because systolic blood pressure rises more sharply than diastolic blood pressure for those middle aged and beyond, leading to an increasing prevalence with advancing age of elevated systolic blood pressure without elevated diastolic pressure, i.e. so-called pure systolic hypertension, the question arises as to whether or not factors that have been shown to be related to blood pressure and hypertension are related to pure systolic hypertension or to 'classical' hypertension, i.e. hypertension defined solely by the level of the diastolic pressure. This question was examined in four Chicago epidemiologic studies by examining the associations between several variables and pulse pressure, with pulse pressure redefined so that the association between a variable and pulse pressure indicated whether the variable was more strongly related to systolic or diastolic blood pressure. In these four studies, glucose, heart rate and cigarette use tended to show a stronger association with systolic pressure, suggesting a possible association with pure systolic hypertension, while hematocrit, serum cholesterol, and uric acid tended to be more strongly associated with diastolic pressure, or equally associated with systolic and diastolic pressure, suggesting an association with 'classical' hypertension. Relative weight tended to be more strongly associated with systolic pressure under the age of 35 and more strongly associated with diastolic pressure after age 45.
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In a patient with a particular index disease, the term co-morbidity refers to any additional co-existing ailment. The failure to classify and analyze co-morbid diseases has led to many difficulties in medical statistics. The omissions create misleading data in mortality rates for a general population, and in fatality rates for an individual disease. ⋯ In addition to these direct effects on clinical course, co-morbidity plays a role in intellectual decisions that may alter the statistical categories of diagnostic classification. These decisions deal with the attribution of symptoms in 'polypathic' patients and with the selection of an inception manifestation for the index disease. In order to maintain consistency in the management of research data, certain principles of co-morbid differential diagnosis can be developed according to anatomic relation, pathogenetic interplay, and chronometric features of the diseases under consideration.