Journal of chronic diseases最新文献

In gauging the achievements of surgical treatment it is important to try to measure the quality of functional result vouchsafed to the patient and his capacity for work and recreation. Because the impairments of function that may occur after different operations very considerably, an operation-specific assessment for each type of procedure is essential.

In regulatory or decision-making contexLs related to carcinogenic hazards, one would like to know the extra risks associated with various levels, durations, and ages of exposure to a carcinogen. To supply that information, quantitative risk assessments are required that make extrapolations on variables related to dose levels, timing of exposure, and age. Quantitative models that express age-specific mortality rates as functions of the exposure pattern and that allow such extrapolations to be made are presented. The uncertainty inherently associated with those extrapolations is discussed and is found to be exacerbated by small data sets and inadequate data availability. Specific examples are provided that involve asbestos-induced mesothelioma and leukemia caused by benzene exposure.

To examine sociodemographic, menstrual, reproductive, and other factors which may influence the age at natural menopause, the authors analyzed data from a large series of women participating in a nationwide breast cancer screening program conducted between 1973 and 1980. Standard life table techniques permitted assessment of factors suspected of varying the time to menstrual cessation among 983 premenopausal women, 1091 surgically menopausal women, and 1423 naturally menopausal women. The median age at natural menopause was 51.1 years. Multivariate analysis indicated that parity, irregularity of menstrual cycles before age 25 or first livebirth, and high socioeconomic status were significantly related to menopausal age. These data provide evidence for the hypothesis that certain environmental and hormonal factors which affect ovulation during reproductive years may ultimately postpone the menopause.

The association between level of alcohol consumption and 15-year mortality, focusing particularly on the possible protective effect of light drinking compared to abstention, was studied in a representative population sample of 6928 residents of Alameda County, California. Because abstainers differ from light, moderate and heavy drinkers on a number of demographic, physical, and psychosocial characteristics, the role of these as confounders of the alcohol/mortality association was examined. Using multiple logistic models, the mortality experience of abstainers, moderate drinkers, heavy drinkers and very heavy drinkers was compared with that of light drinkers. Among men only, very heavy drinkers were at significantly greater risk of death from all causes than were light drinkers (OR = 2.5, p < 0.01). Neither abstainers nor other drinkers were at significantly higher risk of death from ischemic heart disease than were light drinkers. This pattern of results persisted with adjustment for 11 covariates of alcohol consumption in addition to age.

The relationship of behavioral factors and resting blood pressure was assessed in a random sample of 192 young middle class black adults. Framingham Type A behavior was positively associated with diastolic blood pressure (r = 0.17, p < 0.05) among the women. Also, anger-in and trait anxiety were positively correlated with diastolic blood pressure for the women, r = 0.20, p < 0.05 and r = + 0.28 and p < 0.01, respectively. After control for body mass index, trait anxiety and anger-in remained independent predictors of diastolic blood pressure among the women. For men, marijuana use was positively associated with blood pressure. Marijuana use was an independent predictor for systolic blood pressure after adjusting for body mass index among the males. The present study demonstrated a sex difference related to behavioral factors and blood pressure in young middle class blacks.

The Primary Preventive Trial in Göteborg, Sweden, a study of a random population sample of middle-aged men, made it possible to analyse the risk factor pattern cross-sectionally in 166 men with uncomplicated angina pectoris (AP) and compare with 5735 men without angina pectoris or myocardial infarction (MI). A prospective analysis was also performed concerning the risk factor pattern in 128 cases with uncomplicated AP and 34 cases with complicated AP (following an MI) respectively, appearing during a follow-up time of 4 years.

At cross-sectional analysis, uncomplicated AP was related to elevated serum cholesterol, elevated systolic and diastolic blood pressure, increased relative body weight, smoking, diabetes mellitus, low physical activity during leisure time, dyspnea and mental stress.

However at multivariate, prospective analysis only dyspnea, stress, diabetes mellitus and increased relative body weight were predictors for uncomplicated AP. In contrast, elevated serum cholesterol, high blood pressure, smoking, and high physical activity at work were predictors for complicated AP.

Possible reasons for the apparent risk factor differences and different mechanisms in AP and MI are discussed.

Existing classifications of research designs for epidemiologic studies are inconsistent and confusing because of the conceptual “confounding” of three distinct concepts: (1) directionality in which exposure and outcome are investigated, (2) sample selection criteria, and (3) timing of the study proper with respect to the calendar times of exposure and outcome. The authors have attempted to construct a classification in which these three concepts comprise distinct (if not totally independent) axes. Closer attention to the distinctions described may help the planning and interpretation of epidemiologic studies, as well as facilitate future teaching and communication.

Adherence to standards for judging the content validity of health measures and for labeling them is needed for the field of health assessment to proceed in an orderly fashion. This paper discusses the dimensionality of health and the range of health states that can be measured within each dimension. These two attributes of published definitions of health are used to derive minimum standards for judging the validity of health measures in terms of their content. Five generic health concepts are defined: physical health, mental health, social functioning, role functioning, and general health perceptions. Items from widely used health measures are presented to clarify distinctions among these concepts and the different health states they encompass. It is recommended that labels be assigned to health measures in a manner consistent with their content and other evidence of validity.