Journal of chronic diseases最新文献

To confirm the reported association of body fat distribution with cardiovascular disease, diabetes, blood pressure and serum cholesterol, data from the 1960-62 Health Examination Survey were analyzed. In this sample drawn from the noninstitutionalized population of the United States aged 18–79, mean values of two indices of upper versus lower body fat distribution increased steadily with age. Men had higher values than women, and black women had higher values than white women. Higher values of the indices were significantly associated with higher blood pressure, post-load serum glucose and greater prevalence of definite hypertension and definite hypertensive heart disease independent of multiple confounders. Associations with higher serum cholesterol and definite coronary heart disease prevalence were independent of overall ponderosity but not of age and multiple other confounders. Greater abdominal relative to lower body fat deposits were independently associated with increased cardiovascular risk in men and women, blacks and whites.

In summary, from the epidemiologic perspective, the conference made it clear that:

• 1.

  (1) In modern occcurence research in medicine, quality of life is an important aspect of health outcome, along with duration of life; and it is of interest as a determinant of outcome as well.

• 2.

  (2) The concept of quality of life remains ill-defined but is, in the medical sense, some aggregate representation of disability discomfort, and distress resulting from illness and/or medical action.

• 3.

  (3) In medicine, quality of life is, in concept, specific to various types of clinical situation; and empirical scales need to be similarly situation-specific.

• 4.

  (4) Whereas clinical research on quality of life is already being conducted successfully, further development of scales specific to particular types of clinical situation remains a challenge to theorists of quality of life, as well as to experts on clinimetrics who collaborate with clinical specialists.

The 30-item version of the General Health Questionnaire (GHQ) was completed by 1649 new adult enrollees in a Health Maintenance Organization (HMO), Factor analysis of responses disclosed six factors (Anxiety/Strain, Confidence, Depression, Energy, Social Function, and Insomnia) and a strong tendency for items of similar wording (positive phrasing) to cluster together.

Elevations of GHQ scores, especially when persistent over two administrations of the GHQ separated by 7 months, were strongly associated with the probability of both mental health and non-mental health care within 12 months of enrollment. Anxiety/Strain, Depression, and Social Function scores were associated with the probability of use; Confidence and Energy factors were not. Once in care a member's rate of use of service was relatively independent of the response pattern to the GHQ at enrollment.

Prognostic studies hinge on the assembly of a proper inception cohort. The stepwise assembly of a “true” inception cohort of hypertension complicating pregnancy is reported. Standard assembly procedures would have resulted in the preferential reporting of the severest cases of the prognostically worst categories of disease. The less severe cases would have been missed. Prognostic studies should utilize and report a method for assessing potential missed cases, such as a random selection of records for independent review.

By studying 516 healthy adults normal reference intervals were established for the Coulter “S” haematological indices with the plasma ferritin, B₁₂, folate and red cell folate in a subgroup of 306. Significant sex related differences were found for all measurements other than MCV, MCH and B₁₂. After allowing for these sex related differences, the effects of age, body size, fasting, smoking, alcohol, exercise and contraceptive pill usage on the parameters studied was defined.

A qualitative view of mathematical models for cancer is presented. The Armitage and Doll multistage and Moolgavkar two-stage models of cancer are discussed in terms of their physical models. Time-related factors for these models as well as some of their characteristics are presented. The effect of age at first exposure, duration of exposure, time since last exposure and stage of carcinogenic effect on risk are detailed.