Nutritional risk factors for tuberculosis among adults in the United States, 1971-1992.

The risk of developing tuberculosis (TB) may be related to nutritional status. To determine the impact of nutritional status on TB incidence, the authors analyzed data from the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study (NHEFS). NHANES I collected information on a probability sample of the US population in 1971-1975.

Impact of depressive symptoms on hospitalization risk in community-dwelling older persons.

Objective: To determine whether depressive symptoms in older adults are associated with an increased risk for hospitalization.

Design: A 6 month cohort study.

Setting: Five counties in the northern Piedmont of North Carolina from the Duke University site of the Established Populations for Epidemiological Studies of the Elderly project.

Comorbidity of five chronic health conditions in elderly community residents: determinants and impact on mortality.

Background: Comorbidity is common in elderly persons. Its extent, correlates, and life-threatening impact in representative community residents are unclear.

Methods: Self-reported information of physician-diagnosed coronary artery disease (CAD), cerebrovascular disease (CVD), diabetes, and cancer was obtained annually between 1986-87 and 1992-93, and hypertension was obtained triennially from the participants of the Duke Established Populations for Epidemiologic Studies of the Elderly, a stratified multistage sample of 4,126 Black and White community residents aged 65-100, living in a five-county area of North Carolina.

Spondyloarthropathy in the community: differences in severity and disease expression in Alaskan Eskimo men and women.

Objectives: To determine the relative severity and compare the clinical expression of spondyloarthropathy (SpA) in men and women.

Methods: A clinical study was conducted in 43 women and 40 men who made up 80% of all individuals identified as having SpA in a community-wide epidemiologic study of Alaskan Eskimos. The study included interviews, physical, laboratory, radiographic and electrocardiographic examinations, record reviews, and functional assessments.

Insomnia and heart disease: a review of epidemiologic studies.

Since the discovery and successful treatment of sleep apnea, researchers seem to believe that the association between sleep disturbance and coronary heart disease (CHD) has been explained. To determine whether subjective nighttime sleep complaints (trouble sleeping, trouble falling asleep, trouble staying asleep), exclusive of apnea, predicted myocardial infarction and other coronary events, a MEDLINE search was conducted for articles published between January 1976 through August 1997. Ten studies with an explicit measure of association between an insomniac complaint and CHD were identified.

Spondyloarthropathy in the community: clinical syndromes and disease manifestations in Alaskan Eskimo populations.

Objective: To define the clinical spectrum and disease manifestations of spondyloarthropathy (SpA) as seen in a community, rather than a referral setting.

Methods: Eighty percent (83/104) of all individuals identified as having SpA in a community wide epidemiologic study of Alaskan Eskimos and 83 age and sex matched controls from the same regions participated in a 5 year clinical study. The study included baseline and followup interviews, physical, radiographic, and electrocardiographic examinations, record reviews, and functional assessment.

Is there a threshold between peak oxygen uptake and self-reported physical functioning in older adults?

Purpose: Few studies have examined the relationship between directly measured oxygen uptake (VO2) and self-reported physical function (PF). The purpose of this study was: 1) to examine the relationship between peak V02 and PF and 2) to determine whether a threshold or cut point exist that distinguishes between individuals reporting required assistance in the performance of functional tasks (low PF) and those who report ability to perform tasks independently (high PF).

Methods: Participants were 161 community-dwelling adults, ages 65-90, who had a baseline evaluation for a clinical trail that included measurement of peak V02 and PF consisted of a summary score combining scores from the Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire, Nagi Disability Study.

Are sleep complaints an independent risk factor for myocardial infarction?

Purpose: To investigate whether subjective sleep complaints are an independent predictor of myocardial infarction (MI) in a community of older adults and to gain clues as to why the association between sleep complaints and incident MI exists.

Methods: Using longitudinal data from the Piedmont study on 2960 adults aged 65 or older who were free of symptomatic heart disease at baseline, we screened 19 potential confounders to determine if any, alone or in combination, could explain the observed relationship between incident MI and sleep complaints.

Results: During the three-year follow-up period, there were 152 incident MIs.

Physical fitness and functional limitations in community-dwelling older adults.

Background: Conceptual models of disability have focused on disease-specific factors as the primary cause of disability. Functional limitations in the performance of basic tasks are considered primary mediators on the causal pathway from disease to disability.

Purpose: The purpose of this study was to assess the association between three fitness components (cardiorespiratory, morphologic, and strength) and functional limitations.

A comparison of patients with spondyloarthropathy seen in specialty clinics with those identified in a communitywide epidemiologic study. Has the classic case misled us?

Background: Undiagnosed cases of seronegative spondyloarthropathy (Spa) are often observed during epidemiologic studies.

Objective: To determine the extent of and the reasons for the underdiagnosis of Spa.

Methods: We studied 2 groups of Alaskan native patients with Spa using a standardized protocol that included an interview, physical examination, medical record review, and radiographic and laboratory examinations.

Class I HLA antigens in spondyloarthropathy: observations in Alaskan Eskimo patients and controls.

Objective: To assess the role of HLA-B27 and other class I histocompatibility antigens in overall risk and clinical manifestations of spondyloarthropathy (SpA) in Alaskan Eskimos.

Methods: Class I antigens were studied in 104 patients with SpA and in 111 controls. The frequencies of HLA-A, B, and Cw antigens were determined in patients with SpA with various clinical manifestations and compared to frequencies observed in controls.

Spondylarthropathic diseases in indigenous circumpolar populations of Russia and Alaska.

Aims: To compare the nature and frequency of spondylarthropathy in geographically separated but genetically related populations with a high prevalence of HLA-B27.

Methods: Using a common questionnaire and disease criteria, cases were ascertained through cross-sectional community surveys in Russia and by examination and study of possible cases identified through rheumatic disease registries and the Native Health Service's computerized patient care data system in Alaska.

Results: Similar overall prevalences of spondyloarthropathy (2.

Spondyloarthropathies in circumpolar populations: II. Characterization of the populations.

For epidemiologic studies of spondyloarthropathy in circumpolar peoples of Chukotka, Russia and Alaska, we gathered demographic, physical and laboratory data to provide a background for evaluating and comparing factors that may influence susceptibility and clinical expression of disease. The study groups included the Chukchi and Siberian Eskimo of Russia and the Inupiat and Yupik Eskimo of Alaska. The 4 groups were remarkably similar in population structure, educational attainment, mean hemoglobin concentrations and frequency of the Class I histocompatibility antigen HLAB27.

Spondyloarthropathies in circumpolar populations: I. Design and methods of United States and Russian studies.

Parallel epidemiologic studies of spondyloarthropathy in aboriginal circumpolar populations were carried out by U.S. and Russian investigators.

Discrepancies between patient recall and the medical record. Potential impact on diagnosis and clinical assessment of chronic disease.

Background: During a case-control study, data necessary for fulfilling diagnostic and classification criteria for spondyloarthropathy were collected from 121 patients.

Objective: To study the potential impact of differences between patient recall and the medical record on diagnosis and clinical characterization of spondyloarthropathy as a model of chronic disease.

Methods: The study was conducted among four Alaskan Eskimo populations served by the Alaska Native Health Service.

Does weight loss from middle age to old age explain the inverse weight mortality relation in old age?

The authors examined body mass index at middle age, body mass index in old age, and weight change between age 50 years and old age in relation to mortality in old age. The study population from the Established Populations for Epidemiologic Studies of the Elderly consisted of 6,387 whites age 70 years or older who experienced 2,650 deaths during the period 1982-1987. Mortality risk was highest for persons in the heaviest quintile of body mass index at age 50 (men, relative risk (RR) = 1.

Prevalence of spondyloarthropathies in Alaskan Eskimos.

Objective: To estimate the prevalence of spondyloarthropathies (SpA) in 2 Alaskan Eskimo populations, using improved methodology for case ascertainment and new, more inclusive classification criteria.

Methods: Through existing rheumatic disease registries, health care providers and the Alaska Area Native Health Service (AANHS) computerized patient information system, we identified all native residents of the 2 study regions with a diagnosis of any inflammatory arthritis or problems characteristic of SpA, such as iritis or persistent back pain. Individuals with such diagnoses or problems were evaluated in clinic, according to a standardized protocol (interview, examination), and by medical record review, pelvic radiography and laboratory tests.

Diet, indicators of kidney disease, and later mortality among older persons in the NHANES I Epidemiologic Follow-Up Study.

Objectives: The purpose of this study was to determine whether diet adversely affected survival among 2572 older persons with indicators of kidney disease in a population-based cohort. Average follow-up time for survivors, of whom 1453 (57%) had died at analysis, was 14.5 years.

Nutrition and function: is there a relationship between body mass index and the functional capabilities of community-dwelling elderly?

Objective: To determine if there is a relationship between body mass index and the ability to perform the usual activities of living in a sample of community-dwelling elderly.

Design: Secondary data analysis of The National Health and Nutrition Examination Survey-I Epidemiologic Follow-up Study (1982-1984). Follow-up home interview of a population-based sample originally interviewed between 1971 and 1975 in the National Health and Nutrition Examination Survey-I (NHANES-I).

Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index.

Brief measurement devices can alleviate respondent burden and lower refusal rates in surveys. This article reports on a field test of two shorter forms of the Center for Epidemiological Studies Depression (CES-D) symptoms index in a multisite survey of persons 65 and older. Factor analyses demonstrate that the briefer forms tap the same symptoms dimensions as does the original CES-D, and reliability statistics indicate that they sacrifice little precision.

Established populations for epidemiologic studies of the elderly: study design and methodology.

A project initiated by the intramural Epidemiology, Demography and Biometry Program of the National Institute on Aging, entitled "Established Populations for Epidemiologic Studies of the Elderly" (EPESE), has developed information on death, chronic conditions, disabilities, and institutionalization for representative samples of elderly people living in communities. The EPESE consists of prospective epidemiologic studies of approximately 14,000 persons 65 years of age and older in four different communities: East Boston, Massachusetts; two rural counties in Iowa; New Haven, Connecticut; and segments of five counties in the north-central Piedmont area of North Carolina. The study design includes an initial baseline household interview followed by continued surveillance of morbidity and mortality.

Predictors of smoking cessation and relapse in older adults.

We examined longitudinal changes in smoking behavior among older adults in three community cohorts of the Established Populations for Epidemiologic Studies of the Elderly. Smoking prevalence declined from 15% at baseline to 9% during 6 years of follow-up. Annual smoking cessation and relapse rates were 10% and less than 1%, respectively.

Light to moderate alcohol consumption and mortality in the elderly.

Objective: To determine whether there is a relationship of low to moderate alcohol consumption with cardiovascular mortality in the elderly.

Design: Prospective cohort studies with 5-year mortality follow-up.

Setting: Three populations of community-dwelling elders.

Anemia and hemoglobin levels in older persons: relationship with age, gender, and health status.

Objective: To determine the relationship of hemoglobin levels and anemia with age and health status in older adults.

Design: Survey.

Setting: Community.

The risk of nursing home admission in three communities.

Beginning in 1982, the 3-year incidence of nursing home admission was determined for community-dwelling residents aged 65 and over in East Boston, Massachusetts (4%); New Haven, Connecticut (9%); and Iowa and Washington Counties, Iowa (12%). A common methodology was used to collect baseline risk factor and follow-up data on nursing home admissions among persons in each community as part of the National Institute on Aging's Established Populations for Epidemiologic Studies of the Elderly. A multivariate logistic regression model of baseline risk factors that included the participant's age, race, sex, history of prior admission, ADL limitations, cognitive function, living arrangements, and level of income predicted 80% of the users in each community.