Anemia as a risk factor for cardiovascular disease in The Atherosclerosis Risk in Communities (ARIC) study.
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OBJECTIVES: We investigated whether the presence of anemia is a risk factor for cardiovascular disease (CVD) outcomes in the general population. BACKGROUND: Chronic anemia is a risk factor for CVD outcomes in patients with kidney disease and in patients with heart failure, but has not been evaluated as a risk factor in the general population. METHODS: The Atherosclerosis Risk in Communities (ARIC) study was used to evaluate the relationship of anemia, defined by hemoglobin <13 g/dl in men and <12 g/dl in women, to CVD. Cox proportional hazards regression was used to adjust the relationship between anemia and CVD outcomes for other covariates in the entire study cohort, as well as in subgroups of men, women, African Americans and whites. RESULTS: A total of 14,410 subjects (6,267 men and 8,143 women) without CVD at baseline had hemoglobin levels measured. Three hundred men (4.8%) and 1,058 women (13.0%) were anemic. During an average follow-up of 6.1 years there was a total of 549 (3.8%) CVD events. The presence of anemia was independently associated with an increased risk of CVD (hazard ratio [95% confidence interval] of 1.41 [1.01, 1.95]) in the entire study cohort. In subgroup analyses the hazard ratios were in the same direction, although not statistically significant in all cases. CONCLUSIONS: Anemia is an independent risk factor for CVD outcomes in the ARIC cohort, a community cohort of subjects between the ages of 45 and 64 years. (+info)
Contributions of 18 additional DNA sequence variations in the gene encoding apolipoprotein E to explaining variation in quantitative measures of lipid metabolism.
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Apolipoprotein E (ApoE) is a major constituent of many lipoprotein particles. Previous genetic studies have focused on six genotypes defined by three alleles, denoted epsilon2, epsilon3, and epsilon4, encoded by two variable exonic sites that segregate in most populations. We have reported studies of the distribution of alleles of 20 biallelic variable sites in the gene encoding the ApoE molecule within and among samples, ascertained without regard to health, from each of three populations: African Americans from Jackson, Miss.; Europeans from North Karelia, Finland; and non-Hispanic European Americans from Rochester, Minn. Here we ask (1) how much variation in blood levels of ApoE (lnApoE), of total cholesterol (TC), of high-density lipoprotein cholesterol (HDL-C), and of triglyceride (lnTG) is statistically explained by variation among APOE genotypes defined by the epsilon2, epsilon3, and epsilon4 alleles; (2) how much additional variation in these traits is explained by genotypes defined by combining the two variable sites that define these three alleles with one or more additional variable sites; and (3) what are the locations and relative allele frequencies of the sites that define multisite genotypes that significantly improve the statistical explanation of variation beyond that provided by the genotypes defined by the epsilon2, epsilon3, and epsilon4 alleles, separately for each of the six gender-population strata. This study establishes that the use of only genotypes defined by the epsilon2, epsilon3, and epsilon4 alleles gives an incomplete picture of the contribution that the variation in the APOE gene makes to the statistical explanation of interindividual variation in blood measurements of lipid metabolism. The addition of variable sites to the genotype definition significantly improved the ability to explain variation in lnApoE and in TC and resulted in the explanation of variation in HDL-C and in lnTG. The combination of additional sites that explained the greatest amount of trait variation was different for different traits and varied among the six gender-population strata. The role that noncoding variable sites play in the explanation of pleiotropic effects on different measures of lipid metabolism reveals that both regulatory and structural functional variation in the APOE gene influences measures of lipid metabolism. This study demonstrates that resequencing of the complete gene in a sample of >/=20 individuals and an evaluation of all combinations of the identified variable sites, separately for each population and interacting environmental context, may be necessary to fully characterize the impact that a gene has on variation in related traits of a metabolic system. (+info)
Weekly update: West Nile virus activity--United States, July 17-23, 2002.
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This report summarizes West Nile virus (WNV) surveillance data reported to CDC through ArboNET and verified by states and other jurisdictions as of July 23, 2002. During the reporting week of July 17-23, nine human cases of WNV were reported from two states (Louisiana and Mississippi). During the same period, WNV infections were reported in 202 dead crows, 48 other dead birds, 13 horses, and 69 mosquito pools. (+info)
West Nile virus activity--United States, August 8-14, 2002, and Mississippi, July 1-August 14, 2002.
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This report summarizes West Nile virus (WNV) surveillance data reported to CDC through ArboNET and by states and other jurisdictions as of August 14, 2002. (+info)
Acute flaccid paralysis syndrome associated with West Nile virus infection--Mississippi and Louisiana, July-August 2002.
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West Nile virus (WNV) infection can cause severe, potentially fatal neurologic illnesses including encephalitis and meningitis. Acute WNV infection also has been associated with acute flaccid paralysis (AFP) attributed to a peripheral demyelinating process (Guillain-Barre Syndrome [GBS]), or to an anterior myelitis. However, the exact etiology of AFP has not been assessed thoroughly with electrophysiologic, laboratory, and neuroimaging data. This report describes six cases of WNV-associated AFP in which clinical and electrophysiologic findings suggest a pathologic process involving anterior horn cells and motor axons similar to that seen in acute poliomyelitis. Clinicians should evaluate patients with AFP for evidence of WNV infection and conduct tests to differentiate GBS from other causes of AFP. (+info)
Improving breastfeeding knowledge, attitudes, and practices of WIC clinic staff.
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OBJECTIVE: This study was conducted to assess the impact of a breastfeeding promotion clinic environment project implemented by the state of Mississippi on breastfeeding knowledge, attitudes, and practices of WIC clinic staff. METHODS: Thirteen pairs of matched intervention and comparison WIC clinics participated in the study. Clinical and administrative staff completed pre-test and post-test self-administered questionnaires in 1998 and 1999. RESULTS: A total of 397 staff members provided pre-test data, and 277 staff members provided post-test data. Before project implementation, the intervention and comparison groups were similar overall. The majority of staff had positive attitudes/beliefs about breastfeeding, but gaps in knowledge and practices were noted. Post-test data showed that the project improved knowledge, attitudes/beliefs, and confidence/practice of intervention clinic staff. CONCLUSIONS: Clinic environment projects, which combine physical improvements and staff training, are effective in promoting support for breastfeeding among public health clinic staff. Similar interventions may contribute to the overall effectiveness of breastfeeding promotion programs. (+info)
Analysis of environmental and biologic methyl parathion data to improve future data collection.
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The Agency for Toxic Substances and Disease Registry analyzed concurrently collected data on environmental methyl parathion (MP) and urinary p-nitrophenol (PNP) at the request of the U.S. Environmental Protection Agency (U.S. EPA). The purpose of the analysis was to assess whether individuals' age or level of residential MP contamination might predict their urinary PNP level. Unlicensed pesticide applicators had sprayed residences in Mississippi with MP, which is approved as a pesticide only for outdoor agricultural use. Data were received from Mississippi for MP wipe sample levels for 409 homes and urinary PNP levels for 929 residents of the residences sampled. In addition to descriptive and bivariate analyses, ordinal logistic regression was performed after categorizing the data. Interpretation of results was limited by several identified data gaps and pre-existing data-quality issues. On the basis of the lessons learned from identified data gaps, specific recommendations were made to the U.S. EPA for improving future data collection methods for more meaningful exposure assessment in similar environmental contaminations. The recommended changes were successfully incorporated in subsequent data collected by other states that had experienced similar residential MP spraying. (+info)
Methods of assessing neurobehavioral development in children exposed to methyl parathion in Mississippi and Ohio.
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Methyl parathion (MP), an organophosphate pesticide, was sprayed illegally for pest control in U.S. residences and businesses in Mississippi and Ohio. To evaluate the association between MP exposure and neurobehavioral development, children 6 years of age or younger at the time of the spraying and local comparison groups of unexposed children were assessed using the pediatric environmental neurobehavioral test battery (PENTB). The PENTB is composed of informant-based procedures (parent interview and questionnaires) and performance-based procedures (neurobehavioral tests for children 4 years of age or older) that evaluate each of the four broad domains (cognitive, motor, sensory, and affect) essential to neurobehavioral assessment. Children were classified as exposed or unexposed using urinary p-nitrophenol (PNP) levels and environmental wipe samples for MP. Exposure was defined as a urinary PNP level of greater than or equal to 100 ppb for the child or any other individual living in the household. Environmental wipe sample levels of greater than or equal to 150 g MP/100 cm2 and greater than or equal to 132.9 g MP/100 cm2 were used to define MP exposure for children living in Mississippi and Ohio, respectively. The PENTB was first administered in summer 1999 (year 1). The PENTB was readministered in summer 2000 (year 2) to children who participated in year 1 of the study. A description of the methods used in the study are presented. Results of data analyses for both years of the study will be presented in a separate publication. (+info)