Childhood and adult socioeconomic conditions and 31-year mortality risk in women

Links between low socioeconomic position and poor health are well established. Most previous research, however, has focused on middle-aged males and has relied on limited socioeconomic data, usually measured at one point over the life course. This paper examines all-cause, cardiovascular, and noncardiovascular mortality in women in relation to socioeconomic position at different stages of the life course. Information was collected in 1965, 1974, 1983, and 1994 and included recalled father's occupation and education as a measure of childhood socioeconomic position and the respondent's household income, education and occupation, and spouse's occupation from a sample of 3,087 women participating in the Alameda County Study. Cox regression models were used to estimate hazard ratios for risk of death. Lower childhood socioeconomic position was associated with an increased mortality due to cardiovascular disease (hazard ratio (HR) = 1.29, 95% confidence interval (CI): 1.09, 1.54) but was unrelated to death due to other causes (HR = 0.97, 95% CI: 0.82, 1.15). Overall mortality was higher among women reporting the lowest level of education (HR = 1.17, 95% CI: 0.99, 1.39), but education was most strongly related to noncardiovascular disease-related deaths (HR = 1.41, 95% CI: 1.10, 1.81). Low household income was also associated with higher mortality, for both cardiovascular disease-related (HR = 1.47, 95% CI: 1.14, 1.91) and noncardiovascular disease-related (HR = 1.30, 95% CI: 1.03, 1.63) deaths. Both early and later life indicators of socioeconomic position contribute to increased mortality risk among socioeconomically disadvantaged women, but these effects appear stronger for cardiovascular mortality.     

Inhaled beta-2 adrenergic receptor agonists and primary cardiac arrest

PURPOSE: We sought to investigate if short-acting, inhaled beta2-adrenergic receptor agonists were associated with higher risk of primary cardiac arrest in patients with asthma or chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS: We conducted a population-based study involving 454 patients enrolled in a health maintenance organization, aged 40 to 79 years, who had asthma or COPD and who experienced primary cardiac arrest during 1980 to 1994. We randomly selected 586 controls from strata of enrollees, defined by age, sex, calendar year, and prior heart disease. Medication use was assessed from computerized pharmacy data, and risk factors from medical record review. RESULTS: Use of inhaled beta-agonists was associated with a twofold increased risk of primary cardiac arrest (odds ratio [OR] = 1.9; 95% confidence interval [CI]: 1.1 to 3.3) among patients with asthma, but not among those with COPD (OR = 1.3; 95% CI: 0.6 to 2.7), after adjustment for risk factors. This association was observed only with use of two or more canisters of metered-dose, inhaled beta-agonists for 3 months, and when inhaled steroids were not used. CONCLUSION: These results support current guidelines recommending inhaled steroids as first-line asthma therapy.     

Use of multiple imputation to correct for nonresponse bias in a survey of urologic symptoms among African-American men

The Flint Men's Health Study is an ongoing population-based study of African-American men designed to address questions related to prostate cancer and urologic symptoms. The initial phase of the study was conducted in 1996-1997 in two stages: an interviewer-administered survey followed by a clinical examination. The response rate in the clinical examination phase was 52%. Thus, some data were missing for clinical examination variables, diminishing the generalizability of the results to the general population. This paper is a case study demonstrating the application of multiple imputation to address important questions related to prostate cancer and urologic symptoms in a data set with missing values. On the basis of the observed clinical examination data, the American Urological Association Symptoms Score showed a surprising reduction in symptoms in the oldest age group, but after multiple imputation there was a monotonically increasing trend with age. It appeared that multiple imputation corrected for nonresponse bias associated with the observed data. For other outcome measures-namely, the age-adjusted 95th percentile of prostate-specific antigen level and the association between urologic symptoms and prostate volume-results from the observed data and the multiply imputed data were similar.     

Lipid-lowering medication and risk of injury

Meta-analyses of early primary prevention trials of lipid-lowering therapies suggested increased risk of injury deaths among treated persons. Our population-based case-control study examined the association of lipid-lowering medication use with fatal and nonfatal injuries in 298 cases and 332 controls. No increased injury risk was observed among current (OR = 0.46, 95% CI 0.18–1.21) or past users (OR = .92, 95% CI 0.44–1.95), after adjustment for behavioral disorders, medical conditions, and health status. Stratified analyses did not reveal sub-groups at significantly increased risk. These results, consistent with recent clinical trials and meta-analyses, suggest no increased injury risk associated with lipid-lowering medications.     

Ontogeny of the immune system: fetal lamb as a model

We examined adult sheep lymphocytes for the following surface markers: Surface membrane immunoglobulin, antigen identified by anti-sheep thymocyte globulin and complement receptors. We quantitated sheep peripheral blood mononuclear leukocyte proliferative responses to mitogens and alloantigens, and demonstrated a neutrophil-directed chemotactic factor (N-LDCF) liberated by mitogen-stimulated sheep mononuclear cells. A comparison of adult and fetal sheep from 120-150 d of gestation demonstrated that 1) fetal sheep had adult proportions of surface membrane Ig+ and T+ lymphocytes but a significant decrease in FcIgG receptor+ lymphocytes, 2) proliferative responses of fetal sheep blood mononuclear cells to mitogens and alloantigens were comparable to adult responses, and 3) fetal mononuclear leukocytes failed to produce the lymphokine, N-LDCF, in response to mitogen stimulation.     

High-throughput mutation detection underlying adaptive evolution of Escherichia coli-K12

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) analysis of base-specific cleavage products is an efficient, highly accurate tool for the detection of single base sequence variations. We describe the first application of this comparative sequencing strategy for automated high-throughput mutation detection in microbial genomes. The method was applied to identify DNA sequence changes that occurred in Escherichia coli K-12 MG1655 during laboratory adaptive evolution to new optimal growth phenotypes. Experiments were based on a genome-scale in silico model of E. coli metabolism and growth. This model computes several phenotypic functions and predicts optimal growth rates. To identify mutations underlying a 40-d adaptive laboratory evolution on glycerol, we resequenced 4.4% of the E. coli-K12 MG1655 genome in several clones picked at the end of the evolutionary process. The 1.54-Mb screen was completed in 13.5 h. This resequencing study is the largest reported by MALDI-TOF mass spectrometry to date. Ten mutations in 40 clones and three deviations from the reference sequence were detected. Mutations were predominantly found within the glycerol kinase gene. Functional characterization of the most prominent mutation shows its metabolic impact on the process of adaptive evolution. All sequence changes were independently confirmed by genotyping and Sanger-sequencing. We demonstrate that comparative sequencing by base-specific cleavage and MALDI-TOF mass spectrometry is an automated, fast, and highly accurate alternative to capillary sequencing.     

Monte carlo methods for exloring sensitivity to distributional assumptions in a bayesian analysis of a series of 2 × 2 tables

This paper develops Monte Carlo methods for a Bayesian analysis of a series of 2 × 2 tables under a variety of distributional assumptions. I assume that the data in each table were generated from a pair of binomial distributions and the logarithm of odds of a favourable response follows a bivariate distribution with means that are linear functions of covariates and an arbitrary covariance matrix. I use Gibbs and importance sampling methods to obtain various characteristics of the posterior distribution of the quantities of interest. I apply the method to analyse the data from a population case-control study. Given the size of the population at risk I also derive the posterior distribution of the risk difference defined as the difference in the probabilities of disease development in the exposed and unexposed groups.     

Changes in Magnetic Resonance Imaging and Sex Behavior After 6-OHDA Injection in the Medial Preoptic Area

Magnetic resonance imaging (MRI) of the brains of male rats was done before and after destroying the catecholamine (CA) fibers by local application of 6-hydroxydopamine (6-OHDA) in the medial preoptic area (mPOA). The male sexual behavior was also assessed before and after injection of this toxic drug. The administration of 6-OHDA (8 μg) resulted in highly variable lesions, as shown by MRI and confirmed by histological examination. A hyperintense area was visible either on one or on both sides, about 1–3 h after the administration of the drug. Postmortem histofluorescence showed destruction of CA fibers in the mPOA on those sides that showed hyperintense areas in the MRI. No CA fiber destruction was seen in those rats that had shown no change in MRI after 6-OHDA injection. There was a transient reduction in sex drive score in all the 6-OHDA-treated rats. The present findings point out a correlation between the MRI changes and CA fiber destruction, whereas the transient reduction in the sexual behavior was not related to these changes. It is suggested that some biochemical events related to 6-OHDA destruction of CA fibers may have been responsible for the hyperintensity seen in the MRI.     

Race/ethnicity, life-course socioeconomic position, and body weight trajectories over 34 years: the Alameda County Study

OBJECTIVES: We investigated whether race differences in weight gain over 34 years were because of socioeconomic position (SEP) and psychosocial and behavioral factors (physical activity, cigarette smoking, alcohol consumption, depression, marital status, number of children). We used a life-course approach to SEP with 4 measures of SEP (childhood SEP, education, occupation, income) and a cumulative measure of SEP. METHODS: We used mixed models and data collected from the Alameda County Study to examine the association between race and weight change slopes and baseline weight in men (n=1186) and women (n=1375) aged 17 to 40 years at baseline (in 1965). RESULTS: All subjects gained weight over time. African American women weighed 4.96 kg (P < .001) more at baseline and gained 0.10 kg/year (P = .043) more weight than White women. Black men weighed 2.41 kg (P = .006) more at baseline but did not gain more weight than White men. The association of race with weight gain in women was largely because of cumulative SEP score. CONCLUSIONS: Interventions to prevent overweight and obesity should begin early in life and target the socioeconomically disadvantaged.     

The health of poor women under welfare reform

OBJECTIVES: We compared the health of single mothers affected by welfare reform with the health of a nationally representative sample of women to document the prevalence of poor health as single mothers experience the effects of welfare reform. METHODS: We compared risk factors and measures of health among women randomly sampled from the welfare rolls with similar data from a nationally representative sample of women. RESULTS: Women in our welfare recipient sample had higher rates of elevated glycosylated hemoglobin (> or = 6%; prevalence ratio [PR]=4.87; 95% confidence interval [CI]=2.69, 7.04), hypertension (systole > or = 140 or diastole > or = 90; PR=2.36; 95% CI = 1.47, 3.24), high body mass index ( > or = 30; PR = 1.78; 95% CI = 1.49, 2.08), and high-density lipoprotein cholesterol (< or = 35 mg/dL; PR=1.91; 95% CI=1.17, 2.65); lower peak expiratory flow; and less physical functioning. Current smoking rates were higher (PR = 1.85; 95% CI = 1.50, 2.19) and smoking cessation rates were lower (PR=0.62; 95% CI=0.37, 0.86) than in the national sample. CONCLUSIONS: Current and former welfare recipients bear a substantial burden of illness. Further studies are necessary to interpret our findings of worsened health in the wake of welfare reform.