Cardiovascular Disease Risk Factors and Obesity of Rural and Urban Elementary School Children

Previous studies on the influence of a rural/urban setting on the prevalence of cardiovascular disease risk factors in children have not sufficiently controlled for socioeconomic status, race, gender, and perhaps, may not have included a representative sample of rural and urban children. This study compared the cardiovascular disease risk factors and rate of obesity of children living in rural and urban settings. It also determined the magnitude of the effect of the rural/urban setting on cardiovascular disease risk factors and obesity when controlling for race, socioeconomic status, and gender. The subjects were 2,113 third- and fourth-grade children; 962 from an urban setting and 1,151 from a rural setting. Height, weight, skinfolds, resting blood pressure, and total cholesterol levels were measured. Aerobic power (pVO2max) was estimated from cycle ergometry. Physical activity and smoking history were obtained from a questionnaire. Clustering analyses using adjustment for sample error indicated that total cholesterol, blood pressure, smoking, and physical activity levels of rural and urban children were not different (P > 0.10); however, body mass index and sum of skinfolds was greater for rural youth (P < 0.004). Logistic regression indicated that rural children had a 54.7 percent increased risk of obesity (P = 0.0001). This study's results indicate that, in children, a rural setting is associated with obesity, but not with the major risk factors associated with cardiovascular disease.     

The evolution of medical and surgical therapy for coronary artery disease. A 15-year perspective

To elucidate the factors associated with improved survival following coronary artery bypass surgery, we studied 5809 patients receiving medical or surgical therapy for coronary artery disease. Three factors were associated with a significant surgical survival benefit: more severe coronary disease, a worse prognosis with medical therapy, and a more recent operative date. Patients with more extensive coronary obstruction had the greatest improvement in survival. Patients with a poor prognosis because of factors such as older age, severe angina, or left ventricular dysfunction had a reduction in risk that was proportionate to their overall risk on medical therapy. Survival with surgery progressively improved over the study period and by 1984 surgery was significantly better than medical therapy for most patient subgroups. Thus, contemporary coronary revascularization is associated with improved longevity in many patients with ischemic heart disease, especially in those with adverse prognostic indicators.     

Pseudoepidural reverberation artifact: a common ultrasound artifact in fetal cranium

High-intensity reverberation artifacts frequently occur within the fetal cranium during obstetric ultrasound examinations. One hundred ninety-six static ultrasonograms obtained from 100 consecutive obstetric patients were reviewed to determine the incidence, shape, and location of high-intensity reverberation artifacts within the fetal head. Such artifacts occurred in one-third of the fetuses examined. The most common appearance was an arc-shaped artifact that occurred most frequently in the fetal hemicranium farthest from the maternal skin surface. Such an artifact can mimic epidural fluid collections and cause confusion for examiners not familiar with this finding. A discussion of this “pseudoepidural” artifact, its cause, and ways of excluding underlying intracranial pathology is presented.     

False-positive transcarinal needle aspirate in the evaluation of bronchogenic carcinoma

Advances in the staging of regional mediastinal lymph node metastases from lung carcinoma include transcarinal needle aspiration. However, since most clinicians feel that documented tumor involvement of subcarinal nodes is a strong contraindication to aggressive surgical resection, a falsely positive carinal aspirate could deny a patient potentially curative resectional surgery. Herein, we present a case of a falsely positive transcarinal needle aspirate in which resectional surgery was carried out with a subsequent 34-month disease-free state.     

Assessment of reliability and validity of IBD phenotyping within the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK) IBD Genetics Consortium (IBDGC)

BACKGROUND: The NIDDK IBD Genetics Consortium (IBDGC) collects DNA and phenotypic data from inflammatory bowel disease (IBD) subjects to provide a resource for genetic studies. No previous studies have been performed on the reliability and validity of phenotypic determinations in either Crohn's disease (CD) or ulcerative colitis (UC) using primary records. Our aim was to determine the reliability and validity of these phenotypic assessments. METHODS: The de-identified records of 30 IBD patients were reviewed by 2 phenotypers per center using a standard protocol for phenotypic assessment. Each phenotyper evaluated 10 charts on 2 occasions 5 months apart. Reliability was expressed as the kappa (kappa) statistic. Performance characteristics were determined by comparison to a consensus-derived "gold standard" and by generation of receiver operating characteristic (ROC) curves. RESULTS: Agreement for diagnosis was excellent (kappa = 0.82; 95% confidence interval [CI]: 0.71-0.92). Agreement for CD location was good for jejunal, ileal, colorectal, and perianal disease with kappa between 0.60 and 0.74 but was fair for esophagogastroduodenal (kappa = 0.36). Agreement for UC extent (kappa = 0.67; 95% CI: 0.48-0.85), and CD behavior (kappa = 0.67; 95% CI: 0.49-0.83) were very good. Area under the ROC curves was greater than 0.84 for diagnosis, CD behavior, UC extent, and ileal and colonic CD location. CONCLUSIONS: IBD phenotype classification using a standard protocol exhibited very good to excellent inter- and intrarater agreement and validity. This study highlights the importance of standard protocols in generating reliable and valid phenotypic assessments. The data will facilitate estimates of phenotyping misclassification rates that should be considered when making inferences from IBD genotype-phenotype studies.     

CES-D four-factor structure is confirmed, but not invariant, in a large cohort of African American women

This study examined the factor structure of the Centers for Epidemiologic Studies Depression Scale (CES-D) in a sample of 40,403 African American women participating in the Black Women's Health Study (BWHS). To examine within group differences in the structural characteristics of the CES-D, women were stratified by age (< 60 vs. > or = 60 years). Confirmatory factor analysis indicated that a four-factor solution was a good fit for the data in both groups. The four factors extracted (depressed, somatic, positive, and interpersonal) matched findings from previous studies in other populations. Although item loadings were identical for 19 of 20 items, when equality restrictions were placed on factor loadings, the factors were not shown to be equivalent across groups. The only observed difference in item loadings was that the item "people disliked me" loaded higher on the interpersonal factor for younger women than older women. The variance/covariance matrix differed between groups. The correlations between the depressed and somatic factors were identical for the two age groups. However, correlations among the other factors were weaker among older women. We conclude that four-factor structure of the CES-D is supported for African American women, but the relationships among the factors vary with age.