Mark Ghamsary | Loma Linda University (original) (raw)
Papers by Mark Ghamsary
Journal of Neuroimmunology, 2012
In the present study, we investigated how increased sympathetic tone during middle-age affects th... more In the present study, we investigated how increased sympathetic tone during middle-age affects the splenic sympathetic neurotransmission. Fifteen-month-old (M) F344 rats received rilmenidine (0, 0.5 or 1.5mg/kg/day, i.p. for 90 days) to lower sympathetic tone. Controls for age were untreated 3 or 18M rats. We report that rilmenidine (1) reduced plasma and splenic norepinephrine concentrations and splenic norepinephrine turnover, and partially reversed the sympathetic nerve loss; and (2) increased β-adrenergic receptor (β-AR) density and β-AR-stimulated cAMP production. Collectively, these findings suggest a protective effect of lowering sympathetic tone on sympathetic nerve integrity, and enhanced sympathetic neurotransmission in secondary immune organs.
Pharmacotherapy, Jan 3, 2015
To evaluate the long-term risk of developing cognitive symptoms (e.g., dementia, hallucinations),... more To evaluate the long-term risk of developing cognitive symptoms (e.g., dementia, hallucinations), dyskinesia, falls, and freezing of gait (FoG) in patients with Parkinson's disease (PD) who received monoamine oxidase type B inhibitors (MAOB-Is) compared with patients who had never received MAOB-Is. Retrospective, cross-sectional, cohort study. Academic movement disorders clinic. One hundred eighty-one patients with idiopathic PD who were receiving MAOB-I therapy on a long-term basis for a minimum of 1 year (MAOB-I current-user cohort) and 121 patients with idiopathic PD who had never received MAOB-I therapy (MAOB-I never-user cohort [control group]) between January 1, 1996, and November 30, 2011. The five study outcome variables were dementia, dyskinesia, falls, FoG, and hallucinations. Baseline and outcome data were collected from medical records. Patients in the MAOB-I current-user group were included only if absence of the specified outcomes was documented at baseline. Adjust...
Epidemiology, 2004
ABSTRACT An abstract is unavailable. This article is available as HTML full text and PDF.
Parkinson's Disease, 2015
Background. Novel rehabilitation strategies have demonstrated potential benefits for motor and no... more Background. Novel rehabilitation strategies have demonstrated potential benefits for motor and non-motor symptoms of Parkinson's disease (PD). Objective. To compare the effects of Lee Silverman Voice Therapy BIG (LSVT BIG therapy) versus a general exercise program (combined treadmill plus seated trunk and limb exercises) on motor and non-motor symptoms of PD. Methods. Eleven patients with early-mid stage PD participated in the prospective, double-blinded, randomized clinical trial. Both groups received 16 one-hour supervised training sessions over 4 weeks. Outcome measures included the Unified Parkinson's Disease Rating Scale (UPDRS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Modified Fatigue Impact Scale (MFIS). Five patients performed general exercise and six patients performed LSVT BIG therapy. Post-intervention evaluations were conducted at weeks 4, 12 and 24. Results. The combined cohort made improvements at all follow-up evaluations with statistical significance for UPDRS total and motor, BDI, and MFIS ( < 0.05). Conclusion. This study demonstrated positive effects of general exercise and LSVT BIG therapy on motor and non-motor symptoms of patients with PD. Our results suggest that general exercise may be as effective as LSVT BIG therapy on symptoms of PD for patients not able to readily access outpatient LSVT BIG therapy.
Epidemiology, 2003
ABSTRACT The relationship between ambient air pollution and cardiovascular disease is currently a... more ABSTRACT The relationship between ambient air pollution and cardiovascular disease is currently a topic of debate. If there is a relationship, this could have great implications for policy regulations. Methods: To study the health effect of long-term ambient air pollution, a cohort of 6,338 nonsmoking, white California Seventh-day Adventists was followed with respect to health outcomes from 1977. To be included in the study, participants must have lived within 10 miles of their 1977 address for the previous 10 years. At baseline in 1977, a comprehensive lifestyle and diet questionnaire was completed and the cohort was followed with update of residence and workplace in order to assess monthly averages of ambient air pollutants throughout the study period. Exposure to environmental tobacco smoke, dusts and fumes in the workplaces, and time spent outdoors was assessed through selfadministered questionnaires in 1977, 1987, and again in 1992. The risk of fatal stroke (ICD: 430-438) was ascertained between 1977 and 1992 through matching with death certificates obtained from the National Death Index (NDI). Monthly indices of gaseous ambient air pollutant concentrations (O3, NO2, SO2) were obtained from the California Air Resource Board monitoring stations from 1973-1992, and interpolated to zip code centroids. Cox proportional hazards were used to estimate relative risks (RR) of CHD death associated with an interquartile range (IQR) increase in mean concentrations of each ambient air pollutant averaged over the 5-year period immediately preceding death. The analyses excluded those with prevalent strock at baseline and was controlled for age, pack-years of past cigarette smoking, history of diabetes, history of hypertension, BMI, years of education, and total exercise level. Results: Elevated risk of fatal stroke was found for all gaseous ambient air pollution levels with the highest risk estimates for SO2. Table: ISEE-346
Neuroimmunomodulation, 2008
Aging is associated with reduced cellular immunity, which leads to increased rates of infectious ... more Aging is associated with reduced cellular immunity, which leads to increased rates of infectious disease, cancer and autoimmunity in the elderly. Previous findings from our laboratory revealed an age-related decline in sympathetic innervation of immune organs that affects immunity. These studies suggested potential sympathetic nervous system involvement in age-induced immune dysregulation. The purpose of this study was to longitudinally characterize the effects of age on sympathetic neurotransmission in the spleen and net sympathetic activity/tone in male Fischer 344 rats. Splenic sympathetic neurotransmission was evaluated between 8 and 24 months of age by (1) splenic norepinephrine (NE) concentration and turnover, (2) beta-adrenergic receptor (beta-AR) expression and (3) beta-AR-stimulated splenocyte cAMP production. Measures of sympathetic neurotransmission were correlated with age-related changes in Concanavalin A (Con A)-stimulated splenocyte proliferation. Splenic NE turnover increased during middle age, then subsequently declined by 18 months of age compared with 8-month-old controls (young). Splenic NE concentration increased at 10 months and decreased at 18-24 months, compared with young rats; however, plasma NE levels were not affected by age. Plasma epinephrine levels were decreased at 24 months. NE synthesis blockade increased and decreased the rate of plasma catecholamine depletion in middle and old age, respectively. beta-AR-stimulated cAMP production increased in splenocytes by 15 months. An age-related decrease in Con A-induced splenocyte proliferation was apparent by 10 months and persisted through 24 months. The decline in Con A-induced splenocyte proliferation correlated with the age-related increase in cAMP production. Aging alters sympathetic nervous system metabolism in the spleen to affect beta-AR signaling to splenocytes, suggesting that altered sympathetic-immune modulation changes are evident by early middle age.
Journal of the American College of Cardiology, 2010
Epidemiology, 2006
ABSTRACT An abstract is unavailable. This article is available as HTML full text and PDF.
Epidemiology, 2006
ABSTRACT Home > November 2006 - Volume 17 - Issue 6 > Zip Codes or Street Addresses... more ABSTRACT Home > November 2006 - Volume 17 - Issue 6 > Zip Codes or Street Addresses? Comparing Ambient Ozone Expos... < Previous Article | Next Article > Epidemiology: November 2006 - Volume 17 - Issue 6 - p S110 ISEE/ISEA 2006 Conference Abstracts Supplement: Session Abstracts: Abstracts Zip Codes or Street Addresses? Comparing Ambient Ozone Exposures for Alternative Spatial Resolutions of Cohort Subjects Soret, S*; Ghamsary, M*; Shavlik, D*; Beeson, W L.*; Chen, L H.*; Wiafe, S*; Press, J†; Knutsen, S* Free Access Article Outline Author Information *School of Public Health, Loma Linda University, Loma Linda, CA; and †University of California, Riverside, CA SM5-PD-03 Back to Top | Article Outline Introduction: Accurate estimation of exposures is of the outmost importance for drawing valid inferences about the spatial relationship of risk factors with health outcomes of concern. In air pollution epidemiology, estimates are often derived from monitoring data. With GIS technology, we can map individuals to their street address rather than to a central location by zip code. Assuming the validity of the spatial interpolation method chosen and the representativeness of exposure data, an independent question remains: Does enhanced positional accuracy of subjects result in reduced exposure misclassification? We compared the estimated ozone exposures assigned to our cohort subjects when their locations are resolved alternatively by zip code centroids and by street addresses.
Epidemiology, 2003
ABSTRACT The relationship between ambient air pollution and cardiovascular disease is currently a... more ABSTRACT The relationship between ambient air pollution and cardiovascular disease is currently a topic of debate. If there is a relationship, this could have great implications for policy regulations. Methods: To study the health effect of long-term ambient air pollution, a cohort of 6,338 nonsmoking, white California Seventh-day Adventists was followed with respect to health outcomes from 1977. To be included in the study, participants must have lived within 10 miles of their 1977 address for the previous 10 years. At baseline in 1977, a comprehensive lifestyle and diet questionnaire was completed and the cohort was followed with update of residence and workplace in order to assess monthly averages of ambient air pollutants throughout the study period. Exposure to environmental tobacco smoke, dusts and fumes in the workplaces, and time spent outdoors was assessed through selfadministered questionnaires in 1977, 1987, and again in 1992. The risk of fatal stroke (ICD: 430-438) was ascertained between 1977 and 1992 through matching with death certificates obtained from the National Death Index (NDI). Monthly indices of gaseous ambient air pollutant concentrations (O3, NO2, SO2) were obtained from the California Air Resource Board monitoring stations from 1973-1992, and interpolated to zip code centroids. Cox proportional hazards were used to estimate relative risks (RR) of CHD death associated with an interquartile range (IQR) increase in mean concentrations of each ambient air pollutant averaged over the 5-year period immediately preceding death. The analyses excluded those with prevalent strock at baseline and was controlled for age, pack-years of past cigarette smoking, history of diabetes, history of hypertension, BMI, years of education, and total exercise level. Results: Elevated risk of fatal stroke was found for all gaseous ambient air pollution levels with the highest risk estimates for SO2. Table: ISEE-346
Environmental Health Perspectives, 2005
The purpose of this study was to assess the effect of long-term ambient particulate matter (PM) o... more The purpose of this study was to assess the effect of long-term ambient particulate matter (PM) on risk of fatal coronary heart disease (CHD). A cohort of 3,239 nonsmoking, non-Hispanic white adults was followed for 22 years. Monthly concentrations of ambient air pollutants were obtained from monitoring stations [PM < 10 µm in aerodynamic diameter (PM 10 ), ozone, sulfur dioxide, nitrogen dioxide] or airport visibility data [PM < 2.5 µm in aerodynamic diameter (PM 2.5 )] and interpolated to ZIP code centroids of work and residence locations. All participants had completed a detailed lifestyle questionnaire at baseline (1976), and follow-up information on environmental tobacco smoke and other personal sources of air pollution were available from four subsequent questionnaires from 1977 through 2000. Persons with prevalent CHD, stroke, or diabetes at baseline (1976) were excluded, and analyses were controlled for a number of potential confounders, including lifestyle. In females, the relative risk (RR) for fatal CHD with each 10-µg/m 3 increase in PM 2.5 was 1.42 [95% confidence interval (CI), 1.06-1.90] in the singlepollutant model and 2.00 (95% CI, 1.51-2.64) in the two-pollutant model with O 3 . Corresponding RRs for a 10-µg/m 3 increase in PM 10-2.5 and PM 10 were 1.62 and 1.45, respectively, in all females and 1.85 and 1.52 in postmenopausal females. No associations were found in males. A positive association with fatal CHD was found with all three PM fractions in females but not in males. The risk estimates were strengthened when adjusting for gaseous pollutants, especially O 3 , and were highest for PM 2.5 . These findings could have great implications for policy regulations. Key words: air pollution, coronary disease, ischemic heart disease, long-term exposure, mortality, particulate matter.
Annals of Epidemiology, 2005
PURPOSE: Diabetes, reported as the sixth major cause of death in the US, may be an underestimate,... more PURPOSE: Diabetes, reported as the sixth major cause of death in the US, may be an underestimate, as it is often under-reported on the death certificate. This study examines the change over time in accurate reporting and death certificate sensitivity and specificity of diabetes. METHODS: Death certificates for 3209 decedents from the Rancho Bernardo cohort were obtained. Decedents were aged 30 and older at enrollment ; mortality data was available through 2003. True diabetes status was based on history obtained at periodic clinic visits and mailed questionnaires during follow up. Diabetes listed as cause of death or reported anywhere on death certificates was abstracted. Sensitivity and specificity were stratified by sex, age at death, year, place, and cause of death, and medication use among diabetic participants; characteristics that contributed to reporting diabetes were analyzed in univariate and multivariate logistic regression models. RESULTS: There were 378 decedents with diabetes, of whom 168 had diabetes listed anywhere on the death certificates. Thus the sensitivity and specificity of diabetes reporting anywhere on the death certificate were 34.7% and 98.1% respectively.
American Journal of Kidney Diseases, 2011
Annals of Epidemiology, 2015
We sought to evaluate and distinguish roles of sociodemographic predictors for delayed- versus ea... more We sought to evaluate and distinguish roles of sociodemographic predictors for delayed- versus early-stage cervical cancer. Demographic variables for 13,624 cervical cancers having complete data for age at diagnosis (4 categories), race and ethnicity (4 categories), socioeconomic status (SES) quintiles, and marital status (3 categories) were extracted from the California Cancer Registry database for the period 1996 to 2005 and analyzed using multiple logistic regression as predictors of delayed- versus early-stage diagnosis. Fifty-eight percent of cervical cancers were among women younger than 50 years, compared with 46% of delayed-stage cases. Independent odds of delayed- versus early-stage cervical cancer were higher for older age categories within each race and ethnic group. Declining odds of delayed- versus early-stage diagnosis were evident for increasing SES quintiles among Asian or other (trend P = .015), non-Hispanic black (P = .024), Hispanic (P = .001), and non-Hispanic white (P = .001) women. Odds of delayed- versus early-stage cervical cancer were highest among unmarried compared with married women. Our findings support evidence that older age, low SES, and unmarried status predict delayed-stage cervical cancer diagnosis in each of the four major race and ethic groups. The two lowest SES quintiles independently identified larger percentages of delayed-stage cervical cancers in each of the race and ethnicity groups assessed, particularly among Hispanic and non-Hispanic black women.
Journal of Neuroimmunology, 2012
In the present study, we investigated how increased sympathetic tone during middle-age affects th... more In the present study, we investigated how increased sympathetic tone during middle-age affects the splenic sympathetic neurotransmission. Fifteen-month-old (M) F344 rats received rilmenidine (0, 0.5 or 1.5mg/kg/day, i.p. for 90 days) to lower sympathetic tone. Controls for age were untreated 3 or 18M rats. We report that rilmenidine (1) reduced plasma and splenic norepinephrine concentrations and splenic norepinephrine turnover, and partially reversed the sympathetic nerve loss; and (2) increased β-adrenergic receptor (β-AR) density and β-AR-stimulated cAMP production. Collectively, these findings suggest a protective effect of lowering sympathetic tone on sympathetic nerve integrity, and enhanced sympathetic neurotransmission in secondary immune organs.
Pharmacotherapy, Jan 3, 2015
To evaluate the long-term risk of developing cognitive symptoms (e.g., dementia, hallucinations),... more To evaluate the long-term risk of developing cognitive symptoms (e.g., dementia, hallucinations), dyskinesia, falls, and freezing of gait (FoG) in patients with Parkinson's disease (PD) who received monoamine oxidase type B inhibitors (MAOB-Is) compared with patients who had never received MAOB-Is. Retrospective, cross-sectional, cohort study. Academic movement disorders clinic. One hundred eighty-one patients with idiopathic PD who were receiving MAOB-I therapy on a long-term basis for a minimum of 1 year (MAOB-I current-user cohort) and 121 patients with idiopathic PD who had never received MAOB-I therapy (MAOB-I never-user cohort [control group]) between January 1, 1996, and November 30, 2011. The five study outcome variables were dementia, dyskinesia, falls, FoG, and hallucinations. Baseline and outcome data were collected from medical records. Patients in the MAOB-I current-user group were included only if absence of the specified outcomes was documented at baseline. Adjust...
Epidemiology, 2004
ABSTRACT An abstract is unavailable. This article is available as HTML full text and PDF.
Parkinson's Disease, 2015
Background. Novel rehabilitation strategies have demonstrated potential benefits for motor and no... more Background. Novel rehabilitation strategies have demonstrated potential benefits for motor and non-motor symptoms of Parkinson's disease (PD). Objective. To compare the effects of Lee Silverman Voice Therapy BIG (LSVT BIG therapy) versus a general exercise program (combined treadmill plus seated trunk and limb exercises) on motor and non-motor symptoms of PD. Methods. Eleven patients with early-mid stage PD participated in the prospective, double-blinded, randomized clinical trial. Both groups received 16 one-hour supervised training sessions over 4 weeks. Outcome measures included the Unified Parkinson's Disease Rating Scale (UPDRS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Modified Fatigue Impact Scale (MFIS). Five patients performed general exercise and six patients performed LSVT BIG therapy. Post-intervention evaluations were conducted at weeks 4, 12 and 24. Results. The combined cohort made improvements at all follow-up evaluations with statistical significance for UPDRS total and motor, BDI, and MFIS ( < 0.05). Conclusion. This study demonstrated positive effects of general exercise and LSVT BIG therapy on motor and non-motor symptoms of patients with PD. Our results suggest that general exercise may be as effective as LSVT BIG therapy on symptoms of PD for patients not able to readily access outpatient LSVT BIG therapy.
Epidemiology, 2003
ABSTRACT The relationship between ambient air pollution and cardiovascular disease is currently a... more ABSTRACT The relationship between ambient air pollution and cardiovascular disease is currently a topic of debate. If there is a relationship, this could have great implications for policy regulations. Methods: To study the health effect of long-term ambient air pollution, a cohort of 6,338 nonsmoking, white California Seventh-day Adventists was followed with respect to health outcomes from 1977. To be included in the study, participants must have lived within 10 miles of their 1977 address for the previous 10 years. At baseline in 1977, a comprehensive lifestyle and diet questionnaire was completed and the cohort was followed with update of residence and workplace in order to assess monthly averages of ambient air pollutants throughout the study period. Exposure to environmental tobacco smoke, dusts and fumes in the workplaces, and time spent outdoors was assessed through selfadministered questionnaires in 1977, 1987, and again in 1992. The risk of fatal stroke (ICD: 430-438) was ascertained between 1977 and 1992 through matching with death certificates obtained from the National Death Index (NDI). Monthly indices of gaseous ambient air pollutant concentrations (O3, NO2, SO2) were obtained from the California Air Resource Board monitoring stations from 1973-1992, and interpolated to zip code centroids. Cox proportional hazards were used to estimate relative risks (RR) of CHD death associated with an interquartile range (IQR) increase in mean concentrations of each ambient air pollutant averaged over the 5-year period immediately preceding death. The analyses excluded those with prevalent strock at baseline and was controlled for age, pack-years of past cigarette smoking, history of diabetes, history of hypertension, BMI, years of education, and total exercise level. Results: Elevated risk of fatal stroke was found for all gaseous ambient air pollution levels with the highest risk estimates for SO2. Table: ISEE-346
Neuroimmunomodulation, 2008
Aging is associated with reduced cellular immunity, which leads to increased rates of infectious ... more Aging is associated with reduced cellular immunity, which leads to increased rates of infectious disease, cancer and autoimmunity in the elderly. Previous findings from our laboratory revealed an age-related decline in sympathetic innervation of immune organs that affects immunity. These studies suggested potential sympathetic nervous system involvement in age-induced immune dysregulation. The purpose of this study was to longitudinally characterize the effects of age on sympathetic neurotransmission in the spleen and net sympathetic activity/tone in male Fischer 344 rats. Splenic sympathetic neurotransmission was evaluated between 8 and 24 months of age by (1) splenic norepinephrine (NE) concentration and turnover, (2) beta-adrenergic receptor (beta-AR) expression and (3) beta-AR-stimulated splenocyte cAMP production. Measures of sympathetic neurotransmission were correlated with age-related changes in Concanavalin A (Con A)-stimulated splenocyte proliferation. Splenic NE turnover increased during middle age, then subsequently declined by 18 months of age compared with 8-month-old controls (young). Splenic NE concentration increased at 10 months and decreased at 18-24 months, compared with young rats; however, plasma NE levels were not affected by age. Plasma epinephrine levels were decreased at 24 months. NE synthesis blockade increased and decreased the rate of plasma catecholamine depletion in middle and old age, respectively. beta-AR-stimulated cAMP production increased in splenocytes by 15 months. An age-related decrease in Con A-induced splenocyte proliferation was apparent by 10 months and persisted through 24 months. The decline in Con A-induced splenocyte proliferation correlated with the age-related increase in cAMP production. Aging alters sympathetic nervous system metabolism in the spleen to affect beta-AR signaling to splenocytes, suggesting that altered sympathetic-immune modulation changes are evident by early middle age.
Journal of the American College of Cardiology, 2010
Epidemiology, 2006
ABSTRACT An abstract is unavailable. This article is available as HTML full text and PDF.
Epidemiology, 2006
ABSTRACT Home > November 2006 - Volume 17 - Issue 6 > Zip Codes or Street Addresses... more ABSTRACT Home > November 2006 - Volume 17 - Issue 6 > Zip Codes or Street Addresses? Comparing Ambient Ozone Expos... < Previous Article | Next Article > Epidemiology: November 2006 - Volume 17 - Issue 6 - p S110 ISEE/ISEA 2006 Conference Abstracts Supplement: Session Abstracts: Abstracts Zip Codes or Street Addresses? Comparing Ambient Ozone Exposures for Alternative Spatial Resolutions of Cohort Subjects Soret, S*; Ghamsary, M*; Shavlik, D*; Beeson, W L.*; Chen, L H.*; Wiafe, S*; Press, J†; Knutsen, S* Free Access Article Outline Author Information *School of Public Health, Loma Linda University, Loma Linda, CA; and †University of California, Riverside, CA SM5-PD-03 Back to Top | Article Outline Introduction: Accurate estimation of exposures is of the outmost importance for drawing valid inferences about the spatial relationship of risk factors with health outcomes of concern. In air pollution epidemiology, estimates are often derived from monitoring data. With GIS technology, we can map individuals to their street address rather than to a central location by zip code. Assuming the validity of the spatial interpolation method chosen and the representativeness of exposure data, an independent question remains: Does enhanced positional accuracy of subjects result in reduced exposure misclassification? We compared the estimated ozone exposures assigned to our cohort subjects when their locations are resolved alternatively by zip code centroids and by street addresses.
Epidemiology, 2003
ABSTRACT The relationship between ambient air pollution and cardiovascular disease is currently a... more ABSTRACT The relationship between ambient air pollution and cardiovascular disease is currently a topic of debate. If there is a relationship, this could have great implications for policy regulations. Methods: To study the health effect of long-term ambient air pollution, a cohort of 6,338 nonsmoking, white California Seventh-day Adventists was followed with respect to health outcomes from 1977. To be included in the study, participants must have lived within 10 miles of their 1977 address for the previous 10 years. At baseline in 1977, a comprehensive lifestyle and diet questionnaire was completed and the cohort was followed with update of residence and workplace in order to assess monthly averages of ambient air pollutants throughout the study period. Exposure to environmental tobacco smoke, dusts and fumes in the workplaces, and time spent outdoors was assessed through selfadministered questionnaires in 1977, 1987, and again in 1992. The risk of fatal stroke (ICD: 430-438) was ascertained between 1977 and 1992 through matching with death certificates obtained from the National Death Index (NDI). Monthly indices of gaseous ambient air pollutant concentrations (O3, NO2, SO2) were obtained from the California Air Resource Board monitoring stations from 1973-1992, and interpolated to zip code centroids. Cox proportional hazards were used to estimate relative risks (RR) of CHD death associated with an interquartile range (IQR) increase in mean concentrations of each ambient air pollutant averaged over the 5-year period immediately preceding death. The analyses excluded those with prevalent strock at baseline and was controlled for age, pack-years of past cigarette smoking, history of diabetes, history of hypertension, BMI, years of education, and total exercise level. Results: Elevated risk of fatal stroke was found for all gaseous ambient air pollution levels with the highest risk estimates for SO2. Table: ISEE-346
Environmental Health Perspectives, 2005
The purpose of this study was to assess the effect of long-term ambient particulate matter (PM) o... more The purpose of this study was to assess the effect of long-term ambient particulate matter (PM) on risk of fatal coronary heart disease (CHD). A cohort of 3,239 nonsmoking, non-Hispanic white adults was followed for 22 years. Monthly concentrations of ambient air pollutants were obtained from monitoring stations [PM < 10 µm in aerodynamic diameter (PM 10 ), ozone, sulfur dioxide, nitrogen dioxide] or airport visibility data [PM < 2.5 µm in aerodynamic diameter (PM 2.5 )] and interpolated to ZIP code centroids of work and residence locations. All participants had completed a detailed lifestyle questionnaire at baseline (1976), and follow-up information on environmental tobacco smoke and other personal sources of air pollution were available from four subsequent questionnaires from 1977 through 2000. Persons with prevalent CHD, stroke, or diabetes at baseline (1976) were excluded, and analyses were controlled for a number of potential confounders, including lifestyle. In females, the relative risk (RR) for fatal CHD with each 10-µg/m 3 increase in PM 2.5 was 1.42 [95% confidence interval (CI), 1.06-1.90] in the singlepollutant model and 2.00 (95% CI, 1.51-2.64) in the two-pollutant model with O 3 . Corresponding RRs for a 10-µg/m 3 increase in PM 10-2.5 and PM 10 were 1.62 and 1.45, respectively, in all females and 1.85 and 1.52 in postmenopausal females. No associations were found in males. A positive association with fatal CHD was found with all three PM fractions in females but not in males. The risk estimates were strengthened when adjusting for gaseous pollutants, especially O 3 , and were highest for PM 2.5 . These findings could have great implications for policy regulations. Key words: air pollution, coronary disease, ischemic heart disease, long-term exposure, mortality, particulate matter.
Annals of Epidemiology, 2005
PURPOSE: Diabetes, reported as the sixth major cause of death in the US, may be an underestimate,... more PURPOSE: Diabetes, reported as the sixth major cause of death in the US, may be an underestimate, as it is often under-reported on the death certificate. This study examines the change over time in accurate reporting and death certificate sensitivity and specificity of diabetes. METHODS: Death certificates for 3209 decedents from the Rancho Bernardo cohort were obtained. Decedents were aged 30 and older at enrollment ; mortality data was available through 2003. True diabetes status was based on history obtained at periodic clinic visits and mailed questionnaires during follow up. Diabetes listed as cause of death or reported anywhere on death certificates was abstracted. Sensitivity and specificity were stratified by sex, age at death, year, place, and cause of death, and medication use among diabetic participants; characteristics that contributed to reporting diabetes were analyzed in univariate and multivariate logistic regression models. RESULTS: There were 378 decedents with diabetes, of whom 168 had diabetes listed anywhere on the death certificates. Thus the sensitivity and specificity of diabetes reporting anywhere on the death certificate were 34.7% and 98.1% respectively.
American Journal of Kidney Diseases, 2011
Annals of Epidemiology, 2015
We sought to evaluate and distinguish roles of sociodemographic predictors for delayed- versus ea... more We sought to evaluate and distinguish roles of sociodemographic predictors for delayed- versus early-stage cervical cancer. Demographic variables for 13,624 cervical cancers having complete data for age at diagnosis (4 categories), race and ethnicity (4 categories), socioeconomic status (SES) quintiles, and marital status (3 categories) were extracted from the California Cancer Registry database for the period 1996 to 2005 and analyzed using multiple logistic regression as predictors of delayed- versus early-stage diagnosis. Fifty-eight percent of cervical cancers were among women younger than 50 years, compared with 46% of delayed-stage cases. Independent odds of delayed- versus early-stage cervical cancer were higher for older age categories within each race and ethnic group. Declining odds of delayed- versus early-stage diagnosis were evident for increasing SES quintiles among Asian or other (trend P = .015), non-Hispanic black (P = .024), Hispanic (P = .001), and non-Hispanic white (P = .001) women. Odds of delayed- versus early-stage cervical cancer were highest among unmarried compared with married women. Our findings support evidence that older age, low SES, and unmarried status predict delayed-stage cervical cancer diagnosis in each of the four major race and ethic groups. The two lowest SES quintiles independently identified larger percentages of delayed-stage cervical cancers in each of the race and ethnicity groups assessed, particularly among Hispanic and non-Hispanic black women.