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6. Changes in Spina Bifida Lesion Level After Folic Acid Fortification in the US

Author

Mai, Cara T., Evans, Jane, Alverson, Clinton J., Yue, Xin, Flood, Timothy, Arnold, Kathryn, Nestoridi, Eirini, Denson, Lindsay, Adisa, Olufunmilola, Moore, Cynthia A., Nance, Amy, Zielke, Katherine, Rice, Sydney, Shan, Xiaoyi, Dean, Jane H., Ethen, Mary, Hansen, Brenda, Isenburg, Jennifer, and Kirby, Russell S.

Abstract

In 1992, the US Public Health Service recommended that all women capable of becoming pregnant should consume 400 μg of folic acid daily to decrease the risk of neural tube defects (ie, spina bifida and anencephaly). The year 1998 brought mandated folic acid fortification of cereal products within the United States, following which a substantial decline in neural tube defects at birth occurred. Studies also have suggested that lesion levels in cases of spina bifida are directly affected by folic acid fortification. Locations of such lesions contribute to outcome and prognosis of the condition. When compared with sacral and lower lumbar lesions, the greatest risks of disability and mortality are associated with cervical, thoracic, and high lumbar lesions. Individuals with thoracic or high lumbar lesions require a wheelchair and orthosis in adulthood for ambulation 70% to 99% of the time. As lesion levels therefore determine function and overall quality of life, assessment of whether folic acid fortification significantly impacts lesion levels is important. This study aimed to examine patterns of lesion levels in spina bifida following mandatory folic acid fortification in the United States.A call was issued by the National Birth Defects Prevention Network for State Birth Defects Programs' spina bifida lesion data before and after fortification mandate. To be eligible, programs needed to provide verbatim medical record text descriptions of spina bifida diagnoses. The 6 participating programs were from the states of Arizona, California (covering 8 counties), Oklahoma, South Carolina, Utah, and metropolitan Atlanta (Georgia). Birth years examined included the prefortification years of 1992–1996 and the postfortification period of 1999–2016. Central processing and analysis occurred as each program provided case-level data (deidentified) based on the exclusion/inclusion criteria to the Centers for Disease Control and Prevention. Medical and record text description of the spina bifida diagnosis and codes were the basis of case information, using the International Classification of Diseases, Ninth Edition, Clinical Modificationor the Centers for Disease Control and Prevention and Prevention/British Pediatric Association coding system. Types of spina bifida included in the study were spinal rachischisis, myelomeningocele/meningomyelocele, meningocele, and spina bifida not otherwise specified. Cases excluded were cranial lesions, lipomyelomeningocele/lipomeningomyelocele, dysraphism related to split cord malformations, and spina bifida occulta.Lesion-level information was provided based on the highest lesion using nonradiographic clinical assessment. Classification of severe upper-level lesions included cervical or thoracic lesion-level cases, whereas lower-level lesions included cases with lumbar or sacral. The study defined open lesion as leaking spinal fluid or membrane covered only, whereas closed lesions were defined as having intact-skin covering and lacking fluid leakage. Spina bifida cases were considered isolated when no other anomalies related to the primary cause of abnormal neural tube closure were present (nor were secondary to the neurologic complications caused by it). Examining associations between fortification period and the outcomes (lesion level and spina bifida) occurred using the generalized estimating approach to logistic (case severity analyses) and log-linear (PR analyses) regression, which accounted for clustering of cases by state.From a total of 7,816,062 live births, 2593 cases of spina bifida met the case inclusion criteria. Overall, 573 cases were included in the prefortification period (birth prevalence of 4.07 per 10,000 live births), and 2020 cases were included in the postfortification period (birth prevalence of 3.15 per 10,000 live births). Overall, 80.2% of cases resulted in live births, and most cases of spina bifida involved lower-level lesions (81.3%). Most lesions were lumbar, and the proportions prefortification and postfortification were 61.4% and 72.0%, respectively, with a higher proportion of lumbar lesions seen in the postfortification period. The odds of upper-level to lower-level lesions decreased by 70% after fortification. The spina bifida live birth prevalence decreased significantly and remained consistently low throughout the early, mid, and recent postfortification periods. The study found a 72% decrease overall in prevalence of severe, upper-level lesions following mandatory folic acid fortification in the United States.The limitations of the study include the shortcomings of relying on diagnostic codes, the difficulty of coding lesion level using the International Classification of Diseases, Ninth Edition, Clinical Modificationcoding scheme, the lack of recorded functional outcome for children in medical records (indirect indicators of severity), the lack of preconception and prenatal folic acid data, and the possible variation of case ascertainment within programs contributing studies. A major study strength is its potential to address additional important questions regarding epidemiology and spina bifida. The classification of spinal defects is complex, and this study adds to the limited distribution data that exist for prefortification and postfortification subtypes.The study concluded that the overall prevalence of severe upper-level lesions in spina bifida cases experienced a steep reduction following mandatory folic acid fortification institution within the United States, whereas no change in the prevalence of less severe lower-level lesions took place. Additional examinations are warranted to better understand the magnitude and mechanism of spina bifida severity in relation to folic acid intake.

Published
2023
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7. Argon Laser Photocoagulation For Macular Edema In Branch Vein Occlusion

Author

Clarkson, John G., primary, Gass, J. Donald M., additional, Curtin, Victor T., additional, Norton, Edward W.D., additional, Blankenship, George W., additional, Flynn, Harry W., additional, Mulé, Marilyn, additional, Leyden, Kathy, additional, Guice, Ivy, additional, Liang, James, additional, Diddie, Kenneth R., additional, Rvan, Stephen J., additional, Smith, Ronald E., additional, Ober, Richard R., additional, Walonker, Frances, additional, Borkowski, Nancy, additional, Trempe, Clement L., additional, Schepens, Charles L., additional, Freeman, H. MacKenzie, additional, McMeel, J. Wallace, additional, Anderson, Sherrill F., additional, Lane, Lynda, additional, Orth, David H., additional, Flood, Timothy P., additional, Vygantas, Charles M., additional, June-Arredondo, Linda, additional, Martia, Roberta, additional, Goldberg, Morton F., additional, T'so, Mark O.M., additional, Fitzgerald, Teri, additional, Finkelstein, Daniel, additional, Patz, Arnall, additional, Fine, Stuart, additional, Rice, Thomas, additional, Rytel, Dolores, additional, Clarkson, John, additional, Orth, David, additional, Trempe, Clement, additional, Kimball, Allyn W., additional, Goldberg, Israel, additional, Kelley, James S., additional, Patz, Amall, additional, Carr, Ronald E., additional, Goldberg, Everett F., additional, Jensen, Allan D., additional, Meinert, Curtis, additional, Ferris, Frederick, additional, Hillis, Argye, additional, Melia, Michele, additional, Mead, Lucy, additional, Massof, Darcy, additional, Marquart, Chestina H., additional, and Bowman, Janet, additional

Published
2018
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8. Photic Maculopathy After Pterygium Excision

Author

SUDARSHAN, ALEXANDER P., KARP, KENNETH O., FLOOD, TIMOTHY P., WILDER, AMY L., and EPSTEIN, RANDY J.

Subjects
Macula lutea, Anesthesia -- Dosage and administration, Health
Published
2000

10. Changes in Spina Bifida Lesion Level after Folic Acid Fortification in the US.

Author

Mai, Cara T., Evans, Jane, Alverson, Clinton J., Yue, Xin, Flood, Timothy, Arnold, Kathryn, Nestoridi, Eirini, Denson, Lindsay, Adisa, Olufunmilola, Moore, Cynthia A., Nance, Amy, Zielke, Katherine, Rice, Sydney, Shan, Xiaoyi, Dean, Jane H., Ethen, Mary, Hansen, Brenda, Isenburg, Jennifer, and Kirby, Russell S.

Abstract

Objective: To assess whether the severity of cases of spina bifida changed after the institution of mandatory folic acid fortification in the US.Study Design: Six active population-based birth defects programs provided data on cases of spina bifida for 1992-1996 (prefortification period) and 1999-2016 (postfortification period). The programs contributed varying years of data. Case information included both a medical record verbatim text description of the spina bifida diagnosis and spina bifida codes (International Classification of Diseases, Clinical Modification, or a modified birth defects surveillance coding system). Comparing the prefortification and postfortification periods, aORs for case severity (upper-level lesions [cervical, thoracic] vs lower-level lesions [lumbar, sacral]) and prevalence ratios (PRs) were estimated.Results: A total of 2593 cases of spina bifida (out of 7 816 062 live births) met the inclusion criteria, including 573 cases from the prefortification period and 2020 cases from the postfortification period. Case severity decreased by 70% (aOR, 0.30; 95% CI, 0.26-0.35) between the fortification periods. The decrease was most pronounced for non-Hispanic White mothers. Overall spina bifida prevalence declined by 23% (PR, 0.77; 95% CI, 0.71-0.85), with similar reductions seen across the early, mid, and recent postfortification periods. A statistically significant decrease in upper-level lesions occurred in the postfortification period compared with the prefortification period (PR, 0.28; 95% CI, 0.22-0.34), whereas the prevalence of lower-level lesions remained relatively similar (PR, 0.94; 95% CI, 0.84-1.05).Conclusions: The severity of spina bifida cases decreased after mandatory folic acid fortification in the US. Further examination is warranted to better understand the potential effect of folic acid on spina bifida severity. [ABSTRACT FROM AUTHOR]

Published
2022
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14. Author reply

Author

Karp, Kenneth O, primary, Flood, Timothy P, additional, Wilder, Amy L, additional, and Epstein, Randy J, additional

Published
2000
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15. The Endophthalmitis Vitrectomy Study

Author

Johnson, Mark W., primary, Doft, Bernard H., additional, Kelsey, Sheryl F., additional, Barza, Michael, additional, Wilson, Louis A., additional, Barr, Charles C., additional, Wisniewski, Stephen R., additional, Vine, Andrew K., additional, Blodi, Barbara A., additional, Elner, Susan G., additional, Johnson, Mark W., additional, Jessup, Laurie M., additional, Khanderia, Sharad, additional, Pierson, Carl L., additional, Willis, Julie, additional, McIver, Frances, additional, Stanley, Sally, additional, Sneed, Scott R., additional, Capone, Antonio, additional, Aaberg, Thomas M., additional, Lim, Jennifer I., additional, Sternberg, Paul, additional, Coffman, Diana S., additional, Moore, Cameile N., additional, Gardner, Susanne K., additional, Nolte, Frederick S., additional, Fremstad, Ann, additional, Gibbs, Deborah, additional, Gilman, James, additional, Swords, Ray, additional, Aguilar, H.Edith, additional, Meredith, Travis A., additional, Lakhanpal, Vinod, additional, Christian, Faith D., additional, Hood, A., additional, Schwalbe, Richard S., additional, Billings, Emery E., additional, Buie, William, additional, Mallonee, James J., additional, Millar, Mary Ann, additional, Verbeek, Sharon, additional, Campochiaro, Peter A., additional, Palardy, Carol B., additional, Reynolds, Lois, additional, Dick, James D., additional, Cain, Dennis, additional, D'Amico, Donald J., additional, Frederick, Albert R., additional, Morley, Michael G., additional, Pesavento, Richard D., additional, Puliafito, Carmen A., additional, Topping, Trexler M., additional, Finn, Susan M., additional, Raymond, Laura A., additional, Baker, Ann Sullivan, additional, Paton, Barbara, additional, Evans, Claudia, additional, Napoli, Jeffrey, additional, Kierman, Christine, additional, Makris, Kathryn, additional, McInnes, Tom, additional, Reidy, Wini T., additional, White, Ruth, additional, Garfinkel, Richard A., additional, Pilkerton, A.Raymond, additional, Frantz, Robert A., additional, Abernathy, Gill B., additional, Barbaccia, Jay G., additional, Ensey, H.Russell, additional, Ormes, Carol A., additional, Park, Choong H., additional, Caplan, Joel, additional, Russell, Kathryn, additional, Toma, Robert, additional, Packo, Kirk H., additional, de Bustros, Serge, additional, Flood, Timothy P., additional, Glazer, Louis, additional, DeAlba, Maggie, additional, Evanich, Evangeline, additional, Montwill, Michael A., additional, Rothman, Jeri J., additional, Ruderman, Gail, additional, Beard, Melodie, additional, Landau, William, additional, Shen, Min H., additional, Gordon, Martha, additional, Graff, Sharon, additional, Kwiatkowski, Kathy, additional, Pappas, Loreen, additional, Bryant, Douglas, additional, Doherty, Don, additional, Morini, Frank, additional, Arredondo, Linda, additional, Garretson, Bruce R., additional, Gerena, Carlos, additional, Hunt, Maureen, additional, Kinnaird, Sharon M., additional, Neri, Toni, additional, Rice, Thomas A., additional, Novak, Michael A., additional, Rowe, Pamela S., additional, Jamieson, Scott, additional, Newberry, Deborah, additional, Rech, Glenn R., additional, Dul, Michael J., additional, Kinser, Livia, additional, Strozewski, Krystyna, additional, Clark-Rath, Susan, additional, DeLisio, Marty, additional, Dempsey, David L., additional, Kukula, Donna, additional, Pinter-Smith, Anne, additional, Smith-Brewer, Sheila, additional, Ludwig, Tracey, additional, Chambers, Robert B., additional, Davidorf, Frederick H., additional, Taylor, Cindy S., additional, Hale, Karen N., additional, Buesching, William J., additional, Chaudhuri, Chhanda, additional, Cover, Nanci J., additional, Shortlidge, Gail R., additional, Keating, Michael J., additional, Savage, Scott J., additional, Andrzejewska, Paula, additional, Cometet, Susan, additional, Milliron, Jill D., additional, Richmond, Rob, additional, Schneider, Lori, additional, Weisenberger, Debra, additional, Cantrill, Herbert L., additional, Ramsay, Robert C., additional, Brallier, Amy B., additional, Johnson, Timothy P., additional, Rossing, Edith E., additional, Knauth, Kathleen A., additional, Monahan, Martha M., additional, Oestreich, Neal W., additional, Clark, Kenneth F., additional, Glennen, Anita M., additional, Yarian, David L., additional, Green, Stuart N., additional, Leff, Steven R., additional, Masciulli, Leo, additional, Lucido, Margaret M., additional, Ludwig, Edward J., additional, Marano, Charlotte L., additional, Peters, Linda, additional, Joho, Kim, additional, Volkert, Doris C., additional, Andersen, Finn, additional, Coffey, Donna, additional, Schlosser, Alex, additional, Honeywell, Ann, additional, Mames, Robert N., additional, Driebe, William T., additional, Stern, George A., additional, Francis, Amye, additional, Zam, Z.Suzanne, additional, Cooper, Rhonda, additional, Gaskins, Darla, additional, Shamis, Diana J., additional, Willingham, Melinda, additional, Barker, Kay, additional, Rosa, Harry, additional, Friedman, Scott M., additional, Gardner, Thomas W., additional, Blankenship, George W., additional, Coyle, Carole J., additional, Bero, Christopher J., additional, Halas, Cindy, additional, Schick, Suzanne, additional, Walker, Jean, additional, Cunningham, Denise, additional, Lambert, H.Michael, additional, Clogston, Pamela S., additional, Frady, Pamela M., additional, Gardner, S.Neal, additional, Osato, Michael S., additional, Carr, Louise, additional, Shigley, James, additional, Lopez, Pedro F., additional, Chong, Lawrence P., additional, Frambach, Donald A., additional, CisnerosMargaret^Padilla, Lupe, additional, Yee, Edmond Ming, additional, Nakamura, Tamako, additional, Walonker, A.Frances, additional, Morales, Ronald, additional, Nichols, Tracy, additional, Huete, Maria E., additional, Liggett, Peter E., additional, Ober, Richard R., additional, Quillen-Thomas, Beth, additional, Williams, Mark, additional, Bloom, Steven M., additional, Greene, Pamela J., additional, Whittington, Greg K., additional, Martin, Mark E., additional, Watson, Glen, additional, Jenkins-Curry, Betty, additional, Gilkey, Leigh A., additional, Huelsman, Steven, additional, Han, Dennis P., additional, Burton, Thomas C., additional, Mieler, William F., additional, Pulido, Jose S., additional, Reeser, Frederick H., additional, Newman, Janet L., additional, Werner, Kathy A., additional, Pisarzewicz, Paul J., additional, Reinerio, Nina A., additional, Walloch, Mary Lee K., additional, Wilmer, Zuzana, additional, Laabs, Jan, additional, Picchiottino, Ruth, additional, Phillips, Jim, additional, Wipplinger, Walter, additional, Abrams, Gary W., additional, Jurkiewicz, Dale T., additional, Leet, Margaret L., additional, Mandel, Paul, additional, Metzger, Kim, additional, Suchla, Lori, additional, Zarling, Denise, additional, Balles, Mark W., additional, Ryan, Edwin H., additional, Knobloch, William H., additional, Cook, Sally M., additional, Luke, Darlette G., additional, Ferrieri, Patricia, additional, Schiminsky, Norynne M., additional, Genia, Anne, additional, Philiph, David A., additional, Stinson, Elizabeth K., additional, Wright, Linda M., additional, McMichael, William C., additional, Mielke, Sandy J., additional, Ponwith, Lisa J., additional, Pavan, Peter Reed, additional, Pautler, Scott E., additional, Coats, Marion L., additional, Kirk, Nancy M., additional, Millard, Sharon M., additional, Castellano, Frank C., additional, Edwards, Charlotte R., additional, Marquardt, Angela, additional, McCormack, Amy J., additional, McCormick, Michael T., additional, Renshaw, Bernard, additional, Restuccia, Angela, additional, Campbell, Monica, additional, Christopher, Nell, additional, Garrett, L.Scott, additional, Halkias, Demetrios G., additional, Hothersall, Kim, additional, Mickler, Karen, additional, Minnick, Thomas S., additional, Burr, Cheryl, additional, Saxon, Wyatt, additional, Arcacha, Miguel A., additional, Carlton, Steve, additional, Edison, Sonya K., additional, Mallis, Marc J., additional, Sayers, Tamre L., additional, Sudds, Thomas W., additional, Tiberia, Robert J., additional, Wolabaugh, Sherry, additional, Bradford, Reagan H., additional, Parke, David W., additional, Wolf, Thomas C., additional, Shofner, Janie M., additional, Tobey, Lee E., additional, Jensen, Harold G., additional, Sanchez, Dinah, additional, Shofner, Janie, additional, Burris, Russell, additional, Drake, Kellie K., additional, Grissom, Kay R., additional, Rowsey, J.James, additional, Wilkinson, Charles P., additional, Brown, Gary C., additional, Benson, William E., additional, Federman, Jay L., additional, Lucier, Alfred C., additional, Maguire, Joseph I., additional, Sarin, Lov K., additional, Shakin, Eric P., additional, Sivalingam, Arunan, additional, Tasman, William, additional, Vander, James F., additional, Ward, Nancy, additional, Weisbecker, Clement A., additional, Agnew, Caroline L., additional, Lambert, Richard, additional, Torner, Terrance, additional, Carlson, Kathy, additional, Franchine, Gerrie, additional, Serfass, Michelle S., additional, Bergren, Robert L., additional, Lobes, Louis A., additional, Olsen, Karl R., additional, Rinkoff, Jeffrey S., additional, Metz, Donna J., additional, Leonard, Margaret N., additional, Karenchak, Lisa M., additional, Kowalski, Regis P., additional, Wellman, Lynn A., additional, Wilcox, Linda A., additional, Campbell, Alan F., additional, Steinberg, David R., additional, Vagstad, Gary L., additional, Flook, Kimberly A., additional, Good, Mary M., additional, Keenen, Beverly J., additional, Mellinger, Kim A., additional, Margherio, Raymond R., additional, Cox, Morton S., additional, Murphy, Patrick L., additional, Trese, Michael T., additional, Werner, Jane C., additional, Williams, George A., additional, Manatrey, Patricia E., additional, Prote, Janet L., additional, Lucarotti, Richard, additional, Martin, Susan, additional, Band, Jeff, additional, Bostic, Grace, additional, Gumming, Kristi, additional, Mitchell, Beth, additional, Regan, Virginia S., additional, Bridges, Craig, additional, Cox, Sam, additional, Houston, Gary, additional, Johnson, John, additional, Streasik, Pat, additional, Wood, Betty, additional, Blumenkranz, Mark S., additional, Cayo, Lisa, additional, Kaye, Virginia, additional, Valenzuela, Carmen Luz, additional, Orgel, Ira K., additional, Poliner, Lon S., additional, Tornambe, Paul E., additional, Cannon, Sarah V., additional, Nielsen, Janet L., additional, Carlson, Anne, additional, Chan, Pauline, additional, Drake, Lynne, additional, Grim, Martha, additional, Peterson, Corky, additional, Borg, Lynn A., additional, Gillyatt, Joann, additional, Beyer, Conny, additional, Hammer, Mark E., additional, Grizzard, W.Sanderson, additional, Shannon, Theresa L., additional, Traynom, Janet R., additional, Collado, Melinda J., additional, McManus, Dennis W., additional, Sweeney, Daniel E., additional, Adams, Donald H., additional, Watson, Thomas T., additional, Antworth, Michael V., additional, Araos, Johanna Glacy, additional, Greenwald, Mark A., additional, Habib, Mohsen, additional, Myers, Sandra K., additional, Ockers, Karen M., additional, Thibodeau, Judy-Ann, additional, Watkins, Brett, additional, Nelsen, Philip T., additional, Rosenthal, J.Gregory, additional, Mintz, Fay V., additional, Biedenbach, Michael, additional, Leonardy, Nicholas J., additional, Lawniczak, Sue M., additional, Bork, Chuck, additional, Hageage, George, additional, Hunter, Evelyn B., additional, Marshall, MarLynn J., additional, Roman, Patricia, additional, Hill, Rick, additional, Hofbauer, Thomas, additional, Lemanowicz, Jack, additional, Cupples, Howard P., additional, Guzman, Gladys I., additional, Brodeur, Richard J., additional, Yee, Donald, additional, Delaha, Edward C., additional, Geyer, Stanley L., additional, Slovis, Stacey, additional, Shields, William J., additional, Lauber, Susan, additional, Michelitsch, Karl, additional, Kassoff, Aaron, additional, Watling, Sharon, additional, Buehler, JoAnne C., additional, McVay, Jeffrey, additional, Podobinski, Gale K., additional, Sillett, Robert L., additional, Groer, Shirley, additional, Avery, Brian, additional, Belle, Steven H., additional, Boles, James, additional, Henry, Linda, additional, Shema, Sarah J., additional, Titus-Emstoff, Linda, additional, Davis, Matthew, additional, Magli, Yvonne L., additional, Hubbard, Larry, additional, Thomas, Suzanne, additional, Everett, Donald F., additional, Mowery, Richard, additional, Everett, Donald, additional, Davis, Kathryn, additional, Azen, Stanley, additional, Covey, Preston, additional, McCuen, Brooks, additional, Packer, Andrew, additional, and Robin, Jeffrey, additional

Published
1997
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16. Authors' reply

Author

Clarkson, John G., primary, Coscas, Gabriel, additional, Finkelstein, Daniel, additional, Flood, Timothy P., additional, Gutman, Froncie A., additional, Hillis, Argye, additional, Klein, Michael L., additional, Orth, David H., additional, Singerman, Lawrence J., additional, Trempe, Clement, additional, and Wallow, Ingolf H.L., additional

Published
1996
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17. Evaluation of Grid Pattern Photocoagulation for Macular Edema in Central Vein Occlusion

Author

Clarkson, John G., primary, Chuang, Elaine, additional, Gass, Donald, additional, Pedroso, Maria, additional, Cubillas, Tony, additional, Duria, Erlinda S., additional, Hess, Ditte J., additional, Rams, Isabel, additional, Ball, Marguerite, additional, Gutierrez, Alex, additional, Muniz, Nayla, additional, Thompson, June, additional, Pall, Michele, additional, Pappas, Charles J., additional, Finkelstein, Daniel, additional, Patz, Arnall, additional, Rytel, Dolores, additional, Belt, Judy, additional, Cain, Dennis, additional, Cain, Terri, additional, Emmert, David, additional, George, Terry, additional, Herring, Mark, additional, Sotirakos, Pete, additional, Orth, David H., additional, Flood, Timothy P., additional, Packo, Kirk H., additional, Larsen, Toni, additional, Perez, Nancy, additional, Bryant, Doug, additional, Doherty, Don, additional, Fitzgerald, Jay, additional, Gordon, Martha, additional, Holod, Cynthia, additional, Kwiatkowski, Kathy, additional, MacLeod, Celeste, additional, Morrison, Chris, additional, Westcott, Charlotte, additional, Klein, Michael L., additional, Wilson, David, additional, Weleber, Richard G., additional, Nolte, Susan, additional, Hurlburt, Nancy, additional, Evans, Mark, additional, Wallace, Patrick, additional, Steinkamp, Peter, additional, Funkner, Debora, additional, Gordon, Cathy, additional, Trempe, Clement, additional, Jalkh, Alex, additional, Weiter, John, additional, Anderson, Sherry, additional, Donovan, Dennis, additional, O'Day, Tom, additional, Friedman, Gerald, additional, Immerman, Rodney, additional, Coscas, Gabriel, additional, Soubrane, Gisele, additional, Haran, Rose Marie, additional, Debibie, Christophe, additional, Gizelsky, Jean, additional, Wallow, Ingolf H.L., additional, de Venecia, Guillermo, additional, Bresnick, George, additional, Larson, Sandra, additional, Fuller, Sandy, additional, Harrison, Bob, additional, Knutson, Gene, additional, Neider, Michael, additional, Weber, Greg, additional, Bahr, Ruth, additional, Grosnick, Bonnie, additional, Lazorik, Robert, additional, Lyngaas, Helen, additional, Quackenboss, Diane, additional, Somers, Guy, additional, Gutman, Froncie A., additional, Myers, Sanford, additional, Kiss, Tina, additional, Ross, Deborah, additional, Vargo, Pamela, additional, Edgarton, Janet, additional, Hanson, Sue, additional, Nader, Janet, additional, Tomsak, Nancy, additional, Singerman, Lawrence J., additional, Zegarra, Hernando, additional, Lichterman, Susan, additional, Fowler Kramer, Adrienne, additional, Smith-Brewer, Sheila, additional, Brown Rowe, Pam, additional, Daley, Geraldine, additional, Pinter, Anne, additional, Coreno, Kathy, additional, Cooper, Lori, additional, Delisio, Marty, additional, Cross, Donna, additional, Lord, Wendy, additional, Hillis, Argye, additional, Riggs, Mark W., additional, KasbergPreece, Cheryl, additional, Rajab, M. Hasan, additional, Giniewicz, Krista Carlson, additional, Gilmore, Kevin, additional, Zimmerman, Carol, additional, Clarkson, John G., additional, Lewis, Mary Lou, additional, Wells, Maria Cristina, additional, Forbes, Julie Lord, additional, Fetzer, Kathleen C., additional, McNish, Heather, additional, Bresnick, George H., additional, McNulty, Lissa, additional, Baliker, Jim, additional, Alanen, Linda, additional, Gentry, Laura, additional, Mowery, Richard L., additional, Everett, Donald F., additional, Hardy, Robert J., additional, Abrams, Gary, additional, Frank, Robert N., additional, Maguire, Maureen G., additional, and McCall, Abner V., additional

Published
1995
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18. Pneumatic Retinopexy

Author

Tornambe, Paul E., primary, Hilton, George F., additional, Brinton, Daniel A., additional, Flood, Timothy P., additional, Green, Stuart, additional, Grizzard, W. Sanderson, additional, Hammer, Mark E., additional, Leff, Steven R., additional, Masciulli, Leo, additional, Morgan, Craig M., additional, Orth, David H., additional, Packo, Kirk H., additional, Poliner, Lon S., additional, Taren, Douglas L., additional, Tiedeman, James S., additional, and Yarian, David L., additional

Published
1991
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20. Process for Determining the Cancer Burden of the Hopi Tribe

Author

Brown, Sylvia R., Joshweseoma, Lori, Flood, Timothy, and Coe, Kathryn

Abstract

The Hopi Tribe is located in the northeastern part of Arizona on more than one million acres of federally reserved land. Tribally based community research, conducted in collaboration with University of Arizona researchers, has been successfully implemented on Hopi beginning with a cross-sectional community survey in 1993 and continuing with a second survey in 2006. Both surveys identified a strong community interest in cancer.This article reports on the process involved in a third study, in which official Hopi enrollment data were matched with Arizona Cancer Registry data. The process involved bringing in a new partner and obtaining tribal, state, and university approvals, as well as a signed data exchange agreement between the state and the Hopi Tribe. Technical implementation of the data match required computer programming and epidemiologic expertise, as well as an understanding of the community and the culture. Close collaboration among Hopi residents and university epidemiologists was critical.

Published
2010
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21. Premaxillary Osteotomy and Guided Tissue Regeneration in Secondary Bone Grafting in Children with Bilateral Cleft Lip and Palate

Author

Scott, Julia K., Webb, Roger M., and Flood, Timothy R.

Abstract

Objective: To introduce a surgical technique for secondary alveolar bone grafting performed in conjunction with premaxillary osteotomy and guided tissue regeneration in children with bilateral clefts. This paper also looks at the outcomes of this surgery in a series of 15 consecutive patients.Methods: Secondary alveolar bone grafting (with a premaxillary osteotomy and guided tissue regeneration with a collagen membrane) is usually carried out in the mixed dentition stage. This retrospective study used patients’ medical records, radiographs, and clinical examination to assess the outcome of the surgery. Patients were followed up for an average of 3 years.Results: Bone grafting was successful in all cases. No premaxillae were lost and there was no long-term morbidity of the donor site. Radiographic assessment of the bone heights showed an average of 94% retention, 3 months postoperatively. Preliminary assessment of maxillary canine eruption is encouraging, with 79% being fully erupted in those patients who are at least 3 years post–bone grafting.Conclusion: Premaxillary osteotomy allows repositioning of the premaxilla to its optimal preplanned position and successful closure of all fistulae. We have found that use of a collagen membrane is a useful adjunct.

Published
2007
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22. Prevalence of birth defects among infants of Gulf War veterans in Arkansas, Arizona, California, Georgia, Hawaii, and Iowa, 1989–1993This article was prepared by a group consisting of both United States government employees and non‐United States government employees, and as such is subject to 17 U.S.C. Sec. 105.This article is a US government work and, as such, is in the public domain in the United States of America.This study was conducted in accordance with the Department of the Navy's Protection of Human Subjects guidelines. This represents report no. 01‐25 supported by the Bureau of Medicine and Surgery Navy Medical Research, under DoD/HA reimbursable‐6423. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, the Department of Defense, or the U.S. Government. Approved for public release; distribution unlimited.

Author

G. Araneta, Maria Rosario, Schlangen, Karen M., Edmonds, Larry D., Destiche, Daniel A., Merz, Ruth D., Hobbs, Charlotte A., Flood, Timothy J., Harris, John A., Krishnamurti, Diane, and Gray, Gregory C.

Abstract

Epidemiologic studies of birth defects among infants of Gulf War veterans (GWV) have been limited to military hospitals, anomalies diagnosed among newborns, or self‐reported data. This study was conducted to measure the prevalence of birth defects among infants of GWVs and nondeployed veterans (NDV) in states that conducted active case ascertainment of birth defects between 1989–93.Military records of 684,645 GWVs and 1,587,102 NDVs were electronically linked with 2,314,908 birth certificates from Arizona, Hawaii, Iowa, and selected counties of Arkansas, California, and Georgia; 11,961 GWV infants and 33,052 NDV infants were identified. Of these, 450 infants had mothers who served in the Gulf War, and 3966 had NDV mothers.Infants conceived postwar to male GWVs had significantly higher prevalence of tricuspid valve insufficiency (relative risk [RR], 2.7; 95% confidence interval [CI], 1.1–6.6; p = 0.039) and aortic valve stenosis (RR, 6.0; 95% CI, 1.2–31.0; p = 0.026) compared to infants conceived postwar to NDV males. Among infants of male GWVs, aortic valve stenosis (RR, 16.3; 95% CI, 0.09–294; p = 0.011) and renal agenesis or hypoplasia (RR, 16.3; 95% CI, 0.09–294; p = 0.011) were significantly higher among infants conceived postwar than prewar. Hypospadias was significantly higher among infant sons conceived postwar to GWV women compared to NDV women (RR, 6.3; 95% CI, 1.5–26.3; p = 0.015).We observed a higher prevalence of tricuspid valve insufficiency, aortic valve stenosis, and renal agenesis or hypoplasia among infants conceived postwar to GWV men, and a higher prevalence of hypospadias among infants conceived postwar to female GWVs. We did not have the ability to determine if the excess was caused by inherited or environmental factors, or was due to chance because of myriad reasons, including multiple comparisons. Although the statistical power was sufficient to compare the combined birth defects prevalence, larger sample sizes were needed for less frequent individual component defects. Birth Defects Research (Part A) 67:246–260, 2003. Published 2003 Wiley‐Liss, Inc.

Published
2003
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23. Foveal Neovascularization in Diabetic Retinopathy

Author

Joondeph, Brian C., Joondeph, Howard C., and Flood, Timothy P.

Abstract

• Retinal neovascularization in diabetes mellitus almost always occurs at the optic disc and/or near the major nasal and temporal vascular arcades, sparing the foveal area. We examined seven eyes of seven patients with long-standing insulin-dependent diabetes mellitus who had unilateral foveal retinal neovascularization. The neovascularization originated from the perifoveal capillaries and demonstrated typical leakage on fluorescein angiography.

Published
1987
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24. Vitrectomy and Whipple's Disease

Author

Durant, William J., Flood, Timothy, Goldberg, Morton F., Tso, Mark O. M., Pasquali, Larry A., and Peyman, Gholam A.

Abstract

• We diagnosed Whipple's disease from the vitreous aspirate of two patients who underwent vitrectomies. In one case, the vitrectomy specimen would have indicated the diagnosis three years before the jejunal biopsy was performed had the appropriate PAS stain been used. In the second case, the PAS-positive macrophages were identified at the time of surgery.

Published
1984
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27. Pneumatic Retinopexy

Author

Tornambe, Paul E., primary, Hilton, George F., additional, Tornambe, Paul E., additional, Poliner, Lon S., additional, Brinton, Daniel A., additional, Flood, Timothy P., additional, Orth, David H., additional, Packo, Kirk H., additional, Green, Stuart, additional, Leff, Steven R., additional, Masciulli, Leo, additional, Yarian, David L., additional, Grizzard, W. Sanderson, additional, Hammer, Mark E., additional, Taren, Douglas L., additional, Morgan, Craig M., additional, and Tiedeman, James S., additional

Published
1989
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33. The use of Fundus Photographs and Fluorescein Angiograms in the Identification and Treatment of Choroidal Neovascularization in the Macular Photocoagulation Study

Author

Chamberlin, Judith A., primary, Bressler, Neil M., additional, Bressler, Susan B., additional, Elman, Michael J., additional, Murphy, Robert P., additional, Flood, Timothy P., additional, Hawkins, Barbara S., additional, Maguire, Maureen G., additional, and Fine, Stuart L., additional

Published
1989
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36. Do Oral Flora Colonize the Nasal Floor of Patients with Oronasal Fistulae?

Author

Brennan, Peter A., Markus, Anthony F., Flood, Timothy R., Downie, Ian P., and Uppal, Rajvinder

Abstract

Objective: To determine if oral bacteria colonize the cleft nasal floor in patients with unilateral oronasal fistula when compared with the unaffected nasal floor and whether the results obtained would be of benefit in assessing oronasal fistulae in the clinic.Design: Prospective study of 26 patients with cleft palate and unilateral oronasal fistula. Microbiological culture swabs were taken from the mouth and nasal floors of patients. The unaffected nasal floor was used as a control. Bacterial isolates were identified and compared in the laboratory by a senior microbiologist.Main Outcomes Measure: A significant growth of oral bacteria from the cleft nasal floor when compared with the unaffected nasal floor.Results: Four patients were excluded because no growth was found on any culture plate. In the remaining 22 cases, a light growth of oral flora was found in the cleft nasal floor in only 3 patients. No statistical correlation between culture of oral bacteria and the cleft nasal floor could be found (p = .12).Conclusions: The relative lack of colonization of the cleft nasal floor by oral bacteria may reflect poor transmission of bacteria through the fistula, competition with commensal nasal flora, or an inability of oral bacteria to survive in a saliva-depleted area. The investigation is not helpful in the assessment of oronasal fistulae in the clinic.

Published
2001
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37. The Endophthalmitis Vitrectomy Study: Relationship Between Clinical Presentation and Microbioloaic Spectrum

Author

Vine, Andrew K., Blodi, Barbara A., Elner, Susan G., Johnson, Mark W., Jessup, Laurie M., Khanderia, Sharad, Pierson, Carl L., Willis, Julie, McIver, Frances, Stanley, Sally, Sneed, Scott R., Capone, Antonio, Jr., Aaberg, Thomas M., Lim, Jennifer I., Sternberg, Paul, Jr., Coffman, Diana S., Moore, Cameile N., Gardner, Susanne K., Nolte, Frederick S., Fremstad, Ann, Gibbs, Deborah, Gilman, James, Swords, Ray, Aguilar, H.Edith, Meredith, Travis A., Lakhanpal, Vinod, Christian, Faith D., Hood, A., Schwalbe, Richard S., Billings, Emery E., Buie, William, Jr., Mallonee, James J., Jr., Millar, Mary Ann, Verbeek, Sharon, Campochiaro, Peter A., Palardy, Carol B., Reynolds, Lois, Dick, James D., Cain, Dennis, D'Amico, Donald J., Frederick, Albert R., Jr., Morley, Michael G., Pesavento, Richard D., Puliafito, Carmen A., Topping, Trexler M., Finn, Susan M., Raymond, Laura A., Baker, Ann Sullivan, Paton, Barbara, Evans, Claudia, Napoli, Jeffrey, Kierman, Christine, Makris, Kathryn, McInnes, Tom, Reidy, Wini T., White, Ruth, Garfinkel, Richard A., Pilkerton, A.Raymond, Frantz, Robert A., Abernathy, Gill B., Barbaccia, Jay G., Ensey, H.Russell, Ormes, Carol A., Park, Choong H., Caplan, Joel, Russell, Kathryn, Toma, Robert, Packo, Kirk H., de Bustros, Serge, Flood, Timothy P., Glazer, Louis, DeAlba, Maggie, Evanich, Evangeline, Montwill, Michael A., Rothman, Jeri J., Ruderman, Gail, Beard, Melodie, Landau, William, Shen, Min H., Gordon, Martha, Graff, Sharon, Kwiatkowski, Kathy, Pappas, Loreen, Bryant, Douglas, Doherty, Don, Morini, Frank, Arredondo, Linda, Garretson, Bruce R., Gerena, Carlos, Hunt, Maureen, Kinnaird, Sharon M., Neri, Toni, Rice, Thomas A., Novak, Michael A., Rowe, Pamela S., Jamieson, Scott, Newberry, Deborah, Rech, Glenn R., Dul, Michael J., Kinser, Livia, Strozewski, Krystyna, Clark-Rath, Susan, DeLisio, Marty, Dempsey, David L., Kukula, Donna, Pinter-Smith, Anne, Smith-Brewer, Sheila, Ludwig, Tracey, Chambers, Robert B., Davidorf, Frederick H., Taylor, Cindy S., Hale, Karen N., Buesching, William J., Chaudhuri, Chhanda, Cover, Nanci J., Shortlidge, Gail R., Keating, Michael J., Savage, Scott J., Andrzejewska, Paula, Cometet, Susan, Milliron, Jill D., Richmond, Rob, Schneider, Lori, Weisenberger, Debra, Cantrill, Herbert L., Ramsay, Robert C., Brallier, Amy B., Johnson, Timothy P., Rossing, Edith E., Knauth, Kathleen A., Monahan, Martha M., Oestreich, Neal W., Clark, Kenneth F., Glennen, Anita M., Yarian, David L., Green, Stuart N., Leff, Steven R., Masciulli, Leo, Lucido, Margaret M., Ludwig, Edward J., Marano, Charlotte L., Peters, Linda, Joho, Kim, Volkert, Doris C., Andersen, Finn, Coffey, Donna, Schlosser, Alex, Honeywell, Ann, Mames, Robert N., Driebe, William T., Jr., Stern, George A., Francis, Amye, Zam, Z.Suzanne, Cooper, Rhonda, Gaskins, Darla, Shamis, Diana J., Willingham, Melinda, Barker, Kay, Rosa, Harry, Friedman, Scott M., Gardner, Thomas W., Blankenship, George W., Coyle, Carole J., Bero, Christopher J., Halas, Cindy, Schick, Suzanne, Walker, Jean, Cunningham, Denise, Lambert, H.Michael, Clogston, Pamela S., Frady, Pamela M., Gardner, S.Neal, Osato, Michael S., Carr, Louise, Shigley, James, Lopez, Pedro F., Chong, Lawrence P., Frambach, Donald A., CisnerosMargaret^Padilla, Lupe, Yee, Edmond Ming, Nakamura, Tamako, Walonker, A.Frances, Morales, Ronald, Nichols, Tracy, Huete, Maria E., Liggett, Peter E., Ober, Richard R., Quillen-Thomas, Beth, Williams, Mark, Barr, Charles C., Bloom, Steven M., Greene, Pamela J., Whittington, Greg K., Martin, Mark E., Watson, Glen, Jenkins-Curry, Betty, Gilkey, Leigh A., Huelsman, Steven, Han, Dennis P., Burton, Thomas C., Mieler, William F., Pulido, Jose S., Reeser, Frederick H., Newman, Janet L., Werner, Kathy A., Pisarzewicz, Paul J., Reinerio, Nina A., Walloch, Mary Lee K., Wilmer, Zuzana, Laabs, Jan, Picchiottino, Ruth, Phillips, Jim, Wipplinger, Walter, Abrams, Gary W., Jurkiewicz, Dale T., Leet, Margaret L., Mandel, Paul, Metzger, Kim, Suchla, Lori, Zarling, Denise, Balles, Mark W., Ryan, Edwin H., Jr., Knobloch, William H., Cook, Sally M., Luke, Darlette G., Ferrieri, Patricia, Schiminsky, Norynne M., Genia, Anne, Philiph, David A., Stinson, Elizabeth K., Wright, Linda M., McMichael, William C., Mielke, Sandy J., Ponwith, Lisa J., Pavan, Peter Reed, Pautler, Scott E., Coats, Marion L., Kirk, Nancy M., Millard, Sharon M., Castellano, Frank C., Edwards, Charlotte R., Marquardt, Angela, McCormack, Amy J., McCormick, Michael T., Renshaw, Bernard, Restuccia, Angela, Campbell, Monica, Christopher, Nell, Garrett, L.Scott, Halkias, Demetrios G., Hothersall, Kim, Mickler, Karen, Minnick, Thomas S., Burr, Cheryl, Saxon, Wyatt, Arcacha, Miguel A., Jr., Carlton, Steve, Edison, Sonya K., Mallis, Marc J., Sayers, Tamre L., Sudds, Thomas W., Tiberia, Robert J., Wolabaugh, Sherry, Bradford, Reagan H., Jr., Parke, David W., II, Wolf, Thomas C., Shofner, Janie M., Tobey, Lee E., Jensen, Harold G., Sanchez, Dinah, Shofner, Janie, Burris, Russell, Drake, Kellie K., Grissom, Kay R., Rowsey, J.James, Wilkinson, Charles P., Brown, Gary C., Benson, William E., Federman, Jay L., Lucier, Alfred C., Maguire, Joseph I., Sarin, Lov K., Shakin, Eric P., Sivalingam, Arunan, Tasman, William, Vander, James F., Ward, Nancy, Weisbecker, Clement A., Agnew, Caroline L., Lambert, Richard, Torner, Terrance, Carlson, Kathy, Franchine, Gerrie, Serfass, Michelle S., Doft, Bernard H., Bergren, Robert L., Lobes, Louis A., Jr., Olsen, Karl R., Rinkoff, Jeffrey S., Metz, Donna J., Leonard, Margaret N., Karenchak, Lisa M., Kowalski, Regis P., Wellman, Lynn A., Wilcox, Linda A., Campbell, Alan F., Steinberg, David R., Vagstad, Gary L., Flook, Kimberly A., Good, Mary M., Keenen, Beverly J., Mellinger, Kim A., Margherio, Raymond R., Cox, Morton S., Jr., Murphy, Patrick L., Trese, Michael T., Werner, Jane C., Williams, George A., Manatrey, Patricia E., Prote, Janet L., Lucarotti, Richard, Martin, Susan, Band, Jeff, Bostic, Grace, Gumming, Kristi, Mitchell, Beth, Regan, Virginia S., Bridges, Craig, Cox, Sam, Houston, Gary, Johnson, John, Streasik, Pat, Wood, Betty, Blumenkranz, Mark S., Cayo, Lisa, Kaye, Virginia, Valenzuela, Carmen Luz, Orgel, Ira K., Poliner, Lon S., Tornambe, Paul E., Cannon, Sarah V., Nielsen, Janet L., Carlson, Anne, Chan, Pauline, Drake, Lynne, Grim, Martha, Peterson, Corky, Borg, Lynn A., Gillyatt, Joann, Beyer, Conny, Hammer, Mark E., Grizzard, W.Sanderson, Shannon, Theresa L., Traynom, Janet R., Collado, Melinda J., McManus, Dennis W., Sweeney, Daniel E., Adams, Donald H., Jr., Watson, Thomas T., Antworth, Michael V., Araos, Johanna Glacy, Greenwald, Mark A., Habib, Mohsen, Myers, Sandra K., Ockers, Karen M., Thibodeau, Judy-Ann, Watkins, Brett, Nelsen, Philip T., Rosenthal, J.Gregory, Mintz, Fay V., Biedenbach, Michael, Leonardy, Nicholas J., Lawniczak, Sue M., Bork, Chuck, Hageage, George, Hunter, Evelyn B., Marshall, MarLynn J., Roman, Patricia, Hill, Rick, Hofbauer, Thomas, Lemanowicz, Jack, Cupples, Howard P., Guzman, Gladys I., Brodeur, Richard J., Yee, Donald, Delaha, Edward C., Geyer, Stanley L., Slovis, Stacey, Shields, William J., Lauber, Susan, Michelitsch, Karl, Barza, Michael, Kassoff, Aaron, Watling, Sharon, Wilson, Louis A., Buehler, JoAnne C., McVay, Jeffrey, Kelsey, Sheryl F., Wisniewski, Stephen R., Podobinski, Gale K., Sillett, Robert L., Groer, Shirley, Avery, Brian, Belle, Steven H., Boles, James, Henry, Linda, Shema, Sarah J., Titus-Emstoff, Linda, Davis, Matthew, Magli, Yvonne L., Hubbard, Larry, Thomas, Suzanne, Everett, Donald F., Mowery, Richard, Everett, Donald, Davis, Kathryn, Azen, Stanley, Covey, Preston, McCuen, Brooks, Packer, Andrew, and Robin, Jeffrey

Published
1997
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38. Assessment of the Spatial Occurrence of Childhood Leukaemia Mortality Using Standardized Rate Ratios with a Simple Linear Poisson Model

Author

AICKIN, MIKEL, CHAPIN, CHARLES A, FLOOD, TIMOTHY J, ENGLENDER, STEVEN J, and CALDWELL, GLYN G

Abstract

Aickin M (Department of Family and Community Medicine, University of Arizona, Tucson, Arizona, USA), Chapin C A, Flood T J, Englender S J and Caldwell G G. Assassment of the spatial occurrence of childhood leukaemia mortality using standardized rate ratios with a simple linear Poisson model. International Journal of Epidemiology 1992; 21: 649–655. Reports of a suspected cluster of childhood leukaemia cases in West Central Phoenix have led to a number of epidemiological studies in the geographical area. We report here on a death certificate-based mortality study, which indicated an elevated rate ratio of 1.95 during 1966–1988, using the remainder of the Phoenix standard metropolitan statistical area (SMSA) as a comparison region. In the process of analysing the data from this study, a methodology for dealing with denominator variability in a standardized mortality ratio was developed using a simple linear Poisson model. This new approach is seen as being of general use in the analysis of standardized rate ratios (SRR), as well as being particularly appropriate for cluster investigations.

Published
1992
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