American Journal of Epidemiology

Nathanson, Neal;Wilesmith, John;Griot, Christian

doi: 10.1093/oxfordjournals.aje.a009064pmid: 9169904

Abstract Bovine spongiform encephalopathy (BSE) is a transmissible spongiform encephalopathy (TSE) or prion disease of cattle first recognized in 1986 in the United Kingdom, where it produced a common source epidemic that peaked in January 1993 and has subsided markedly since that time. The epidemic began simultaneously at many geographic locations and was traced to contamination of meat and bone meal (MBM), a dietary supplement prepared from rendering of slaughterhouse offal. It appears that the epidemic was initiated by the presence of the agent of scrapie (a long-standing TSE of sheep) that was first transmitted to cattle, beginning in the early 1980s, when most rendering plants abandoned the use of organic solvents in the preparation of MBM. The epidemic was probably accelerated by the recycling of infected bovine tissues prior to the recognition of BSE. To terminate the epidemic, a prohibition on the feeding of ruminant-derived protein to ruminants was introduced in the United Kingdom in July 1988. The ruminant feed ban accounts for the decline of the epidemic after an interval of about 5 years, approximately equivalent to the average incubation period of BSE. Relatively few cases of BSE have occurred in cattle born after 1993, and it is predicted that the epidemic will terminate about the year 2000 based on an extrapolation of the present declining curve. A comparison of data from the United Kingdom with data from relatively low incidence countries, such as Switzerland, indicates that this epidemic has been mainly confined to the United Kingdom because of a unique concatenation of risk factors, including: 1) a high ratio of sheep to cattle; 2) a relatively high rate of endemic scrapie; 3) the heavy feeding of MBM to dairy cattle; and 4) changes in the rendering process used to prepare MBM. Recently, cases of a variant form of Creutzfeldt-Jakob disease (a TSE of humans) have been reported in the United Kingdom. These cases, at least 10 of which had onset in 1994–1995, are distinguished by their occurrence in subjects under age 40 years, by their clinical presentation, and by their neurohistopathologic picture. The appearance of this novel disease and its concentration in the United Kingdom have raised the question that it might represent the transmission of BSE to humans. However, the cases gave no history indicating an unusual exposure to live cattle, to the preparation of beef products, or of dietary exposure to bovine tissues, and it remains to be determined whether they are associated with BSE. Am J Epidemiol 1997; 145: 959–69. Creutzfeldt-Jakob syndrome, disease outbreaks, encephalopathy, bovine spongiform, prion diseases © 1997 by The Johns Hopkins University School of Hygiene and Public Health

Nathanson, Neal; Wilesmith, John; Griot, Christian

doi: N/Apmid: N/A

Bovine spongiform encephalopathy (BSE) is a transmissible spongiform encephalopathy (TSE) or prion disease of cattle first recognized in 1986 in the United Kingdom, where it produced a common source epidemic that peaked in January 1993 and has subsided markedly since that time. The epidemic began simultaneously at many geographic locations and was traced to contamination of meat and bone meal (MBM), a dietary supplement prepared from rendering of slaughterhouse offal. It appears that the epidemic was initiated by the presence of the agent of scrapie (a long-standing TSE of sheep) that was first transmitted to cattle, beginning in the early 1980s, when most rendering plants abandoned the use of organic solvents in the preparation of MBM. The epidemic was probably accelerated by the recycling of infected bovine tissues prior to the recognition of BSE. To terminate the epidemic, a prohibition on the feeding of ruminant-derived protein to ruminants was introduced in the United Kingdom in July 1988. The ruminant feed ban accounts for the decline of the epidemic after an interval of about 5 years, approximately equivalent to the average incubation period of BSE. Relatively few cases of BSE have occurred in cattle born after 1993, and it is predicted that the epidemic will terminate about the year 2000 based on an extrapolation of the present declining curve. A comparison of data from the United Kingdom with data from relatively low incidence countries, such as Switzerland, indicates that this epidemic has been mainly confined to the United Kingdom because of a unique concatenation of risk factors, including: 1) a high ratio of sheep to cattle; 2) a relatively high rate of endemic scrapie; 3) the heavy feeding of MBM to dairy cattle; and 4) changes in the rendering process used to prepare MBM. Recently, cases of a variant form of Creutzfeldt-Jakob disease (a TSE of humans) have been reported in the United Kingdom. These cases, at least 10 of which had onset in 1994–1995, are distinguished by their occurrence in subjects under age 40 years, by their clinical presentation, and by their neurohistopathologic picture. The appearance of this novel disease and its concentration in the United Kingdom have raised the question that it might represent the transmission of BSE to humans. However, the cases gave no history indicating an unusual exposure to live cattle, to the preparation of beef products, or of dietary exposure to bovine tissues, and it remains to be determined whether they are associated with BSE. Am J Epidemiol 1997; 145: 959–69.

Neal Nathanson, John Wilesmith, Christian Griot

doi: aje;145/11/959pmid: N/A

Bovine spongiform encephalopathy (BSE) is a transmissible spongiform encephalopathy (TSE) or prion disease of cattle first recognized in 1986 in the United Kingdom, where it produced a common source epidemic that peaked in January 1993 and has subsided markedly since that time. The epidemic began simultaneously at many geographic locations and was traced to contamination of meat and bone meal (MBM), a dietary supplement prepared from rendering of slaughterhouse offal. It appears that the epidemic was initiated by the presence of the agent of scrapie (a long-standing TSE of sheep) that was first transmitted to cattle, beginning in the early 1980s, when most rendering plants abandoned the use of organic solvents in the preparation of MBM. The epidemic was probably accelerated by the recycling of infected bovine tissues prior to the recognition of BSE. To terminate the epidemic, a prohibition on the feeding of ruminant-derived protein to ruminants was introduced in the United Kingdom in July 1988. The ruminant feed ban accounts for the decline of the epidemic after an interval of about 5 years, approximately equivalent to the average incubation period of BSE. Relatively few cases of BSE have occurred in cattle born after 1993, and it is predicted that the epidemic will terminate about the year 2000 based on an extrapolation of the present declining curve. A comparison of data from the United Kingdom with data from relatively low incidence countries, such as Switzerland, indicates that this epidemic has been mainly confined to the United Kingdom because of a unique concatenation of risk factors, including: 1) a high ratio of sheep to cattle; 2) a relatively high rate of endemic scrapie; 3) the heavy feeding of MBM to dairy cattle; and 4) changes in the rendering process used to prepare MBM. Recently, cases of a variant form of Creutzfeldt-Jakob disease (a TSE of humans) have been reported in the United Kingdom. These cases, at least 10 of which had onset in 1994–1995, are distinguished by their occurrence in subjects under age 40 years, by their clinical presentation, and by their neurohistopathologic picture. The appearance of this novel disease and its concentration in the United Kingdom have raised the question that it might represent the transmission of BSE to humans. However, the cases gave no history indicating an unusual exposure to live cattle, to the preparation of beef products, or of dietary exposure to bovine tissues, and it remains to be determined whether they are associated with BSE. Am J Epidemiol 1997; 145: 959–69. Key words Creutzfeldt-Jakob syndrome disease outbreaks encephalopathy, bovine spongiform prion diseases © 1997 by The Johns Hopkins University School of Hygiene and Public Health « Previous | Next Article » Table of Contents This Article Am. J. Epidemiol. (1997) 145 (11): 959-969. » Abstract Free Full Text (PDF) Free Classifications REVIEWS AND COMMENTARY Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Disclaimer Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Nathanson, N. Articles by Griot, C. Search for related content PubMed PubMed citation Articles by Nathanson, N. Articles by Wilesmith, J. Articles by Griot, C. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue November 1, 2015 182 (9) Alert me to new issues The Journal About this journal Publishers' Books for Review Rights & Permissions Dispatch date of the next issue This journal is a member of the Committee on Publication Ethics (COPE) We are mobile - find out more Journals Career Network Published on behalf of The Johns Hopkins Bloomberg School of Public Health In association with The Society for Epidemiologic Research (SER) Impact factor: 5.230 5-Yr impact factor: 5.632 Editor-in-Chief Moyses Szklo, MD, DrPH View full editorial board For Authors Instructions to authors Author Self Archiving Policy Online Submission Submit a manuscript Open access options for authors - visit Oxford Open This journal enables compliance with the NIH Public Access Policies Policy Epidemiologic Reviews 2016 Call for Papers With questions or concerns, please contact the Editorial Office at (410) 223-1649 or via [email protected] . Alerting Services Email table of contents Email Advance Access CiteTrack XML RSS feed Corporate Services Advertising sales Reprints Supplements Classified Advertising Sales Widget Get a widget

Goodman-Gruen, Deborah; Barrett-Connor, Elizabeth

doi: N/Apmid: N/A

Insulin-like growth factor-l (IGF-I) is abundant in the circulation and has been shown to have a wide array of biologic effects. The authors carried out a cross-sectional community-based study of 420 men and 419 nonestrogen-using postmenopausal women aged 50–97 years to ascertain the within-person and laboratory reliability of IGF-I measurements, and the association of IGF-I with common epidemiologic confounders. There was no evidence of seasonal or diurnal variation. IGF-I decreased linearly with age in both sexes, with significantly lower levels in men than women (126.9 μg/liter vs. 134.1 μg/liter; p = 0.03). In age-adjusted analyses, IGF-I was not associated with height, total or central body fat, lean body mass, current smoking, physical activity, or commonly used medications. By contrast, in both men and women who reported any alcohol use, IGF-I levels were significantly higher compared with those in men and women who reported no alcohol use, and alcohol as a continuous variable showed a significant positive linear trend in men (p = 0.0007). The authors conclude that IGF-I varied significantly only with age, sex, and alcohol use. The minimal number of confounding variables, good reliability, and little intraindividual variation suggest that IGF-I should be suitable for epidemiologic research. Am J Epidemiol 1997; 145: 970-6.

Goodman-Gruen, Deborah;Barrett-Connor, Elizabeth

doi: 10.1093/oxfordjournals.aje.a009065pmid: 9169905

Abstract Insulin-like growth factor-l (IGF-I) is abundant in the circulation and has been shown to have a wide array of biologic effects. The authors carried out a cross-sectional community-based study of 420 men and 419 nonestrogen-using postmenopausal women aged 50–97 years to ascertain the within-person and laboratory reliability of IGF-I measurements, and the association of IGF-I with common epidemiologic confounders. There was no evidence of seasonal or diurnal variation. IGF-I decreased linearly with age in both sexes, with significantly lower levels in men than women (126.9 μg/liter vs. 134.1 μg/liter; p = 0.03). In age-adjusted analyses, IGF-I was not associated with height, total or central body fat, lean body mass, current smoking, physical activity, or commonly used medications. By contrast, in both men and women who reported any alcohol use, IGF-I levels were significantly higher compared with those in men and women who reported no alcohol use, and alcohol as a continuous variable showed a significant positive linear trend in men (p = 0.0007). The authors conclude that IGF-I varied significantly only with age, sex, and alcohol use. The minimal number of confounding variables, good reliability, and little intraindividual variation suggest that IGF-I should be suitable for epidemiologic research. Am J Epidemiol 1997; 145: 970-6. aged, alcohol drinking, insulin-like growth factor I, sex © 1997 by The Johns Hopkins University School of Hygiene and Public Health

Deborah Goodman-Gruen, Elizabeth Barrett-Connor

doi: aje;145/11/970pmid: N/A

Insulin-like growth factor-l (IGF-I) is abundant in the circulation and has been shown to have a wide array of biologic effects. The authors carried out a cross-sectional community-based study of 420 men and 419 nonestrogen-using postmenopausal women aged 50–97 years to ascertain the within-person and laboratory reliability of IGF-I measurements, and the association of IGF-I with common epidemiologic confounders. There was no evidence of seasonal or diurnal variation. IGF-I decreased linearly with age in both sexes, with significantly lower levels in men than women (126.9 μg/liter vs. 134.1 μg/liter; p = 0.03). In age-adjusted analyses, IGF-I was not associated with height, total or central body fat, lean body mass, current smoking, physical activity, or commonly used medications. By contrast, in both men and women who reported any alcohol use, IGF-I levels were significantly higher compared with those in men and women who reported no alcohol use, and alcohol as a continuous variable showed a significant positive linear trend in men ( p = 0.0007). The authors conclude that IGF-I varied significantly only with age, sex, and alcohol use. The minimal number of confounding variables, good reliability, and little intraindividual variation suggest that IGF-I should be suitable for epidemiologic research. Am J Epidemiol 1997; 145: 970-6. Key words aged alcohol drinking insulin-like growth factor I sex © 1997 by The Johns Hopkins University School of Hygiene and Public Health « Previous | Next Article » Table of Contents This Article Am. J. Epidemiol. (1997) 145 (11): 970-976. » Abstract Free Full Text (PDF) Free Classifications Original Contribution Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Disclaimer Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Goodman-Gruen, D. Articles by Barrett-Connor, E. Search for related content PubMed PubMed citation Articles by Goodman-Gruen, D. Articles by Barrett-Connor, E. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue November 1, 2015 182 (9) Alert me to new issues The Journal About this journal Publishers' Books for Review Rights & Permissions Dispatch date of the next issue This journal is a member of the Committee on Publication Ethics (COPE) We are mobile - find out more Journals Career Network Published on behalf of The Johns Hopkins Bloomberg School of Public Health In association with The Society for Epidemiologic Research (SER) Impact factor: 5.230 5-Yr impact factor: 5.632 Editor-in-Chief Moyses Szklo, MD, DrPH View full editorial board For Authors Instructions to authors Author Self Archiving Policy Online Submission Submit a manuscript Open access options for authors - visit Oxford Open This journal enables compliance with the NIH Public Access Policies Policy Epidemiologic Reviews 2016 Call for Papers With questions or concerns, please contact the Editorial Office at (410) 223-1649 or via [email protected] . Alerting Services Email table of contents Email Advance Access CiteTrack XML RSS feed Corporate Services Advertising sales Reprints Supplements Classified Advertising Sales Widget Get a widget

Siscovick, David S.; Fried, Linda; Mittelmark, Maurice; Rutan, Gale; Bild, Diane; O'Leary, Daniel H.; ,

doi: N/Apmid: N/A

The authors assessed the cross-sectional association between intensity of exercise in later life and coronary heart disease risk factors and subclinical disease among 2,274 men and women, 65 years of age and older, who were participants in the Cardiovascular Health Study (CHS) during 1989–1990. Subjects were free of prior clinical cardiovascular disease or impairment of physical function. Exercise intensity was characterized as low, moderate, or high, based on highest intensity exercise reported over the 2 weeks prior to the CHS baseline examination. After adjustment for age, education, and postmenopausal hormone therapy (among women), there was an inverse dose-response relationship of exercise intensity with selected risk factors. By low, moderate, and high exercise intensity, respectively: fasting insulin—men, 15.6 μU/ml, 14.1 μU/ml, and 12.6 μU/ml, p for trend <0.001; women, 14.8 μU/ml, 13.8 μU/ml, and 12.0 μU/ml, p for trend = 0.01; serum fibrinogen—men, 316.2 mg/dl, 315.4 mg/dl, and 300.0 mg/dt, p for trend = 0.01; women, 327.3 mg/dl, 317.0 mg/dl, and 310.7 mg/dl, p for trend = 0.01; lower extremity arterial disease by percent with ankle-arm index <0.9—men, 18.3, 5.5, and 3.7, p for trend = 0.01; women, 10.0, 5.7, and 2.8, p for trend = 0.02; evidence of myocardial injury by cardiac infarction/injury score (CIIS)—men, 8.0, 6.0, 3.9, p for trend <0.001; women, 4.6, 3.9, and 3.6, p for trend = 0.03. Adjustment for smoking, alcohol consumption, and total kilocalories expended in exercise altered the findings only slightly. The authors conclude that intensity of exercise in later life is associated with favorable coronary disease risk factor levels and a reduced prevalence of several markers of subclinical disease. Am J Epidemiol 1997; 145: 977–86.

David S. Siscovick, Linda Fried, Maurice Mittelmark, Gale Rutan, Diane Bild, Daniel H. O'Leary, Cardiovascular Health Study Research Group

doi: aje;145/11/977pmid: N/A

The authors assessed the cross-sectional association between intensity of exercise in later life and coronary heart disease risk factors and subclinical disease among 2,274 men and women, 65 years of age and older, who were participants in the Cardiovascular Health Study (CHS) during 1989–1990. Subjects were free of prior clinical cardiovascular disease or impairment of physical function. Exercise intensity was characterized as low, moderate, or high, based on highest intensity exercise reported over the 2 weeks prior to the CHS baseline examination. After adjustment for age, education, and postmenopausal hormone therapy (among women), there was an inverse dose-response relationship of exercise intensity with selected risk factors. By low, moderate, and high exercise intensity, respectively: fasting insulin—men, 15.6 μU/ml, 14.1 μU/ml, and 12.6 μU/ml, p for trend <0.001; women, 14.8 μU/ml, 13.8 μU/ml, and 12.0 μU/ml, p for trend = 0.01; serum fibrinogen—men, 316.2 mg/dl, 315.4 mg/dl, and 300.0 mg/dt, p for trend = 0.01; women, 327.3 mg/dl, 317.0 mg/dl, and 310.7 mg/dl, p for trend = 0.01; lower extremity arterial disease by percent with ankle-arm index <0.9—men, 18.3, 5.5, and 3.7, p for trend = 0.01; women, 10.0, 5.7, and 2.8, p for trend = 0.02; evidence of myocardial injury by cardiac infarction/injury score (CIIS)—men, 8.0, 6.0, 3.9, p for trend <0.001; women, 4.6, 3.9, and 3.6, p for trend = 0.03. Adjustment for smoking, alcohol consumption, and total kilocalories expended in exercise altered the findings only slightly. The authors conclude that intensity of exercise in later life is associated with favorable coronary disease risk factor levels and a reduced prevalence of several markers of subclinical disease. Am J Epidemiol 1997; 145: 977–86. Key words aged atherosclerosis ardiovascular diseases echocardiography electrocardiography exercise physical fitness risk factors © 1997 by The Johns Hopkins University School of Hygiene and Public Health « Previous | Next Article » Table of Contents This Article Am. J. Epidemiol. (1997) 145 (11): 977-986. » Abstract Free Full Text (PDF) Free Classifications Original Contribution Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Disclaimer Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Siscovick, D. S. Search for related content PubMed PubMed citation Articles by Siscovick, D. S. Articles by Fried, L. Articles by Mittelmark, M. Articles by Rutan, G. Articles by Bild, D. Articles by O'Leary, D. H. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue November 1, 2015 182 (9) Alert me to new issues The Journal About this journal Publishers' Books for Review Rights & Permissions Dispatch date of the next issue This journal is a member of the Committee on Publication Ethics (COPE) We are mobile - find out more Journals Career Network Published on behalf of The Johns Hopkins Bloomberg School of Public Health In association with The Society for Epidemiologic Research (SER) Impact factor: 5.230 5-Yr impact factor: 5.632 Editor-in-Chief Moyses Szklo, MD, DrPH View full editorial board For Authors Instructions to authors Author Self Archiving Policy Online Submission Submit a manuscript Open access options for authors - visit Oxford Open This journal enables compliance with the NIH Public Access Policies Policy Epidemiologic Reviews 2016 Call for Papers With questions or concerns, please contact the Editorial Office at (410) 223-1649 or via [email protected] . Alerting Services Email table of contents Email Advance Access CiteTrack XML RSS feed Corporate Services Advertising sales Reprints Supplements Classified Advertising Sales Widget Get a widget

Siscovick, David S.;Fried, Linda;Mittelmark, Maurice;Rutan, Gale;Bild, Diane;O'Leary, Daniel H.;Group, Cardiovascular Health Study Research

doi: 10.1093/oxfordjournals.aje.a009066pmid: 9169906

Abstract The authors assessed the cross-sectional association between intensity of exercise in later life and coronary heart disease risk factors and subclinical disease among 2,274 men and women, 65 years of age and older, who were participants in the Cardiovascular Health Study (CHS) during 1989–1990. Subjects were free of prior clinical cardiovascular disease or impairment of physical function. Exercise intensity was characterized as low, moderate, or high, based on highest intensity exercise reported over the 2 weeks prior to the CHS baseline examination. After adjustment for age, education, and postmenopausal hormone therapy (among women), there was an inverse dose-response relationship of exercise intensity with selected risk factors. By low, moderate, and high exercise intensity, respectively: fasting insulin—men, 15.6 μU/ml, 14.1 μU/ml, and 12.6 μU/ml, p for trend <0.001; women, 14.8 μU/ml, 13.8 μU/ml, and 12.0 μU/ml, p for trend = 0.01; serum fibrinogen—men, 316.2 mg/dl, 315.4 mg/dl, and 300.0 mg/dt, p for trend = 0.01; women, 327.3 mg/dl, 317.0 mg/dl, and 310.7 mg/dl, p for trend = 0.01; lower extremity arterial disease by percent with ankle-arm index <0.9—men, 18.3, 5.5, and 3.7, p for trend = 0.01; women, 10.0, 5.7, and 2.8, p for trend = 0.02; evidence of myocardial injury by cardiac infarction/injury score (CIIS)—men, 8.0, 6.0, 3.9, p for trend <0.001; women, 4.6, 3.9, and 3.6, p for trend = 0.03. Adjustment for smoking, alcohol consumption, and total kilocalories expended in exercise altered the findings only slightly. The authors conclude that intensity of exercise in later life is associated with favorable coronary disease risk factor levels and a reduced prevalence of several markers of subclinical disease. Am J Epidemiol 1997; 145: 977–86. aged, atherosclerosis, ardiovascular diseases, echocardiography, electrocardiography, exercise, physical fitness, risk factors © 1997 by The Johns Hopkins University School of Hygiene and Public Health

Väinö Kannisto, Kaare Christensen, James W. Vaupel

doi: aje;145/11/987pmid: N/A

Nutrition early in life may influence adult mortality. The fetal-origins hypothesis suggests that nourishment before birth and during the individual's infancy programs the development of risk factors for several important diseases of middle and old age. The present study was designed to evaluate the impact of extreme nutritional deprivation in utero and during infancy and early childhood on mortality in later life. The authors analyzed the survival of the cohorts bom in Finland during the severe 1866–1868 famine and during the 5 years immediately preceding and 5 years immediately following the famine. The study included 331, 932 individuals bom prior to the famine, 161, 744 bom during the famine, and 323, 321 bom after the famine. The authors assessed survival by cohorts from birth to age 17 years and from age 17 to 40, 60, and 80 years, as well as average length of life after age 80 years. Survival from birth to age 17 years was significantly lower in cohorts born before and during the famine than in the cohorts bom after the famine (males, 0.566 vs. 0.671, a difference of 0.105 (95% confidence interval (CI) 0.102–0.108); females, 0.593 vs. 0.692, a difference of 0.099 (95% CI 0.096–0.102)). At subsequent ages, inCIuding old age, mortality was practically identical in the famine-bom cohorts and in the five cohorts bom before and after the crisis. For both males and females, survival from 17 to 80 years and mean remaining lifetime at age 80 years were very similar across the 13 cohorts studied. These findings suggest that, although cohorts subjected to prolonged and extreme nutritional deprivation in utero and during infancy and early childhood suffer an immediate rise in mortality, after the crisis has passed, they carry no aftereffects that influence their survival in later life. Am J Epidemiol 1997; 145: 987-94. Key words cohort effect fetal growth retardation mortality nutrition survival rate © 1997 by The Johns Hopkins University School of Hygiene and Public Health « Previous | Next Article » Table of Contents This Article Am. J. Epidemiol. (1997) 145 (11): 987-994. » Abstract Free Full Text (PDF) Free Classifications Original Contribution Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Disclaimer Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Kannisto, V. Articles by Vaupel, J. W. Search for related content PubMed PubMed citation Articles by Kannisto, V. Articles by Christensen, K. Articles by Vaupel, J. W. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue November 1, 2015 182 (9) Alert me to new issues The Journal About this journal Publishers' Books for Review Rights & Permissions Dispatch date of the next issue This journal is a member of the Committee on Publication Ethics (COPE) We are mobile - find out more Journals Career Network Published on behalf of The Johns Hopkins Bloomberg School of Public Health In association with The Society for Epidemiologic Research (SER) Impact factor: 5.230 5-Yr impact factor: 5.632 Editor-in-Chief Moyses Szklo, MD, DrPH View full editorial board For Authors Instructions to authors Author Self Archiving Policy Online Submission Submit a manuscript Open access options for authors - visit Oxford Open This journal enables compliance with the NIH Public Access Policies Policy Epidemiologic Reviews 2016 Call for Papers With questions or concerns, please contact the Editorial Office at (410) 223-1649 or via [email protected] . Alerting Services Email table of contents Email Advance Access CiteTrack XML RSS feed Corporate Services Advertising sales Reprints Supplements Classified Advertising Sales Widget Get a widget