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Biomedical subjects

M G Larson

Publications and source records attributed to M G Larson.

At least 91 records · Page 5Linked to original sources
PubMed1994

Reduced heart rate variability and mortality risk in an elderly cohort. The Framingham Heart Study.

BACKGROUND: The prognostic implications of alterations in heart rate variability have not been studied in a large community-based population. METHODS AND RESULTS: The first 2 hours of ambulatory ECG recordings obtained on original subjects of the Framingham Heart Study attending the 18th biennial examination were reprocessed to assess heart rate variability. Subjects with transient or persistent nonsinus rhythm, premature beats > 10% of total beats, < 1 hour of recording time, processed time < 50% of recorded time, and those taking antiarrhythmic medications were excluded. The associations between heart rate variability measures and all-cause mortality during 4 years of follow-up were assessed. There were 736 eligible subjects with a mean age (+/- SD) of 72 +/- 6 years. The following five frequency domain measures and three time domain measures were obtained: very-low-frequency power (0.01 to 0.04 Hz), low-frequency power (0.04 to 0.15 Hz), high-frequency power (0.15 to 0.40 Hz), total power (0.01 to 0.40 Hz), the ratio of low-frequency to high-frequency power, the standard deviation of total normal RR intervals, the percentage of differences between adjacent normal RR intervals that are > 50 milliseconds, and the square root of the mean of the squared differences between adjacent normal RR intervals. During follow-up, 74 subjects died. In separate proportional hazards regression analyses that adjusted for relevant risk factors, very-low-frequency power (P < .0001), low-frequency power (P < .0001), high-frequency power (P = .0014), total power (P < .0001), and the standard deviation of total normal RR intervals (P = .0019) were significantly associated with all-cause mortality. When all eight heart rate variability measures were assessed in a stepwise analysis that included other risk factors, low-frequency power entered the model first (P < .0001); thereafter, none of the other measures of heart rate variability significantly contributed to the prediction of all-cause mortality. A 1 SD decrement in low-frequency power (natural log transformed) was associated with 1.70 times greater hazard for all-cause mortality (95% confidence interval of 1.37 to 2.09). CONCLUSIONS: The estimation of heart rate variability by ambulatory monitoring offers prognostic information beyond that provided by the evaluation of traditional risk factors.

Aged↗
PubMed1994

Hemodynamic predictors of incident hypertension. The Framingham Heart Study.

Previous reports indicate that cardiac output is increased early in the course of hypertension. The purpose of this study was to identify with echocardiography hemodynamic features in normotensive adults that predicted the development of hypertension. Framingham Heart Study subjects were eligible for this investigation if they were normotensive at the baseline examination (systolic blood pressure < 140 mm Hg, diastolic blood pressure < 90 mm Hg, and no antihypertensive medications) and if they were free of coronary heart disease, congestive heart failure, valvular heart disease, atrial fibrillation, hypertrophic cardiomyopathy, diabetes mellitus, and renal insufficiency. The study included 1118 men (mean age, 44 years) and 1559 women (mean age, 46 years). After 4 years of follow-up, of this normotensive cohort, 201 men (18.0%) and 257 women (16.5%) had developed hypertension. In separate, age-adjusted multivariable logistic regression analyses, increased cardiac index (men: odds ratio = 1.19 for one standard deviation increment, P = .03; women: odds ratio = 1.17, P = .02) and end-systolic wall stress (men: odds ratio = 1.24, P = .006; women: odds ratio = 1.43, P < .001) were related to the development of hypertension in both sexes. In addition, increased heart rate in men (odds ratio = 1.25, P = .006) was a significant predictor of hypertension. After adjustment for age and baseline blood pressure, none of the hemodynamic variables was a significant predictor of hypertension. In addition, load-independent indexes of contractility revealed only a minimally greater proportion of subjects with increased contractility at baseline in the group that developed hypertension compared with those who remained normotensive.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

The natural history of borderline isolated systolic hypertension.

BACKGROUND: Patients with isolated systolic hypertension are at increased risk for cardiovascular disorders. We attempted to determine whether those with borderline isolated systolic hypertension (defined as a systolic blood pressure of 140 to 159 mm Hg and a diastolic blood pressure below 90 mm Hg) have a greater risk of progression to definite (more severe) hypertension and of major morbid or fatal events than people with normal blood pressure (< 140/90 mm Hg). METHODS: A total of 2767 of the original participants in the Framingham Heart Study were monitored with biennial examinations for up to 34 years for the development of definite hypertension (defined as a systolic blood pressure of > or = 160 mm Hg, a diastolic blood pressure of > or = 90 mm Hg, or the initiation of antihypertensive therapy) and for major cardiovascular events. RESULTS: Borderline isolated systolic hypertension was the most common type of untreated hypertension among adults over the age of 60. After 20 years of follow-up, 80 percent of those with borderline isolated systolic hypertension had progression to definite hypertension, as compared with 45 percent of the normotensive participants (P < 0.001). After adjustment for age, sex, and risk factors for cardiovascular disease, participants with borderline isolated systolic hypertension had an excess long-term risk of cardiovascular disease (hazard ratio, 1.47; 95 percent confidence interval, 1.24 to 1.74) and death from cardiovascular disease (hazard ratio, 1.57; 95 percent confidence interval, 1.24 to 2.00), as compared with normotensive participants. In an analysis of pooled data from biennial examinations to study short-term sequelae, subjects with borderline isolated systolic hypertension had an increased risk of progression to definite hypertension (odds ratio, 3.84; 95 percent confidence interval, 3.35 to 4.41) and of cardiovascular disease (odds ratio, 1.39; 95 percent confidence interval, 1.06 to 1.82). CONCLUSIONS: In both the short term and the long term, subjects with borderline isolated systolic hypertension are at increased risk of progression to definite hypertension and the development of cardiovascular disease.

Adult↗
PubMed1993

The impact of female hormone usage on the lipid profile. The Framingham Offspring Study.

BACKGROUND: Exogenous female hormone use appears to affect cardiovascular disease risk in both premenopausal and postmenopausal women. The purpose of this study was to evaluate the impact of exogenous female hormone usage on the lipid profile among premenopausal and postmenopausal women. METHODS: One thousand nine hundred thirty female participants of the Framingham Offspring study comprised the study population. Of the 992 premenopausal subjects, 57 were current oral contraceptive users; among the 938 postmenopausal subjects, 80 were current hormone users. The influence of hormone use on lipid and lipoprotein levels was determined using multivariable linear regression models that adjusted for age, body mass index, smoking, alcohol intake, beta-blocker, and diuretic therapy. Adjusted least-squares means were calculated for each lipid and lipoprotein according to female hormone usage and menopausal status. RESULTS: In the premenopausal analysis, pooled oral contraceptive use was significantly related to increased levels of total cholesterol, triglycerides, high-density lipoprotein cholesterol and apolipoprotein A-I. Increased estrogen content was inversely associated with low-density lipoprotein cholesterol, and apolipoprotein B levels, while increased progestin content was inversely related to high-density lipoprotein cholesterol and apolipoprotein A-I levels. Among postmenopausal women, use of premarin only was significantly associated with increased high-density lipoprotein cholesterol and apolipoprotein A-I levels. Combination use of premarin and provera was significantly associated with increased apolipoprotein A-I levels; less powerful but still significant associations with increased high-density lipoprotein cholesterol and decreased low-density lipoprotein cholesterol were also observed. CONCLUSION: In this cross-sectional analysis, oral contraceptive use is associated with both favorable and unfavorable lipid alterations with respect to atherogenic risk. Among postmenopausal women, hormone replacement therapy (both premarin only and combined premarin and provera) appears to be associated with favorable effects on the lipid profile.

Adolescent↗
PubMed1993

Echocardiographic assessment of left ventricular structure and diastolic filling in elderly subjects with borderline isolated systolic hypertension (the Framingham Heart Study).

Abnormalities in left ventricular (LV) structure and function have been shown in patients with diastolic hypertension and recently in subjects with isolated systolic hypertension. The purpose of this study was to determine whether abnormalities of cardiac structure or function are present in elderly subjects with borderline isolated systolic hypertension (defined as systolic blood pressure [BP] between 140 and 159 mm Hg, and diastolic BP < 90 mm Hg). Ninety-one subjects (mean age 77 years) from the original Framingham Heart Study with untreated borderline isolated systolic hypertension, who were free of cardiovascular disease, were compared with 139 normotensive (BP < 140/90 mm Hg) subjects (mean age 76 years). Measurements included M-mode values for LV structure, and 6 Doppler indexes of LV diastolic filling. Subjects with borderline isolated systolic hypertension and the control group differed in mean systolic (147 vs 125 mm Hg) and diastolic (76 vs 70 mm Hg) BP. Borderline systolic hypertension was the most frequent form of untreated hypertension in this elderly group. The sum of LV wall thicknesses (septum+posterior wall) was significantly higher in borderline hypertensive subjects than in normotensive ones (20.5 vs 19.7 mm; p = 0.002). No difference was detected in LV internal dimension or systolic function. After adjustment for age and other clinical variables, comparisons between the groups revealed significant differences in indexes of Doppler diastolic filling. Peak velocity of early filling, and the ratio of early to late peak velocities were lower in the hypertensive group (40 vs 44 cm/s [p = 0.03] and 0.69 vs 0.76 [p = 0.01], respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Asymptomatic ventricular arrhythmias and mortality risk in subjects with left ventricular hypertrophy.

OBJECTIVES: The purpose of this study was to evaluate the long-term prognostic role of asymptomatic ventricular arrhythmias in original Framingham Heart Study subjects and Framing-ham Offspring Study subjects who had echocardiographic evidence of left ventricular hypertrophy. BACKGROUND: Echocardiographically determined left ventricular hypertrophy is associated with increased risk for ventricular arrhythmias. There are no population-based data available with regard to the long-term prognostic implications of asymptomatic ventricular arrhythmias in subjects with left ventricular hypertrophy. METHODS: In a population-based cohort study, we studied 224 men and 393 women with echocardiographically determined left ventricular hypertrophy who were free of coronary heart disease and had 1-h ambulatory electrocardiograms at the baseline examination. The age-adjusted prevalence of complex or frequent ventricular arrhythmias (> 30 ventricular premature beats/h, multiform premature complexes, couplets, ventricular tachycardia or R on T ventricular premature complexes) was 28% (51 of 224) in men and 17% (71 of 393) in women. The mean follow-up period was 5.7 years for cohort and 4.5 years for offspring subjects. RESULTS: In men with complex or frequent arrhythmias, the 6-year cumulative incidence of all-cause mortality was 38%, whereas in those free of arrhythmia it was 12%; corresponding values in women were 22% and 11%. The cumulative incidence of myocardial infarction or death due to coronary heart disease was 20% for men with and 10% for men without arrhythmia, but in women little difference was noted (5% vs. 4%). After adjustment for age and gender in a Cox proportional hazards model, subjects with complex or frequent arrhythmia were at increased risk for all-cause mortality (hazard ratio 1.80, 95% confidence interval [CI] 1.13 to 2.87, p = 0.013). After adjusting for eight clinical covariates, the increased risk for all-cause mortality remained marginally significant (hazard ratio 1.62, 95% CI 0.98 to 2.68, p = 0.058). No significant increased risk was noted for myocardial infarction or death due to coronary heart disease. CONCLUSIONS: In subjects with left ventricular hypertrophy, the presence of asymptomatic ventricular arrhythmias was associated with higher mortality, which was statistically significant after adjusting for age and gender and marginally significant after taking into account other covariates.

Aged↗
PubMed1993

Prognosis after the onset of coronary heart disease. An investigation of differences in outcome between the sexes according to initial coronary disease presentation.

BACKGROUND: Differences exist between men and women in prognosis after the onset of coronary heart disease (CHD). METHODS AND RESULTS: All Framingham Heart Study subjects with the onset of clinically apparent coronary disease from 1951 through 1986 were studied to compare prognosis in men and women according to CHD presentation. Coronary disease presentations included angina, coronary insufficiency (unstable angina), recognized myocardial infarction, unrecognized myocardial infarction, and coronary death. Less than 1% of subjects were lost to follow-up for overall mortality. Cox modeling was used to examine the sex differences in outcome for each coronary presentation. New nonfatal coronary disease developed in 750 men (mean age, 63 years) and 583 women (mean age, 67 years). After onset of angina, men were at greater risk than women for myocardial infarction (hazards ratio [HR], 2.20; 95% confidence interval [CI], 1.45 to 3.34) and coronary death (HR, 2.11; 95% CI, 1.32 to 3.36) after adjustment for age and coronary disease risk factors. After a recognized myocardial infarction, there was a trend toward greater risk for overall mortality in women than men after adjustment for age and risk factors (HR, 0.75; 95% CI, 0.53 to 1.08). In contrast, after an unrecognized myocardial infarction, men were at increased risk for death compared with women (HR, 2.01; 95% CI, 1.28 to 3.15). CONCLUSIONS: Women fare at least as poorly as men after recognized myocardial infarction, whereas women have a more favorable outlook than men after the onset of angina or unrecognized myocardial infarction. The favorable outcome in women after angina and unrecognized myocardial infarction is due, in part, to greater misclassification of these coronary events in women than in men.

Adult↗
PubMed1993

Teaching and social support: effects on knowledge, attitudes, and behaviors to prevent low back injuries in industry.

An educational program designed to reduce low back injuries was modeled after several well-known back schools and taught to postal workers in a randomized trial of about 4,000 workers. Physical therapists taught 3 hours of class sessions, including knowledge, skills, and individual work station assessment, to small groups of workers and supervisors, with reinforcement every 6 months afterward. At 2 1/2 years, a random sample of 209 workers was surveyed for program impact on intermediate outcomes. We observed increased knowledge among experimental unit workers, but no significant improvements in behaviors associated with back health or in proportion of workers with tired backs. Experimental unit workers who had received training by the time of the survey were less likely to report helping/reinforcement for healthy behaviors than controls or untrained experimental unit workers. The program might have led trained workers to perceive a lack of support and reinforcement for back safety among coworkers and supervisors by sensitizing them to what is possible and raising expectations. There appeared to be group social effects in the dissemination of knowledge and perhaps of helpful behaviors; however, it is apparent that worker social support for change in health behaviors is a complex phenomenon that cannot always be relied upon to enhance program goals.

Back↗
PubMed1992

Prognostic implications of asymptomatic ventricular arrhythmias: the Framingham Heart Study.

OBJECTIVE: To evaluate the prevalence and prognostic significance of asymptomatic complex or frequent ventricular premature beats detected during ambulatory electrocardiographic (ECG) monitoring. DESIGN: Cohort study with a follow-up period of 4 to 6 years. SETTING: Population-based. PARTICIPANTS: Surviving patients of the original Framingham Heart Study cohort and offspring of original cohort members (2727 men and 3306 women). MEASUREMENTS: One-hour ambulatory electrocardiography. RESULTS: The age-adjusted prevalence of complex or frequent arrhythmia (more than 30 ventricular premature complexes per hour or multiform premature complexes, ventricular couplets, ventricular tachycardia, or R-on-T ventricular premature complexes) was 12% (95% Cl, 11% to 13%) in the 2425 men without clinically evident coronary heart disease and 33% (Cl, 24% to 42%) in the 302 men with coronary heart disease. The corresponding values in women (3064 without disease and 242 with disease) were 12% (Cl, 11% to 13%) and 26% (Cl, 9% to 43%). After adjusting for age and traditional risk factors for coronary heart disease in a Cox proportional hazards model, men without coronary heart disease who had complex or frequent ventricular arrhythmias were at increased risk for both all-cause mortality (relative risk, 2.30; Cl, 1.65 to 3.20) and the occurrence of myocardial infarction or death from coronary heart disease (relative risk, 2.12; Cl, 1.33 to 3.38). In men with coronary heart disease and in women with and without coronary heart disease, complex or frequent arrhythmias were not associated with an increased risk for either outcome. CONCLUSIONS: In men who do not have clinically apparent coronary heart disease, the incidental detection of ventricular arrhythmias is associated with a twofold increase in the risk for all-cause mortality and myocardial infarction or death due to coronary heart disease. The preventive and therapeutic implications of these findings await further investigation.

Adult↗
PubMed1992

A controlled evaluation of continuous passive motion in patients undergoing total knee arthroplasty.

OBJECTIVE: To evaluate the efficacy of continuous passive motion (CPM) in the postoperative management of patients undergoing total knee arthroplasty. DESIGN: A randomized controlled single-blind trial of CPM plus standardized rehabilitation vs standard rehabilitation alone. SETTING: A referral hospital for arthritis and musculoskeletal care. PATIENTS: Consecutive patients with end-stage osteoarthritis or rheumatoid arthritis undergoing primary total knee arthroplasty who had at least 90 degrees of passive knee flexion. One hundred fifty-four patients were eligible and 102 patients agreed to participate and were randomized. Ninety-three patients completed the study protocol. INTERVENTION: Continuous passive motion machines programmed for rate and specified arc of motion within 24 hours of surgery with range increased daily as tolerated with standardized rehabilitation program compared with standardized rehabilitation program alone. MAIN OUTCOME MEASURES: Primary outcomes were pain, active and passive knee range of motion, swelling (or circumference), quadriceps strength at postoperative day 7, as well as complications, length of stay, and active and passive range of motion and function at 6 weeks. RESULTS: Use of CPM increased active flexion and decreased swelling and the need for manipulations but did not significantly affect pain, active and passive extension, quadriceps strength, or length of hospital stay. At 6 weeks there were no differences between the two groups in either range of motion or function. In this series, use of CPM resulted in a net savings of $6764 over conventional rehabilitation in achieving these results. CONCLUSION: For the average patient undergoing total knee arthroplasty, CPM is more effective in improving range of motion, decreasing swelling, and reducing the need for manipulation than is conventional therapy and lowers cost.

Aged↗
PubMed1992

An improved method for adjusting the QT interval for heart rate (the Framingham Heart Study)

Several formulas have been proposed to adjust the QT interval for heart rate, the most commonly used being the QT correction formula (QTc = QT/square root of RR) proposed in 1920 by Bazett. The QTc formula was derived from observations in only 39 young subjects. Recently, the adequacy of Bazett's formula has been questioned. To evaluate the heart rate QT association, the QT interval was measured on the initial baseline electrocardiogram of 5,018 subjects (2,239 men and 2,779 women) from the Framingham Heart Study with a mean age of 44 years (range 28 to 62). Persons with coronary artery disease were excluded. A linear regression model was developed for correcting QT according to RR cycle length. The large sample allowed for subdivision of the population into sex-specific deciles of RR intervals and for comparison of QT, Bazett's QTc and linear corrected QT (QTLC). The mean RR interval was 0.81 second (range 0.5 to 1.47) heart rate 74 beats/min (range 41 to 120), and mean QT was 0.35 second (range 0.24 to 0.49) in men and 0.36 second (range 0.26 to 0.48) in women. The linear regression model yielded a correction formula (for a reference RR interval of 1 second): QTLC = QT + 0.154 (1-RR) that applies for men and women. This equation corrects QT more reliably than the Bazett's formula, which overcorrects the QT interval at fast heart rates and undercorrects it at low heart rates. Lower and upper limits of normal QT values in relation to RR were generated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

A controlled study of the prevalence of cognitive dysfunction in randomly selected patients with systemic lupus erythematosus.

OBJECTIVE: To investigate the prevalence of cognitive dysfunction in randomly selected patients with systemic lupus erythematosus (SLE). METHODS: Randomly selected, ambulatory patients with SLE (n = 49) or with rheumatoid arthritis (RA) (n = 40) completed neuropsychological tests. These included Associate Learning, Switching Attention, Continuous Performance, Associate Recall, Hand-Eye Coordination, Pattern Comparison, Pattern Memory, the Stroop Color and Word Test, and the Symptoms Checklist-90R. Results were evaluated by multiple linear regression analysis. RESULTS: SLE patients had poorer performance than RA patients on the test of attention (P = 0.002) and tests of visuospatial ability (P = 0.03) and P = 0.04), independent of age, education, or steroid use. The conservative level of statistical significance, adjusting for multiple comparisons, was 0.005. SLE patients reported more symptoms of cognitive difficulty. CONCLUSION: Cognitive dysfunction is common in ambulatory SLE patients as measured by standardized tests and is a cause of distress and impaired functioning. Self-reported cognitive difficulty appears to correlate with objective performance.

Adult↗
PubMed1992

Psychosocial adjustment in juvenile arthritis.

Psychosocial adjustment in 102 children with arthritis, ages 4-16, and their families was assessed by parents, who completed the Child Behavior Checklist (CBCL) and Profile of Mood States (POMS). On average, parental distress (POMS) was lower than reference norms. POMS distress was correlated with children's behavioral problems (r = .41) but not with children's social competence (r = .15). General linear models explained 25% of the variance in CBCL behavioral problem scores. Older age was associated with more behavior problems in males, but not females. Disease severity and disease activity were also associated with behavioral problems. Although 27% of the variance in CBCL social competence could be explained, no single predictor variable was especially strong. Poorer social competence was associated with older age and shorter disease duration. Teenagers, especially those with recent onset and those with mild disease activity, may be at increased risk for psychosocial maladjustment.

Adaptation, Psychological↗
PubMed1992

Comparative measurement sensitivity of short and longer health status instruments.

Short measures of health status are used increasingly in health services research, yet their sensitivities to clinical change have not been compared with longer, established instruments. In this study, 5 health status measures were administered preoperatively and 3 months postoperatively to 54 patients undergoing total hip arthroplasty. These instruments included the Sickness Impact Profile (SIP)--an established, long measure--and 4 short forms: the SF-36, Functional Status Questionnaire, shortened Arthritis Impact Measurement Scales, and Modified Health Assessment Questionnaire. Scores for physical, psychological, and global dimensions were constructed by aggregating subscales. Sensitivity to change, or responsiveness, was expressed with the standardized response mean (SRM), calculated as the mean change in score divided by the standard deviation of the change in score. The sampling distribution of the SRM was estimated with a jackknife procedure. Preoperative scores were moderately to highly correlated across instruments. The physical and global dimension SRMs of the brief health status measures ranged from 0.85 to 1.27 and were as large as or larger than the corresponding SIP SRMs. The SIP had the highest SRM on the psychological dimension. None of the instruments was significantly more sensitive than the others at the critical value (P = 0.005) adjusted for multiple comparisons. The brief health status measures were equally or more responsive than the SIP after total hip arthroplasty in the physical and global dimensions. Much larger samples are required to demonstrate statistically significant differences in SRMs among instruments.

Activities of Daily Living↗
PubMed1992

Predictors of functional outcomes after arthroscopic partial meniscectomy.

OBJECTIVE: To confirm previous studies that have identified knee osteoarthritis as the principal correlate of poor outcomes after arthroscopic partial meniscectomy (APM), we considered a range of other preoperative characteristics using multivariable analyses to control for confounding variables. METHODS: One hundred five patients who had APM were studied. Selected demographic and clinical features were obtained from charts and operative notes. Preoperative and current functional status were determined by patient interviews. The principal outcomes were functional status at the time of followup, measured by the Physical Activity Scale of the SF-36 Health Status Inventory, and the Lysholm Knee Rating Scale. RESULTS: SF-36 scores improved from a mean of 53.7 to a mean of 18.2. The percentage of patients with satisfactory (> or = 77) Lysholm scores increased from 5% preoperatively to 73%. In multivariable analyses, Worker's Compensation (p = 0.003), worse baseline physical functional status (p = 0.007), and Grade III-IV cartilage damage (p = 0.05) were associated with worse post-operative function. CONCLUSION: The outcome of APM is generally favorable. The extent of cartilage damage was confirmed as a correlate of poor outcome. However, Worker's Compensation and preoperative physical functional status had the greatest prognostic value and should be ascertained routinely in orthopedic outcome studies.

Adult↗
PubMed1991

Evaluation of Social Security disability in claimants with rheumatic disease.

We compared the Social Security Administration's (SSA) judgment of disability with uninvolved rheumatologists' evaluations of ability to work. With the cooperation of the SSA, 52 new disability claimants who alleged rheumatoid arthritis, osteoarthritis, or systemic lupus erythematosus were identified at the beginning of their claim. At the same time that their claim was being formally reviewed, they had a standardized examination by an independent rheumatologist who was not involved with their care, and they had a standardized test of observed performance. Rheumatologists' judgments of ability to work were compared with the SSA judgments. Rheumatologist and SSA judgments were in agreement for 35 of the 52 claimants (67%). All 11 claimants who met or equaled the SSA medical evaluation criteria were judged work-disabled by the rheumatologist. Of 27 judged able to work by the SSA, the rheumatologist judged 11 to be unable. Agreement between the SSA judgment of residual functional capacity and observed performance was no more than would be expected by chance. Most SSA judgments agree with a clinician's evaluation but a standardized physical evaluation by a rheumatologist and performance-based tests appear to add important information.

Activities of Daily Living↗
PubMed1991

A case-control study of risk factors for industrial low back injury: implications for primary and secondary prevention programs.

Data were collected on 228 consecutive back injuries in Boston's General Mail Facility and 228 non-injured controls drawn randomly from each case's work unit, matching on craft (clerk, mailhandler, maintenance), shift, and general supervisor. Data were collected on age, gender, duration of employment, 3 year history of injury claims, overtime work in the past 2 weeks, job change in the past 60 days, and machine vs. manual job. Risk factors for back injury were examined simultaneously in a conditional logistic regression for matched pairs. Risk factors included history of back injury claim (OR = 16.5, p less than 0.0001), younger age (OR = 3.0, p = 0.0001), shorter duration of employment (OR = 2.6, p = 0.0007), recent job change (OR = 2.5, p = 0.06), and history of non-back injury claim (OR = 2.0, p = 0.08). Among heavy lifters (vs. clerks) overtime and being female increased the risk of injury. In this setting, higher risk workers who may benefit from preventive education programs can be identified.

Accidents, Occupational↗