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Showing papers by "Ralph B. D'Agostino published in 1988"


Journal ArticleDOI
TL;DR: To deal with the exceedingly difficult health care issues posed by frail elderly persons, health professionals need to collect, organize, and use a vast array of clinically relevant information.
Abstract: he population of elderly persons in the developed nations is growing with extraordinary rapidity. Although the majority enjoy good T health, many older people suffer from multiple illnesses and significant disability. Comprehensive assessment methodologies, while not solely applicable to frail elderly persons, are believed to be particularly suited to their situation. These individuals tend to exhibit great medical complexity and vulnerability; have illnesses with atypical and obscure presentations; suffer major cognitive, affective, and functional problems; are especially vulnerable to iatrogenesis; are often socially isolated and economically deprived; and are at high risk for premature or inappropriate institutionalization. To deal with the exceedingly difficult health care issues posed by frail elderly persons, health professionals need to collect, organize, and use a vast array of clinically relevant information. This process, compre-

1,353 citations


Journal ArticleDOI
19 Feb 1988-JAMA
TL;DR: Smoking was significantly related to stroke after age and hypertension were taken into account and even after pertinent cardiovascular disease risk factors were added to the Cox model, cigarette smoking continued to make a significant independent contribution to the risk of stroke generally and brain infarction specifically.
Abstract: The impact of cigarette smoking on stroke incidence was assessed in the Framingham Heart Study cohort of 4255 men and women who were aged 36 to 68 years and free of stroke and transient ischemic attacks. During 26 years of follow-up, 459 strokes occurred. Regardless of smoking status and in each sex, hypertensive subjects had twice the incidence of stroke. Using the Cox proportional hazard regression method, smoking was significantly related to stroke after age and hypertension were taken into account. Even after pertinent cardiovascular disease risk factors were added to the Cox model, cigarette smoking continued to make a significant independent contribution to the risk of stroke generally and brain infarction specifically. The risk of stroke increased as the number of cigarettes smoked increased. The relative risk of stroke in heavy smokers (>40 cigarettes per day) was twice that of light smokers (fewer than ten cigarettes per day). Lapsed smokers developed stroke at the same level as nonsmokers soon after stopping. Stroke risk decreased significantly by two years and was at the level of nonsmokers by five years after cessation of cigarette smoking. ( JAMA 1988;259:1025-1029)

814 citations


Journal ArticleDOI
TL;DR: The technique is a generalized person-years approach in that it treats each observation interval as a mini-follow-up study in which the current risk factor measurements are employed to predict an event in the interval.
Abstract: The purpose of this paper is to indicate how repeated measures on risk factors have been employed in the prediction of the development of disease in the Framingham Heart Study. Since these measures vary over time, the method accounts for time dependent covariates. The technique is a generalized person-years approach in that it treats each observation interval (of equal length) as a mini-follow-up study in which the current risk factor measurements are employed to predict an event in the interval. Observations over multiple intervals are pooled into a single sample to predict the short term risk of an event. This approach is compared to the long-term prediction of disease which utilizes only the baseline measurements and ignores subsequent repeated measures on the risk factors.

263 citations


Journal ArticleDOI
TL;DR: The use of the Fisher exact test and the chi-squared test with Yates's continuity correction for testing the equality of two independent binomial populations is often suggested for small and intermediate size samples.
Abstract: For testing the equality of two independent binomial populations the Fisher exact test and the chi-squared test with Yates's continuity correction are often suggested for small and intermediate size samples. The use of these tests is inappropriate in that they are extremely conservative. In this article we demonstrate that, even for small samples, the uncorrected chi-squared test (i.e., the Pearson chi-squared test) and the two-independent-sample t test are robust in that their actual significance levels are usually close to or smaller than the nominal levels. We encourage the use of these latter two tests.

201 citations


Journal ArticleDOI
16 Dec 1988-JAMA
TL;DR: It is concluded that ISH is a highly prevalent disorder whose major determinants are age, sex, increasing levels of blood pressure, and obesity in women.
Abstract: Isolated systolic hypertension (ISH), defined as systolic blood pressure of 160 mm Hg or greater when the diastolic pressure is less than 95 mm Hg, is a common form of hypertension among the elderly. We collected incidence and prevalence data on ISH and evaluated several potential factors for its occurrence in the Framingham Heart Study during 16 biennial examinations. The factors evaluated were age, sex, all components of the blood pressure (systolic and diastolic blood pressure, pulse pressure, and mean arterial pressure), Metropolitan relative weight, serum cholesterol level, serum uric acid level, cigarette smoking, ventricular heart rate, glucose intolerance, and hematocrit. The population at risk (1687 men and 1992 women) were those members of the Framingham cohort with a systolic blood pressure less than 160 mm Hg in the first four biennial examinations. Results showed ISH in 14.4% of the men and 22.8% of the women. Cumulative incidence rates were 418 per 1000 in men and 533 per 1000 in women. Significant risk factors for ISH were age, sex, all components of the blood pressure, and increased relative weight in women. We conclude that ISH is a highly prevalent disorder. Its major determinants are age, sex, increasing levels of blood pressure, and obesity in women. ( JAMA 1988;260:3451-3455)

173 citations


Journal Article
TL;DR: In acute stroke, medical factors dominated rates of survival, however, in those who survived, family and social factors had an equal impact in determining final outcome from stroke.

98 citations


Journal ArticleDOI
TL;DR: Multivariate analysis taking into account the level of blood pressure, electrocardiographic abnormalities, and previously diagnosed coronary heart disease and cardiac failure indicated a persistent increased risk of sudden death hi association with antihypertensive treatment.
Abstract: During 30 years of follow-up, there were 183 sudden deaths in men and 77 in women ages 35 to 94 years who participated in the Framingham Study. Risk of sudden death was increased threefold in hypertensive persons but only if there was no previously diagnosed coronary heart disease. Men receiving antihypertensive treatment had more than twice the risk of sudden death compared with those who were untreated, whether or not they had prior manifestations of coronary heart disease. More than twice as many men who died suddenly were receiving antihypertensive therapy compared with those in the population at risk of the same age. In those with overt coronary heart disease, 34% of those dying suddenly were on antihypertensive treatment compared with 18% of those of the same age in the general population. Multivariate analysis taking into account the level of blood pressure, electrocardiographic abnormalities, and previously diagnosed coronary heart disease and cardiac failure, all of which are predisposing factors for sudden death, indicated a persistent increased risk of sudden death in association with antihypertensive treatment. Tests of interaction indicate that the excess sudden death risk was not confined to those with electrocardiographic abnormalities. In women, it may be associated with diabetes. These data suggest that some feature of antihypertensive treatment as practiced in the general population may contribute to sudden death incidence in an ill-defined subgroup of hypertensive persons.

68 citations



Journal ArticleDOI
TL;DR: A predictive instrument for use in a handheld programmable calculator, which, based on a mathematical logistic regression formula, computes a patient's probability of having acute cardiac ischemia, could reduce the number of CCU admissions in the United States by more than 250,000 per year.

31 citations


Journal ArticleDOI
TL;DR: Goodness-of-fit Techniques as mentioned in this paper is a well-known technique in the field of statistics textbooks and monographs, and it has been used extensively in many applications.
Abstract: Goodness‐of‐fit Techniques. Edited by R. B. D'Agostino and M. A. Stephens. ISBN 0 8247 7487 6. Marcel Dekker, 1986. $95.50. (Vol. 68 of Statistics Textbooks and Monographs)

11 citations


Journal ArticleDOI
TL;DR: Goodness-of-fit Techniques as discussed by the authors is a well-known technique in the area of good-fitting and fitness, and it has been used in many applications in the real world.
Abstract: 5. Goodness‐of‐fit Techniques. Edited by Ralph B. D'Agostino and Michael A. Stephens. ISBN 0 8247 7487 6. Marcel Dekker, 1986. 576p. $95.90. (Statistics: Textbooks and Monographs Series, Volume 68)