[Show abstract][Hide abstract] ABSTRACT: Several studies have reported that individualized residential place-based discrimination (PBD) affects residents' health. However, studies exploring the association between institutionalized PBD and health are scarce, especially in Asian countries including Japan.
BMC Public Health 05/2014; 14(1):449. · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: No previous study has performed multivariate analysis of the risk factors of fatty liver disease (FL), focusing on the effect of weight gain of ≥10 kg since the age of 20 years, and no analysis model exists that simultaneously evaluates body mass index (BMI) and body fat percentage (BFP) as adjustment variables.
To investigate these, we collected anthropometric data from health checkups, and conducted a cross-sectional study (targeting 1,851 males and 1,259 females aged 30 years or over).
Regardless of sex, weight gain of ≥10 kg since the age of 20 years was positively associated with FL. Our stratified analysis of BFP into two categories, to evaluate the interaction between BMI and BFP in FL, indicated an approximately five-fold increase in the odds ratio in the male group with high BMI and BFP values compared to those with low BMI and BFP values, with a synergy index of 1.77 >1. On the other hand, females demonstrated no significant additive interaction, with a synergy index of 0.49 <1.
We revealed that weight gain ≥10 kg since the age of 20 years is significantly associated with FL regardless of sex. In addition, by performing a synergy index (S), we showed that the additive interaction between BMI and BFP in FL differs according to gender.
Journal of Gastroenterology and Hepatology 08/2013; · 3.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background : The prevalence of chronic kidney disease (CKD) is increasing dramatically. The aim of the present study is to explore the prevalence of and the factors associated with CKD in subjects without notable chronic disease. Methods: In a cross-sectional study, we analyzed the annual health checkup data of 39,211 residents (11,636 males and 27,575 females) aged 40 - 74 years (58.6 ± 8.6 years) without notable chronic diseases, who underwent a health checkup at the Public Health Centers of Osaka city. CKD was defined as those with an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73m(2) and/or urinary protein of (+) or more. Results: The overall prevalence of CKD was 20.5%, and increased remarkably with age. Multivariate logistic regression analysis demonstrated that male gender (OR: 0.83, p<0.0001), age of 50-59 years (2.92, p<0.0001), age of 60-74 years (4.92, p<0.0001), the presence of diabetes (0.80, p=0.0307), dyslipidemia (1.21, p=0.0138), obesity (1.23, p<0.0001), hyperuricemia (2.63, p<0.0001) and a history of cardiovascular disease (1.26, p=0.0135) were significant factors that were independently associated with CKD. Conclusions: In urban subjects without notable chronic disease, the prevalence of CKD was 20.5%. Several metabolic abnormalities, i.e., dyslipidemia and hyperuricemia, were significantly associated with CKD.
Kidney and Blood Pressure Research 10/2012; 36(1):139-148. · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Prospective multicenter study.
To identify radiographic or magnetic resonance (MR) images of fresh vertebral fractures that can predict a high risk for delayed union or nonunion of osteoporotic vertebral fractures (OVFs).
Vertebral body fractures are the most common fractures in osteoporosis patients. Conservative treatments are typically chosen for OVFs, and associated back pain generally subsides within several weeks with residual persistent deformity of the vertebral body. In some patients, OVF healing is impaired and correlated with prolonged back pain. However, assessments such as plain radiograph or MR images taken during the early phase to predict high risks for nonunions of OVFs and/or poor prognoses have not been identified.
A total of 350 OVF patients from 25 institutes were enrolled in this clinical study. Plain radiograph and MR images of the OVFs were routinely taken at enrollment at the respective institutes. The findings on the plain radiograph and MR images were classified after enrollment in the study. All the patients were treated conservatively without any surgical intervention. After a 6-month follow-up, the patients were classified into two groups, a union group and a nonunion group, depending on the presence of an intravertebral cleft on plain radiograph or MR images. The associations of the images from the first visit with those of the corresponding nonunions at the 6-month follow-up were analyzed by multivariate logistic regression to elucidate specific image characteristics that may predict a high risk for nonunion of OVFs.
Forty-eight patients (49 vertebrae) among the 350 patients (363 vertebrae) were classified as nonunions, indicating a nonunion incidence of 13.5% for conventional conservative treatments for OVFs. The statistical analyses revealed that a vertebral fracture in the thoracolumbar spine, presence of a middle-column injury, and a confined high intensity or a diffuse low intensity area in the fractured vertebrae on T2-weighted MR images were significant risk factors for nonunion of OVFs.
The results of this study revealed significant relationships between plain radiograph and MR images of acute phase OVFs and the incidence of nonunion. As these risk factors are defined more clearly and further validated, they may become essential assessment tools for determining subsequent OVF treatments. Patients with one or more of the earlier-described risk factors for nonunion should be observed carefully and provided with more intensive treatments.
[Show abstract][Hide abstract] ABSTRACT: To summarize data on associations between inactivated influenza vaccines and the Guillain-Barré syndrome.
The association between inactivated influenza vaccines and the Guillain-Barré syndrome was described and discussed, mainly on the basis of previous studies cited in "Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices".
The A/New Jersey/76 swine influenza vaccine has been reported to be associated with occurrence of the Guillain-Barré syndrome. However, it is unclear whether seasonal inactivated influenza vaccines are associated with the occurrence of the syndrome. According to a study from the United States, which reported a statistically significant association between seasonal inactivated influenza vaccines and Guillain-Barré syndrome, the best estimate of maximum attributable risk, after allowing for study limitations, is 1.6 cases per million vaccinations.
We could not draw any definite conclusions about any causal relationship between seasonal influenza vaccination and the Guillain-Barré syndrome. Therefore we considering the estimated benefits of seasonal influenza vaccination to outweigh the reported risk of subsequent development of the Guillain-Barré syndrome.
[Nippon kōshū eisei zasshi] Japanese journal of public health 08/2010; 57(8):605-11.
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to investigate the influenza vaccine effectiveness among young children in Japan. Study subjects were recruited from 43 pediatric clinics. Influenza-like illness (ILI) was defined as an acute febrile illness with respiratory symptoms; ILI with a fever of > or =39 degrees C was considered to be severe ILI (SILI). The adjusted OR of vaccination significantly decreased to 0.75 for SILI. Influenza vaccination for young children had a protective effect on the occurrences of SILI. This study also indicated that three key tools (case surveillance with equal scrutiny, confining observation to the peak epidemic period, and adoption of strict criteria for ILI) could minimize outcome misclassification and thus provide adequate methodology for monitoring vaccine effectiveness without laboratory confirmation.
[Show abstract][Hide abstract] ABSTRACT: It remains unclear whether selective amygdalohippocampectomy, an operative technique developed for use in epilepsy surgery to spare unaffected brain tissue and thus minimize the cognitive consequences of temporal lobe surgery, actually leads to a better memory outcome. The present study was performed to determine the effects of selective surgery on memory outcome in patients with intractable mesial temporal lobe epilepsy due to hippocampal sclerosis treated using transsylvian selective amygdalohippocampectomy (TSA).
The study population consisted of 62 patients with left hemisphere language dominance who underwent left-(31 patients) or right-sided (31 patients) TSA. All patients underwent comprehensive neuropsychological testing before and 1 month and 1 year after unilateral TSA. Verbal Memory I, Nonverbal Memory I, Total Memory, Attention, and Delayed Recall were assessed using the Wechsler Memory Scale-Revised, whereas Verbal Memory II was assessed using the Miyake Verbal Retention Test (MVRT), and Nonverbal Memory II was assessed using the Benton Visual Retention Test. Separate repeated-measures multivariate analysis of variance (MANOVA) were performed for these intervals with memory scores.
The results of MANOVA indicated that patients who underwent right-sided TSA showed significant improvements in Verbal Memory I (preoperatively vs 1 month postoperatively, p < 0.0001; and preoperatively vs 1 year postoperatively, p = 0.0002), Nonverbal Memory I (preoperatively vs 1 month postoperatively, p = 0.0003; and preoperatively vs 1 year postoperatively, p = 0.006), and Delayed Recall (preoperatively vs 1 month postoperatively, p = 0.028) at both 1-month and 1-year follow-ups. In addition, Verbal Memory II (MVRT) was also significantly improved 1 year after surgery (p = 0.001). In the group of patients who underwent left-sided TSA, both Verbal Memory I and II were maintained at the same level 1 month after surgery, whereas the Verbal Memory I score 1 year after surgery increased with marginal significance (p = 0.074). In addition, Verbal Memory II showed significant improvement 1 year after surgery (p = 0.049). There were no significant changes in Nonverbal Memory I and II, Attention, or Delayed Recall at either the 1-month or 1-year follow-up.
Results of the present study indicated that left-sided TSA for hippocampal sclerosis tends to improve verbal memory function with the preservation of other types of memory function. Moreover, right-sided TSA for hippocampal sclerosis can lead to significant improvement in memory function, with memory improvement observed 1 month after right-sided TSA and persisting 1 year after surgery.
Journal of Neurosurgery 01/2009; 110(6):1164-9. · 3.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although nasal carriage of MRSA has been identified as one of the risk factors for surgical site infection (SSI) with MRSA, there have been no reports of this in the orthopedics field.
This prospective observational cohort study included 2,423 consecutive patients who were admitted to our department over 26 months and who underwent orthopedic surgery. We examined the relationship between pre-existing nasal MRSA and subsequent occurrence of SSI with MRSA.
63 patients (2.6%) had a positive nasal MRSA culture. 15 patients (0.6%) developed SSI with MRSA. The occurrence of SSI with MRSA in nasal MRSA carriers was significantly higher than that in non-carriers (4 out of 63 (6.3%) vs. 11 out of 2,360 (0.5%); p < 0.001) (adjusted OR: 11; 95% CI: 3-37; p = 0.001).
We recommend appropriate treatment of patients who are nasal carriers of MRSA before orthopedic surgery.
[Show abstract][Hide abstract] ABSTRACT: Both abnormal lipid metabolisms and coagulopathy have been suggested to be associated with the development of steroid-induced osteonecrosis (ON). We examined plasma risk factors for development of steroid-induced ON in rabbits after prophylaxis with a lipid-lowering agent and/or an anticoagulant.
Seventy adult male rabbits were injected intramuscularly once with 20 mg/kg methylprednisolone acetate. Fifty-five rabbits received prophylaxis with probucol (a lipid-lowering agent; n = 20) or warfarin (an anticoagulant; n = 14) or both (n = 21). Probucol and warfarin were administered beginning 1 to 2 weeks prior to steroid injection. Two weeks after steroid injection, the bilateral femora and humeri were examined histopathologically for the presence of ON. Based on a logistic regression model, laboratory variables before steroid injection were assessed to determine whether they demonstrated any association with the risk of ON.
Twenty-one rabbits developed ON. In the univariate analyses, significant positive associations were observed between plasma concentrations of triglyceride and low-density lipoprotein and the risk of development of ON. In the multivariate model, only the plasma triglyceride level suggested a positive association. Even after adjusting for probucol and warfarin use, the plasma triglyceride level was still suggested to be a predictor for development of ON. Rabbits with higher baseline triglyceride levels had a more pronounced triglyceride increase in their response to steroids.
Our study suggests that, after prophylaxis with probucol and/or warfarin, plasma triglyceride level is associated with the development of steroid-induced ON in rabbits.
The Journal of Rheumatology 12/2008; 35(12):2391-4. · 3.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We evaluated the usefulness of intravenous lidocaine therapy for managing of status epilepticus (SE) during childhood in a retrospective multi-institutional study. Questionnaires were sent to 28 hospitals concerning patients admitted for SE who were managed with lidocaine, assessing patient characteristics, treatment protocols and efficacy. In 279 treated patients, 261 SE occurrences at ages between 1 month and 15 years were analyzed. SE was classified as showing continuous, clustered, or frequently repeated seizures. Considering efficacy and side effects in combination, the usefulness of lidocaine was classified into six categories: extremely useful, useful, slightly useful, not useful, associated with deterioration, or unevaluated. In 148 SE cases (56.7%), lidocaine was rated as useful or extremely useful. Multivariate analysis indicated lidocaine was to be useful in SE with clustered and frequently repeated seizures, and SE attributable to certain acute illnesses, such as convulsions with mild gastroenteritis. Efficacy was poor when SE caused by central nervous system (CNS) infectious disease. Standard doses (approximately 2mg/kg as a bolus, 2mg/kg/h as maintenance) produced better outcomes than lower or higher doses. Poor responders to the initial bolus injection of lidocaine were less likely to respond to subsequent continuous infusion than good initial responders. We recommend lidocaine for use in SE with clustered or frequently repeated seizures, and in SE associated with benign infantile convulsion and convulsions with mild gastroenteritis. Lidocaine should be initiated with a bolus of 2mg/kg. If SE is arrested by the bolus, continuous maintenance infusion should follow; treatment should proceed to different measures when SE shows a poor response to the initial bolus of lidocaine.
Brain and Development 10/2008; 30(8):504-12. · 1.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study, done during the 2002--2003 season among children <6 years of age to investigate influenza vaccine effectiveness and confounding factors, involved 2913 children (1512 vaccinees, 1401 non-vaccinees) recruited from 54 paediatric clinics. Between December 2002 and April 2003, parents reported their children's maximum body temperatures weekly. Influenza-like illness (ILI) was defined as an acute febrile illness (> or =38.0 degrees C) during the peak epidemic period. Adjusted odds ratios (ORs) for ILI were obtained using a logistic regression model. In analysis for total subjects, the ORs were significantly decreased for vaccinees (OR: 0.76, 95% CI: 0.66-0.88) and significantly increased for younger age groups, including children aged 2.0-3.9 years (1.42, 1.18-1.72) and those < 2.0 years (2.02,1.61-2.54), compared to those between 4.0 and 5.9 years. ORs were significantly increased for children who visited a physician within the last 6 months for a cold (1.27, 1.08-1.50), attended preschool (1.72, 1.45-2.04), and had > or =3 siblings (1.42, 1.15-1.74). These confounding factors are suggested to be considered in estimating vaccine effectiveness among young children. In subgroup analysis by age groups, significantly decreased ORs were seen in 2.0-3.9-year-old (0.59, 0.47-0.74) and 4.0-5.9-year-old (0.75, 0.58-0.98) vaccinees; no significant vaccine effectiveness was detected for those < 2.0 years (1.07, 0.80-1.44). Thus, among very young children vaccine effectiveness could not be demonstrated.
[Show abstract][Hide abstract] ABSTRACT: A retrospective clinical study.
To evaluate the effect of preservation of paraspinal muscles attached at the spinous process of C2 or C7 in selective laminoplasty on postoperative axial pain.
Several methods of modified laminoplasty such as selective decompression and/or reconstruction of detached paraspinal muscles have been reported. It is still unclear, however, which posterior muscles need to be preserved to reduce postoperative problems.
The study group consisted of 145 patients who underwent cervical laminoplasty. The level of decompression was decided based on preoperative cervical magnetic resonance imaging. The level of detachment of muscle from the spinous process was from 1 cranial to the decompression level and to the same level caudal to the level of decompression. Clinical outcome was evaluated based on improvement ratio of Japanese Orthopedic Association (JOA) score. In addition, the risk factors for postoperative axial pain were examined by multivariate logistic regression analysis.
In 113 patients, C2 paraspinal muscles were detached, with elevation of the C3 lamina, and the improvement ratio of JOA score was 56.0%. In 32 patients, the muscles were preserved, without elevation of the C3 lamina, with corresponding ratio of 54.8%. In 112 patients, C7 paraspinal muscles were detached, with elevation of the C7 lamina, and in 33 patients the muscles were preserved; the improvement ratios of JOA score for these groups were 56.7% and 52.4%, respectively. There were no significant differences in clinical outcome among the groups. Older age (odds ratios: 0.17, 95% confidence intervals: 0.04-0.72) and preservation of muscles attached at the C2 spinous process (OR: 0.13, 95% CI: 0.02-0.98) decreased the risk of postoperative axial pain.
Muscle-preserving selective laminoplasty yielded clinical outcomes equivalent to those of conventional C3-C7 laminoplasty in cervical compression my elopathy. Preservation of the muscles attached at C2 resulted in reduction of postoperative axial pain.
[Show abstract][Hide abstract] ABSTRACT: Osteonecrosis of the femoral head (ONF) often develops following corticosteroid administration. We previously investigated the genetic background for the development of corticosteroid-induced ONF and found relations between ONF development and genetic polymorphisms in the ATP binding cassette B1 (ABCB1) gene (C3435T), apolipoprotein B (ApoB) gene (C7623T), and cAMP-response element binding protein-binding protein (CBP) gene (rs3751845). In the present study, we examined whether combined information regarding these three single nucleotide polymorphisms (SNPs) in the ABCB1, ApoB, and CBP genes is useful for predicting ONF development.
A case-control study was performed to study the development of corticosteroid-induced ONF. The cases were 34 patients who developed ONF, and the references were 123 patients who did not develop ONF. To evaluate the presence of interactions among the ABCB1, ApoB, and CBP genes, a synergistic index was calculated using an additive model.
The synergistic index between the ABCB1 and CBP genes was >1.00 (1.99), revealing the presence of an interaction.
Through analysis of multiple genes that may affect ONF development, we have shown a possible relation among genes encoding completely different proteins. We believe that analysis of the interactions among these genes can contribute to elucidating the mechanism of ONF development in addition to enabling identification of high-risk patients for ONF development.
Journal of Orthopaedic Science 07/2008; 13(4):297-303. · 0.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to validate the usefulness of positron emission tomography with fluorine-18-fluorodeoxyglucose (FDG-PET) in predicting degree of malignancy and prognosis, evaluated in terms of Japan Integrated Staging (JIS) score, in cirrhotic patients with hepatocellular carcinoma (HCC).
FDG-PET was performed in 50 patients with HCC. The activity within regions of interest placed over tumors was measured, and standardized uptake values (SUVs) were calculated by dividing the tissue activity by injected dose of radioactivity per unit body weight. SUV ratio (SUVR) was expressed as tumor-to-nontumor ratio of SUV. Patients were allocated to 3 groups of similar size: group A, SUVR < or = 1.1; group B, 1.1 < SUVR < 1.6; and group C, 1.6 < or = SUVR.
SUVR significantly correlated with tumor node metastasis stage score (p < 0.001) or JIS score (p = 0.022). Survival rate in SUVR group C was significantly lower than that in group A (p < 0.001), and close to being significantly lower than that in group B. On multivariate analysis, JIS scores 2 and > or = 3, SUVR group C were significantly related to survival (All p < 0.05).
SUVR was well associated with a tumor staging which is the factor of JIS score and with survival, and indicated malignancy and prognosis of patients especially with high-grade HCC.
[Show abstract][Hide abstract] ABSTRACT: The present study investigated factors associated with knee pain and functional limitation in knee OA patients. Subjects were 109 Japanese males who were newly diagnosed with knee OA at three university hospitals over a 1-year period. Knee pain and functional limitation in walking and climbing and/or descending stairs were selected as outcome measures. To assess factors associated with outcomes, we calculated odds ratios (OR) using logistic regression analysis. Taller height (> or =163 vs. <163 cm) showed a negative association with knee pain, "Pain on walking": OR = 0.08, 95% confidence interval = 0.01-0.79; "Pain on stairs": 0.25, 0.08-0.82. A significant characteristic related to a lesser degree of functional disability was alcohol consumption ("Waking distance": 0.34, 0.14-0.84; "Help on stairs": 0.21, 0.09-0.51). In the present study, knee pain was associated with shorter height in male Japanese patients with knee OA. Functional limitation was associated with no consumption of alcohol.
Rheumatology International 11/2007; 27(12):1135-42. · 2.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Osteonecrosis of the femoral head (ONFH) is one of the major side effects of corticosteroid therapy. Because corticosteroids are metabolized by hepatic cytochrome P450 (CYP) 3A, a low endogenous activity of this enzyme may contribute to the pathogenesis of ONFH. The purpose of this study was to examine the possible association of hepatic CYP3A activity and the susceptibility to ONFH in patients treated with corticosteroids.
In this prospective controlled study we measured the clearance of intravenous midazolam (0.25 mg/kg) to estimate hepatic CYP3A activity in patients with steroid-induced ONFH (n = 26), patients with alcohol-related ONFH (n = 29), and non-ONFH control patients (n = 75) undergoing orthopedic surgery. Midazolam clearance was compared between the groups, and the relationship between the level of hepatic CYP3A activity and the prevalence of ONFH was evaluated by multivariate analysis.
Midazolam clearance in patients with steroid-induced ONFH was significantly lower than that in control patients and patients with alcohol-related ONFH (7.7 +/- 1.8 mL x kg(-1) x min(-1) versus 11.4 +/- 3.5 mL x kg(-1) x min(-1) and 10.5 +/- 2.8 mL x kg(-1) x min(-1), respectively; P < .001). Patients with low midazolam clearance (<9.5 mL x kg(-1) x min(-1)) had a 9-fold greater risk for steroid-induced ONFH (adjusted odds ratio, 9.08 [95% confidence interval, 2.79-29.6]; P < .001). Midazolam clearance did not show a significant correlation with the prevalence of alcohol-related ONFH.
Low hepatic CYP3A activity may significantly contribute to the risk for steroid-induced ONFH.
[Show abstract][Hide abstract] ABSTRACT: This study was carried out to investigate the effectiveness of influenza vaccine among 2913 children (1512 vaccinees and 1401 nonvaccinees) under 6 years of age during the 2002-2003 season. Study subjects were recruited from 54 paediatric clinics, located in eight areas in Japan. Maximum body temperatures were obtained weekly from parents between 2002 December 16 and 2003 April 13. Influenza-like illness (ILI) was defined as an acute febrile illness (> or =38.0 degrees C) during the peak epidemic period in each study area. The vaccine antigens included were A/New Caledonia/20/99(H1N1), A/Panama/2007/99(H3N2) and B/Shandong/7/97. Vaccine effectiveness was analyzed by comparing the frequencies of ILI between vaccinees and nonvaccinees. The adjusted odds ratio (OR) and its 95% confidence interval (95% CI) were calculated by the proportional odds model using logistic regression with three-level outcome variables (<38.0/38.0-38.9/> or =39.0 degrees C). A significantly decreased OR of vaccination was observed (OR: 0.76; 95% CI: 0.66-0.88), corresponding to a vaccine effectiveness (1-OR) of 24% (95% CI: 12%-34%). When the analysis was confined to those aged > or =2 years, a more pronounced OR (0.67, 0.56-0.79) was obtained with a vaccine effectiveness of 33% (21%-44%). On the other hand, no significant vaccine effectiveness was detected among very young children; the ORs were 1.84 (0.81-4.19) for those <1 year of age and 0.99 (0.72-1.36) for those 1.0-1.9 years of age and 1.07 (0.80-1.44) when these two age groups were combined. Thus, among very young children vaccine effectiveness could not be demonstrated.
[Show abstract][Hide abstract] ABSTRACT: Osteoarthritis (OA) of the knee is a common form of arthritis, and affects quality of life. We investigated factors associated with functional limitation in stair climbing among female Japanese patients with knee OA. As weight is a known risk factor for knee OA, we focused on body weight at 40 years of age, and examined the association with present weight, past weight, and weight change.
Subjects were 360 Japanese women aged 40-92 years who were newly diagnosed with knee OA at 3 university hospitals over a 1-year period. Factors associated with the severity of functional limitation in stair climbing were assessed by calculating odds ratios (OR) using the proportional odds model in logistic regression.
Weight at diagnosis showed a positive association with severe functional limitation in stair climbing; however, a negative association was observed for weight change since age 40. Further analysis indicated that the association with weight at age 40 (highest vs. lowest quartile, OR=2.84, 95% confidence interval: 1.03-7.83, trend p=0.071) is stronger than weight at diagnosis. Other significant characteristics were age (70+ vs. 40-59 years, OR=7.37), previous knee pain and/or swelling 12 years or more before diagnosis (OR=2.67), and physical work (OR=1.94). In addition, higher parity was found to be a negatively associated factor (for tripara or more, OR=0.41).
This study identified factors, such as heavy weight at age 40 and physical labor, which are potentially useful for preventing severe functional limitation for female knee OA patients. In addition, higher parity was associated with milder stair climbing limitation.
Journal of Epidemiology 02/2006; 16(1):21-9. · 2.11 Impact Factor