Transitions in employment, morbidity, and disability among persons ages 51-61 with musculoskeletal and non-musculoskeletal conditions in the US, 1992-1994.

OBJECTIVE: To provide estimates of the prevalence of musculoskeletal conditions in a sample of persons ages 51-61 living in the community in the US in 1992, to indicate the incidence of such conditions between 1992 and 1994, and to describe the proportion of individuals with these conditions who developed or recovered from disability and who left and entered employment during this time. METHODS: The estimates were derived from the Health and Retirement Survey, consisting of data on a national probability sample of 8,739 persons, ages 51-61, who were interviewed in the community in 1992 and reinterviewed in 1994. RESULTS: In 1992, 62.4% of persons (14.4 million) between the ages of 51 and 61 years reported at least 1 musculoskeletal condition; the rate increased to 70.5% by 1994. More than 40% of persons with musculoskeletal conditions reported disability, which was almost 90% of all persons with disability in this age group. Persons with musculoskeletal conditions had lower employment rates, were less likely to enter employment, and were more likely to leave employment compared with persons without these conditions. High rates of disability account for much of these differences. CONCLUSION: Musculoskeletal conditions affected more than two-thirds of persons ages 51-61 and accounted for all but 10% of those with disabilities. The prevention of disability among such persons should improve their employment prospects.

Change in paternity: a risk factor for preeclampsia in multiparas.

Preeclampsia, a hypertensive disorder of pregnancy, is hypothesized to be a maternal immunologic response to foreign fetal antigen derived from the father's sperm. This response may be reduced by prolonged exposure to father's antigen, such as through a prior pregnancy, which may explain why multiparas are typically at lower risk for preeclampsia than nulliparas. Since multiparas with new partners are presented with a new set of paternal antigen, we hypothesize that they would have the same elevated risk for preeclampsia and gestational hypertension as nulliparas, compared with multiparas with no change in partner. We studied 5,068 nulliparas and 5,800 multiparas, 573 of whom had new partners, selected from the Child Health and Development Studies cohort (Oakland, CA, 1959-1967). Preeclampsia was diagnosed in 3.2% of nulliparas, 3.0% of multiparas with changed paternity, and 1.9% of multiparas with no change. Compared with multiparas with no change, the adjusted odds ratio for preeclampsia among nulliparas was 2.5 [95% confidence interval (CI) = 1.8-3.5]; among multiparas with new partners, the adjusted odds ratio for preeclampsia was 1.4 (95% CI = 0.8-2.4). There was a similar pattern of results for gestational hypertension. The adjusted attributable risk of preeclampsia in multiparas associated with a change in paternity was 29%. Although these findings in part support the immunologic theory of preeclampsia, they also suggest that a subsequent pregnancy with any partner is associated with a reduced risk for preeclampsia.

Passive and active maternal smoking during pregnancy, as measured by serum cotinine, and postnatal smoke exposure. II. Effects on neurodevelopment at age 5 years.

The authors sought to determine the neurobehavioral effects of prenatal exposure to maternal active smoking and environmental tobacco smoke (ETS), assessed by maternal serum cotinine level, and of postnatal exposure to smoke based on maternal report. Five-year-old children (n = 2,124) who were participants in the Child Health and Development Studies in Oakland, California, between 1964 and 1967 were evaluated with the use of the Peabody Picture Vocabulary Test (PPVT) and the Raven Coloured Progressive Matrices Test, and also assessed on a behavioral rating scale completed by the mother that included questions on activity level. Children of ETS-exposed women did not differ from children of other nonsmokers on neurobehavioral assessment. Children whose mothers smoked during pregnancy had somewhat higher adjusted Raven (p = 0.10) and PPVT scores (p = 0.06) than children of nonsmokers, although they did not differ in their activity level (p = 0.32). However, children smoke-exposed during childhood did have lower adjusted Raven (p = 0.01) and PPVT scores (p = 0.16), and were rated more active by their mothers (p = 0.04). These differences may be attributed to uncontrolled confounding of sociobehavioral variables. However, the authors cannot rule out the possibility that ETS exposure during childhood may be more hazardous to neurodevelopment than prenatal exposure.