相关论文
1996 - The Journal of clinical investigation
The effect of non-insulin-dependent diabetes mellitus and obesity on glucose transport and phosphorylation in skeletal muscle.

Defects of glucose transport and phosphorylation may underlie insulin resistance in obesity and non-insulin-dependent diabetes mellitus (NIDDM). To test this hypothesis, dynamic imaging of 18F-2-deoxy-glucose uptake into midthigh muscle was performed using positron emission tomography during basal and insulin-stimulated conditions (40 mU/m2 per min), in eight lean nondiabetic, eight obese nondiabetic, and eight obese subjects with NIDDM. In additional studies, vastus lateralis muscle was obtained by percutaneous biopsy during basal and insulin-stimulated conditions for assay of hexokinase and citrate synthase, and for immunohistochemical labeling of Glut 4. Quantitative confocal laser scanning microscopy was used to ascertain Glut 4 at the sarcolemma as an index of insulin-regulated translocation. In lean individuals, insulin stimulated a 10-fold increase of 2-deoxy-2[18F]fluoro-D-glucose (FDG) clearance into muscle and significant increases in the rate constants for inward transport and phosphorylation of FDG. In obese individuals, the rate constant for inward transport of glucose was not increased by insulin infusion and did not differ from values in NIDDM. Insulin stimulation of the rate constant for glucose phosphorylation was similar in obese and lean subjects but reduced in NIDDM. Insulin increased by nearly twofold the number and area of sites labeling for Glut 4 at the sarcolemma in lean volunteers, but in obese and NIDDM subjects translocation of Glut 4 was attenuated. Activities of skeletal muscle HK I and II were similar in lean, obese and NIDDM subjects. These in vivo and ex vivo assessments indicate that impaired glucose transport plays a key role in insulin resistance of NIDDM and obesity and that an additional impairment of glucose phosphorylation is evident in the insulin resistance of NIDDM.

2014
The pre-exit performance of German plants - How long is the 'shadow of death'?

This paper deals with the question whether firms' employment performance in the periods preceding their exit can be regarded as casting a 'Shadow of Death' on their final leaving the market. This aspect is of high relevance for politicians and other decision-makers, because by knowing more about possible indicators of market exit and possible problems of firms, they might have instruments at hand to detain unwanted firm deaths. Although it can be seen as a stylized fact that exiting firms exhibit a worse economic performance in the time before exit, a systematic and detailed analysis of the pre-exit perfomance seems warranted. With specific regard to Germany, it is not clear how long the Shadow of Death is and which influence can be attributed to other factors specific to the firm, its employees or its environment. We study the pre-exit performance of German plants in terms of employment change and to this use a comprehensive data set that covers the whole of Germany and contains monthly plant data for the years from 1999 to 2012. Carrying out detailed sector-, region- and time-specific analyses, in a first step we are able to complement the existing literature on the Shadow of Death in detailed descriptive respects. Furthermore, it is not very clear how long the Shadow of Death is and which influence can be attributed to factors specific to the firm, its employees or its environment. Therefore, in a second step we use statistical matching approaches to identify the causal relations. We use a two-step matching procedure using covariate and nearest neighbour matching. In a final step, the conditional difference-in-difference estimator is applied. First descriptive results show that most of the exits take place at the end of a quarter in a year, especially at the end of the fourth quarter. Furthermore, the surviving plants start and operate with more employees. A Shadow of Death exists nearly as long as the plant exists, i.e. here eight or nine years long. On average and for larger plants, employment decline starts between 54 and 63 months before closure.

1987
Cryogenic Detection of Particles, Development Effort in the United States (With 3 Figures)

We review the development of cryogenic detectors of particles in the USA, with emphasis on large mass devices. Most groups are still tooling up and exploring basic properties of sensors. We summarize the main discussion themes and describe some of the early experimental results.

2013 - Morbidity and Mortality Weekly Report
Vital Signs: Overdoses of Prescription Opioid Pain Relievers and Other Drugs Among Women — United States, 1999–2010

Background Overdose deaths have increased steadily over the past decade. This report describes drug-related deaths and emergency department (ED) visits among women. Methods CDC analyzed rates of fatal drug overdoses and drug misuse- or abuse-related ED visits among women using data from the National Vital Statistics System (1999–2010) and the Drug Abuse Warning Network (2004–2010). Results In 2010, a total of 15,323 deaths among women were attributed to drug overdose, a rate of 9.8 per 100,000 population. Deaths from opioid pain relievers (OPRs) increased fivefold between 1999 and 2010 for women; OPR deaths among men increased 3.6 times. In 2010, there were 943,365 ED visits by women for drug misuse or abuse. The highest ED visit rates were for cocaine or heroin (147.2 per 100,000 population), benzodiazepines (134.6), and OPR (129.6). ED visits related to misuse or abuse of OPR among women more than doubled between 2004 and 2010. Conclusions Although more men die from drug overdoses than women, the percentage increase in deaths since 1999 is greater among women. More women have died each year from drug overdoses than from motor vehicle–related injuries since 2007. Deaths and ED visits related to OPR continue to increase among women. The prominent involvement of psychotherapeutic drugs, such as benzodiazepines, among overdoses provides insight for prevention opportunities. Implications for Public Health Practice Health-care providers should follow guidelines for responsible prescribing, including screening and monitoring for substance abuse and mental health problems, when prescribing OPR. Health-care providers who treat women for pain should use their state’s prescription drug monitoring program and regularly screen patients for psychological disorders and use of psychotherapeutic drugs, with or without a prescription.

2012 - Boston college environmental affairs law review
The Role of NEPA in Fossil Fuel Resource Development and Use in the Western United States

The National Environmental Policy Act (NEPA) has become a legal tool used to slow or prevent the development and use of energy in the United States. This article reviews the elements of NEPA that are most important in energy project compliance. It then examines recent NEPA case law regarding energy projects in the western United States, including the integration of climate change analysis into the NEPA process. This article focuses specifically on NEPA compliance by the Department of Energy and the Bureau of Land Management in the Department of the Interior, and concludes that federal agencies are susceptible to NEPA challenges against energy development projects.

2011 - Proceedings of the 2011 IEEE International Symposium on Sustainable Systems and Technology
Greening the service industries: A case study of a United States engineering consulting firm

The shift towards service based economic growth in developed countries is typically viewed positively with respect to environmental impact. Research in the past decade, however, has shown that service industries actually account for a large portion of environmental loadings in terms of emissions and energy use. Recently, more research has focused upon the development of tools and methods to properly assess the impacts of service industries. This paper discusses the environmental and economic performance of one service based company, a civil engineering consulting firm. This analysis employed a hybrid-based life cycle assessment (LCA) model to analyze the impacts of the aforementioned case study firm. The evaluation also included an energy audit, waste audit, and a personnel survey. This paper primarily focuses on the findings and results of the energy and waste audits, the survey, and the LCA as well as programs and initiatives that came as a result of the study. The findings point to both the difficulty and the importance of improving staff awareness of the environmental impacts associated with their work habits.

1984
The Traffic Conflict Technique of The United States of America

The traffic conflict technique (TCT) has been practiced in the United States for over 15 years. Traffic conflict observation began on a large scale in 1969 when the U.S. Federal Highway Administration (FHWA) awarded contracts to three state highway agencies. Teams of observers were employed and the TCT was practiced on a regular basis. Other states also began applying the TCT. The TCT was being utilized to solve operational problems at intersections. There also was the belief that an intersection safety record could be determined without relying on historical accident records. However, because there was a lack of a proven, direct relationship between accidents and conflicts, the United States TCT has received less emphasis from highway administrators and is not being practiced on the large scale that it once was.

2013 - Journal of chemical information and modeling
Fighting Obesity with a Sugar-Based Library: Discovery of Novel MCH-1R Antagonists by a New Computational-VAST Approach for Exploration of GPCR Binding Sites

Obesity is an increasingly common disease. While antagonism of the melanin-concentrating hormone-1 receptor (MCH-1R) has been widely reported as a promising therapeutic avenue for obesity treatment, no MCH-1R antagonists have reached the market. Discovery and optimization of new chemical matter targeting MCH-1R is hindered by reduced HTS success rates and a lack of structural information about the MCH-1R binding site. X-ray crystallography and NMR, the major experimental sources of structural information, are very slow processes for membrane proteins and are not currently feasible for every GPCR or GPCR-ligand complex. This situation significantly limits the ability of these methods to impact the drug discovery process for GPCR targets in "real-time", and hence, there is an urgent need for other practical and cost-efficient alternatives. We present here a conceptually pioneering approach that integrates GPCR modeling with design, synthesis, and screening of a diverse library of sugar-based compounds from the VAST technology (versatile assembly on stable templates) to provide structural insights on the MCH-1R binding site. This approach creates a cost-efficient new avenue for structure-based drug discovery (SBDD) against GPCR targets. In our work, a primary VAST hit was used to construct a high-quality MCH-1R model. Following model validation, a structure-based virtual screen yielded a 14% hit rate and 10 novel chemotypes of potent MCH-1R antagonists, including EOAI3367472 (IC50 = 131 nM) and EOAI3367474 (IC50 = 213 nM).

2015 - Int. J. Appl. Geospat. Res.
Enabling Healthy Living: Spatiotemporal Patterns of Prevalence of Overweight and Obesity among Youths in the United States

The increasing burden of overweight and obesity in the United States (U.S.) demands a better understanding of its local and regional spatial patterns and trends. The study examines the hypothesis that there are spatial differences in the prevalence of overweight and obesity in U.S. youths at regional and local levels. It used spatial, statistical, and spatiotemporal analyses and a synthesis of regionally and locally relevant data from a cohort of large, nationally representative, longitudinal data sets, the National Longitudinal Survey of Youth (NLSY`97) to analyze overweight and obesity prevalence. Specifically, the methods used included the spatial Generalized Linear Mixed Model (GLMM), spatial interpolation techniques (Inverse Distance Weighting — IDW), and Kulldorf's scan space-time analysis. The paper analyzed 12 waves (1997—2008) of data from the NLSY data sets. Its findings revealed there is an upward trend both in males and in females in obesity prevalence in US youths during the twelve-year period. Youth obesity prevalence was also higher among females than among males. The cohort shows evidence of increase in overweight and obesity prevalence. There are mixed trends in youth obesity prevalence patterns in rural and urban areas. Counties identified as consistently experiencing higher prevalence of obesity and with the potential of becoming an obesogenic environment are Copiah, Holmes, and Hinds in Mississippi; Harris and Chamber, Texas; Oklahoma and McCain, Oklahoma; Jefferson, Louisiana; and Chicot and Jefferson, Arkansas. The twelve-year study indicated spatial variation in obesity and overweight prevalence among U.S. youths, with pockets of clustered prevalence. This information can guide programs, policies, and initiatives for obesity prevention at regional and local levels.

1990 - International journal of mass emergencies and disasters
The Federal Emergency Management System in the United States: Past and Present

The paper begins by providing a historical overview of wartime and peacetime emergency preparedness in the United States in terms of major historical trends and unresolved issues which preceded the establishment of the Federal Emergency Management Agency (FEMA) in 1979. With the unresolved issues serving as a historical backdrop, FEMA's contemporary role in the federal emergency management system is then examined to see what progress toward their resolution is being achieved. The paper closes with a brief comment on what the historical evolution of federal emergency management in the United States suggests about what can and cannot be accomplished.

2004 - Accident; analysis and prevention
Evaluation of effectiveness of safety seatbelt legislation in the United Arab Emirates.

Seatbelt legalisation was implemented in the United Arab Emirates (UAE) in January 1999. This provided the opportunity to evaluate the effectiveness of the legislation in the Eastern District of Abu Dhabi Emirate in the UAE by establishing levels of injury severity from motor vehicle crashes (MVC) before and after the legislation and the rate of compliance with the legislation. Data were obtained from a major hospital in the Eastern District of Abu Dhabi Emirate, UAE. Subjects were a systematic sample of MVC victims who arrived alive at hospital in either the pre-implementation period (January-June 1998) or the post-implementation period (February-August 2000). The main measures of outcome were injury severity codes, numbers of hospital bed days and rates of admission and discharge at hospital. The analysis of injury severity from MVCs, from the pre- to the post-implementation period, revealed a significant declining trend (chi-square = 77.68, P < 0.001). While the proportion of minor injuries increased from 42% (95% CI: 36-48%) in the pre-implementation period to 77% (95% CI: 71-83%) in the post-implementation period, the proportion of "moderate to fatal injuries" declined from 54% (95% CI: 48-60%) to 17% (P = 0.001) and the median number of hospital bed days declined from 5 days (25% = 2; 75% = 8 ) to 3 days (25% = 1; 75% = 4 ). The rate of seatbelt compliance reported by occupants involved in MVCs in the post-implementation period was 59% (95% CI: 52-67%). The implementation of the seatbelt legislation in the Eastern District of Abu Dhabi Emirate was associated with statistically significant reduction in morbidity in those arriving alive at hospital following MVC, including reduced severity of injury, admission rate to hospital and the duration of hospital stay. More active implementation of seatbelt law would most likely further reduce severity of MVC injuries and fatalities in the Eastern District of Abu Dhabi Emirate, UAE.

2019 - International journal of medical informatics
Automatic classification of free-text medical causes from death certificates for reactive mortality surveillance in France

BACKGROUND Mortality surveillance is of fundamental importance to public health surveillance. The real-time recording of death certificates, thanks to Electronic Death Registration System (EDRS), provides valuable data for reactive mortality surveillance based on medical causes of death in free-text format. Reactive mortality surveillance is based on the monitoring of mortality syndromic groups (MSGs). An MSG is a cluster of medical causes of death (pathologies, syndromes or symptoms) that meets the objectives of early detection and impact assessment of public health events. The aim of this study is to implement and measure the performance of a rule-based method and two supervised models for automatic free-text cause of death classification from death certificates in order to implement them for routine surveillance. METHOD A rule-based method was implemented using four processing steps: standardization rules, splitting causes of death using delimiters, spelling corrections and dictionary projection. A supervised machine learning method using a linear Support Vector Machine (SVM) classifier was also implemented. Two models were produced using different features (SVM1 based solely on surface features and SVM2 combining surface features and MSGs classified by the rule-based method as feature vectors). The evaluation was conducted using an annotated subset of electronic death certificates received between 2012 and 2016. Classification performance was evaluated on seven MSGs (Influenza, Low respiratory diseases, Asphyxia/abnormal respiration, Acute respiratory disease, Sepsis, Chronic digestive diseases, and Chronic endocrine diseases). RESULTS The rule-based method and the SVM2 model displayed a high performance with F-measures over 0.94 for all MSGs. Precision and recall were slightly higher for the rule-based method and the SVM2 model. An error-analysis shows that errors were not specific to an MSG. CONCLUSION The high performance of the rule-based method and SVM2 model will allow us to set-up a reactive mortality surveillance system based on free-text death certificates. This surveillance will be an added-value for public health decision making.

2007 - PloS one
Cortical Modulations Increase in Early Sessions with Brain-Machine Interface

Background During planning and execution of reaching movements, the activity of cortical motor neurons is modulated by a diversity of motor, sensory, and cognitive signals. Brain-machine interfaces (BMIs) extract part of these modulations to directly control artificial actuators. However, cortical modulations that emerge in the novel context of operating the BMI are poorly understood. Methodology/Principal Findings Here we analyzed the changes in neuronal modulations that occurred in different cortical motor areas as monkeys learned to use a BMI to control reaching movements. Using spike-train analysis methods we demonstrate that the modulations of the firing-rates of cortical neurons increased abruptly after the monkeys started operating the BMI. Regression analysis revealed that these enhanced modulations were not correlated with the kinematics of the movement. The initial enhancement in firing rate modulations declined gradually with subsequent training in parallel with the improvement in behavioral performance. Conclusions/Significance We conclude that the enhanced modulations are related to computational tasks that are significant especially in novel motor contexts. Although the function and neuronal mechanism of the enhanced cortical modulations are open for further inquiries, we discuss their potential role in processing execution errors and representing corrective or explorative activity. These representations are expected to contribute to the formation of internal models of the external actuator and their decoding may facilitate BMI improvement.

2009
The Current Use of Offsite Construction Techniques in the United States Construction Industry

Even though the use of offsite construction techniques provides numerous significant advantages the current level of using these techniques in the US construction industry is limited. This study aimed to 1) identify the driving forces and challenges in using these techniques in residential, commercial, and industrial sectors, 2) investigate the perceived benefits and barriers, and 3) compare the perceived benefits and barriers in using these techniques in residential, commercial, and industrial construction sectors. The results indicated that benefits of using these techniques include 1) reducing the project schedule, 2) reducing the need for skilled craft workers, 3) reducing the negative environmental impact, and 4) increasing safety performance. The most significant barriers were 1) transportation restraints and 2) inability to make changes onsite. The top 3 driving forces for its use were 1) to reduce the construction duration, 2) to reduce the overall project schedule, and 3) to compensate for the effect of incremental weather conditions. The top 3 challenges were 1) the inability to make changes onsite, 2) transportation constraints, and 3) limited design options. Several practical recommendations were proposed in this study based on the findings.

2021 - Sustainable Cities and Society
Exploring spatiotemporal effects of the driving factors on COVID-19 incidences in the contiguous United States

Since December 2019, the world has witnessed the stringent effect of an unprecedented global pandemic, coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As of January 29, 2021, there have been 100, 819, 363 confirmed cases and 2, 176, 159 deaths reported. Among the countries affected severely by COVID-19, the United States tops the list. Research has been conducted to discuss the causal associations between explanatory factors and COVID-19 transmission in contiguous United States. However, most of these studies focus more on spatial associations of the estimated parameters, yet exploring the time-varying dimension in spatial econometric modeling has appears to be utmost essential. This research adopts various relevant approaches to explore the potential effects of driving factors on COVID-19 counts in the contiguous United States. A total of three global spatial regression models and two local spatial regression models, the latter including geographically weighted regression (GWR) and multiscale GWR (MGWR), are performed at the county scale to take into account the scale effects. For COVID-19 cases, ethnicity, crime, and income factors are found to be the strongest covariates and explain most of the variance of modeling estimation. For COVID-19 deaths, migration (domestic and international) and income factors play a critical role in explaining spatial differences of COVID-19 deaths across counties. Such associations also exhibit temporal variations from March to July, as supported by better performance of MGWR than GWR. Both global and local associations among the parameters vary highly over space and change across time. Therefore, time dimension should be paid more attention to the spatial epidemiological analysis. Among the two local spatial regression models, MGWR performs more accurately, as it has slightly higher Adj. R2 values (for cases, R2 = 0.961; for deaths, R2 = 0.962), compared to GWR’s Adj. R2 values (for cases, R2 = 0.954; for deaths, R2 = 0.954). To inform policy-makers at the nation and state levels, understanding the place-based characteristics of the explanatory forces and related spatial patterns of the driving factors is of paramount importance. Since COVID-19 is not the first time we are facing public health emergency, the findings of the present research therefore could be used as a reference for policy designing and effective decision making.

1962
The Production and Distribution of Knowledge in the United States

The Production and Distribution of Knowledge in the United States marked the beginning of the study of our postindustrial information society. Austrian-born economist Fritz Machlup had focused his research on the patent system, but he came to realize that patents were simply one part of a much bigger "knowledge economy." He then expanded the scope of his work to evaluate everything from stationery and typewriters to advertising to presidential addresses--anything that involved the activity of telling anyone anything. The Production and Distribution of Knowledge in the United States then revealed the new and startling shape of the U.S. economy. Machlup's cool appraisal of the data showed that the knowledge industry accounted for nearly 29 percent of the U.S. gross national product, and that 43 percent of the civilian labor force consisted of knowledge transmitters or full-time knowledge receivers. Indeed, the proportion of the labor force involved in the knowledge economy increased from 11 to 32 percent between 1900 and 1959--a monumental shift. Beyond documenting this revolution, Machlup founded the wholly new field of information economics. The transformation to a knowledge economy has resonated throughout the rest of the century, especially with the rise of the Internet. As two recent observers noted, "Information goods--from movies and music to software code and stock quotes--have supplanted industrial goods as the key drivers of world markets." Continued study of this change and its effects is testament to Fritz Machlup's pioneering work.

2003 - Accident; analysis and prevention
Occupant deaths in large truck crashes in the United States: 25 years of experience.

There is public concern about the magnitude of the problem of large truck crashes in the US. Fatalities in large truck crashes have not declined much; however, more large trucks are driving more miles than ever before while fatalities per mile driven have dropped substantially. This study examined how the public health burden of large truck crashes versus the risk per unit of travel has changed over 25 years. The present study focused on the US vehicle occupants in fatal crashes involving a large truck during 1975-1999. Occupant fatalities per 100000 population, per 10000 licensed drivers, per 10000 registered trucks and per 100 million vehicle-miles of travel (VMT) were calculated to determine trends in occupant deaths in large truck crashes. In 1999, large truck crashes resulted in 3916 occupant deaths in passenger vehicles and 747 in large trucks. Passenger vehicle occupant deaths in large truck crashes per 100000 population have increased somewhat since 1975 (1.28 in 1975 and 1.44 in 1999). There have been appreciable declines in occupant deaths per truck VMT since 1975, but the percentage reduction has been greater for occupants of large trucks (67%) than for passenger vehicle occupants (43%). However, truck drivers are at elevated risk of dying relative to their numbers in the workforce. Overall large truck involvements in fatal crashes per truck VMT decreased more than passenger vehicle involvements per passenger VMT (PVMT; 68% versus 33% decreases for single-vehicle crashes and 43% versus 23% for multiple-vehicle crashes). Large truck involvement in fatal crashes has dropped substantially when measured per unit of travel, but the public health burden of large truck crashes, as measured by deaths per 100000 population, has not improved over time because of the large increase in truck mileage. Research is needed on measures to better protect both occupants of large trucks and passenger vehicle occupants colliding with them.

2005 - International Journal of Obesity
Childhood IQ in relation to obesity and weight gain in adult life: the National Child Development (1958) Study

Objective:To examine the relation of childhood intelligence (IQ) test results with obesity in middle age and weight gain across the life course.Methods:We analysed data from the National Child Development (1958) Study, a prospective cohort study of 17 414 births to parents residing in Great Britain in the late 1950s. Childhood IQ was measured at age 11 years and body mass index (BMI), an indicator of adiposity, was assessed at 16, 23, 33 and 42 years of age. Logistic regression (in which BMI was categorised into obese and non-obese) and structural equation growth curve models (in which BMI was retained as a continuous variable) were used to estimate the relation between childhood IQ and adult obesity, and childhood IQ and weight gain, respectively.Results:In unadjusted analyses, lower childhood IQ scores were associated with an increased prevalence of adult obesity at age 42 years. This relation was somewhat stronger in women (ORper SD decrease in IQ score [95% CI]: 1.38 [1.26, 1.50]) than men (1.26 [1.15, 1.38]). This association remains statistically significant after adjusting for childhood characteristics, including socio-economic factors, but was heavily attenuated following control for adult characteristics, particularly education (women: 1.11 [0.99, 1.25]; men: 1.10 [0.98, 1.23]). When weight gain between age 16 and 42 years was the outcome of interest, structural equation modelling revealed that education and dietary characteristics in adult life mediated the association with childhood IQ.Conclusions:A lower IQ score in childhood is associated with obesity and weight gain in adulthood. In the present study, this relation appears to be largely mediated via educational attainment and the adoption of healthy diets in later life.

2008 - Cognitive science
Understanding Mortality and the Life of the Ancestors in Rural Madagascar Understanding Mortality and the Life of the Ancestors in Rural Madagascar

Across two studies, a wide age range of participants was interviewed about the nature of death. All participants were living in rural Madagascar in a community where ancestral beliefs and practices are widespread. In Study 1, children (8-17 years) and adults (19-71 years) were asked whether bodily and mental processes continue after death. The death in question was presented in the context of a narrative that focused either on the corpse or on the ancestral practices associated with the afterlife. Participants aged 8 years and older claimed that death brings an end to most bodily and mental processes. Nevertheless, particularly in the context of the religious narrative, they claimed that certain mental processes continue even after death. This assertion of an afterlife was more evident among adults than children, especially with respect to cognitive processes, such as knowing and remembering. In Study 2, 5- and 7-year-olds were asked similar questions in connection with the death of a bird and a person. Seven-year-olds consistently claimed that bodily and mental processes cease at death, whereas 5-year-olds were unsystematic in their replies. Together, the two studies replicate and extend findings obtained with Western children showing that, in the course of development, different conceptions of death are elaborated-a biological conception in which death terminates living processes and a religious conception in which death marks the beginning of a new form of spiritual existence.

1994 - JAMA
Actual causes of death in the United States.

To the Editor. —The article entitled "Actual Causes of Death in the United States"1was misleading in a number of ways. First, the title should have been something like "Nongenetic Causes of Death" or "Potentially Preventable Nongenetic Causes of Premature Death," or adjustments should have been made so that ordinary causes of death not credited to one of Drs McGinnis and Foege's major external factors were kept in. Otherwise, listing nine or 10 leading "actual causes" misleadingly suggests that heart disease and cancers are not leading causes of death. In fact, subtract those cancers and heart diseases that McGinnis and Foege attribute to external causes, lifestyles, and the like, and heart disease remains comfortably in third place as a cause of death, and cancers not attributable to outside influences kill more than toxic agents do. Second, either some deaths are counted twice or virtually no firearm-related deaths are attributed

Excess deaths associated with underweight, overweight, and obesity.

M. Gail
|
K. Flegal
|
D. Williamson
|
B. Graubard

Abstract:CONTEXT As the prevalence of obesity increases in the United States, concern over the association of body weight with excess mortality has also increased. OBJECTIVE To estimate deaths associated with underweight (body mass index [BMI] <18.5), overweight (BMI 25 to <30), and obesity (BMI > or =30) in the United States in 2000. DESIGN, SETTING, AND PARTICIPANTS We estimated relative risks of mortality associated with different levels of BMI (calculated as weight in kilograms divided by the square of height in meters) from the nationally representative National Health and Nutrition Examination Survey (NHANES) I (1971-1975) and NHANES II (1976-1980), with follow-up through 1992, and from NHANES III (1988-1994), with follow-up through 2000. These relative risks were applied to the distribution of BMI and other covariates from NHANES 1999-2002 to estimate attributable fractions and number of excess deaths, adjusted for confounding factors and for effect modification by age. MAIN OUTCOME MEASURES Number of excess deaths in 2000 associated with given BMI levels. RESULTS Relative to the normal weight category (BMI 18.5 to <25), obesity (BMI > or =30) was associated with 111,909 excess deaths (95% confidence interval [CI], 53,754-170,064) and underweight with 33,746 excess deaths (95% CI, 15,726-51,766). Overweight was not associated with excess mortality (-86,094 deaths; 95% CI, -161,223 to -10,966). The relative risks of mortality associated with obesity were lower in NHANES II and NHANES III than in NHANES I. CONCLUSIONS Underweight and obesity, particularly higher levels of obesity, were associated with increased mortality relative to the normal weight category. The impact of obesity on mortality may have decreased over time, perhaps because of improvements in public health and medical care. These findings are consistent with the increases in life expectancy in the United States and the declining mortality rates from ischemic heart disease.

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