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1.  Magnitude, impact, and stability of primary headache subtypes: 30 year prospective Swiss cohort study 
Objective
To determine the prevalence, impact, and stability of different subtypes of headache in a 30 year prospective follow-up study of a general population sample.
Design
Prospective cohort study.
Setting
Canton of Zurich, Switzerland.
Participants
591 people aged 19–20 from a cohort of 4547 residents of Zurich, Switzerland, interviewed seven times across 30 years of follow-up.
Main outcome measures
Prevalence of headache; stability of the predominant subtype of headache over time; and age of onset, severity, impact, family history, use of healthcare services, and drugs for headache subtypes.
Results
The average one year prevalences of subtypes of headache were 0.9% (female:male ratio of 2.8) for migraine with aura, 10.9% (female:male ratio of 2.2) for migraine without aura, and 11.5% (female:male ratio of 1.2) for tension-type headache. Cumulative 30 year prevalences of headache subtypes were 3.0% for migraine with aura, 36.0% for migraine without aura, and 29.3% for tension-type headache. Despite the high prevalence of migraine without aura, most cases were transient and only about 20% continued to have migraine for more than half of the follow-up period. 69% of participants with migraine and 58% of those with tension-type headache manifested the same predominant subtype over time. However, the prospective stability of the predominant headache subtypes was quite low, with substantial crossover among the subtypes and no specific ordinal pattern of progression. A gradient of severity of clinical correlates and service use was present across headache subtypes; the greatest effect was for migraine with aura followed by migraine without aura, and then tension-type headache and unclassified headaches.
Conclusions
These findings highlight the importance of prospective follow-up of people with headache. The substantial longitudinal overlap among subtypes of headache shows the developmental heterogeneity of headache syndromes. Studies of the causes of headache that apply diagnostic nomenclature based on distinctions between discrete headache subtypes may not capture the true nature of headache in the general population.
PMCID: PMC3161722  PMID: 21868455
4.  Kidney Function and Risk of Cardiovascular Disease and Mortality in Women: a Prospective Cohort Study 
Objective
Studies suggest that impaired kidney function is associated with cardiovascular disease (CVD) and mortality, particularly CVD death, among patients with existing kidney disease or CVD. Data in primary prevention are sparse. We aimed to evaluate the association of kidney function with CVD and mortality among apparently healthy women.
Design
Prospective cohort study among 27,939 female health professionals aged ≥45 who were free of CVD and provided a blood sample at study entry.
Setting
Women's health study, United States.
Main outcome measures
Time to CVD (nonfatal stroke, nonfatal myocardial infarction, coronary revascularization procedures, or death from cardiovascular cause), specific CVD events, and all-cause mortality. Endpoints were confirmed after medical record and death certificate review.
Results
We estimated glomerular filtration rate (GFR) using the abbreviated Modification-of-Diet-in-Renal-Disease-Study equation. At baseline, 1,315 (4.7%) women had GFR <60 ml/min/1.73m2. During 12 years of follow-up, 1,199 incident CVD events and 856 deaths (179 from CVD) occurred. Compared with women with GFR ≥90 ml/min/1.73m2, the multivariable-adjusted hazard ratios (HRs) (95% confidence intervals) were 0.95 (0.83−1.08), 0.84 (0.70−1.00), and 1.00 (0.79−1.27) for any first CVD and 0.93 (0.79−1.09), 1.03 (0.85−1.26), and 1.09 (0.83−1.45) for all-cause mortality among women with GFR levels of 75−89.9, 60−74.9, and <60 ml/min/1.73 m2, respectively. Similar null findings were observed for myocardial infarction, stroke, coronary revascularization, and non-cardiovascular death. In contrast, we observed an increased risk of CVD death (HR=1.68; 1.02−2.79) for women with GFR <60 ml/min/1.73m2.
Conclusions
In this large cohort of women, GFR <60 ml/min/1.73m2 appeared to be associated with increased risk of CVD death but not other CVD events or non-CVD mortality. We observed no increase in risk of any of the outcomes among women with less severe impairment of kidney function.
PMCID: PMC2704981  PMID: 19564178
kidney; cardiovascular disease; women; epidemiology
5.  The Dynamic Spread of Happiness in a Large Social Network 
Background
A broad range of stimuli to human happiness has been explored, but past studies have not addressed a possibly key stimulus to human happiness: the happiness of others.
Objectives
To evaluate whether happiness can spread from person to person and whether niches of happiness form within social networks.
Design
Longitudinal social network analysis.
Setting
Framingham Heart Study Social Network.
Participants
4,739 individuals followed from 1983 to 2003.
Main Outcome Measures
We measured happiness using a validated four-item scale, and we ascertained a broad array of social network attributes as well as diverse social ties.
Results
Clusters of happy and unhappy people are visible in the network, and the relationship between people’s happiness appears to extend up to three degrees of separation (e.g., to one’s friends’ friends’ friends). People who are surrounded by many happy people and those who are central in the network are more likely to become happy in the future. Longitudinal statistical models suggest that happiness clusters result from the spread of happiness and not just a tendency for people to associate with similar individuals. A friend who lives within a mile and who becomes happy increase the probability a person is happy by 25% (95% C.I. 1% to 57%). Similar effects are seen in coresident spouses (8%, 0.2% to 16%), siblings who live within a mile (14%, 1% to 28%), and next-door neighbors (34%, 7% to 70%). Effects are not seen between co-workers. The effect decays with time and with geographic separation.
Conclusions
People’s happiness depends on the happiness of others to whom they are connected. This provides further justification for seeing happiness, like health, as a collective phenomenon.
PMCID: PMC2600606  PMID: 19056788

Results 1-5 (5)