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Biomedical subjects

A J Wells

Publications and source records attributed to A J Wells.

17 recordsLinked to original sources
PubMed1998

Heart disease from passive smoking in the workplace.

OBJECTIVES: This review sought to determine whether passive smoking in the workplace has roughly the same association with heart disease as passive smoking at home and to update a previous 1994 review on the effects of home-based passive exposure on the heart. BACKGROUND: To predict the effects of passive smoking at work on heart disease, public agencies have had to assume that workplace exposure to tobacco smoke was equivalent to home exposure. With the availability of more workplace exposure data, it is now possible to make a direct comparison. METHODS: The odds ratios and relative risks (RRs) of the eight studies that contained data on workplace exposure (1,699 cases) were arranged in what was believed to be the order of the quality of their tobacco smoke exposure measurements. A meta-analysis was performed to obtain combined RRs. Data from seven new studies on largely home-based exposure and heart disease that were not included in the 1994 review were also evaluated. RESULTS: The combined RR for the three top-rated workplace studies was 1.50 (95% confidence interval [CI] 1.12 to 2.01). Adding four lower rated studies reduced the RR to 1.35 (95% CI 1.09 to 1.67). Adding the largest study but the one with questionable exposure history reduced the combined RR to 1.18 (95% CI 1.04 to 1.34). Adding the seven new, largely home-based studies increased the home-based morbidity RR to 1.49 (95% CI 1.29 to 1.72) compared with 1.42 in 1994 while leaving the mortality RR unchanged at 1.23 (95% CI 1.14 to 1.32). CONCLUSIONS: The RRs for heart disease from passive smoking at work are roughly equal to those from home-based exposure.

Case-Control Studies↗
PubMed1998

Misclassification rates for current smokers misclassified as nonsmokers.

OBJECTIVES: This paper provides misclassification rates for current cigarette smokers who report themselves as nonsmokers. Such rates are important in determining smoker misclassification bias in the estimation of relative risks in passive smoking studies. METHODS: True smoking status, either occasional or regular, was determined for individual current smokers in 3 existing studies of nonsmokers by inspecting the cotinine levels of body fluids. The new data, combined with an approximately equal amount in the 1992 Environmental Protection Agency (EPA) report on passive smoking and lung cancer, yielded misclassification rates that not only had lower standard errors but also were stratified by sex and US minority majority status. RESULTS: The misclassification rates for the important category of female smokers misclassified as never smokers were, respectively, 0.8%, 6.0%, 2.8%, and 15.3% for majority regular, majority occasional, US minority regular, and US minority occasional smokers. Misclassification rates for males were mostly somewhat higher. CONCLUSIONS: The new information supports EPA's conclusion that smoker misclassification bias is small. Also, investigators are advised to pay attention to minority/majority status of cohorts when correcting for smoker misclassification bias.

Bias↗
PubMed1998

Lung cancer from passive smoking at work.

OBJECTIVES: This study was undertaken to determine whether exposure at work to environmental tobacco smoke is associated with an increased risk of lung cancer. METHODS: Data from 14 studies providing information on lung cancer and exposure to environmental tobacco smoke at work were examined. Six quality criteria were developed for determining usable data. A meta-analysis was performed to obtain a combined risk for those data that met the quality restrictions. RESULTS: Five studies met the quality standards. Their combined relative risk was 1.39 (95% confidence interval [CI] = 1.15, 1.68) based on 835 lung cancer cases. In various meta-analyses prepared by tobacco industry employees or consultants, no increase in risk was found. The main reason for this difference is that the earlier analysts failed to find errors in 2 underlying studies that resulted in overweighting of the odds ratios from those studies, both of which were less than unity. CONCLUSIONS: When appropriate cognizance is taken of the quality of data inputs, the increase in lung cancer risk from workplace exposure to environmental tobacco smoke is about the same as that from household exposure.

Confidence Intervals↗
PubMed1994

Passive smoking as a cause of heart disease.

The effects of passive smoking on ischemic heart disease are reviewed. Short-term exposures of 20 min to 8 h result in increased platelet sensitivity and decreased ability of the heart to receive and process oxygen. Longer term exposure results in plaque buildup and adverse effects on blood cholesterol. The available epidemiology is reviewed, and it is concluded that passive smoking increases the coronary death rate among U.S. never smokers by 20% to 70%. The newest Environmental Protection Agency procedures for estimating deaths from passive smoking, when applied to the epidemiologic results on heart disease and passive smoking, indicate that in 1985 an estimated 62,000 ischemic heart disease deaths in the United States were associated with exposure to environmental tobacco smoke. Clinicians are advised to counsel their patients to avoid tobacco smoke at home, at work and in transportation settings.

Cardiovascular System↗
PubMed1989

Deadly smoke.

Explore the source record for details and available documents.

Adult↗
PubMed1988

Variations in mothers' self-esteem in daily life.

In this study we used a new procedure, the experience sampling method (ESM; Csikszentmihalyi & Larson, 1987), to assess variations in self-esteem of mothers. Responding to random signals, 49 middle-class White working mothers reported present experience by answering a one-page questionnaire four to five times a day for 2 weeks. A measure of current, ongoing self-esteem was built from mothers' responses to the ESM and was compared with three standard self-esteem measures. Results support Fiske's (1971) ideas that although both types of procedures give a view of self-esteem, the views differ and cannot be considered interchangeable. Results showed that mothers' ongoing self-esteem fluctuated according to who mothers were with, was lower when they were with children than when with adults, and was related to aspects of their interpersonal situation. Results support viewing self-esteem as a complex phenomenon that is likely to require several types of measurement procedures to bring into clearer focus.

Adult↗
PubMed1988

Neuroleptic rechallenge after neuroleptic malignant syndrome: case report and literature review.

Neuroleptic malignant syndrome (NMS) is associated with essentially all of the currently available antipsychotic agents. The signs and symptoms associated with the syndrome are hyperpyrexia, defined by body temperature greater than 38 degrees C; extreme muscle rigidity, with or without elevated creatine phosphokinase or hyperreflexia; and other symptoms such as altered level of consciousness and/or autonomic dysfunction as manifested by labile blood pressure, tachycardia, tachypnea, urinary or fecal incontinence, pallor, or diaphoresis. This potentially fatal syndrome complicates the treatment of patients with recurrent psychotic symptoms because of the possibility for recurrence of the NMS. A case of recurrent NMS is presented in which the patient was rechallenged with an antipsychotic agent. In addition, 41 reported cases of antipsychotic rechallenge after NMS are reviewed. The results of the review suggest that neuroleptic rechallenge following NMS is associated with an acceptable risk of recurrence in most patients. However, close monitoring for NMS and careful selection of patients for antipsychotic rechallenge is mandatory. A minimal time period of five days before rechallenge may also reduce the risk of recurrent NMS. Recurrence was not associated with patient age or gender, nor the antipsychotic agent used.

Antipsychotic Agents↗