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Biomedical subjects

A M Lilienfeld

Publications and source records attributed to A M Lilienfeld.

At least 19 recordsLinked to original sources

Declining trends in mortality from cerebrovascular disease at ages 10-65 years: a test of validity.

Recent reports of declining trends in mortality rates from cerebrovascular disease are based on underlying cause of death as stated on the death certificate, and may contain inaccuracies because death certificates are often completed without reference to all information in medical records, and because of changes in coding conventions and diagnostic fashion. This is a report of trends in mortality rates from cerebrovascular disease in Baltimore, Md., during 1950-1970 using data validated by reference to individual medical records from 19 hospitals. Overall accuracy of death certificate diagnoses did not change markedly during the study period. Death rates from subarachnoid hemorrhage increased in white women, but decreased in white men and in nonwhites of both sexes. Death rates from other cerebrovascular diseases declined in most sex and color groups, a result which cannot be attributed to errors in death certificate diagnoses. The increasing rates of subarachnoid hemorrhage observed in white women deserve further attention.

Adolescent

Risk factors for ischemic stroke: a prospective study in Rochester, Minnesota.

A cohort of 1,804 residents of Rochester, Minnesota, who were at least 50 years old, free of stroke, and who underwent examination at the Mayo Clinic in 1960, was followed for 13 years. During this period, there were 110 first ischemic strokes and 616 deaths without stroke. The time of onset, if available, or the time of diagnosis of potential risk factors was determined for all patients during the study and was used to construct a proportional hazards model of time to occurrence of stroke with time-dependent risk factors. The model included 8 risk factors (2 fixed and 6 time-dependent). For these, the individual relative risks are: 1.6 for age (per 10 years), 2.0 for males, 4.0 for definite hypertension, 3.9 for transient ischemic attacks, 2.2 for hypertensive heart disease, 2.2 for coronary heart disease, 1.7 for congestive heart failure, and 1.7 for diabetes mellitus. Atrial fibrillation was not a significant risk factor using time-dependent multivariate analysis.

Brain Ischemia

Inter- and intra-pathologist variability in the diagnosis of gestational trophoblastic neoplasia.

All 190 cases of gestational trophoblastic neoplasia diagnosed in the Baltimore metropolitan area from 1975-1982 were identified. Histologic slides were requested and reviewed independently by two pathologists who agreed upon uniform criteria for the diagnosis of hydatidiform (complete) mole, invasive mole, and choriocarcinoma. A representative sample of the slides was selected and resubmitted to one of the study pathologists for a second review. The inter- and intra-pathologist variability in the diagnosis of gestational trophoblastic neoplasia was calculated using the kappa statistic (K). Our findings indicated that the variability in the diagnosis of gestational trophoblastic neoplasia was low whereas that for the related tumor of incomplete mole was high.

Choriocarcinoma

Risk factors for gestational trophoblastic neoplasia.

A case-control study to determine the gynecologic and reproductive risk factors for gestational trophoblastic neoplasia was conducted in the Baltimore Metropolitan Area. All cases (N = 190) that were pathologically diagnosed from 1975 to 1982 as hydatidiform mole, invasive mole, or choriocarcinoma were ascertained. Slides were independently reviewed by two pathologists. Cases were matched by age, race, and last menstrual period to controls who were delivered of normal pregnancies at term. In the analysis of medical record and interview data, factors found to be positively associated with gestational trophoblastic neoplasia included professional occupations (odds ratio = 2.56, p less than 0.0001), prior spontaneous abortions (odds ratio = 2.32, p = 0.02), and the mean number of months from the last pregnancy to the index pregnancy (cases = 35.9, controls = 28.2; p = 0.03). Factors found not to be associated with disease included contraceptive history, irradiation, ABO blood group, and smoking factors of the male partner. The findings suggest that gestational trophoblastic neoplasia may be part of a continuum of early (first-trimester) reproductive abnormalities.

Abortion, Spontaneous

Mortality in chromium chemical production workers: a prospective study.

Mortality among male employees was studied in a chromium chemical production plant, part of which was rebuilt in 1950-51 and the remainder in 1960, to reduce exposure to chromium bearing dusts. Of 2 101 employees initially employed between 1945 and 1974 and having worked at least 90 days, the vital status of 88% was ascertained, as of mid-1977. Lung cancer mortality for hourly workers initially employed between 1945 and 1959 was significantly higher than in the comparison Baltimore City population (SMR = 2.0), yet it was lower than that reported in previous studies of this industry. A dose response effect was evident from the relationship between duration of employment and mortality. The lung cancer mortality among those employed for three or more years exclusively in the new facility was similar to that observed for such long-term workers in other parts of the plant. Specific job positions were examined. A history of employment in the Bichromate and Special Products Department (production of chromic acid and other products), known as the 'wet end', was associated with the increased lung cancer mortality in contrast to the Mill and Roast Department, known as the 'dry end'. Because of the long latency period associated with chromium exposure and cancer, it was not possible to adequately assess the risk of cancer for workers initially employed after 1960. Methodological issues related to these findings are discussed.

Chemical Industry

Babel.

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Epidemiologic Methods

Epidemiology 101: the new frontier.

An introductory course in epidemiology for pre-baccalaureate junior and senior undergraduate students is described as part of a Public Health Option programme. The course was similar to that given in schools of public health with additional material on vital statistics. It was well received by the students and stimulated several students to enter graduate programmes in epidemiology in schools of public health. Epidemiology has now matured as an independent scientific discipline so that consideration should be given to establishing University Departments of Epidemiology similar to those in such fields as statistics and biology.

Curriculum

Re: "causes".

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Epidemiology