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Biomedical subjects

D Lackland

Publications and source records attributed to D Lackland.

14 recordsLinked to original sources
PubMed2000

Racial, age, and rural/urban disparity in cervical cancer incidence.

PURPOSE: High mortality rates of cervical cancer among black women have been observed for several decades in the Southeast. The purpose of this study is to assess the factors associated with this geographic and racial enigma, and to see if incidence is consistent with mortality.METHODS: Using the Savannah River Regional Health Information System (SRRHIS), a 5-year cancer registry from 1991-1995, incidence rates were calculated and compared to rates from Surveillance, Epidemiology, and End Results (SEER). The rates per 100,000/year were analyzed by race, rural/nonrural, and age (<45 and >/=45).Rates are similar between SRRHIS and SEER except in the case of black women over the age of 45. These women in rural SRRHIS have 1.66 times the incidence rate compared to those in nonrural SRRHIS and 1.97 times the rate of rural SEER.RESULTS:Table 1CONCLUSIONS: The results of the study suggest that the incidence of cervical cancer in the region is consistent with the mortality rates. The age-group with the highest rates are black women over 45 in rural areas, suggesting the need to target this group to reduce the racial disparity in cervical cancer.

Journal Article↗
PubMed2000

Geographic patterns of pulmonary disease in south carolina.

PURPOSE: The purpose of this study is to assess the patterns of geographic variation of the following pulmonary diseases: tuberculosis (TB), lung cancer (LC), berylliosis (BR), sarcoidosis (SR), and asthma (AS).METHODS: Hospitalization rates for the five diseases were calculated for the 46 South Carolina (SC) counties from 1985-1995. Variation in rates was assessed by county, region, and urban/rural status using analysis of variance. SC was divided into 4 regions, according to proximity to the coastline and to physiographic characteristics. Region 1 comprised counties in the western-most part of the state, and region 4 comprised the counties closest to the coastline. SC was also divided into 5 population density settings: extreme rural (<15,000), rural (15,000-30,000), middle-size (30,000-50,000), middle-urban (50,000-100,000) and urban (>100,000). Statistical analyses were performed with SAS Version 8.RESULTS:Table 1The rates of SR, TB, and BR were significantly higher in the coastal region. In contrast, no coastal pattern was detected by population density.CONCLUSIONS: The consistent association of SR, TB, and BR with geographical region, as opposed to the inconsistent association with population density, suggests that environmental factors may be involved in these pulmonary diseases. These results demonstrate the need for further analysis of the relationship between socio-economic, behavioral, and environmental factors and the development of these diseases.

Journal Article↗
PubMed2000

Possible relationship between birth weight and cancer incidence among young adults.

PURPOSE: Fetal and early life events have been associated with diseases that develop later in life. Low birth weight and the adult onset of hypertension, coronary heart disease, cerebrovascular disease, and non-insulin dependent diabetes have been identified. As well, associations with breast, ovarian, and prostate cancer to high birth weight have been found. An assessment of birth weight and cancer incidence was conducted in a cohort of black and white residents under the age of 46 years.METHODS: Cases were obtained from the Savannah River Region Health Information System cancer registry incident cases (1991-1995) and were limited to South Carolinians born in 1950 and later. Controls were obtained from birth certificate records by choosing the next two records after a cancer case record that matched on year of birth, race, and sex. Results were obtained for 117 cancer cases and 238 controls.RESULTS: After examining the birth distribution, the births were split into two groups based on mean birth weight among controls (3215 grams). Conditional logistic regression (CLR) showed that individuals with higher birth weights (> = 3215 g) were 1.65 (95% CI = 1.03-2.64) times more likely to be cancer cases than those with lower birth weights. When weights were categorized into 500 g increments, a CLR Score statistic showed there was a significant trend (p = 0.0006) of increasing proportion of cancer cases with increasing birth weight. Eight out of the eight cases of lymphoma had birth weights greater than 3579 g.CONCLUSIONS: The results of this preliminary study suggest that cancer incidence among the young may be associated with higher birth weights. One possible reason for this finding, which requires further investigation, might be that larger infants are exposed to higher levels of hormones and/or growth factor than smaller infants in utero that might increase the risk of certain cancers later in life. This may be suggestive of possible environmental factors affecting early growth. These findings support the need for additional study of this association.

Journal Article↗
PubMed2000

The impact of birth weight on the racial disparity of end-stage renal disease.

PURPOSE: Blacks have a high rate of end-stage renal disease (ESRD) and low birthweight (LBW) than whites. LBW has been associated with ESRD. The purpose of this study was to assess impact of LBW on the racial difference in ESRD.METHODS: Patients born in SC after 1950 and diagnosed with ESRD between 1991-1996 were identified from the ESRD registry. Birth weight was compared for 858 black and 372 white patients and 2460 controls matched for age, sex, and race. LBW was defined as birthweight <2500 g.RESULTS: Among patients with ESRD, mean birthweight was lower in blacks than whites (3179 vs 3367 g, p < 0.001). LBW was more common in blacks than whites with ESRD (13.9 vs 7.5%, p = 0.02). The risk ratio for LBW among ESRD patients was 1.4 (95% C.I. 1.1 to 1.8) for blacks and 1.5 (95% C.I. 0.9 to 2.5) for whites. The population attributable risk (PAR) for ESRD due to LBW was greater for blacks than whites (33.6 vs 4.2 per 100,000).CONCLUSIONS: Birthweights were lower and LBW was more common among blacks than whites with ESRD. Moreover, LBW contributed more to the PAR of ESRD in blacks than whites. Thus, LBW may contribute to the greater risk for ESRD in African Americans than Caucasians. This preliminary study indicates that further research on the link between LBW and ESRD could be instructive in understanding the racial health disparities.

Journal Article↗
PubMed2000

Disparity between whites and african-americans in knowledge and treatment of cholesterol. Carolina heart survey.

PURPOSE: Elevated cholesterol is a known risk factor for coronary heart disease and studies have demonstrated a decrease in myocardial infarctions and strokes in those treated with cholesterol-lowering medications. A statewide survey was conducted to determine knowledge and treatment of cholesterol in South Carolina residents.METHODS: In 1998, a random digit telephone survey was conducted of 1200 adults in South Carolina, including 28.2% African Americans (AA), using a 46-item instrument developed to quantify awareness, knowledge and treatment of cholesterol.RESULTS: Nearly 90% of both AA and Whites (W) believe high cholesterol levels can cause a "heart attack." However, more AA (90.2%) than W (82.8%) believe that high cholesterol levels cause a "stroke" (p = 0.005). Though not statistically significant, 19.5% of W compared to 23.4% of AA reported not ever having their cholesterol checked (p = 0.066). Of those who had their cholesterol checked, less than half (47%) knew their most recent cholesterol or knew a "good" cholesterol level for an adult (41%). Fewer AA could recall their cholesterol level (p = 0.011), or knew a "good" cholesterol level for an adult (p < 0.001) as compared with W. Of the 24.2% who were told they had elevated cholesterol, 59% were under the care of a physician for cholesterol treatment, of which 56.6% reported taking cholesterol-lowering medications. There was a significant difference in the reported treatment with cholesterol-lowering medications between W and AA, 63% versus 33%, respectively (p = 0.006) and ranged from a high of 73.5% in W males to 29.4% in AA females (p = 0.005).CONCLUSIONS: The results of this population assessment suggest less knowledge about cholesterol among AA and racial disparity with regard to treatment with medications of elevated cholesterol levels.

Journal Article↗
PubMed2000

Magnetic field exposure of commercial airline pilots.

PURPOSE: Airline pilots are exposed to magnetic fields generated by the aircraft's electrical and electronic systems. The purpose of this study was to directly measure the flight deck magnetic fields to which commercial airline pilots are exposed when flying on different aircraft types over a 75-hour flight-duty month.METHODS: Magentic field measurements were taken using personal dosimeters capable of measuring magnetic fields in the 40-800 Hz frequency range. Dosimeters were carried by either the Captain or the First Officer on Boeing 737/200, Boeing 747/400, Boeing 767/300ER, and Airbus 320 aircraft. The data were analyzed by aircraft type, with statistics based on block hours. Block hours begin when the aircraft departs the gate prior to take off and end when the aircraft returns to the gate after landing.RESULTS: Approximately 1008 block hours were recorded at a sampling rate of 3 seconds. Total block time exposure to the pilots ranged from a harmonic geometric mean of 6.7 milliGauss (mG) for the Boeing 767/300ER to 12.7 mG for the Boeing 737/200.CONCLUSIONS: Measured flight deck magnetic field levels were substantially above the 0.8 to 1 mG level typically found in the home or office and suggest the need for further study to evaluate potential health effects of long-term exposure.

Journal Article↗
PubMed2000

Epidemiology of lung cancer with special reference to genetics, bioassays, women, and developing countries.

The twentieth century may be looked back upon as the century of lung cancer. At the beginning of the century lung cancer was quite rare, but this century the rates have increased approximately 10-fold and it is the second most common type of cancer and has become the leading cause of death due to cancer in the United States. The rate of lung cancer among U.S. women continues to rise, in contrast rates in U.S. men have been declining since about 1990. Cigarette smoking accounts for 85-90% of lung cancer deaths in the United States. However, only 10-15% of smokers eventually develop lung cancer. In the past 25 years, since the U.S. Surgeon General's ground breaking report in 1964, overall smoking rates have been declining, but smoking still remains a significant behavior. More troubling, the rates of smoking continue to increase in many parts of the world. Advances in molecular biology and early diagnosis have increased the understanding of lung cancer etiology and may be effective in uncovering more efficient detection and treatment regimens. These advances will hopefully make lung cancer as uncommon at the end of the twenty-first century, as it was at the beginning of the twentieth century.

Journal Article↗
PubMed1999

Leukaemia in the vicinity of two tritium-releasing nuclear facilities: a comparison of the Kruemmel Site, Germany, and the Savannah River Site, South Carolina, USA.

In 1991, an increased rate of childhood leukaemia was reported from the small northern German community of Elbmarsch, which is located on the banks of the River Elbe opposite the Kruemmel nuclear power plant. Owing to the fact that the increase occurred six years after the start-up of the plant, radioactive discharges were suspected as being implicated in the development of the cases. Previous investigations have failed to identify any exposure which might be associated with the cluster. Nonetheless, concern regarding the increased tritium burden in the environment remains. To further assess the impact of tritium releases to the environment upon population cancer rates, the releases and leukaemia rates at the Savannah River site, USA, were compared with the Kruemmel site. Based on the data from 1991 to 1995, the incidence of childhood leukaemia in the vicinity of the Savannah River site was non-significantly less than expected compared with the significantly higher than expected rates close to the German plant. In contrast, tritium releases from the Savannah River site exceed those from the Kruemmel site by several orders of magnitude. The results of this observational study suggest that factors other than environmental tritium releases are associated with the increased number of leukaemia cases near the Kruemmel site.

Child↗
PubMed1999

Managing hypertension in the southeastern United States: applying the guidelines from the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI).

The southeastern United States has the highest occurrence of heart disease and stroke and among the highest rates of congestive heart failure and renal failure in the country. The Consortium for Southeastern Hypertension Control (COSEHC) is cooperating with other organizations in implementing initiatives to reduce morbidity and mortality from hypertension-related conditions in the southeastern United States. This article outlines for clinicians special consideration for implementation of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) in the southeastern United States. Clinicians are encouraged to adapt the recommendations of JNC VI to their own patient groups, paying attention to these specific areas: (1) Ensure screening for hypertension in your practice and community. (2) Evaluate all patients for accompanying risk factors and target organ damage. (3) Promote lifestyle management for individual patients and populations for prevention and treatment of hypertension. (4) Set a goal blood pressure for each patient, and monitor progress toward that goal. (5) Recognize that many patients will be candidates for blood pressure goals of <130/85 mm Hg. (6) Pay attention to compelling and special indications such as diabetes, congestive heart failure, and renal dysfunction. (7) Consider combination therapy. (8) Maximize staff contributions to enhance patient adherence. (9) Encourage patient, family, and community activities to promote healthy lifestyles and blood pressure control.

Black or African American↗
PubMed1998

Specialists achieve better outcomes than generalists for lung cancer surgery.

OBJECTIVE: A push toward care provided by generalists as opposed to specialists has occurred in the health-care marketplace despite a lack of provider specific outcome data. The objective of this study was to determine whether the outcome of patients undergoing lung cancer surgery is different between general surgeons (GSs) and thoracic surgeons (TSs). DESIGN: Examination of data from a state-wide severity-adjusted administrative hospital discharge database. SETTING/PARTICIPANTS: Patients undergoing lung cancer resection in all nonfederal acute care hospitals within South Carolina. MAIN OUTCOME MEASURES: Mortality by specialty adjusted for case mix. RESULTS: From 1991 to 1995, 1,720 resections for lung cancer were performed in South Carolina. One hundred thirty-seven cases were excluded because surgeons did not meet the predefined criteria for board certification, leaving 1,583 resections for analysis. One-half of lobectomies and nearly 60% of pneumonectomies were performed by GSs. Patients were similar in age, sex, gender, race, and the proportion in each severity of illness subclass. Mortality was significantly higher in patients who underwent lobectomy by GSs vs TSs (5.3% vs 3.0%; p<0.05) and in patients with extreme comorbidities (43.6% vs 25.4%; p=0.03) or age >65 years (7.4% vs 3.5%; p<0.05). Seventy percent of TSs performed > 10 cases in the series, whereas 75% of GSs performed <10 (p=0.05). Logistic regression analysis failed to identify any significant variable that might explain the mortality differences between TSs and GSs. CONCLUSION: Mortality is lower for lung cancer resection when the surgery is performed by a TS.

Female↗
PubMed1998

Overview of the Diabetes Initiative of South Carolina.

Implementation is underway for many of these programs, and there are descriptions of activities elsewhere in this symposium. The Board recognizes that in dealing with the complications of a chronic disease like diabetes, many years of intense effort will be needed before significant results may be appreciated. Progress will be monitored regularly by the Surveillance Council and SCDCP/DHEC, and modifications of the plan will be made by the Board at intervals after review of the data. We are optimistic that over the next decade, this system will make a significant impact to reduce mortality, morbidity, and costs of diabetes, and the result will be an increased quality of life for people affected by diabetes in South Carolina.

Diabetes Mellitus↗
PubMed1995

An evaluation of the safety and efficacy of fluconazole in the treatment of onychomycosis.

Sixteen subjects were enrolled in this open-label noncomparative study to evaluate the safety and efficacy of fluconazole as a single daily dose for a period of 6 months. Liver function enzymes were monitored to assess safety. An adverse function questionnaire was used on a monthly basis to assess patient tolerance. A visual analogue scale was used to assess efficacy of treatment. After 6 months of fluconazole, all subjects experienced improvement in the appearance of their nails. None of the subjects evidenced any elevation in liver function enzymes. Adverse reactions were limited and consistent with other studies involving fluconazole. Fluconazole proved to be safe and efficacious in the treatment of onychomycosis. Further studies are needed to determine a cost-effective dosing regimen for the treatment of onychomycosis with fluconazole.

Adult↗
PubMed1992

Diet and cancer.

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Diet↗