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D W Kaufman

Publications and source records attributed to D W Kaufman.

At least 37 records · Page 2Linked to original sources
PubMed1995

An international collaborative case-control study of severe cutaneous adverse reactions (SCAR). Design and methods.

A multicenter international case-control study has been designed to elucidate the etiology of Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN). Although these diseases occur rarely, the morbidity is high and the mortality for TEN is of the order of 30%. These serious dermatologic conditions have often been linked to exposure to drugs. Infective and autoimmune diseases, as well as other non-drug risk factors, have also been postulated to be of importance in increasing the risk. The design and methods are described, with particular attention to the unique challenges for an epidemiologic study of these conditions.

Case-Control Studies↗
PubMed1995

An association of aplastic anaemia in Thailand with low socioeconomic status. Aplastic Anemia Study Group.

The relationship of socioeconomic status to the risk of aplastic anaemia was evaluated in a case-control study conducted in Bangkok and two rural regions of Thailand (Khonkaen and Songkla). Among 152 cases and 921 controls there were significant trends of increasing risk with decreasing years of education (P = 0.01) and total household income (P = 0.0001), after control for confounding. The relative risk estimate for those with monthly incomes of < 1500 baht (about $60 U.S.) was 3.9 (95% confidence interval 2.1-7.3) compared to those with monthly incomes of at least 5000 baht (about $200). The pattern of increasing risk with decreasing income was observed in all three regions, with significant trends in Bangkok (P = 0.004) and Khonkaen (P = 0.003). This finding may partly explain the high incidence of aplastic anaemia in Thailand. Low socioeconomic status may be a surrogate for one or more environmental factors that could cause aplastic anaemia, such as infectious pathogens or toxic exposures.

Adolescent↗
PubMed1995

Alcohol consumption and the risk of major upper gastrointestinal bleeding.

OBJECTIVE: To examine the association between current alcohol consumption and major upper gastrointestinal bleeding. METHODS: In a case-control study in the United States, Sweden, and Hungary, 1004 incident cases with upper gastrointestinal bleeding without predisposing factors were compared with 2446 controls. Relative risks for categories of alcohol consumption (based on the number of drinks currently consumed/wk) were estimated using logistic regression; the potential confounding effects of cigarettes, nonsteroidal anti-inflammatory drugs, and other factors were controlled simultaneously. RESULTS: Compared with drinkers of < one drink/wk, the relative risks among other current drinkers ranged from 0.8 for 1-6 drinks/wk to 6.3 for > or = 35 drinks; the trend was statistically significant (p < 0.001). A significantly increased relative risk was seen for the heaviest consumption category within various subgroups: gastric and duodenal hemorrhage; males and females; age < 60 yr and > or = 60 yr; and those who consumed beer, wine, liquor, or a combination of beverages. CONCLUSIONS: These findings provide evidence that consumption of alcohol increases the risk of major gastric and duodenal bleeding in nonpredisposed individuals.

Adult↗
PubMed1994

Epidemiologic approaches to the study of toxic epidermal necrolysis.

The appropriate epidemiologic strategy for studying the etiology of toxic epidermal necrolysis is determined by the characteristics of the disease, particularly its rarity and the fact that it is caused by numerous drugs. Although information about drugs as risk factors can in principal be obtained from case reports and experimental studies, the former are subject to bias and the latter are impractical because toxic epidermal necrolysis is so rare. Cohort studies are also impractical because of the rarity of the outcome. An automated database, even if based on a large population, can only yield valid results if it is used as the starting point for a case-control study that includes access to the subjects and to the medical records for information to confirm the diagnosis. A population-based case registry can provide a large enough and well-documented series of cases, but does not allow for the valid estimation of risks because it lacks a comparison series. This leaves a case-control study as the only strategy that is both practical and valid. An ongoing international case-control study of toxic epidermal necrolysis and Stevens-Johnson syndrome in relation to the use of drugs is described. Data collection has proceeded in France, Italy, Germany, and Portugal. The study in Germany is conducted within a population-based case registry, and the study in Portugal is also population based; this will allow for the estimation of absolute risks. Data on demographic factors and medical history, a detailed history of drug use in the month before hospital admission, and various other factors are collected by interview of the cases and hospital controls. Cases are confirmed in an independent review process in which the diagnoses, and classification along a spectrum of Stevens-Johnson syndrome and toxic epidermal necrolysis, are determined without knowledge of drug use. As of June, 1993, 459 cases and 1299 controls have been enrolled. At the scheduled end of data collection in 1995, the projected totals are 691 cases and 1956 controls. These large numbers will allow for the detailed evaluation of even relatively uncommonly used drugs, for the evaluation of more commonly used drugs in relation to subtypes of toxic epidermal necrolysis/Stevens-Johnson syndrome, and for the comparison of results between countries.

Case-Control Studies↗
PubMed1993

Acute thrombocytopenic purpura in relation to the use of drugs.

The relation of acute thrombocytopenic purpura (TP) to the use of drugs was investigated in a case-control study conducted in eastern Massachusetts, Rhode Island, and the Philadelphia region; 62 cases over the age of 16 years with acute onset and with a rapid recovery were compared with 2,625 hospital controls. After control for confounding by multiple logistic regression, use of the following drugs in the week before the onset of symptoms was significantly associated: trimethoprim/sulfamethoxazole (relative risk [RR] estimate, 124), quinidine/quinine (101), dipyridamole (14), sulfonylureas (4.8), and salicylates (2.6). The overall annual incidence of acute TP was estimated to be 18 cases per million population. The excess risks for the associated drugs were estimated to be 38 cases per million users of trimethoprim/sulfamethoxazole per week, 26 per million for quinidine/quinine, 3.9 per million for dipyridamole, 1.2 per million for sulfonylureas, and 0.4 per million for salicylates. Associations with sulfonamides, quinidine/quinine, sulfonylureas, and salicylates have been previously reported, but the present study has provided the first quantitative measures of the risk. The association with dipyridamole was unexpected. In general, despite large RRs, the incidence rates attributable to the drugs at issue (excess risks) were low, suggesting that TP is not an important consideration in the use of the various drugs.

Acute Disease↗
PubMed1993

Risk of agranulocytosis and aplastic anemia in relation to history of infectious mononucleosis: a report from the international agranulocytosis and aplastic anemia study.

The general objective of this study was to evaluate the risks of agranulocytosis and aplastic anemia in relation to drug use. Other potential risk factors, including history of infectious mononucleosis, were also evaluated. In an international population-based case-control study, cases of agranulocytosis and aplastic anemia and controls, who were patients with selected diagnoses, were identified from the same hospitals. Information on drug use was obtained in a structured interview. Limited information on environmental exposures and on selected items of medical history, including infectious mononucleosis, was also recorded. The possible effects of these factors on the risk of the two blood dyscrasias were evaluated. Relative risks were estimated by stratified analysis and by multiple logistic regression. Among 319 cases of agranulocytosis, 12 patients (4%) gave a history of infectious mononucleosis at least 1 year previously; among 2180 controls the corresponding number was 11 (0.5%) (multivariate relative risk estimate, 6.2; 95% confidence interval, 2.3-17). A nonsignificant elevation in the relative risk was observed for aplastic anemia. The data suggest that infectious mononucleosis may confer a long-term increase in the risk of agranulocytosis. However, the association was an unexpected one, identified in the course of multiple comparisons, and it must be independently confirmed.

Adolescent↗
PubMed1993

Nonsteroidal anti-inflammatory drug use in relation to major upper gastrointestinal bleeding.

In a study in the United States, Sweden, and Hungary, 335 cases of gastric bleeding without predisposing factors were compared with 670 control subjects, and 239 cases of duodenal bleeding were compared with 489 control subjects. For aspirin taken at least every other day during the week before the onset of bleeding (regular use), the relative risk of gastric bleeding was 4.4 (95% confidence interval [CI], 2.9 to 6.7); for occasional use, it was 3.3 (95% CI, 2.1 to 5.0). For ibuprofen, the corresponding estimates were 1.0 (95% CI, 0.4 to 2.6) and 1.1 (95% CI, 0.5 to 2.4). For naproxen, the estimate for regular use was 4.0 (95% CI, 1.5 to 11). The estimates for any use of piroxicam (crude estimate), indomethacin, and diclofenac during the week before onset were 18 (95% CI, 4.1 to 83), 1.6 (95% CI, 0.4 to 5.9), and 0.9 (95% CI, 0.2 to 4.2), respectively. The corresponding relative risks of duodenal bleeding were 7.1 (95% CI, 4.2 to 12) and 2.2 (95% CI, 1.3 to 3.7) for the regular and occasional use of aspirin, 2.4 (95% CI, 0.5 to 11) and 0.8 (95% CI, 0.3 to 2.0) for ibuprofen, 12 (95% CI, 2.8 to 54) and 9.9 (95% CI, 2.3 to 44) for naproxen, 17 (95% CI, 3.6 to 79) for any use of piroxicam (crude estimate), and 1.7 (95% CI, 0.2 to 14) for any use of indomethacin. There was a significant trend in the risk of gastric bleeding with increasing dose of regular aspirin use (p = 0.002). The relative risk estimates for the regular use of 325 mg or less were significantly elevated for both gastric and duodenal bleeding at 3.1 and 6.4, respectively.

Aged↗
PubMed1993

5-Hydroxytryptamine1-like receptors linked to increases in intracellular calcium concentration and inhibition of cyclic AMP accumulation in cultured vascular smooth muscle cells derived from bovine basilar artery.

Vascular smooth muscle cells derived from bovine basilar artery by the explant method were grown in culture. In the presence of 1 microM forskolin and the phosphodiesterase inhibitor rolipram, 5-hydroxytryptamine (5-HT) agonists inhibited by 90 to 100% the accumulation of intracellular cyclic AMP (cAMP) with a rank order of potency 5-carboxamidotryptamine (5-CT) > or = 5-HT > 5-benzyloxytryptamine = sumatriptan > RU24969 [5-methoxy-3(1,2,3,6-tetrahydro-4-pyridinyl)-1H indole succinate] > (+/-)-8-hydroxydipropylaminotetralin. In suspensions of cells loaded with the calcium-sensitive probe fura-2, 5-CT and 5-HT caused a biphasic increase in the concentration of intracellular free calcium ([Ca++]i) that consisted of both transient and sustained phases. The transient phase was reduced and the sustained phase abolished in the absence of extracellular calcium. The EC50 for 5-CT-induced increase in [Ca++]i (6 nM) was similar to that for inhibition of cAMP accumulation (1.3 nM). Both the inhibition of cAMP accumulation and increase in [Ca++]i were inhibited by the antagonist methiothepin (pA2 = 8.9), but not by the antagonists ketanserin, spiperone and pindolol. Both the inhibition of cAMP accumulation and increase in [Ca++]i were attenuated by greater than 85% in cells that were pretreated with pertussis toxin. PI turnover was not stimulated by 5-CT. The rank order of agonist potency, as well as the antagonist sensitivity, indicates responses mediated by one or more 5-HT1-like-type receptors.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Estrogen replacement therapy and the risk of breast cancer: results from the case-control surveillance study.

To examine the relation of noncontraceptive estrogen use to the risk of breast cancer among postmenopausal women, the authors conducted a case-control study: 1,686 cases were compared with 2,077 hospital control subjects, of whom 1,120 had non-gynecologic cancers and 957 had nonmalignant (also non-gynecologic) conditions. Data were obtained from 1980 to 1986, by interview of subjects in hospitals in the United States and Canada. The relative risk estimate for any use of replacement estrogens unopposed by progestogens was 1.2 (95% confidence interval (Cl) 1.0-1.4), after adjustment for age and type of menopause; when all known risk factors for breast cancer were taken into account in a multivariate analysis, the estimate was similar. For use of at least 15 years duration, the estimate was 0.9 (95% Cl 0.5-1.9). Most of the unopposed use was of conjugated estrogens: overall, the relative risk (95% Cl) was 1.3 (1.0-1.6); for durations of 15 or more years, it was 0.9 (0.4-1.9); for use of 5 years followed by a latent interval of 15 or more years, it was 1.3 (0.7-2.4); and for current use it was 1.1 (0.7-1.6). There was no evidence of increased breast cancer risk when the conjugated estrogen users were divided according to dose. There was little use of estrogens opposed by progestogens; the relative risk estimate was 1.7 (95% Cl 0.9-3.3). The results of this large study provide no evidence that the use of unopposed conjugated estrogens increases the risk of breast cancer, even after long durations of use or long latent intervals, but the possibility of a modest increase (less than a doubling) could not be excluded. There were insufficient data to evaluate the effects of nonconjugated estrogens and of combined estrogen and progestogen therapy.

Adult↗
PubMed1991

Incidence of aplastic anemia in Bangkok. The Aplastic Anemia Study Group.

The annual incidence of aplastic anemia in metropolitan Bangkok, Thailand, and its five suburban provinces was prospectively determined. All patients first diagnosed during the period from January through December 1989 who met specific clinical and pathologic criteria were included. Thirty-two cases were identified, yielding an overall incidence of 3.7 per million. The incidence rates for the age groups 0 through 24, 25 through 59, and over 60 years were 4.3, 3.2, and 2.1 per million, respectively; the highest rate, 7.2 per million, was found for individuals aged 15 to 24 years. The male-to-female ratio was 1.9. The incidence of aplastic anemia in Bangkok is higher than that reported in recent European studies. The peak rate in young persons is almost fourfold higher than in comparable recent western studies and suggests an environmental etiology peculiar to Thailand.

Adolescent↗
PubMed1991

Endometrial cancer and age at last delivery: evidence for an association.

Because the role hormonal and reproductive factors play in the etiology of endometrial cancer is incompletely understood, the authors evaluated the risk of this cancer in relation to age at last delivery. The data were obtained in a hospital-based case-control study of 483 women with endometrial cancer (cases) and 693 women with other conditions (controls) conducted in a number of hospitals in the United States and Canada from 1978 to 1985. There was an inverse association between age at last delivery and endometrial cancer risk: Compared with women who last gave birth before age 25 years, the rate ratio was 0.9 (95% confidence interval (CI) 0.5-1.6) for last delivery at ages 25-29 years, 0.6 (95% CI 0.3-1.0) for last delivery at ages 30-34 years, 0.5 (95% CI 0.3-1.0) for last delivery at ages 35-39 years, and 0.4 (95% CI 0.1-0.9) for last delivery at age 40 years or older. The trend of decreasing rate ratio with increasing age at last delivery was statistically significant (p = 0.02). The association was apparent regardless of parity or menopausal status. There was no evidence for an association between age at first pregnancy and risk. These data suggest that women who bear children late in reproductive life may be at lower risk for endometrial cancer than those who complete their families early.

Adult↗
PubMed1991

Risks of agranulocytosis and aplastic anemia in relation to the use of cardiovascular drugs: The International Agranulocytosis and Aplastic Anemia Study.

The risks of agranulocytosis and aplastic anemia in relation to the use of cardiovascular drugs were estimated in a population-based case-control study conducted in Israel and Europe (total population, 23 million). Cardiovascular drug use in the week before onset of illness was compared between 270 patients hospitalized with agranulocytosis and 1870 hospitalized control subjects. Propranolol (relative risk, 2.5), dipyridamole (3.8), digoxin (2.5), and acetyldigoxin (9.9) were significantly associated with agranulocytosis. The excess risks attributable to these drugs ranged from one to three cases per 10 million persons exposed for up to 1 week. Increased risks were also observed for cinepazide (used by six cases and no control subjects), procainamide (7, 1), and aprindine (5, 1); based on crude relative risk estimates, the excess risks for the latter two drugs were approximately three per million persons exposed for up to 1 week. The use of cardiovascular drugs in a 5-month period ending 1 month before hospital admission was compared between 152 patients with aplastic anemia and 2180 control subjects. Furosemide was the only significantly associated drug (relative risk, 3.1); the excess risk attributable to any exposure in a 5-month interval was 1.7 per million.

Adrenergic beta-Antagonists↗
PubMed1990

Case-control study of idiopathic retinal detachment.

A case-control study of idiopathic, rhegmatogenous retinal detachment (IRD) was conducted to investigate potential risk factors for developing IRD. These included some factors reported previously, such as cardiovascular disease, and some not under suspicion, such as cigarette smoking and iris colour. Cases (n = 198) were incident cases of IRD who were hospitalized for surgical repair of their detachments. Controls (n = 655) were patients hospitalized for conditions unrelated to suspected risk factors for IRD. The risk of IRD appeared to increase with increasing age, and the relative risk for self-reported myopes, compared with non-myopes, was elevated (RR = 3.4, 95% CI = 2.3 - 5.0). The relative risk of IRD was decreased in current smokers (RR = 0.5, 95% CI = 0.3 - 0.8); although there was not a significant trend of decreasing relative risk with increasing amount smoked, the estimate was lowest in those who smoked most heavily. Risk did not appear to be related to gender, eye colour, history of myocardial infarction, or history of hypertension.

Adolescent↗
PubMed1990

Reliability of personal interview data in a hospital-based case-control study.

Responses to interview questions were compared for concordance among 492 individuals interviewed more than once in a hospital-based case-control surveillance system in the United States, Canada, and Israel between 1976 and 1982. Reliability of the data was determined using the Kappa statistic and the intraclass correlation coefficient. Reliability was good to excellent for demographic factors, such as birthplace, and for medical conditions/procedures that require hospitalization or continuing medical care, such as hysterectomy. Reliability was fair to good for less serious or less well-defined medical conditions/procedures, such as cystic breast disease, and for current habits, such as daily coffee consumption. Regarding medication use, reliability was poor to fair for drugs taken intermittently, such as aspirin and penicillin, and good to excellent for drugs taken on a regular basis, such as oral contraceptives. As expected, medications were reported more consistently when duration of use was prolonged. The data were also analyzed according to two intervals between interviews (less than 1 year and greater than or equal to 1 year). For most factors, reliability was not materially affected by interval. Where differences were observed, reliability tended to be better when the second interview followed the first by less than 1 year. These results suggest that structured interviews administered to hospital patients by trained personnel can elicit reliable data on demographic and medical history factors.

Adult↗
PubMed1990

Diazepam use in relation to breast cancer: results from two case-control studies.

The relation between diazepam use and breast cancer was explored in two case-control studies. The first (1981-1987) was a hospital-based study in the United States of 3,078 cases of breast cancer, 1,259 controls with other malignancies, and 672 controls with nonmalignant conditions. The relative risk estimates for regular diazepam use (at least 4 days per week for at least 6 months) that antedated the diagnosis of breast cancer by at least 12 months were 1.0 (95% confidence interval (CI) 0.6-1.7) using the cancer controls and 0.8 (95% CI 0.4-1.8) using the noncancer controls. Risk factors for breast cancer were taken into account in the estimates. There was no association for regular use lasting at least 5 years or for regular use that took place exclusively in the recent or more distant past. The second study (1982-1986), conducted in Toronto, Ontario, Canada, was community-based, and included 607 cases of breast cancer and 1,214 neighbor controls selected from municipal voting and census records. After control of confounding, the relative risk estimate for regular diazepam use was 0.8 (95% CI 0.5-1.3). Again, there was no association for long-term, past, or recent regular use. The results of both studies suggest that regular diazepam use does not increase the risk of breast cancer. The findings are strengthened by the similarity of the results using three different control groups--women with cancer, women with nonmalignant conditions, and neighbors.

Adolescent↗
PubMed1989

Hydralazine use in relation to cancers of the lung, colon, and rectum.

It has been suggested, based on animal experiments and limited human data, that the anti-hypertensive drug hydralazine might be carcinogenic, and among the sites of concern are the lung and colon. To assess the possible relationship between the use of hydralazine and lung and colorectal cancers in humans, we compared 1006 cases of lung cancer with 3531 hospital control subjects, and 972 cases of colorectal cancer with 3276 controls. Data were collected by interview in hospitals in the United States and Canada. Overall, 1.1% of the lung cancer cases, 1.6% of the colorectal cancer cases, and 1.5% of the controls had used hydralazine. Compared with those who had never used hydralazine, the relative risk estimate of lung cancer for those who first took the drug at least 18 months before hospital admission was 1.1 (95% confidence interval 0.4-2.9). The estimate for use for at least 1 year was 1.4 (0.5-3.8) and for use for at least 5 years the estimate was 0.9 (0.2-4.3). The corresponding relative risk estimates for colorectal cancer were 1.2 (0.5-2.5) for any use, 1.7 (0.8-3.7) for use for at least one year, and 2.4 (0.8-6.9) for five or more years of use. Other antihypertensive treatments and risk factors, including cigarette smoking in the analysis of lung cancer, were taken into account in these estimates. Although the effect of use after long latent intervals could not be evaluated, the results provide no support for the hypothesis that hydralazine use increases the risk of lung cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Breast cancer before age 45 and oral contraceptive use: new findings.

The relation between the risk of breast cancer before 45 years of age and oral contraceptive use was examined in a case-control study conducted in New York, Philadelphia, Baltimore, and Boston from 1983 to 1986 of 407 patients with breast cancer and 424 controls. With allowance for confounding, for ever use, the multivariate relative risk estimate was 2.0 (95% confidence interval (CI), 1.4-2.9). For less than 10 years of use, the estimate approximated 2.0 in all categories of duration, including less than three months; for 10 or more years of use it was 4.1 (95% CI, 1.8-9.3). The association was apparent in virtually all subgroups examined, including younger and older women, and women at low and high underlying risk of breast cancer. Contrary to some previous reports, the association was not stronger for use before a first term pregnancy or at an early age. The results suggest that oral contraceptive users, particularly those with very long durations of use, may be at increased risk of breast cancer. However, information bias, particularly for short-term use, could not be ruled out. There may also have been selection bias if oral contraceptive users were under more intensive medical surveillance. It has not been possible to reconcile the findings of the various studies to date, including the authors' earlier results showing no association. The latter results were derived from data collected using methods almost identical to those used in the present study.

Adult↗