Biomedical subjects

Elizabeth M Ward

Publications and source records attributed to Elizabeth M Ward.

12 recordsLinked to original sources

PubMed2006

U.S. congressional district cancer death rates.

BACKGROUND: Geographic patterns of cancer death rates in the U.S. have customarily been presented by county or aggregated into state economic or health service areas. Herein, we present the geographic patterns of cancer death rates in the U.S. by congressional district. Many congressional districts do not follow state or county boundaries. However, counties are the smallest geographical units for which death rates are available. Thus, a method based on the hierarchical relationship of census geographic units was developed to estimate age-adjusted death rates for congressional districts using data obtained at county level. These rates may be useful in communicating to legislators and policy makers about the cancer burden and potential impact of cancer control in their jurisdictions. RESULTS: Mortality data were obtained from the National Center for Health Statistics (NCHS) for 1990-2001 for 50 states, the District of Columbia, and all counties. We computed annual average age-adjusted death rates for all cancer sites combined, the four major cancers (lung and bronchus, prostate, female breast, and colorectal cancer) and cervical cancer. Cancer death rates varied widely across congressional districts for all cancer sites combined, for the four major cancers, and for cervical cancer. When examined at the national level, broad patterns of mortality by sex, race and region were generally similar with those previously observed based on county and state economic area. CONCLUSION: We developed a method to generate cancer death rates by congressional district using county-level mortality data. Characterizing the cancer burden by congressional district may be useful in promoting cancer control and prevention programs, and persuading legislators to enact new cancer control programs and/or strengthening existing ones. The method can be applied to state legislative districts and other analyses that involve data aggregation from different geographic units.

Age Distribution↗

PubMed2006

Interpreting cancer trends.

The interpretation of cancer incidence trends is complicated by short-term random variation, artifactual fluctuations introduced by screening, changes in diagnosis or disease classification, completeness of reporting, and by the multiplicity of factors that may affect risk for specific cancer sites. We analyzed trends in 56 different cancer sites and subsites in the U.S. SEER registries in the period 1975-2002 using join-point analysis. The increase in cancer incidence for all sites combined that became evident with the inception of the SEER registries in the mid-1970s has abated since the early 1990s. Among the 15 most common cancer sites in men, sites with increasing incidence rates during the most recent time period include melanoma of the skin and cancers of the prostate, kidney and renal pelvis (kidney), and esophagus. Among women, incidence rates are increasing for leukemia, non-Hodgkin's lymphoma, melanoma, and cancers of the breast, thyroid, urinary bladder, and kidney. Incidence rates for all childhood cancers combined increased 0.6% per year from 1975 to 2002. Cancer mortality rates have decreased in the United States since 1991 in both men and in women; site-specific death rates have decreased in the most recent time period for 12 of the top 15 cancer sites in men and 9 of the top 15 cancer sites in women. Similar trends in cancer incidence and mortality have been reported in other industrialized countries. Possible reasons for these trends are discussed.

Child, Preschool↗

PubMed2006

Mortality and exposure response among 14,458 electrical capacitor manufacturing workers exposed to polychlorinated biphenyls (PCBs).

BACKGROUND: We expanded an existing cohort of workers (n = 2,588) considered highly exposed to polychlorinated biphenyls (PCBs) at two capacitor manufacturing plants to include all workers with at least 90 days of potential PCB exposure during 1939-1977 (n = 14,458). Causes of death of a priori interest included liver and rectal cancers, previously reported for the original cohort, and non-Hodgkin lymphoma (NHL), melanoma, and breast, brain, intestine, stomach, and prostate cancers, based on other studies. METHODS: We ascertained vital status of the workers through 1998, and cumulative PCB exposure was estimated using a new job exposure matrix. Analyses employed standardized mortality ratios (SMRs; U.S., state, and county referents) and Poisson regression modeling. RESULTS: Mortality from NHL, melanoma, and rectal, breast, and brain cancers were neither in excess nor associated with cumulative exposure. Mortality was not elevated for liver cancer [21 deaths; SMR 0.89; 95% confidence interval (CI), 0.55-1.36], but increased with cumulative exposure (trend p-value = 0.071). Among men, stomach cancer mortality was elevated (24 deaths; SMR 1.53; 95% CI, 0.98-2.28) and increased with cumulative exposure (trend p-value = 0.039). Among women, intestinal cancer mortality was elevated (67 deaths; SMR 1.31; 95% CI, 1.02-1.66), especially in higher cumulative exposure categories, but without a clear trend. Prostate cancer mortality, which was not elevated (34 deaths; SMR 1.04; 95% CI, 0.72-1.45), increased with cumulative exposure (trend p-value = 0.0001). CONCLUSIONS: This study corroborates previous studies showing increased liver cancer mortality, but we cannot clearly associate rectal, stomach, and intestinal cancers with PCB exposure. This is the first PCB cohort showing a strong exposure-response relationship for prostate cancer mortality.

Adult↗

PubMed2005

Urinary and hand wipe pesticide levels among farmers and nonfarmers in Iowa.

In the spring and summer of 2001, as part of a larger study investigating farm family pesticide exposure and home contamination in Iowa, urine and hand wipe samples were collected from 24 male farmers and 23 male nonfarmer controls. On two occasions approximately 1 month apart, one hand wipe sample and an evening and morning urine sample were collected from each participant. The samples were analyzed for the parent compound or metabolites of six commonly used agricultural pesticides: alachlor, atrazine, acetochlor, metolachlor, 2,4-dichlorophenoxyacetic acid (2,4-D) and chlorpyrifos. For atrazine, acetochlor, metolachlor and 2,4-D, farmers who reported applying the pesticide had significantly higher urinary metabolite levels than nonfarmers, farmers who did not apply the pesticide, and farmers who had the pesticide commercially applied (P-value <0.05). Generally, there were no differences in urinary pesticide metabolite levels between nonfarmers, farmers who did not apply the pesticide, and farmers who had the pesticide commercially applied. Among farmers who reported applying 2,4-D themselves, time since application, amount of pesticide applied, and the number of acres to which the pesticide was applied were marginally associated with 2,4-D urine levels. Among farmers who reported applying atrazine themselves, time since application and farm size were marginally associated with atrazine mercapturate urine levels. Farmers who reported using a closed cab to apply these pesticides had higher urinary pesticide metabolite levels, although the difference was not statistically significant. Farmers who reported using closed cabs tended to use more pesticides. The majority of the hand wipe samples were nondetectable. However, detection of atrazine in the hand wipes was significantly associated with urinary levels of atrazine above the median (P-value <0.01).

Agriculture↗

PubMed2005

Pesticide contamination inside farm and nonfarm homes.

Twenty-five farm (F) households and 25 nonfarm (NF) households in Iowa were enrolled in a study investigating agricultural pesticide contamination inside homes. Air, surface wipe, and dust samples were collected. Samples from 39 homes (20 F and 19 NF) were analyzed for atrazine, metolachlor, acetochlor, alachlor, and chlorpyrifos. Samples from 11 homes (5 F and 6 NF) were analyzed for glyphosate and 2,4-Dichlorophenoxyac etic acid (2,4-D). Greater than 88% of the air and greater than 74% of the wipe samples were below the limit of detection (LOD). Among the air and wipe samples, chlorpyrifos was detected most frequently in homes. In the dust samples, all the pesticides were detected in greater than 50% of the samples except acetochlor and alachlor, which were detected in less than 30% of the samples. Pesticides in dust samples were detected more often in farm homes except 2,4-D, which was detected in 100% of the farm and nonfarm home samples. The average concentration in dust was higher in farm homes versus nonfarm homes for each pesticide. Further analysis of the data was limited to those pesticides with at least 50% of the dust samples above the LOD. All farms that sprayed a pesticide had higher levels of that pesticide in dust than both farms that did not spray that pesticide and nonfarms; however, only atrazine and metolachlor were significantly higher. The adjusted geometric mean pesticide concentration in dust for farms that sprayed a particular pesticide ranged from 94 to 1300 ng/g compared with 12 to 1000 ng/g for farms that did not spray a particular pesticide, and 2.4 to 320 ng/g for nonfarms. The distributions of the pesticides throughout the various rooms sampled suggest that the strictly agricultural herbicides atrazine and metolachlor are potentially being brought into the home on the farmer's shoes and clothing. These herbicides are not applied in or around the home but they appear to be getting into the home para-occupationally. For agricultural pesticides, take-home exposure may be an important source of home contamination.

Agriculture↗

PubMed2005

Gliomas and farm pesticide exposure in women: the Upper Midwest Health Study.

An excess incidence of brain cancer in male farmers has been noted in several studies, but few studies have focused on women. The National Institute for Occupational Safety and Health Upper Midwest Health Study evaluated effects of rural exposures for 341 female glioma cases and 528 controls, all adult (18-80 years of age) nonmetropolitan residents of Iowa, Michigan, Minnesota, and Wisconsin. On average, controls lived longer on farms than did cases. After adjusting for age, age group, education, and farm residence, no association with glioma was observed for exposure to arsenicals, benzoic acids, carbamates, chloroacetanilides, dinitroanilines, inorganics, organochlorines, organophosphates, phenoxys, triazines, or urea-based or estrogenic pesticides. An increased risk of glioma was observed for carbamate herbicides but was not statistically significant (odds ratio = 3.0; 95% confidence interval, 0.9-9.5). No association was observed between glioma and exposure to 12 widely used specific pesticides, after adjustment for age, age group, education, and any other pesticide exposure. These results were not affected after exclusion of proxy respondents (43% of cases, 2% of controls). Women were less likely than men to have applied pesticides, but more likely to have laundered pesticide-contaminated clothes. Storing pesticides in the house was associated with a statistically non-significant increased risk. Results show that exposure to pesticides was not associated with an increased risk of intracranial gliomas in women. Other farm-related factors could be etiologic factors and will be discussed in future reports.

Adolescent↗

PubMed2004

Mortality patterns among workers exposed to styrene in the reinforced plastic boatbuilding industry: an update.

BACKGROUND: Mortality was updated through 1998 for 5,204 workers exposed to styrene between 1959 and 1978 at two reinforced plastic boatbuilding plants. The a priori hypothesis: leukemia and lymphoma excesses would be found. METHODS: Standardized mortality ratios (SMR) and 95% confidence intervals (CI) used Washington State and U.S. rates. RESULTS: Overall, 860 deaths occurred (SMR 1.09, CI 1.02-1.17), with excess mortality for esophageal cancer (n = 12, SMR 2.30, CI 1.19-4.02), prostate cancer (n = 24, SMR 1.71, CI 1.09-2.54), and accidents (n = 99, SMR 1.26, CI 1.02-1.53). Among 2,062 highly exposed workers, urinary tract cancer (n = 6, SMR 3.44, CI 1.26-7.50) and respiratory disease (n = 12, SMR 2.54, CI 1.31-4.44) rates were elevated. Urinary tract cancer SMR increased with duration of employment. CONCLUSIONS: We found no excess leukemia or lymphoma mortality. Unanticipated excess urinary tract cancer and respiratory disease mortality, possibly associated with styrene exposure, are difficult to interpret and could be chance findings.

Adult↗

PubMed2004

Gliomas and farm pesticide exposure in men: the upper midwest health study.

The National Institute for Occupational Safety and Health evaluated farm pesticide exposure and glioma risk in a study that included 457 glioma cases and 648 population-based controls, all adult men (18-80 yr old) and nonmetropolitan residents of Iowa, Michigan, Minnesota, and Wisconsin. Multiple logistic regressions were used to control for farm residence, age, age group, education, and exposure to other pesticides. No associations were found between glioma and 12 specific pesticides. We estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) and found reduced glioma risk for insecticides (OR = 0.53, CI = 0.37-0.77), fumigants (OR = 0.57, CI = 0.34-0.95), and organochlorines (OR = 0.66, CI = 0.47-0.94). In analyses excluding proxy respondents (47% of cases) most CIs included 1.0. No positive association of farm pesticide exposure and glioma was found. Other farm exposures may explain the excess brain cancer risk seen in previous studies.

Adolescent↗

PubMed2004

Reproductive factors and risk of glioma in women.

OBJECTIVE: Glioma is the most common primary malignant brain tumor in adults, responsible for 75% of adult primary malignant brain tumors, yet aside from its association with ionizing radiation, its etiology is poorly understood. Sex differences in brain tumor incidence suggest that hormonal factors may play a role in the etiology of these tumors, but few studies have examined this association in detail. The objective of this study was to explore the role of reproductive factors in the etiology of glioma in women. METHOD: As part of a population-based case-control study, histologically confirmed primary glioma cases (n = 341 women) diagnosed between January 1, 1995 and January 31, 1997 were identified through clinics and hospitals in four Midwest U.S. states. Controls (n = 527 women) were randomly selected from lists of licensed drivers and Health Care Finance Administration enrollees. In-person interviews with subjects (81%) or their proxies (19%) collected reproductive history and other exposure information. RESULTS: Glioma risk increased with older age at menarche (P for trend = 0.009) but only among postmenopausal women. Compared with women who never breast-fed, women who breast-fed >18 months over their lifetime were at increased risk of glioma (odds ratio, 1.8; 95% confidence interval, 1.1-2.9). Women who reported using hormones for symptoms of menopause had a decreased risk of glioma compared with women who never used such hormones (odds ratio, 0.7; 95% confidence interval, 0.5-1.1). CONCLUSION: These results support the hypothesis that reproductive hormones play a role in the etiology of glioma among women.

Adult↗

PubMed2003

Priorities for development of research methods in occupational cancer.

Occupational cancer research methods was identified in 1996 as 1 of 21 priority research areas in the National Occupational Research Agenda (NORA). To implement NORA, teams of experts from various sectors were formed and given the charge to further define research needs and develop strategies to enhance or augment research in each priority area. This article is a product of that process. Focus on occupational cancer research methods is important both because occupational factors play a significant role in a number of cancers, resulting in significant morbidity and mortality, and also because occupational cohorts (because of higher exposure levels) often provide unique opportunities to evaluate health effects of environmental toxicants and understand the carcinogenic process in humans. Despite an explosion of new methods for cancer research in general, these have not been widely applied to occupational cancer research. In this article we identify needs and gaps in occupational cancer research methods in four broad areas: identification of occupational carcinogens, design of epidemiologic studies, risk assessment, and primary and secondary prevention. Progress in occupational cancer will require interdisciplinary research involving epidemiologists, industrial hygienists, toxicologists, and molecular biologists.

Animals↗

PubMed1999

Intra-subject variability in post-operative patient-controlled analgesia (PCA): is the patient equally satisfied with morphine, pethidine and fentanyl?

Our previous study suggested that when compared between patients, morphine, pethidine and fentanyl were equally satisfactory for use in patient-controlled analgesia (PCA), although quantitative differences in their side-effect profiles were detectable. The present study evaluated whether individual patients could detect differences or express preferences for individual opioids when treated by PCA with all three in random sequence finishing with the first administered opioid. The main side effects were pruritus, nausea and vomiting. There were few differences in patients' responses to morphine, pethidine and fentanyl, or of satisfaction with these drugs, across patients, but individual patients' responses to the opioids could be highly variable. Some patients were able to tolerate all three opioids investigated, some were intolerant to all and some patients appeared to be sensitive to one or two of the opioids but show a preference for the remainder. These findings support the clinical practice of changing from one opioid to another (with good effect) in post-operative patients experiencing intolerable side-effects. The reasons for a patient responding differently to different opioids and even to the same opioid on separate occasions are not clear and appear inexplicable on the grounds of currently postulated receptor affinities or of physicochemical properties of the opioids studied. A plethora of factors will influence how an individual patient will respond to surgery and how he/she will recover. The physiological response to opioids is one variable which appears to be influenced by this complex set of factors and in turn will affect them. The findings of this study, like that of its predecessor, suggest that morphine, pethidine and fentanyl can be used successfully in PCA and that for some patients who are responding poorly, changing the opioid may be beneficial.

Adult↗

PubMedDate not supplied

Ethical issues in occupational health research.

This is an overview of ethical issues in occupational health research involving human subjects. Research that requires human subjects review must be distinguished from surveillance or public health practice. Confidentiality and privacy concerns are particularly important in an occupational setting because individual participants may be identifiable through job title or other characteristics, and because there may be concerns about employment discrimination associated with participation status or results. Additional issues include notification of individual test results to the study participants, including whether the results have clinical significance and/or provide other potentially relevant information to the study subjects; consent for banking of biological specimens for future research (e.g., uses of the specimens, plans for anonymization, notification of future results); and the higher level of sensitivity of workplace studies involving genetic modifiers of risk. Many occupational studies involve no more than minimal risk. Studies that involve greater than minimal risk require the investigator to document the potential risks and attempt to minimize them.

Confidentiality↗