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Biomedical subjects

H L Howe

Publications and source records attributed to H L Howe.

At least 37 records · Page 2Linked to original sources
PubMed1992

Urban-rural differences in the management of breast cancer.

We conducted a population-based study with medical-record review of breast cancer patients as part of a larger study of an oncology outreach program to improve cancer management for rural patients within their community hospital. This analysis compares the breast cancer care received by the rural population before the oncology outreach program with that of the contiguous urban population. All 1986-87 cases in selected Illinois (United States) counties were identified using the Illinois State Cancer Registry. Data were obtained by hospital record audit and physician survey. Case follow-back was 98 percent complete. Rural cases were evaluated separately when they were diagnosed in an urban facility. State-of-the-art management was defined by the 1986-87 Physician Data Query and included diagnostic evaluation, prognostic evaluation, and stage-specific treatment. A summary variable incorporated whether or not the most appropriate management was offered. Compared with urban cases, rural cases diagnosed in rural hospitals were less likely to have staged tumors and more likely to have node dissections. Rural cases traveling to urban centers were less likely to have limited surgery, hormone therapy, and a biopsy as a first-step surgical procedure, and more likely to have node dissection.

Aged↗
PubMed1991

An algorithm for matching anonymous hospital discharge records used in occupational disease surveillance: anonymous record matching algorithm.

The expense of collecting primary data, coupled with limited authority to mandate reporting, requires alternative methods of implementing an occupational disease registry in Illinois. One alternative data source for surveillance of some occupational diseases is hospital discharge records. Because these records lack personal identifiers, it has been impossible historically to match records belonging to the same individual and obtain reliable case estimates. To circumvent this difficulty, an algorithm has been developed to match anonymous hospital discharge records collected from all Illinois hospitals. The algorithm was based on the assumption that specific combinations of occupational disease code, sex, zip code, and date of birth would identify an individual to whom multiple hospitalizations belong. Matching with the algorithm reduced the 1986 case estimates from 597 to 499 for all cases of coal workers' pneumoconiosis, asbestosis, and silicosis.

Algorithms↗
PubMed1991

A systematic consideration of the neoplastic spectrum of AIDS: registry linkage in Illinois.

To examine unexplored aspects of the association between AIDS and neoplasia, the Illinois AIDS and Cancer Registries were linked. The method integrated use of a personal computer to find exact matches on names and dates of birth with manual review to assure satisfaction of a match definition. Of the factors examined, white race and homosexuality predicted Kaposi's sarcoma (KS) among people with AIDS (PWAs), and white race predicted non-Hodgkin's lymphoma (NHL). Earlier reports of a declining proportion of PWAs with KS were confirmed. Lymphoma (mixed lymphocytic/histiocytic type), while not currently diagnostic of AIDS, occurred more frequently among PWAs than in the Illinois population. For the first time, rates of cancers other than KS and NHL were demonstrated to be significantly increased among PWAs compared with general populations. In the light of these findings, reconsideration of current neoplastic definitions may be useful.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Monitoring for clusters of disease: application to leukemia incidence in upstate New York.

The authors propose a procedure for the detection of significant clusters of chronic diseases, with particular reference to cancer. The procedure allows for variations in population density and avoids the problem of "post hoc" formation of hypotheses or self-defined populations. This accounts for several of the principal problems of cluster evaluations. The techniques are practical but "computer-intensive." The procedure, termed the "cluster evaluation permutation procedure," is applied to leukemia incidence data for an Upstate New York region obtained from the New York State Cancer Registry and census files. Comparisons are made with two other recently proposed clustering methods, namely the U-statistic method of Whittemore et al. (Biometrika 1987;74:631-7) and the "geographical analysis machine" of Openshaw et al. (Lancet 1988;1:272-3). Routine examination of disease occurrence with the cluster evaluation permutation procedure would allow state health officials to prioritize case investigations and to respond in a timely and efficient manner to inquiries of reported clusters.

Cluster Analysis↗
PubMed1990

Predicting public concern regarding toxic substances in the environment.

The purpose of this research was to identify the variables that increase concern about the health, environmental contamination, and economic consequences of toxic substances in the environment. A mail survey was sent to a New York State sample, and a 66% response was obtained. Seven indices were developed from specific concerns about toxic substances in the environment including, among others, exposure, health effects, pollution, and economic consequences. Stepwise regression analysis was conducted for each concern index. The results suggest that the number of information sources regarding environmental issues was a strong predictor of concern in nearly all models. Other variables that were repeatedly found to be important contributors to the models were years of education, attitudes about government involvement in private industry, knowledge of epidemiology and the scientific method, and the perceived proximity to sources of potential contamination. Unlike other research, women and mothers of sick children did not make large contributions to the model.

Adult↗
PubMed1989

Early abortion and breast cancer risk among women under age 40.

In New York State, incidence of cancer and fetal death are reportable health events mandated by state law. These data enabled a population-based record linkage study of the effect of early pregnancy termination on breast cancer risk to be conducted. In upstate New York 1451 cases under age 40 were reported to the Cancer Registry during 1976-1980. Cases were matched with 1451 population controls by year of birth and by residence using zip codes. All names including those changed by marriage were matched with the reports of fetal deaths occurring between 1971 and 1980. Matched pairs analyses revealed an excess of early pregnancy terminations among cases in all categories. Odds ratios (OR) were significantly elevated among those with an induced abortion (OR = 1.9) and a spontaneous abortion (OR = 1.5). Elevated risks were also noted for consecutive abortion events without intervening livebirths.

Abortion, Incomplete↗
PubMed1989

Sentinel health event surveillance: skin cancer of the scrotum in New York State.

Skin cancer of the scrotum is a disease that has been identified as a sentinel health event (occupational) (SHE(O] that is necessarily occupationally related. The present paper examines the feasibility of using this disease in active cancer surveillance in New York State. After consulting cancer case reports, hospital records, death certificates, and city directories, we obtained occupational data for 17 of 22 cases of nonmelanoma skin cancer of the scrotum diagnosed between 1979 and 1984. Only three cases had occupations previously linked to scrotal cancer, while 11 of 19 cases had one or more possibly contributory medical conditions. The probable under-reporting of scrotal cancer cases and incompleteness of occupational data may limit the usefulness of scrotal cancer as a sentinel health event (occupational) unless additional steps are taken.

Death Certificates↗
PubMed1985

Breast self-examination palpation skill: a methodological note.

A current issue in research of breast self-examination (BSE) efficacy is the competency of BSE performance. A nonverbal method for testing two palpation skills were developed. They were designed for mail surveys, or other cost-effective methods of following up subjects in a longitudinal study design. They were also designed to avoid semantics problems associated with verbal descriptions of BSE performance, as noted in earlier research of the author. These pictorial questions were included in three mail surveys of the general female population. The data were consistent across all three surveys for both the verbal and nonverbal questions of palpation skill. The diagram index of the hand part used in BSE suggested that a higher proportion of BSE practicers are using the recommended hand part than their verbal reports would indicate. However, the data from the diagram assessing the amount of pressure used for BSE were not very different from the results of the verbal questions.

Aged↗
PubMed1984

Physicians' attitudes toward breast self-examination: a pilot study.

Recent case control studies suggest that breast self-examination (BSE) is efficacious in the early clinical diagnosis of breast cancer. Population studies also indicate that adoption of this behavior depends largely on physicians. This pilot study was designed to determine whether physicians' attitudes on this subject could be obtained through a mail questionnaire. The results show that a self-administered mail questionnaire can be used successfully in physician studies. Although questionnaire length does affect response rates (78% one page, 69% four page, and 57% eight page), it does not affect either respondent characteristics or question response.

Attitude of Health Personnel↗
PubMed1984

Age-specific hysterectomy and oophorectomy prevalence rates and the risks for cancer of the reproductive system.

A sample survey was conducted in 1982 to determine the prevalence of hysterectomy and oophorectomy among upstate New York women, ages 25-74. The effects of this surgery on age-specific estimates of the risk for cancer of the uterus, cervix, and ovary were calculated. Overall, 16.9 per cent of the women reported having had a hysterectomy and 9.9 per cent reported a bilateral oophorectomy. The adjustment for age-specific hysterectomy increased the 1977-1979 average annual incidence rate of cervical and uterine cancer by 21 per cent. In several five-year age categories, the increase reached 54 per cent. The 1977-1979 average annual incidence rate of ovarian cancer increased by 12 per cent after adjusting for age-specific bilateral oophorectomy. The increase reached 29 per cent in one five-year age group. The sample results show a lower prevalence of hysterectomy among women 25 to 40 years old and among women 70 to 74 than estimates based on the application of mathematical models to data on surgical incidence.

Adult↗
PubMed1983

Breast self-examination and breast cancer: a note on postdisease reporting bias.

Recall bias in retrospective studies among cases reporting events which occur prior to diagnosis is difficult to measure. In this paper breast self-examination (BSE) practice as reported in a general population survey of 395 women is compared to data on BSE practice from six recent retrospective case-control studies of breast cancer. The focus is on the change in reported level of BSE practice which is associated with a change in the level of related study variables. The patterns of these differences in reported BSE practice are compared for the available categories of age, education, marital status, and menopausal status in each retrospective study to the corresponding pattern in the survey data. The patterns are similar except for the comparison by education. The other variables give no evidence of postdisease reporting bias. Factors other than postdisease reporting bias which might account for the education difference are discussed. Further development of a model for the impact of education on reporting bias is needed.

Adult↗
PubMed1982

Increasing efficiency in evaluation research: the use of sequential analysis.

This paper describes Wald's sequential analysis and briefly reviews the history of its applied use. Two public health applications are presented as examples of how the method helped overcome two common problems associated with evaluation research. In one case, the sequential technique reduced dramatically the workload in an evaluation project where hospital records were being reviewed. In the second case, prompt feedback of data to a breast screening program was facilitated by the sequential method allowing program administrators to refocus their efforts on problem areas before the end of the funding period. On the average, Wald's sequential method results in a savings of 50 per cent in observations as compared to classical sampling procedures. The sample sizes will always terminate with a finite number and will rarely exceed three times the average sample size for any single sample.

Black or African American↗
PubMed1981

Social factors associated with breast self-examination among high risk women.

A sample of 708 women, who by sociodemographic characteristics are high risk to breast cancer, were interviewed by telephone about their knowledge, attitude, and practice of breast self-examination (BSE). Reported frequency of BSE, knowledge of BSE and breast cancer, and BSE attitude in this sample are comparable to data reported by others. This report analyzes the associations between the frequency of a breast self-examination practice and the variables, age, education, detection confidence, social influence, modesty, preventive health behaviors, and memory. These relationships are discussed and several new hypotheses are proposed. Since the data were collected retrospectively, they are not able to describe causal relationships.

Adult↗
PubMedDate not supplied

A comparison of actual and perceived residential proximity to toxic waste sites.

Studies of Memphis and Three Mile Island have noted a positive association between actual residential distance and public concern about exposure to the potential of contamination, whereas none was found at Love Canal. In this study, concern about environmental contamination and exposure was examined in relation to both perceived and actual proximity to a toxic waste disposal site (TWDS). It was hypothesized that perceived residential proximity would better predict concern levels that would actual residential distance. The data were abstracted from a New York State, excluding New York City, survey using all respondents (N = 317) from one county known to have a large number of TWDSs. Using linear regression, the variance explained in concern scores was 22 times higher with perceived distance than for actual distance. Perceived residential distance was a significant predictor of concern scores, while actual distance was not. However, perceived distance explained less than 5% of the variance in concern scores.

Adult↗