Biomedical subjects

J F Lando

Publications and source records attributed to J F Lando.

5 recordsLinked to original sources

PubMed1999

Surveillance for use of preventive health-care services by older adults, 1995-1997.

PROBLEM/CONDITION: In 1995, a total of 55 million persons aged > or =55 years lived in the United States. The members of this large and growing segment of the population are major consumers of health care. Their access to medical and dental preventive services contributes to their likelihood of healthy later years and influences their long-term impact on the health-care delivery system. REPORTING PERIOD: 1995-1997. DESCRIPTION OF SYSTEMS: This report summarizes data from the National Health Interview Survey (NHIS), the state-based Behavioral Risk Factor Surveillance System (BRFSS), and the Medicare Current Beneficiary Study (MCBS) to describe national, regional, and state-specific patterns of access to and use of preventive services among persons aged > or =55 years. RESULTS: During 1995-1997, approximately 90% of persons aged > or =55 years living in the United States reported having a regular source of health-care services. However, only 75%-80% reported receiving a routine checkup during the preceding 2 years. The estimated percentage of persons who reported not being able to receive medical care because of cost was highest for those aged 55-64 years. Within this age group, the percentage was highest among Hispanics (4%) and persons without a high school diploma. Approximately 11% of Medicare beneficiaries reported delaying care be cause of cost or because they had no particular source of care. Percentage estimates varied according to age, race/ethnicity, and sociodemographic status. Approximately 95% of persons aged > or =55 years reported having their blood pressure checked during the preceding 2 years, but only 85%-88% had received a cholesterol evaluation during the preceding 5 years. The percentage of women receiving breast and cervical cancer screening decreased with increasing age, and the percentage of persons aged > or =55 years who had received some form of screening for colorectal cancer was low approximately 25% for fecal occult blood testing (FOBT) and 45% for endoscopy. State-specific rates of compliance with vaccination recommendations among persons aged > or =65 years were higher for influenza vaccine (range: 54%-74%) than for pneumococcal vaccine (range: 32%-59%), and compliance increased with advancing age. State-specific estimates of the percentage of annual dental visits varied 40%-75%, and 41%-88% of persons aged > or =65 years reported not having dental insurance. INTERPRETATION: Access to medical services among adults living in the United States is greater for persons aged > or =65 years, compared with those aged <65 years, presumably because of Medicare coverage. In contrast, use of dental services decreased, despite increased need for preventive and restorative dental care. Although Medicare covers many medical services for older adults, financial, personal, and physical barriers to both medical and dental care create racial, regional, and sociodemographic disparities in health status and use of health services in the United States. PUBLIC HEALTH ACTION: Continued surveillance of access to and use of health services among older adults (i.e., persons aged > or =65 years), as well as among persons aged 55-64 years, will help health-care providers target underserved groups, make Medicare coverage decisions, and develop public health programs to ensure equitable access to services and improve the health of older adults.

Aged↗

PubMed1999

Hormone replacement therapy and breast cancer risk in a nationally representative cohort.

BACKGROUND: The relative risk of breast cancer associated with the use of postmenopausal hormone replacement therapy (HRT) continues to be debated. We used a nationally representative cohort to study the issue. METHODS: This analysis utilized data from the NHANES I Epidemiologic Follow-up Study. Subjects were interviewed in 1971 through 1974 and four waves of follow-up interviews were conducted through 1992. Survival analysis of 5,761 postmenopausal women provided estimates of the relative risk of breast cancer in users of HRT when compared with non-users, controlling for potential confounders. RESULTS: There were 219 incident cases of breast cancer in 73,253 person-years of follow-up. The incidence rate was 326 per 100,000 person-years in women who had never used HRT and 255 per 100,000 in women who had ever used HRT. There was no statistically significant association between the HRT use and subsequent development of breast cancer: relative risk (RR) = 0.8, 95% confidence interval 0.6, 1.1. There was no trend in RR by length of HRT use: less than 3 years HRT use, RR = 0.9; 3 to 9 years , RR = 0.5; 10 or more years, RR = 0.8. CONCLUSIONS: This study, based on a nationally representative cohort followed for up to 22 years, failed to find an increased risk of breast cancer associated with the use of HRT. It provides further evidence that if there is an increased risk of breast cancer associated with HRT use, this risk is small.

Breast Neoplasms↗

PubMed1996

The New Mexico Mammography Project. Screening mammography performance in Albuquerque, New Mexico, 1991 to 1993.

BACKGROUND: This project was designed to collect and link population-based mammography and breast carcinoma data to assess the performance of community mammography screening. METHODS: Computerized data were collected from all radiology practices in Albuquerque, New Mexico. The data were linked by computer match to breast carcinomas in a statewide cancer registry. Analysis is based on 126,466 screening mammogram studies performed on 87,443 female residents of New Mexico between the ages of 35 and 84 by 5 radiology groups. Sensitivity, specificity, positive predictive value, and call back rates were calculated as indicators of the discriminative performance of mammography. Carcinoma size and stage distribution were analyzed as outcome measurements. RESULTS: The computer match linked 634 breast carcinomas to the 126,466 screening mammogram series. The community-wide sensitivity was 79.9%, and specificity was 90.5%. The predictive value of an abnormal screen was 4.3%, and that of a biopsy recommendation result was 16.9%. The call back rate was 11.4%. The median invasive breast carcinoma size was 15 mm, 20.3% of carcinomas were in situ, 18.3% were lymph node positive, and 68.1% were Stage 0 or Stage 1. CONCLUSIONS: Mass screening mammography as practiced in Albuquerque, New Mexico, is able to detect breast carcinomas at early, treatable stages. The stage distribution of carcinomas is similar to that seen in successful clinical trials. However, measures of mammography performance show lower sensitivity, more additional studies, and more biopsy recommendations in this community setting than have been reported by expert mammographers.

Adult↗

PubMed1988

Rapid reorganization of adult rat motor cortex somatic representation patterns after motor nerve injury.

The potential for peripheral nerve injury to reorganize motor cortical representations was investigated in adult rats. Maps reflecting functional connections between the motor cortex and somatic musculature were generated with intracortical electrical stimulation techniques. Comparison of cortical somatotopic maps obtained in normal rats with maps generated from rats with a facial nerve lesion indicated that the forelimb and eye/eyelid representations expanded into the normal vibrissa area. Repeated testing from an electrode placed chronically in the motor cortex showed a shift from vibrissa to forelimb within hours after facial nerve transection. These comparatively quick changes in motor cortex representation pattern suggest that synaptic relations between motor cortex and somatic musculature are continually reshaped in adult mammals.

Animals↗

PubMedDate not supplied

Negative affect as a prospective risk factor for hypertension.

OBJECTIVE: The objective of this study was to test the hypothesis that negative affect is a prospective risk factor for hypertension among white and black persons. METHODS: A population-based cohort of 3310 initially normotensive and chronic disease-free persons in the NHANES I Epidemiologic Follow-up Study was tracked through four follow-up waves (maximum, 22 years). The association between hypertension and baseline negative affect was analyzed using Cox proportional hazards regression, adjusting for baseline age, sex, race, education, smoking, alcohol use, diastolic and systolic blood pressure, body mass index, and change in body mass index as a time-dependent covariate. Negative affect was based on combined symptoms of depression and anxiety. Hypertension end points included 1) self-reported, 2) treated (prescription of antihypertensive medications), and 3) incident (blood pressure > or =160/95 mm Hg or treated) hypertension. Blood pressure measurements were obtained only at baseline and the first follow-up examination (maximum, 13 years). RESULTS: Increased negative affect was associated with elevated risk for self-reported, treated, and incident hypertension at first follow-up. Through four waves of follow-up, high negative affect was associated with treated hypertension in baseline risk-adjusted models for white women (relative risk [RR] = 1.73, 95% confidence interval [95% CI] = 1.30-2.30), black women (RR = 3.12, 95% CI = 1.24-7.88), and all men (RR = 1.56, 95% CI = 1.08-2.25). Time-dependent covariate models produced similar RRs. CONCLUSIONS: Negative affect is predictive of development of hypertension. For treated hypertension, white women and all men with increased negative affect had similarly elevated RRs, whereas black women with increased negative affect had substantially higher RRs.

Adult↗