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Biomedical subjects

J L Kelsey

Publications and source records attributed to J L Kelsey.

At least 19 recordsLinked to original sources
PubMed1992

Risk factors for fractures of the distal forearm and proximal humerus. The Study of Osteoporotic Fractures Research Group.

The Study of Osteoporotic Fractures is a prospective cohort study begun in 1986 that includes 9,704 women aged 65 years and older from Maryland, Minnesota, Oregon, and Pennsylvania. A total of 171 women suffered fractures of the distal forearm, and 79 women had fractures of the proximal humerus during the first 2.2 years of follow-up. Most fractures at both sites occurred as a result of a fall. Low bone mineral density was a strong predictor of these fractures; comparing those in the lowest quintile of bone mineral density in the distal radius with those in the highest quintile, the rate ratio was 4.1 for fractures of the distal forearm and 7.5 for fractures of the proximal humerus. Other factors associated with an increased rate of distal forearm fracture independently of low bone mineral density included poor visual acuity, number of falls in the year before baseline, and frequent walking. Factors that appeared to be independently associated with an increased rate of fracture of the proximal humerus included a recent decline in health status, insulin-dependent diabetes mellitus, infrequent walking, and several indicators of neuromuscular weakness such as inability to stand with feet in a tandem position for more than a few seconds. These data support the hypothesis that distal forearm fractures often occur as a result of a fall in women with low bone mineral density who are relatively healthy and active and have good neuromuscular function, while fractures of the proximal humerus tend to occur as a result of a fall in women with low bone mineral density who are less healthy and less active than average and who have poor neuromuscular function.

Age Factors↗
PubMed1992

Evaluation of random digit dialing as a method of control selection in case-control studies.

Control groups selected by random digit dialing are frequently used in case-control studies. Concern about the potential for bias in these control groups has been expressed, primarily because of low response rates. This study compares the characteristics of a hypothetical control group consisting of 341 men and women aged 40-74 years, selected by random digit dialing and participating in an interview in 1990, with the characteristics of 15,563 men and women aged 40-74 years who participated in a privately conducted census in the same upstate New York county in 1989. For most measures, no differences were seen between the random digit dialing sample and the census population. However, the hypothetical control group was more likely to have had their cholesterol checked in the past 2 years and was somewhat more likely to have had other screening tests as well. In addition, the hypothetical control group was somewhat better educated. The results suggest that, at least in this setting, control groups selected by random digit dialing are representative of the general population in most respects; however, caution should be used when studying the relation between screening tests and disease occurrence by means of case-control studies using controls selected by random digit dialing.

Adult↗
PubMed1979

Fibroadenoma in oral contraceptive users: a histopathologic evaluation of epithelial atypia.

We have reviewed histologically a series of 120 fibroadenomas which formed part of the case material from a previous case-control epidemiological investigation of the relationship between oral contraceptive use and breast disease. We evaluated the epithelial component of the fibroadenoma for degree of cytologic atypia. This study indicates that the reduced risk for fibroadenoma among long-term users of oral contraceptives does not vary according to the degree of epithelial atypia present. This is in contrast to our previously reported findings for fibrocystic disease, in which the decreased frequency of occurrence of the disease in long-term users of oral contraceptives was found only for cases with no minimal epithelial atypia.

Adenofibroma↗
PubMed1979

The impact of musculoskeletal disorders on the population of the United States.

Musculoskeletal disorders constitute such a large component of impairments of individuals in the working and geriatric population that good statistical data on them are essential for planning health care. We have collected the pertinent data, with references to recent source material, to determine the incidence, effect on the quality of life, and associated costs of these disorders in the United States.

Adult↗
PubMed1978

Fibrocystic breast disease in oral-contraceptive users. A histopathological evaluation of epithelial atypia.

Epidemiological studies show a lower frequency of fibrocystic breast disease among long-term users of oral contraceptives than among women who have never used them. Fibrocystic disease may be a precursor of breast cancer; yet the incidence of breast cancer does not appear to differ between pill-takers and nontakers. To resolve this conflict, we examined the problem from a histologic standpoint in 205 premenopausal women, and found that this decreased frequency applied only to fibrocystic disease in which epithelial atypia was minimal or absent. In women with marked atypia there was no significant difference in frequency among long-term users as compared to women who have never used oral contraceptives. These findings suggest that a spectrum of cystic disease exists and that the long-term use of oral contraceptives protects against the forms of fibrocystic disease that are not firmly associated with an increased risk of breast cancer, but not against the premalignant forms.

Adult↗
PubMed1978

Role of oral contraception in congenital malformations of offspring.

In a case control study we examined the relationship between congenital malformations in offspring and maternal exposure to oral contraceptives around the time of conception. There were 1 370 with congenital malformations and 2 968 healthy control infants. Maternal oral contraceptive use was unrelated to malformations considered as a whole whether exposure last occurred in the year before conception [odds ratio = 0.9, p=0.25] or during pregnancy [odds ratio = 1.3, p=0.30]. Exposure during pregnancy doubled the risk for some specific diagnoses, including certain cardiovascular defects, but these increases were not statistically significant. Exposure to specific oestrogens or progestogens was also unrelated to the occurrence of malformations. There was a suggestion that women who both smoked more than 20 cigarettes per day and used oral contraceptives during pregnancy were more likely to deliver a malformed infant than were women who neither used oral contraceptives nor smoked during pregnancy.

Abnormalities, Drug-Induced↗
PubMed1978

Oral contraceptives and breast disease. An epidemiological study.

A case-control study of the relationship between use of oral contraceptives and cancer of the breast, cancer of the corpus uteri, cancer of the ovary, and benign breast diseases was undertaken among women in the age group 20--44 years who had been admitted to several large hospitals in Connecticut. No significant association was seen between use of oral contraceptives and breast cancer. It was found that the longer a woman had used sequential oral contraceptives, the lower her relative risk of benign breast disease. Use of combination oral contraceptives, however, did not appear to influence the risk of benign breast diseases. The numbers of cases with cancer of the ovary and of the corpus uteri in this age group were too small for any conclusions to be reached.

Adenofibroma↗
PubMed1978

Multivariate analysis for matched case-control studies.

A multivariate method based on the linear logistic model is presented for the analysis of case-control studies with pairwise matching. This technique enables one to investigate the effect of several variables simultaneously in the analysis while allowing for the matched design. The odds ratio is used as the basic measure of risk. One is able to control for variables which are not matching variables while investigating the odds ratio for a particular factor, and to estimate the change in the odds ratio as the level of one or more interval variables changes. The computing methods used for obtaining maximum conditional likelihood estimates of the parameters of interest are modifications of standard programs for logit regression.

Epidemiologic Methods↗
PubMed1978

Maternal smoking and congenital malformations: an epidemiological study.

In a case-control study undertaken in several hospitals in Connecticut, it was found that women who reported smoking more than 20 cigarettes a day during pregnancy had a relative risk of about 1.6 for congenital malformations in the offspring of that pregnancy compared with women who said they had not smoked at all during pregnancy. However, there was no significant increase in risk among women who reported smoking 20 or fewer cigarettes a day during pregnancy compared with those who said they had not smoked at all during pregnancy. The higher risk among moderate and heavy smokers could not be attributed to any of the potentially confounding variables considered in this study; furthermore, it was specific to smoking during pregnancy rather than before pregnancy, and increased with the average amount smoked a day. Nevertheless, because the increase in risk was modest, because response bias could exist in a study of this type, and because no other studies have examined in detail the smoking-congenital malformation hypothesis, further research is needed to determine whether the relationship between maternal smoking and congenital malformations in offspring is causal.

Adult↗
PubMed1978

The annual Pap test: a dubious policy success.

The annual Pap test became a recommended standard for American women without ever having been subjected to controlled trials to estimate its efficacy and effectiveness. After more than 30 years of routine use, the Pap test fails to meet most of the generally accepted criteria for a mass screening program. The policy persists, however, because the nation's ideology supports the maximum utilization of new technologies; and special interest groups have promoted the test as the major weapon in the "War on Cancer." With some exceptions, this is a questionable allocation of public and private health resources.

American Cancer Society↗
PubMed1978

Epidemiology of radiculopathies.

Many diseases affecting the peripheral nervous system or the spinal canal may be associated with pathology in the nerve roots, but the most common sources of radiculopathy are conditions that cause direct compression of nerve roots, including prolapsed intervertebral disks, disk degeneration, and osteoarthrosis of the apophyseal joints. The risk for prolapsed lumbar disk is highest in the group 20 to 39 years of age, and it is probably increased by the driving of motor vehicles, full-term pregnancies, and sedentary occupations. Cervical disk prolapses tend to occur in a slightly older age group, but very little is known of specific etiologic agents. Both lumbar and cervical prolapses usually occur in a posterior-lateral direction, and thus they are generally associated with nerve root impingement. Both osteoarthrosis of the apophyseal joints and disk degeneration sometimes progress to nerve root involvement. Although the shape and position of the involved structures undoubtedly influence the likelihood of radiculopathy, it is unclear what other factors cause some individuals to progress to the stage of nerve root involvement and not others. Prevalence rates for osteoarthrosis of the lumbar and cervical spines increase markedly with age, and both are sometimes associated with generalized osteoarthrosis. Mechanical stresses from heavy occupations such as mining and from certain structural abnormalities of the spine such as spondylolisthesis predispose to osteoarthrosis of the lumbar spine. However, little is known about factors associated with osteoarthrosis of the cervical spine. The nature of the stress related to development of osteoarthrosis in the lumbar spine is not known. Disk degeneration is also strongly related to age, with preliminary degenerative changes occurring as early as 20 to 29 years of age and osteophyte formation tending to occur from the fifth decade on. Mechanical stress from heavy occupations is associated with lumbar disk degeneration, but, again, little is known about etiologic factors in cervical disk degeneration. It is apparent that much remains to be learned about the etiology and natural history of these conditions, and it is clear that the gaps in knowledge are even greater for the cervical region than for the lumbar spine. In view of the relatively high frequency of occurrence of these conditions and the amount of pain and disability they cause, epidemiologic studies of etiology and natural history are urgently needed.

Adult↗
PubMed1977

The epidemiology of diseases of the hip: a review of the literature.

Diseases of the hip are significant public health problems. Fractures and osteoarthrosis of the hip are common in older age-groups, while congenital dislocation of the hip, Legg-Calvé-Perthes disease, and slipped epiphysis affect a certain proportion of infants, children, and adolescents. The distribution of these five common hip diseases in the population is reviewed, aetiological hypotheses are discussed, and gaps in knowledge identified. Particular attention is focused on the roles of mechanical stress and hormones, since there is evidence for the involvement of one or both of these factors in the aetiology of each of the diseases. Many characteristics of their descriptive epidemiology have still to be explained, however, and it is clear that more research is needed.

Epiphyses, Slipped↗
PubMed1975

An epidemiological study of the relationship between occupations and acute herniated lumbar intervertebral discs.

A case-control study of the epidemiology of acute herniated lumbar intervertebral discs in the New Haven, Connecticut, area indicates that sedentary occupations increase the risk for herniated lumbar discs, particularly among those aged 35 years and older who have had sedentary jobs for several years. People in occupations requiring prolonged driving of motor vehicles, such as truck drivers, appear to be at particularly high risk. The results of this study provide no evidence that people whose jobs involve heavy manual labour are at greater risk for acute herniated lumbar disc than others of their age and sex.

Adult↗
PubMed1975

Driving of motor vehicles as a risk factor for acute herniated lumbar intervertebral disc.

In a case-control study of the epidemiology of acute herniated lumbar intervertebral disc in the New Haven, Connecticut, area, it was found that driving of motor vehicles was associated with an increased risk for developing this disease. It was estimated that men who spend half or more of their time on their job driving a motor vehicle are about three times as likely to develop an acute herniated lumbar disc as those who do not hold such jobs. Persons of either sex who said that they drove a car (either away from work or at work) were more likely to develop an acute herniated lumbar disc than those who did not drive at all. These associations between driving and acute herniated lumbar disc could not be attributed to any confounding variables considered in this study.

Acute Disease↗
PubMed1975

An epidemiological study of acute herniated lumbar intervertebral discs.

In an epidemiological study of acute herniated lumbar intervertebral discs in the New Haven, Connecticut (U.S.A.), area, it was found that this condition was most likely to be diagnosed among persons in the age group 30-39 years, and that the most important risk factors among the variable considered in this study were driving of motor vehicles at or away from work, sedentary occupations, suburban residence, and previous full-term pregnancies. Variables for which there was some suggestion of an association but for which the evidence was inconclusive were the male sex, high social class among females, chronic cough and chronic bronchitis, participation in baseball, golf and bowling, the spring and fall seasons, and possibly lack of physical activity other than at work. No increase in risk for this condition was related to race, social class in males, smoking habits, participation in sports other than baseball, golf and bowling, weight or body bulk, recent episodes of emotional stress, pregnancies which were not full-term, and jobs involving lifting, pushing, pulling, or carrying.

Adult↗
PubMed1975

Pregnancy and the syndrome of herniated lumbar intervertebral disc; an epidemiological study.

In a study of the epidemiology of acute herniated lumbar intervertebral discs in the New Haven, Connecticut, area, it was found that the female cases had had more pregnancies resulting in live births than women of similar age without known herniated discs. However, cases had not had more pregnancies resulting in miscarriages than other women of their age. Among women who underwent surgery for their herniated discs, the association between number of live births and herniated discs was found for women with herniations at the L5 level but not for women with herniations at the L3 level.

Abortion, Spontaneous↗