The pack as advertisement.
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Advertising↗
Biomedical subjects
J Slade
Publications and source records attributed to J Slade.
Nicotine content of the eclipse nicotine delivery device.
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Equipment Design↗
Involving health care workers in screening for alcohol problems.
OBJECTIVES: (1) Examine physician and nursing staff compliance with conducting an alcohol screening interview; (2) Compare compliance with the interview with usual physician and nurse assessment of drinking; (3) Examine reasons why drinking information might not be collected. DESIGN: Residents and nurses were taught how to use an alcohol screening interview and were told by the director of residency training or by the Vice-President for Nursing to administer it to all admitted patients. Data on interviewed patients were compared with medical record data on a randomly selected series of 80 patients who were not interviewed. SETTING: Teaching hospital in an urban/suburban community. PATIENTS/PARTICIPANTS: Residents on internal medicine and family practice services; surgical nurses. MEASUREMENTS AND MAIN RESULTS: Compliance with conducting the interview was low (14.7% of residents' admissions; 13.53% of nurses' admissions). Review of the medical records indicated that some alcohol-related information was recorded in most patients' medical records (physicians recorded information on 94% of patients on the teaching services, nurses on the surgical unit recorded alcohol-related information on 71% of patients). Surgeons and surgical residents recorded alcohol-related information on 30% of their patients. Residents were more likely to interview male than female patients, and residents and nurses tended to interview patients with higher GGTP values. CONCLUSIONS: (1) Compliance with administering a standardized alcohol screening interview was low. (2) Nurses, and residents in family practice and internal medicine made some assessment of drinking for most patients. Surgeons assessed drinking in a minority of patients. (3) Expressed reasons for not administering the standardized interview included discomfort with the interview, viewing the interview as too time-consuming, or not part of the usual responsibilities of the nurses or residents. Other possible reasons for the low levels of compliance are discussed.
Admitting Department, Hospital↗
Tobacco promotion and susceptibility to tobacco use among adolescents aged 12 through 17 years in a nationally representative sample.
OBJECTIVES: The purpose of this study was to examine whether youth participation in tobacco promotion campaigns is associated with susceptibility to tobacco use. METHODS: Data were collected from telephone interviews of a national random sample of 1047 adolescents 12 to 17 years of age. RESULTS: A proportional odds model was used to estimate the effects of age, gender, presence of a tobacco user in the household, awareness of tobacco promotions, knowledge of a young adult or adolescent friend owning a promotional item, participation in tobacco promotions, and receipt of free tobacco samples or direct mail from tobacco companies on susceptibility to tobacco use. All of the covariates, except for receiving direct mailings and knowing a young adult friend who owned a promotional item, were significantly associated with susceptibility. CONCLUSIONS: There is a strong association between an awareness of and involvement with tobacco promotions and being susceptible to tobacco use or a user of tobacco products.
Adolescent↗
Risk of developing multiple primary cutaneous melanomas in patients with the classic atypical-mole syndrome: a case-control study.
The classic atypical-mole syndrome (CAMS) and/or a history of malignant melanoma (MM) increases the risk for multiple melanomas. Case notes of 118 CAMS and 173 control patients, each with a history of MM, were reviewed for the occurrence of second primary MMs. The mean (+/-SD) age at diagnosis of the first MM was 38.8 +/- 12.8 and 48.9 +/- 14.7 years (P < 0.001) for CAMS cases and controls, respectively. Thirty-two of 118 CAMS and 18 of 173 controls developed second primary MMs, for a cumulative 10-year life-table risk of 35.5% and 17.0%, respectively (P < 0.0001). The mean number of months from the time of diagnosis of the first to the second MM was 33.9 +/- 41.8 and 58.6 +/- 57.3 months for the CAMS and controls, respectively (P = 0.08). In both cohorts the second MMs were significantly thinner, compared with the first MMs. The relative risk (RR) for developing second MMs for CAMS patients was 3.2. The RR for the CAMS cohort compared with a matched population from the United States Statistics, Epidemiology. End Results data base was 337, and for the controls, the RR was 84. All patients with MMs are at significant risk for developing multiple MMs: the risk is greater for patients with CAMS. Periodic total cutaneous examinations are indicated for life in an attempt to identify new MMs when they are thin.
Adult↗
Environmental tobacco smoke. The Brown and Williamson documents.
OBJECTIVE: To examine the tobacco industry's public and private responses to rising concern over the health effects of environmental tobacco smoke (ETS). DATA SOURCES: Documents from Brown and Williamson Tobacco Corporation (B&W), the British American Tobacco Company (BAT), and other tobacco interests provided by an anonymous source, obtained from Congress, and received from the private papers of a former BAT officer. STUDY SELECTION: All available materials, including confidential reports regarding research and internal memoranda exchanged between tobacco industry lawyers. CONCLUSIONS: Privately, B&W and BAT began conducting research related to ETS in the mid 1970s. BAT researchers appear to have determined that sidestream smoke produces irritation, that it contains toxic substances including N-nitrosamines, and that it is "biologically active" (eg, carcinogenic) in laboratory tests. During the 1980s, the primary purpose of BAT's research related to ETS was to develop a new cigarette that emitted less irritating and less biologically active sidestream smoke. Publicly, the tobacco industry has denied that exposure to ETS has been proven dangerous to health. It has criticized the methodology of published research on ETS, even when some of its own consultants have privately acknowledged that the research was valid. In addition, the industry has funded scientific research with the stated purpose of anticipating and refuting the evidence against ETS. The tobacco industry's strategy regarding passive smoking has been remarkably similar to its strategy regarding active smoking. It has privately conducted internal research, at least some of which has supported the conclusion that passive smoking is dangerous to health, while it has publicly denied that the hazards have been proven.
Humans↗
Looking through a keyhole at the tobacco industry. The Brown and Williamson documents.
OBJECTIVE: To introduce a series of papers discussing previously undocumented tobacco industry activities regarding strategies to avoid products liability litigation, understand nicotine addiction, and manipulate both internal and external scientific research on the effects of both active and passive smoking. DATA SOURCES: Documents from Brown and Williamson Tobacco Corporation (B&W), the British American Tobacco Company (BAT), and other tobacco interests provided by an anonymous source, obtained from Congress, and received from the private papers of a former BAT officer. STUDY SELECTION: All available materials, including confidential reports regarding research and internal memoranda exchanged between tobacco industry lawyers. CONCLUSIONS: These documents provide our first look at the inner workings of the tobacco industry during the crucial period in which the scientific case that smoking is addictive and kills smokers solidified. The documents show a sophisticated legal and public relations strategy to avoid liability for the diseases induced by tobacco use. The documents show that lawyers steered scientists away from particular research avenues, which is inconsistent with the company's purported disbelief in the causation and addiction claims; if the company had been genuinely unconvinced by the causation and addiction hypotheses, then it should have had no concern that new research would provide ammunition for the enemy. Quite the contrary, the documents show that B&W and BAT recognized more than 30 years ago that nicotine is addictive and that tobacco smoke is "biologically active" (eg, carcinogenic).
Humans↗
Nicotine and addiction. The Brown and Williamson documents.
OBJECTIVE: To learn how nicotine has been regarded by a major tobacco company. DATA SOURCES: Documents from Brown and Williamson Tobacco Corporation (B&W), the British American Tobacco Company (BAT), and other tobacco interests provided by an anonymous source, obtained from Congress, and received from the private papers of a former BAT officer. STUDY SELECTION: All available materials, including confidential reports regarding research and internal memoranda exchanged between tobacco industry lawyers. CONCLUSIONS: During a period of 22 years (1962 to 1984), employees of B&W and BAT conducted research and commented on the pharmacology of nicotine. They consistently regarded nicotine as the pharmacological agent that explained tobacco use. In the early part of the period under study, officials of the companies wrote about nicotine addiction explicitly. Inhalation of cigarette smoke by the consumer was recognized throughout the period as necessary for the normal function of a cigarette. The documents contain little indication that research was conducted on either the taste or the flavor of nicotine. The documents reveal an intention on the part of B&W and its corporate parent to affect the function of the body with nicotine.
Commerce↗
Lawyer control of internal scientific research to protect against products liability lawsuits. The Brown and Williamson documents.
OBJECTIVE: To understand how attorneys for the tobacco industry in general, and Brown and Williamson Tobacco Corporation (B&W) in particular, have responded to the threat of products liability litigation arising from smoking-induced diseases. DATA SOURCES: Documents from B&W, the British American Tobacco Company (BAT), and other tobacco interests provided by an anonymous source, obtained from Congress, or received from the private papers of a former BAT officer. STUDY SELECTION: All available materials, including confidential reports regarding research and internal memoranda exchanged between tobacco industry lawyers. CONCLUSIONS: The documents demonstrate that the tobacco industry in general, and B&W in particular, were very concerned about the threat of products liability lawsuits, and they illustrate some of the steps taken by lawyers at one company to avoid the discovery of documents that might be useful to a plaintiff in such a lawsuit. These steps included efforts to control the language of scientific discourse on issues related to smoking and health, to bring all potentially damaging internal scientific documents under attorney work product and attorney-client privilege to avoid discovery, to remove "deadwood" documents, and to insulate B&W from knowledge of potentially damaging scientific information from other BAT companies.
Consumer Product Safety↗
Lawyer control of the tobacco industry's external research program. The Brown and Williamson documents.
OBJECTIVE: To examine the involvement of tobacco industry lawyers in the selection of tobacco industry scientific research projects and to examine how the research was used to influence public policy. DATA SOURCES: Documents from Brown and Williamson Tobacco Corporation, the British American Tobacco Company (BAT), and other tobacco interests provided by an anonymous source, obtained from Congress, and received from the private papers of a former BAT officer. STUDY SELECTION: All available materials, including confidential reports regarding research and internal memoranda exchanged between tobacco industry lawyers. CONCLUSIONS: The involvement of tobacco industry lawyers in the selection of scientific projects to be funded is in sharp contrast to the industry's public statements about its review process for its external research program. Scientific merit played little role in the selection of external research projects. The results of the projects were used to generate good publicity for the industry, to deflect attention away from tobacco use as a health danger, and to attempt, sometimes surreptitiously, to influence policymakers.
Humans↗
Crocidolite asbestos fibers in smoke from original Kent cigarettes.
The original version of the Kent Micronite cigarette filter used crocidolite, a form of asbestos, from 1952 until at least mid-1956. Cigarettes from intact, unopened packs of the brand from this period were examined. One filter contained approximately 10 mg of crocidolite. Crocidolite structures were found in the mainstream smoke from the first two puffs of each cigarette smoked. At the observed rates of asbestos release, a person smoking a pack of these cigarettes each day would take in more than 131 million crocidolite structures longer than 5 microns in 1 year. These observations suggest that people who smoked the original version of this cigarette should be warned of their possible substantial exposure to crocidolite during the 1950s.
Asbestos, Crocidolite↗
Smoking, alcohol, and neuromuscular function in older women.
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Aged↗
Techniques of cutaneous examination for the detection of skin cancer.
Skin cancers are the most common cancers in humans. The American Cancer Society estimates that in the United States more than 700,000 new skin cancers are diagnosed annually. Although the majority of nonmelanoma skin cancers occur on visibly exposed anatomic areas, most malignant melanomas occur on body sites obscured by clothing. The high mortality associated with advanced melanomas emphasizes the importance of performing regular total cutaneous examinations in all patients to detect early, easily curable lesions. A number of techniques aid in these examinations: (1) physical and psychologic preparation of the patient; (2) appropriate lighting and a suitable examination table; (3) when indicated, use of Wood's light, dermoscopy, and photography. In addition, any suspicious lesion should be biopsied promptly either in parte or in toto. Lastly, the patient should be educated about the signs and symptoms of skin cancer, the role of sunlight in causing skin cancer, and the need for sun avoidance and/or protection. By heightening public awareness of the high incidence of cancers of the skin and by emphasizing the need for routine examination of the entire cutaneous surface, most cutaneous malignancies can be diagnosed early when they can be cured by simple surgical procedures.
Biopsy↗
Basal cell and squamous cell carcinomas are important risk factors for cutaneous malignant melanoma. Screening implications.
BACKGROUND: This study was designed to determine the risk of developing malignant melanoma (MM) in patients with a history of basal cell and/or squamous cell skin cancer (BCC/SCC) and to determine whether surveillance efforts can be directed toward these patients for the detection of early MMs. METHODS: The study cohort was followed by annual total cutaneous examination (TCE). Controls consisted of individuals from the United States population matched for age, sex, and length of follow-up. The anatomic locations of the study cohorts' newly diagnosed MMs were plotted on an anatomic chart. The setting was a private dermatology practice. Two hundred, ninety consecutive white patients with a history of BCC/SCC but with no personal or family history of MM were followed by annual TCEs. The main outcome measures were the relative risk of developing MM and their prognosis. RESULTS: Ten of the 290 patients developed an MM within an average of 109 months of follow-up (range, 3-17 years). All MMs were less than 0.70 mm in Breslow thickness and 80% occurred on usually clothed cutaneous sites. The expected number of MMs in the control population was 0.59 (P = 0.006), resulting in a relative risk of 17. CONCLUSION: Patients with BCC/SCC skin cancer are at substantial increased risk for developing MM. Regular and life-long surveillance TCE is an inexpensive and effective method for detecting curable MMs in such patients.
Adult↗
Risk of developing cutaneous malignant melanoma in atypical-mole syndrome: New York University experience and literature review.
The presence of atypical moles (AM) is considered to be a marker for an increased risk of developing cutaneous malignant melanoma (MM). The extent to which individuals with the atypical-mole syndrome (AMS) are at risk for developing MM is unknown. We present a review of the world literature and of our experience at New York University. We conclude that the presence of AMS in Caucasians significantly increases the risk of developing MM, regardless of geographic location. A further increase in MM risk is noted if there is a personal and/or family history of MM.
Case-Control Studies↗
Case-control study of melanocytic nevi on the buttocks in atypical mole syndrome: role of solar radiation in the pathogenesis of atypical moles.
BACKGROUND: It is not known why melanocytic nevi (MN) become dysmorphic (atypical) in patients with the atypical mole syndrome (AMS). A complex origin for acquired MN has been postulated. Genetic predisposition, solar radiation, and/or the formation of a sun-induced circulating mitogenic factor may contribute to the formation of MN. OBJECTIVE: This study was undertaken to help elucidate the pathogenesis of atypical MN in patients with AMS. METHODS: The number of common and atypical MN was determined for a defined sun-protected area on the buttocks in 150 patients with AMS (cases) and 150 control subjects without AMS. Patients and control subjects were matched for age and sex and were classified into risk groups for the development of malignant melanoma according to the Rigel classification. RESULTS: MN on the buttocks were found in 23% of patients with AMS and 9% of control subjects (p < 0.003). In patients versus control subjects the mean number (1.3 vs 1.2, respectively) and mean diameter (5.7 vs 5.9 mm, respectively) of MN on the buttocks did not differ significantly. The MN in both patients and control subjects were not atypical clinically. The odds ratio for having AMS if MN were present on the buttocks was calculated to be 1.56 (95% confidence interval, 1.25 to 1.95). CONCLUSION: Although the patients were 2.6 times more likely to have MN on their buttocks than the control subjects, clinically the MN did not differ significantly in number or appearance from those found on the buttocks of control subjects. It is hypothesized that the formation of some atypical MN requires direct solar radiation for their phenotypic expression.
Adult↗
Atypical mole syndrome: risk factor for cutaneous malignant melanoma and implications for management.
The incidence of malignant melanoma is increasing faster than that of any other cancer. It is important to identify subsets of the population at high risk of its development so that they can be observed more closely to identify early melanomas when they are curable. It has been reported worldwide that persons with the atypical mole (dysplastic nevus) syndrome are such a subset at increased risk. A risk gradient for the development of melanoma exists and varies from persons with one or two atypical moles and no family history of melanoma at one end of the spectrum to persons with the familial atypical multiple-mole melanoma syndrome at the other. Guidelines for the management of atypical mole syndrome are presented.
Dysplastic Nevus Syndrome↗
Management of cutaneous malignant melanoma by dermatologists of the American Academy of Dermatology. I. Survey of biopsy practices of pigmented lesions suspected as melanoma.
BACKGROUND: The incidence of malignant melanoma (MM) has rapidly increased during the past five decades. Relatively little information is available on whether the role of the dermatologist has increased concomitantly in the surgical management of this cancer. OBJECTIVE: Our purpose was to learn how members of the American Academy of Dermatology (AAD) treat patients with lesions highly suspected as being MM and how the management of these patients may have changed over the past decade. This, the first of a two-part series, concerns biopsies. METHODS: The data for the study were collected by means of a questionnaire that was sent to all members of the AAD practicing in the United States (N = 7412). RESULTS: A total of 2991 valid questionnaires were returned, a response rate of 40%. The majority of respondents (89% in 1982; 90% in 1992) stated that they performed the biopsies of pigmented lesions suspected of being MMs. Excisional biopsy was the preferred technique (58% in 1982; 68% in 1992). The type of biopsy and who performed the initial biopsy of a suspected MM were associated with the following factors: (1) the number of years in practice, (2) the type of practice, and (3) whether the dermatologist subsequently performed the definitive surgery for the MM. Regional variations in biopsy practices were also noted. CONCLUSION: Most AAD dermatologists who responded to the questionnaire perform the biopsies of lesions highly suspected of being MM. During the last decade an increasing proportion of dermatologists are performing excisional biopsies rather than other types of biopsies for such lesions.
Attitude of Health Personnel↗