Biomedical subjects

L A Webster

Publications and source records attributed to L A Webster.

At least 19 recordsLinked to original sources

PubMed1993

Surveillance for geographic and secular trends in congenital syphilis--United States, 1983-1991.

PROBLEM/CONDITION: CDC monitors trends in the occurrence of congenital syphilis (CS) in the United States by using surveillance data sent from state and local health departments. Comparisons of data from this surveillance system with data from the Division of Sexually Transmitted Diseases/HIV Prevention and the Birth Defects Monitoring Program (BDMP) can be used to assess the potential effects of changes in case finding and reporting practices on these trends. REPORTING PERIOD COVERED: This report covers CS surveillance in the United States for the years 1983-1991. DESCRIPTION OF SYSTEM: Cases of CS among infants < 1 year of age and primary and secondary (P&S) syphilis among women are reported quarterly to CDC. The BDMP is a CDC national surveillance system that samples hospital discharge data on U.S. births. RESULTS: During the period 1983-1991, 12,151 CS cases were reported. Before 1988, regional CS incidence increased 35%-131% annually. Larger increases occurred in the Northeast (578%) in 1989 and in the South (178%), Midwest (244%), and West (777%) in 1990. Within regions, these larger increases were temporally related to increases in P&S syphilis in women and changes to a more sensitive CS case definition. INTERPRETATION: CS incidence has increased since 1983 in all regions of the United States. Increases since 1988 reflect both changes in surveillance reporting practices--the surveillance case definition for CS was changed in 1988 and further revised in 1989--and a true increase in incidence. ACTIONS TAKEN: These data indicate where CS prevention efforts need to be targeted. To facilitate reporting of CS cases, CDC has developed a) a shorter form for reporting cases of CS after 1991 and b) a software package for use by state and local health departments to enter and analyze CS data.

Adult↗

PubMed1993

Surveillance for primary and secondary syphilis--United States, 1991.

PROBLEM/CONDITION: From 1986 through 1990, an epidemic of syphilis occurred throughout the United States. In 1991, the number of reported cases of primary and secondary (P&S) syphilis in the United States declined for the first time since 1985. REPORTING PERIOD COVERED: To examine how this decline reflected sex-specific, race/ethnicity-specific, and regional patterns of syphilis morbidity, we analyzed data for syphilis cases reported to CDC from 1984 through 1991. DESCRIPTION OF SYSTEM: Summary data for cases of syphilis reported to state health departments were sent quarterly and annually to CDC. The quarterly data from each state included total number of syphilis cases by sex, stage of disease (primary, secondary, early latent, and late latent), and source of report (public or private). The annual data from each state included total number of P&S syphilis cases by sex, racial/ethnic group (white, not of Hispanic origin; black, not of Hispanic origin; Hispanic; Asian/Pacific Islander; or American Indian/Alaskan Native), 5-year age group, and source of report. RESULTS: The decline in both the number and rate of reported syphilis cases in 1991 occurred in every racial group in the United States and in both sexes. This decline also occurred in every region of the United States except the Midwest, where the total P&S syphilis rate increased 37.3% from 1990 through 1991. Despite the increase in syphilis rates in the Midwest, the highest rates of P&S syphilis in 1991 were reported from the South. INTERPRETATION: The reasons for the decline in syphilis are unclear. No data exist to conclusively identify which STD control program activities affected the level of syphilis morbidity or to what extent those activities may have contributed to the decline. Changes in drug use and limited immunity to Treponema pallidum may have accounted for some of the decrease in syphilis incidence. Higher levels of poverty in the South and poor access to health-care services associated with poverty probably contributed to continued high levels of disease transmission in the South. ACTIONS TAKEN: Better evaluation of STD control program activities will be necessary to help determine the most effective strategies for preventing and controlling syphilis in different high-risk populations.

Female↗

PubMed1993

An evaluation of surveillance for Chlamydia trachomatis infections in the United States, 1987-1991.

PROBLEM/CONDITION: Chlamydia is the most common sexually transmitted bacterial pathogen in the United States; however, no precise data on the prevalence and incidence of chlamydia infection are available because currently no comprehensive national surveillance system exists for chlamydia. Despite the absence of such a system, states do report numbers of male and female chlamydia cases to CDC on a quarterly basis. REPORTING PERIOD COVERED: This report summarizes and reviews the chlamydia surveillance data received by CDC from 1987 through 1991. DESCRIPTION OF SYSTEM: Summary data on cases of chlamydia reported to state health departments were sent quarterly to CDC in Atlanta, Georgia. The quarterly data from each state included total number of chlamydia cases by sex and by source of report (public, private). RESULTS: From 1987 through 1991, the number of states with legislation mandating reporting of chlamydia increased twofold. The reported chlamydia rate from those states also doubled during the same time period, from 91.4 cases per 100,000 population in 1987 to 197.5 cases per 100,000 population in 1991. INTERPRETATION: This twofold increase in the rate of chlamydia reported to CDC did not represent a doubling in chlamydia prevalence or incidence during this time period. Instead, the increase resulted from the increase in the number of states with reporting laws and from the initial attempts of those states to identify and report diagnosed chlamydia infections. ACTIONS TAKEN: More accurate measures of the number of chlamydia infections and of trends in the chlamydia infection rate are needed to justify, develop, and evaluate public health programs to control chlamydia infections. An outline of possible surveillance activities for local communities is presented.

Chlamydia Infections↗

PubMed1993

Surveillance for gonorrhea and primary and secondary syphilis among adolescents, United States--1981-1991.

PROBLEM/CONDITION: During the 1980s, an increasing proportion of adolescent women reported having had premarital sexual intercourse, thus potentially placing an increasing number of young persons at higher risk of acquiring a sexually transmitted infection. REPORTING PERIOD COVERED: To determine rates and examine trends of sexually transmitted infections among adolescents, we analyzed data for reported cases of gonorrhea and primary and secondary syphilis among 10- to 19-year-olds for 1981 through 1991. DESCRIPTION OF SYSTEM: Summary data for cases of gonorrhea and primary and secondary syphilis that were identified and reported to state health departments were sent annually to CDC. These data included total number of cases by disease (gonorrhea, primary and secondary syphilis), sex, racial/ethnic group (white, not of Hispanic origin; black, not of Hispanic origin; Hispanic; Asian/Pacific Islander; or American Indian/Alaskan Native), 5-year age group, and source of report (public, private). RESULTS: From 1981 through 1991, 24%-30% of the reported morbidity from gonorrhea and 10%-12% of the reported morbidity from primary and secondary syphilis in the United States affected the adolescent age groups. Some of the highest rates of gonorrhea during that time period were among 15- to 19-year-olds. Gonorrhea rates among adolescents increased or remained unchanged from 1981 through 1991, while the rates among older age groups decreased. Although primary and secondary syphilis rates were lower among adolescents than older age groups, adolescents contributed to the epidemic of syphilis that occurred from 1987 through 1990. Differences in reported rates of both syphilis and gonorrhea among white, black, and Hispanic adolescents increased during the latter half of the 1980s. INTERPRETATION: Reporting biases could account for some the differences among rates for white, black, and Hispanic adolescents. However, if gonorrhea has been underreported for any racial group, the high rates of gonorrhea among 15- to 19-year-olds represented an underestimate of the true infection rate. Increases in sexual activity among adolescents and a lack of clinical services in settings convenient to adolescents could have contributed to the increasing rates of gonorrhea and syphilis among these young persons during this time period. ACTIONS TAKEN: If gonorrhea and other sexually transmitted infections are cofactors for facilitating the transmission of human immunodeficiency virus (HIV), the high incidence of gonorrhea in some locales among some populations of adolescents could result in dramatic increases in HIV acquisition, a situation that demands attention from public health organizations.

Adolescent↗

PubMed1992

Prevalence and determinants of caesarean section in Jamaica.

The prevalence and determinants of primary caesarean section in Jamaica were estimated from a survey of women aged 14-49 years. Among 2328 women reporting 2395 live hospital births during the period January 1984 to May 1989, the prevalence of caesarean section was 4.1%. Repeat caesarean sections accounted for 1.3% of the hospital births during that period. Of the medical complications studied, prolonged labour and/or cephalopelvic disproportion carried the highest risks of primary caesarean section, followed by breech presentation, maternal diabetes, a high birth-weight baby, maternal hypertension, and a low birth-weight baby. The risk of primary caesarean section increased with maternal age, decreased with parity, was higher for urban than for rural residents, and was higher for births in private versus government hospitals.

Adolescent↗

PubMed1991

Regional and temporal trends in the surveillance of syphilis, United States, 1986-1990.

During the latter half of the 1980s, an epidemic of syphilis occurred throughout the United States. A comparison of regional rates of primary and secondary syphilis in 1990 indicated that the rates were highest in the South, followed by the Northeast, the West, and the Midwest. Primary and secondary syphilis rates from 1986 through 1990 exhibited different regional patterns. Rates of primary and secondary syphilis in the West peaked in 1987 and declined from 1987 to 1990. Rates increased in the Northeast and the South from 1986 to 1990, but the increase reached a plateau in the Northeast in 1990. Rates did not begin to increase in the Midwest until 1988. More detailed analyses of the syphilis epidemics in specific communities in each region are needed to better understand the regional patterns. A comparison of these findings across regions could be helpful in evaluating which sexually transmitted disease intervention and control programs are most effective during epidemic periods.

Female↗

PubMed1989

The independent associations of parity, age at first full term pregnancy, and duration of breastfeeding with the risk of breast cancer. Cancer and Steroid Hormone Study Group.

Although the important influence of a woman's reproductive history on her risk of breast cancer is widely recognized, it is not clear whether this is wholly accounted for by the age at her first full-term pregnancy, or whether there are additional, independent influences of breastfeeding or number of children. To examine the respective contributions to the risk of breast cancer of these reproductive factors, we used logistic regression methods to analyze data from a multicenter case-control study, the Cancer and Steroid Hormone Study. Included in the analysis were 4599 women, 20-55 years of age, identified as having an initial diagnosis of breast cancer by one of eight collaborating population-based cancer registries. The 4536 controls were women of similar ages selected by random dialing of households with telephones in the same eight areas. As expected, age at first full-term pregnancy exerted a strong influence on the risk of breast cancer. However, after it and other potentially confounding factors had been controlled for, parity and duration of breastfeeding also had a strong influence on the risk of breast cancer. Compared with women of parity one, women of parity seven or greater had an adjusted relative risk of breast cancer of 0.59 (95% CL, 0.44-0.79). Compared with parous women who never breastfed, women who had breastfed for 25 months or more had an adjusted relative risk of 0.67 (0.52-0.85). These results do not support the supposed preeminent importance of age at first full-term pregnancy among the reproductive determinants of breast carcinogenesis. Resolution of this issue may have important implications for elucidating hormonal influences on breast cancer and for projecting future trends in the disease.

Adult↗

PubMed1989

Alcoholic beverage consumption and the risk of endometrial cancer. Cancer and Steroid Hormone Study Group.

Previous studies have suggested that alcoholic beverage consumption may lead to a decrease in a woman's oestrogen levels. It is possible that any such alcohol-associated decrease could lead to a decrease in endometrial cancer risk. To study the association between alcohol consumption and endometrial cancer, we examined data from the Cancer and Steroid Hormone Study, a multi-centre, population based, case-control study. A total of 351 women with primary epithelial endometrial cancer and 2247 women selected from the same geographical areas as the cases were interviewed for the study. As part of the interview, the participants provided information regarding their alcohol consumption during the preceding five years. Analysis of these data revealed that women who were non-drinkers had a risk of endometrial cancer of 1.83 relative to the risk of women who had consumed an average of 150 grams or more of alcohol per week (95% Cl, 1.11, 3.01). Women who drank, but who consumed less than 150 grams of alcohol per week, were at an intermediate risk. The increased risk associated with abstinence from alcohol consumption was particularly great in overweight women and was virtually absent in lean women. These results argue that alcohol ingestion may reduce a woman's risk of endometrial cancer, particularly if she is overweight.

Adult↗

PubMed1989

Alcohol consumption and the risk of breast cancer.

To examine the relation between alcohol consumption and breast cancer, the authors used data from the Centers for Disease Control's Cancer and Steroid Hormone Study, a multicenter population-based case-control study. Between August 1981 and December 1982, 3,498 US women aged 20-54 years with newly diagnosed breast cancer and 3,157 women aged 20-54 years selected at random from the same geographic areas were asked about their consumption of alcoholic beverages during the previous five years. Women who drank any alcohol had a risk of breast cancer of 1.0 (95% confidence interval 0.9-1.2) compared with nondrinkers. The risk of breast cancer did not increase appreciably with increasing alcohol consumption: Risk estimates for women consuming 8-14, 15-21, and 22 or more drinks per week were 1.1, 1.0, and 1.2, respectively. The authors also found no notable differences by type of beverage or within specific risk factor subgroups. These findings do not support the hypothesis that alcohol consumption increases the risk of breast cancer.

Adult↗

PubMed1986

Alcohol consumption and ovarian cancer risk.

To study the influence of alcohol consumption on the risk of ovarian cancer in women under age 55, the authors examined data collected in a multicenter, population-based case-control study--the Centers for Disease Control's Cancer and Steroid Hormone Study. Between August 1981 and December 1982, 433 women 20-54 years of age with newly diagnosed ovarian cancer and 2,915 women 20-54 years of age selected at random from the same geographic areas were asked about their consumption of alcoholic beverages during the previous five years. Women who drank any alcohol during the five-year period had a risk of ovarian cancer of 0.9 (95% confidence interval (CI) = 0.7-1.2) compared with nondrinkers. Risk was not associated with the type of alcoholic beverage consumed, nor were the results affected by controlling for demographic characteristics and oral contraceptive use. Although there was no association between moderate alcohol consumption and ovarian cancer, women who drank more than about 20 drinks per week had a relative risk of ovarian cancer of 0.5 (95% CI = 0.2-0.9) compared with women who did not drink.

Adult↗

PubMed1985

Oral contraceptives and breast cancer in young women.

The relation between use of oral contraceptives (OCs) by young women and their risk of breast cancer before 45 years of age was investigated by analysis of data from a population-based, case-control study conducted in eight geographic regions of the United States. 2088 women with breast cancer diagnosed between Dec 1, 1980, and Dec 31, 1982, were compared with 2065 controls selected during the same period. There was no significant increase or decrease in the risk of breast cancer for OC users according to age at first use or subsequent duration of use, even for women who first used OCs before the age of 20 years and who continued to use them for more than 4 years. Risk was not altered significantly for women who used OCs with high progestagen "potency" before the age of 25 years (even when duration of use exceeded 6 years), for those who used OCs before first-term pregnancy (even when duration of use exceeded 4 years), or for OC users according to age at diagnosis. These results suggest that use of OCs by young women in the United States has no effect on the aggregate risk of breast cancer before 45 years of age.

Adult↗

PubMed1985

Family history and the risk of breast cancer.

To investigate whether a family history of breast cancer increases a woman's risk of developing breast cancer, we analyzed data from the Centers for Disease Control's Cancer and Steroid Hormone Study. The 4,735 cases were women 20 to 54 years old with a first diagnosis of breast cancer ascertained from eight population-based cancer registries; the 4,688 controls were women selected at random from the general population of these eight areas. Compared with women without a family history of breast cancer, women who had an affected first-degree relative had a relative risk of 2.3; women with an affected second-degree relative had a relative risk of 1.5; and women with both an affected mother and sister had a relative risk of 14. The risk of breast cancer for a woman was higher if her first-degree relative had unilateral rather than bilateral breast cancer or had breast cancer detected at a younger rather than older age. For women aged 20 to 39, 40 to 44, and 45 to 54 years, the estimated annual incidence of breast cancer per 100,000 women attributable to a first-degree family history of breast cancer was 51.9, 115.1, and 138.6, respectively, and that attributable to a second-degree family history of breast cancer was 12.1, 19.2, and 92.4, respectively.

Adult↗

PubMed1985

Endometrial cancer: how does cigarette smoking influence the risk of women under age 55 years having this tumor?

This analysis of the Cancer and Steroid Hormone Study, a multicenter, population-based case control investigation of hormone use by women of reproductive age and endometrial, breast, and ovarian cancer shows that cigarette smoking is not associated with either an increased or a decreased risk of endometrial cancer. This study included 437 women with endometrial cancer and 3200 control subjects, all of whom were between the ages of 20 and 54 years at the time of interview. The absence of any alteration of the risk of endometrial cancer and smoking was found consistently no matter which variable was used as a measure of smoking--ever or never smoked cigarettes, former or current smoking, light or heavy smoking, or age smoking began.

Adult↗

PubMed1983

Alcohol consumption and risk of breast cancer.

To investigate whether women who consume alcoholic beverages have a greater risk of breast cancer than women who never drink data from a population-based, case-control study, the Centers for Disease Control's Cancer and Steroid Hormone Study, were examined. During the first 15 months of data collection, 1226 women aged 20--54 with newly diagnosed breast cancer and 1279 women of the same age randomly selected from the general population were interviewed. Women who consumed alcoholic beverages had no greater risk of breast cancer than non-drinkers (relative risk 1.0, 95% confidence interval 0.8--1.2). Breast-cancer risk was not associated with the average amount of alcohol consumed per week nor with the type of alcoholic beverage consumed. Compared with non-drinkers, the relative risks of breast cancer for women who ever drank beer, wine, or spirits were 1.0, 0.8, and 0.9, respectively.

Adult↗

PubMed1974