PubMed Health⌕ Search

Biomedical subjects

M K Goldhaber

Publications and source records attributed to M K Goldhaber.

12 recordsLinked to original sources
PubMed1993

Long-term risk of hysterectomy among 80,007 sterilized and comparison women at Kaiser Permanente, 1971-1987.

To study the long-term risk of hysterectomy after tubal sterilization, the authors analyzed historical hospital discharge data on 39,502 parous women sterilized during 1971-1984 and 40,505 comparison women matched on age, race, parity, and interval since last birth. Sterilized women were significantly more likely than were comparison women to undergo hysterectomy (relative risk (RR) = 1.35, 95% confidence interval (CI) 1.26-1.44), especially for diagnoses of menstrual dysfunction and pelvic pain (RR = 1.88, 95% CI 1.65-2.13). Higher relative risks were not associated with greater tissue-destructive methods of tubal occlusion. Relative risks were highest for women who were young on the reference date (RR = 2.45, 95% CI 1.79-3.36 for women aged 20-24 years), but declined steadily as age increased (RR = 0.96, 95% CI 0.72-1.28 for women aged 40-49 years). In all age groups, relative risks were significantly above 1.00 after 7 years of follow-up. Reasons for elevated risks may be related to a greater willingness of sterilized women to forgo their uteruses. The emergence of greater risk in all age groups, however, prevents the authors from ruling out a possible latent biologic effect of tubal sterilization.

Adult↗
PubMed1991

The fetal life table revisited: spontaneous abortion rates in three Kaiser Permanente cohorts.

A cohort of 9,055 singleton pregnancies was identified by conventional urine tests or physician examination at the Kaiser Permanente Medical Care Program in Northern California in 1981-1982. Using life table methods, we estimated the cumulative risk of spontaneous abortion or fetal death through the end of pregnancy as 13.0% of all pregnancies surviving 1 week or more past the time of the first missed menses. This value was lower than the estimates of 15.1% and 16.0%, respectively, from two previous fetal life table studies conducted at Kaiser Permanente in prior decades, but similar to estimates from recent, smaller studies of early pregnancy diagnosed by human chorionic gonadotropin. The major difference in survival between the three Kaiser Permanente cohorts was in the earliest gestational week of observation, week 5 from the last menstrual period, where the older data were sparse and potentially biased. High loss rates during this week accounted for one-fourth to one-third of the cumulative risk observed in the older studies. Although the older cohorts were larger, the 1981-1982 cohort included five times and three times as many pregnancies under observation during week 5 from the last menstrual period, yielding more stable estimates for this period. Because of improved reliability of early pregnancy testing and an emphasis on early prenatal care, the mean gestational age at entry to the 1981-1982 cohort was 10.4 weeks from the last menstrual period compared to 14.3 weeks and 13.7 weeks for the older studies. All three studies showed a peak for risk of spontaneous abortion around weeks 10-12 from the last menstrual period.

Abortion, Spontaneous↗
PubMed1990

Exposure to barbiturates in utero and during childhood risk of intracranial and spinal cord tumors.

Barbiturate exposure during childhood was assessed from medical records of 237 children with intracranial and spinal cord tumors and 474 matched controls in a prepaid health plan. In utero exposure was also examined in a subset of 86 "cases" and 172 controls whose mothers were health plan members during pregnancy. No association of in utero exposure to barbiturates was found [odds ratio (O.R.) = 0.96, 95% confidence interval (C.I.) = 0.47, 1.94]. An association was noted for barbiturate use during childhood (O.R. = 1.80, 95% C.I. = 1.18, 2.74) but was reduced (O.R. = 1.41, 95% C.I. = 0.89, 2.21) when history of epilepsy was taken into account and was no longer significant. An apparent dose-response effect disappeared after adjustment for a history of epilepsy. Although barbiturate use for epilepsy due to preexisting brain tumors clearly explains some of the observed association, the small, residual risk prevents us from ruling out a possible carcinogenic effect of barbiturates. Further study of cohorts of adult as well as childhood users of barbiturates and other anticonvulsants is recommended.

Adolescent↗
PubMed1989

Fetal death ratios in a prospective study compared to state fetal death certificate reporting.

A cohort of 6,254 pregnancies surviving at least 20 weeks of gestation was identified through pregnancy testing and follow-up at three Kaiser Permanente medical offices in northern California in 1981-82. Fetal death ratios per 1,000 live births were 12.1 for all fetal deaths versus 5.0 for the subset of fetal deaths reported to the California state registrar. Only fetal deaths resulting in overnight hospitalization of the mother were reported. Seventy-nine percent of fetal deaths over 28 completed weeks since the last menstrual period (LMP) were reported versus only 10 percent between 20 and 28 completed weeks since the LMP. Ninety-three percent of fetuses over 400 grams were reported. The unreported fetal deaths were mainly those perceived by attending physicians as spontaneous abortion, especially missed or incomplete spontaneous abortion. Physicians apparently preferred the label of spontaneous abortion over stillbirth or fetal death whenever fetal maturity could not be substantiated, regardless of prior estimates of the date of the LMP. Fetuses as large and developed as potentially viable infants were the most likely to be reported.

California↗
PubMed1989

Caffeinated beverages and low birthweight: a case-control study.

A case-control study, examining the effect of first trimester maternal caffeine consumption on low birthweight, was performed in the Kaiser Permanent Medical Care Program. Heavy consumption (greater than 3 servings/day) of coffee, cola and greater than 300 mg/day of caffeine from all sources (coffee, tea and cola) was associated with a marginally increased risk of low birthweight. Our data support previous findings of a modest effect of caffeine consumption on fetal growth.

Adult↗
PubMed1988

The risk of miscarriage and birth defects among women who use visual display terminals during pregnancy.

Use of visual display terminals (VDTs) was examined in a case-control study of pregnancy outcome among 1,583 pregnant women who attended three Kaiser Permanente obstetrics and gynecology clinics in Northern California, 1981-1982. We found a significantly elevated risk of miscarriage for working women who reported using VDTs for more than 20 hr per week during the first trimester of pregnancy compared to other working women who reported not using VDTs (odds ratio 1.8, 95% CI: 1.2-2.8). This risk could not be explained by age, education, occupation, smoking, alcohol consumption, or other maternal characteristics. No significantly elevated risk for birth defects was found among working women although odds ratios were 1.4 for both moderate and high VDT exposure, compared with no exposure (95% CI: 0.7-2.7 and 0.7-2.9, respectively). One possible explanation for these findings is that women who had adverse pregnancy outcomes may have overreported their exposures to VDTs and/or women with normal births may have underreported theirs. The findings may also be due to unmeasured factors confounded with high VDT use such as poor ergonomic conditions or job-related stress. That VDTs themselves are hazardous to the pregnant operator remains a possibility. Our results underscore the need for large cohort studies of working women that will provide objective measures of VDT exposures, ergonomic factors, and stress.

Abortion, Spontaneous↗
PubMed1987

Cholecystectomy and large bowel cancer.

The records of 5898 patients with colorectal cancer and 27,687 controls were examined for previous cholecystectomy. The estimated relative risks (and 95% confidence intervals) of development of any cancer of the large bowel and cancer of the right colon after cholecystectomy were 1.0 (0.8-1.2) and 1.1 (0.8-1.5) in women and 1.1 (0.9-1.5) and 1.2 (0.8-1.9) in men, respectively. Although these data do not rule out a small increase in risk, it is proposed that the association found in some other studies is, at least in part, an artifact. Intense diagnostic effort and treatment aimed at mild abdominal symptoms, encouraged by some patients and some medical care settings, could increase the detection and removal of gallstones and the early detection of colorectal cancer.

Adult↗
PubMed1983

Spontaneous abortions after the Three Mile Island nuclear accident: a life table analysis.

A study was conducted to determine whether the incidence of spontaneous abortion was greater than expected near the Three Mile Island (TMI) nuclear power plant during the months following the March 28, 1979 accident. All persons living within five miles of TMI were registered shortly after the accident, and information on pregnancy at the time of the accident was collected. After one year, all pregnancy cases were followed up and outcomes ascertained. Using the life table method, it was found that, given pregnancies after four completed weeks of gestation counting from the first day of the last menstrual period, the estimated incidence of spontaneous abortion (miscarriage before completion of 16 weeks of gestation) was 15.1 per cent for women pregnant at the time of the TMI accident. Combining spontaneous abortions and stillbirths (delivery of a dead fetus after 16 weeks of gestation), the estimated incidence was 16.1 per cent for pregnancies after four completed weeks of gestation. Both incidences are comparable to baseline studies of fetal loss.

Abortion, Spontaneous↗
PubMedDate not supplied

The Three Mile Island Population Registry.

Shortly after the March 28, 1979, accident at the Three Mile Island (TMI) nuclear plant outside Harrisburg, Pa., the Pennsylvania Department of Health, in conjunction with the Centers for Disease Control and the U.S. Bureau of the Census, conducted a census of the 35,930 persons residing within 5 miles of the plant. With the help of 150 enumerators, demographic and health-related information was collected on each person to provide baseline data for future short- and long-term epidemiologic studies of the effects of the accident. Individual radiation doses were estimated on the basis of residential location and the amount of time each person spent in the 5-mile area during the 10 days after the accident. Health and behavioral resurveys of the population will be conducted approximately every 5 years. Population-mobility, morbidity, and mortality will be studied yearly by matching the TMI Population Registry with postal records, cancer registry records, and death certificate data. Because the radiation dose from TMI was extremely small, any increase in morbidity or mortality attributable to the accident would be so small as not to be measurable by present methods; however, adverse health effects as a result of psychological stress may occur. Also, a temporary increase in reporting of disease could occur because of increased surveillance and attention to health.

Accidents↗