Employment policy. Financial support versus promoting economic independence.
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Cost-Benefit Analysis↗
Biomedical subjects
R C Baron
Publications and source records attributed to R C Baron.
Contribution of different HFE genotypes to iron overload disease: a pooled analysis.
PURPOSE: To determine the contribution of the C282Y and H63D mutations in the HFE gene to clinical expression of hereditary hemochromatosis. METHODS: Pooled analysis of 14 case-control studies reporting HFE genotype data, to evaluate the association of different HFE genotypes with iron overload. In addition, we used data from the pooled analysis and published data to estimate the penetrance of the C282Y/C282Y genotype. RESULTS: Homozygosity for the C282Y mutation carried the largest risk for iron overload (OR = 4383, 95% CI 1374 to >10,000) and accounted for the majority of hemochromatosis cases (attributable fraction (AF) = 0.73). Risks for other genotypes were much smaller: OR = 32 for genotype C282Y/H63D (95% CI 18.5 to 55.4, AF = 0.06); OR = 5.7 for H63D/H63D (95% CI 3.2 to 10.1, AF = 0.01); OR = 4.1 for C282Y heterozygosity (95% CI 2.9 to 5.8, with heterogeneity in study results, making this association uncertain); and OR = 1.6 for H63D heterozygosity (95% CI 1 to 2.6, AF = 0.03). Estimates of penetrance for the C282Y/C282Y genotype were highly sensitive to estimates of the prevalence of iron overload disease. At a prevalence of 2.5 per 1000 or less, penetrance of the C282Y/C282Y genotype is unlikely to exceed 50%. Penetrance of other HFE genotypes is much lower. CONCLUSIONS: C282Y homozygosity confers the highest risk for iron overload but the H63D mutation is also associated with increased risk. Our data indicate a gradient of risk associated with different HFE genotypes and thus suggest the presence of other modifiers, either genetic or environmental, that contribute to the clinical expression of hemochromatosis.
Amino Acid Substitution↗
Female employee participation in a worksite mammography screening program.
We conducted a survey of 1,184 women 35 years of age or older who were employees of a company in Los Angeles County, California, to determine why some women participated in a worksite mammography screening program whereas others did not. Of the 111 who accepted a mammogram, 90 responded to the survey; of the 1,073 who declined mammography, 620 responded. The women were predominantly white, were well educated, and had health insurance. Of the 111 women who received mammograms, one was diagnosed with carcinoma. Seventy-three percent of the respondents to the survey 40 years of age or older who declined mammograms had already fulfilled American Cancer Society (ACS) guidelines for mammography screening at the time of the program. Women who accepted a mammogram were more likely to have had at least one previous mammogram than were women who had not met ACS guidelines yet who declined screening. We conclude that many female employees who are white, are well educated, and have health insurance may not participate in a worksite mammography screening program because they have been screened elsewhere. Companies providing worksite mammography screening should target education to women who have not met ACS guidelines, especially those who have never had a mammogram.
Adult↗
Assessing trends in mortality in 121 U.S. cities, 1970-79, from all causes and from pneumonia and influenza.
The Centers for Disease Control receives weekly reports of mortality due to all causes and to pneumonia and influenza from 121 cities and counties in the United States. To assess the epidemiologic applicability of these data, the trends of death rates based on data compiled by the Centers for Disease Control's mortality reporting system (CDC-MRS) from 1970 through 1979 were compared with trends derived from national mortality statistics compiled by the National Center for Health Statistics (NCHS). In general, CDC-MRS trends in death rates from all causes and from pneumonia and influenza followed patterns similar to those shown by mortality statistics for the entire nation. CDC-MRS data were particularly sensitive to annual fluctuations in the nationwide rate of death from pneumonia and influenza among the elderly population. However, because of higher death rates among residents of the CDC-MRS reporting areas, in addition to other ascertainment biases, CDC-MRS death rates--from all causes and from pneumonia and influenza--consistently exceeded NCHS rates for the nation. Moreover, for each age group, trends based on CDC-MRS reflected an underestimate of the rate of decline in mortality observed over time according to NCHS data. It is concluded that despite its limitations, the CDC-MRS provides mortality data that are both timely and useful for epidemiologic purposes.
Age Factors↗
A description of nonfatal spinal cord injury using a hospital-based registry.
To formulate an epidemiologic description of West Virginia spinal cord injury (SCI) resulting in hospitalization, we used data collected during the West Virginia Spinal Cord Injury Registry's first three years of operation, July 1985 through June 1988, supplemented by data from registries in neighboring states. The West Virginia registry was established to detect newly injured persons potentially in need of rehabilitation services. Because reporting is hospital based, the registry records only injured patients surviving until hospitalization. The overall incidence of hospitalized SCI patients was 25 per million per year; the sex-specific rate among men was 4.6 times the rate among women. Age-specific rates peaked in the 15-24 years age group and declined with increasing age. Motor vehicle crashes accounted for 69% of all hospitalized SCI; falls, for 21%; and sports, falling objects, and violence, for less than 10% each. Most cause-specific incidence rates were highest for young males; however, falls were more common for the elderly. At least 25% of victims used drugs or alcohol shortly before injury, and none injured in auto or truck crashes reported wearing seat belts. Quadriplegia resulted for 56% of recorded SCI patients, whereas paraplegia resulted for the remaining 44%. SCI was more common in the summer months, on weekends, and during late afternoon hours. Both neurologic deficit and time of occurrence varied by cause. Although limitations exist, registry data has proved useful in describing spinal cord injury in West Virginia and has potential public health use in guiding prevention programs.
Accidents↗