Aplastic anemia and occupational pesticide exposure: a case-control study.
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Adolescent↗
Biomedical subjects
S Grufferman
Publications and source records attributed to S Grufferman.
Epidemiologic approaches to the study of cancer.
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Epidemiologic Methods↗
Familial carotid body tumors: case report and epidemiologic review.
We report on the cases of two sisters with carotid body tumor (CBT) and present a literature review that assembles epidemiologic information on 88 familial and 835 nonfamilial CBT patients. The sex ratio (males/females) of 1.0 for familial CBT (0.7 for nonfamilial) and CBT reports with complete sibship information suggest autosomal dominant genetic transmission. As in other familial cancers, bilateral disease is significantly more frequent in familial (31.8% of cases) than in nonfamilial CBT (4.4%). However, there is no difference in age at diagnosis between familial and nonfamilial CBR. Thus, this adult-onset familial cancer does not completely fit the Knudson "two-step mutation" model of carcinogenesis. We also found that 6% of reported CBT patients developed second primary tumors, mostly other paragangliomas. This feature suggests that CBT may be part of a larger neurocristopathy syndrome of multiple tumors of cells of neural crest origin.
Adult↗
Ventricular premature beats and coronary risk factors.
Of 10,119 men aged 35 to 57 years studied in the Multiple Risk Factor Intervention Trial (MRFIT), ventricular premature beats (VPBs) were more frequent among the 112 men who reported having previously had a myocardial infarction (MI) (22.3%) as well as among the 143 men with a history of diabetes mellitus (13.3%) than among the remaining 9864 (7.6%). There was no demonstrable association between VPBs and cholesterol or blood pressure levels, either overall or in various age groups. There was, however, a strongly positive relationship between VPBs and age (p less than 0.001). A positive association between VPBs and smoking was present which was statistically significant overall (risk ratio = 1.21, 95% confidence limits from 1.03 to 1.43), as well as in the age groups 35 to 39 years (1.74, 1.13 to 2.68) and 55 to 57 years (1.50, 1.01 to 2.22). This association, if confirmed, raises the question of whether VPBs offer a mechanism for the increased morbidity and mortality from coronary heart diseases among cigarette smokers compared with nonsmokers.
Adult↗
Evidence against transmission of Hodgkin's disease in high schools.
A survey in Greater Boston identified 1577 new cases of histologically diagnosed Hodgkin's disease between 1959 and 1973. Of these cases, 448 were of ages such that the patients might have attended high school during 1960-73. For 96 per cent of these persons high-school attendance was ascertained. First of all, we studied Hodgkin's disease at high schools in two time periods. The 13 high schools with cases present in 1960-64 were matched with 26 schools that had no cases in this period, and we compared these two groups for the occurrence of Hodgkin's disease during 1965-69. The proportion of "exposed" high schools that had cases diagnosed in the second period was 0.62, and that for the matched high schools was 0.65. We performed this two-time-period analysis for 25 additional combinations of time periods; in none of them did we find a statistically significant positive result. Secondly, we studied the risk of Hodgkin's disease among persons who had attended high school at the same time as a diagnosed case. We followed these "exposed" persons through 1973 and observed 12 cases among them, whereas the expected number of cases was 13.9. Thirdly, we evaluated the extent to which members of all possible pairs of cases had attended the same or nearby high schools at the same time. We found no excess of classmate pairs than might have occurred by chance alone. These data suggest that there is no transmission of an etiologic agent for Hodgkin's disease at high schools.
Adult↗
Mammographic patterns and risk of breast cancer.
A study of 171 breast cancer cases matched by age and race to asymptomatic controls was undertaken to check Wolfe's assertion [1, 2] that breast cancer risk depends strongly on the mammographic classifications N1, P1, P2, and DY. The classifications were made blindly relative to all variables, including the case-control factor. Distribution of the four categories among the breast cancer patients in this study was consistent with the distribution found by Wolfe. (P = .46). Our age-standardized risk ratio estimates of the categories, relative to N1, are 1.5 for P1, 2.7 for P2, and 7.2 for DY. While not as striking as Wolfe's estimates, the same monotone trend is evident, and the cases and controls differ significantly with respect to the distributions of the four categories (P less than .01).
Adult↗
Hodgkin's disease in siblings.
An incidence survey of Hodgkin's disease in Greater Boston during 1959-1973 detected five sibling pairs under the age of 45. The expected number is 0.7; thus, siblings of young adults with Hodgkin's disease have about a sevenfold excess risk of the disease (P = 0.0008). Eight sibling pairs, not in the incidence series, were also identified. Among all 13 pairs, 12 were sex concordant; the number expected is 6.8 (P = 0.01). The literature includes 46 sibling pairs under 45 of which 30 are sex concordant. The expected number is 23.9 (P = 0.05). Combining the present and the literature series suggests that siblings of the same sex as an affected person have a risk of Hodgkin's disease double that of siblings of the opposite sex. The sex concordance suggests that the excess Hodgkin's disease among siblings of affected persons is due either to inter-personal transmission of an etiologic agent by prolonged or intimate contact or to common-source exposures.
Adult↗
Clustering and aggregation of exposures in Hodgkin's disease.
The epidemiologic evidence regarding case clustering and aggregation of etiologic exposures among patients with Hodgkin's disease (HD) is reviewed. In contrast to the literature on leukemia, there are few reported HD clusters. Statistical studies searching for time-space clustering in HD have been negative or inconclusive. The innovative Long Island school study of Vianna and Polan suggests that there is aggregation of etiologic exposures in HD. However, this study has been criticized and further confirmation is required. Additional support for the aggregation of exposures hypothesis is found in studies of familial aggregation of HD. On the other hand, teachers and physicians, groups suggested as having high exposure to HD patients, have been shown to be at no increased risk for HD. Available evidence would suggest that if HD is communicable, it is probably so only prior to manifestation of the disease and exposure must occur in childhood or adolescence. Although most studies have focused on the compatibility of their findings with interpersonal transmission of an etiologic agent, these data are equally compatible with an hypothesis of common source exposure to non-infectious etiologic agents.
Adolescent↗
Occupation and Hodgkin's disease.
An incidence survey of Hodgkin's disease (HD) was conducted in the Boston Standard Metropolitan Statistical Area for 1959-73. Information on affected persons, 20 to 64 years old, was related to the 1960 and 1970 U.S. decennial censuses to evaluate the rates of HD in several occupational groups of special interest. No excess HD risk was found for two groups with high exposure to persons with the disease: Physicians had a relative risk (RR) of 1.2(0.4-2.6, 95% confidence interval) and nurses had an RR of 0.9 (0.4-1.8). Teachers, a group suggested to be at high risk due to exposure to "carriers" or contacts, had an RR of 1.1 (0.7-1.6). A high sex ratio, 1.9:1, at 35-64 years of age suggested that occupational exposures might increase disease risk. However, no difference in HD incidence was seen between employed and unemployed women in this age group. As in previous studies, woodworkers had an excess risk of HD [RR=1.6(0.9-2.6-a)], but the reason for this is obscure.
Adolescent↗
Issues and problems in the conduct of epidemiologic research on chronic fatigue syndrome.
The epidemiologic research approach is perhaps most appropriate for initial studies of chronic fatigue syndrome since the syndrome is vaguely defined, scientific knowledge about it is limited, and an infectious etiology is suspected. Several priority needs appropriate for epidemiologic research are identified, including a refinement of diagnostic criteria; a greater understanding of the natural history of the syndrome; basic incidence, prevalence, and mortality statistics; information on whether asymptomatic cases exist; etiologic studies of possible heterogeneity of cases; investigations of clusters of cases; and determinations of whether patients with the syndrome have an increased risk of malignancy. Because of the lack of cogent etiologic hypotheses regarding the syndrome, case-control studies are identified as a high priority for research. The many difficulties encountered in conducting such research are discussed and approaches to dealing with these problems are suggested.
Epidemiologic Methods↗
Seizures and seizure care in an emergency department.
We evaluated the nature and significance of seizure problems in an emergency department (ED) by studying seizures in an urban community hospital. In 6 months, there were 29,131 ED visits; of these, 200 (0.7%) were for diagnosed seizures. Among these 200 seizure visits, were 69 (34.5%) new-onset seizures, 30 (15%) febrile seizures, and 92 (46%) seizures in epilepsy patients with prescribed antiepileptic drugs (AEDs). These seizures were often serious and complicated by medical and psychosocial problems; e.g., 37 patients (18.5%) had multiple seizures, 14 (7%) had status epilepticus, and 63 (31.5%) required hospitalization. Associated psychosocial problems included 61 patients (31%) who had no medical insurance, 62 others (31%) who were judged indigent, and 60 (30%) who abused alcohol. Of 92 epilepsy patients receiving AEDs, 52 (56.5%) had subtherapeutic blood levels and were noncompliant with AED prescription patients. Problems with continuity of care were demonstrated by the failure of the ED to communicate with primary care providers about drug levels, noncompliance, and changes in therapy in greater than 85% of patients. A hospital ED is a major source for epilepsy and seizure care, but this care is not always optimum. EDs need to be prepared to manage common acute seizure problems. However, EDs must also place greater emphasis on significant nonemergency aspects of seizure care such as AED compliance, associated psychosocial problems, and effective communication with primary care providers.
Adolescent↗
Barriers to measles and pertussis immunization: the knowledge and attitudes of Pennsylvania primary care physicians.
OBJECTIVES: To understand the causes of low childhood immunization rates, physicians were interviewed about their knowledge, attitudes, and self-reported immunization practices. METHODS: Trained interviewers conducted a standardized telephone survey of physicians. A random sample of Pennsylvania family physicians, pediatricians, and general practitioners younger than 65 years of age who were in office-based practices was selected from the combined listings of the American Medical Association and American Osteopathic Association. Physicians seeing > or = 5 patients per week under age 6 years, seeing a total of > or = 15 patients per week, and having > or = 50% primary care patients were eligible. Of 383 eligible physicians, 70% (268) responded. The questionnaire was designed using the Health Belief Model, immunization barriers, and input from practitioners in primary care, pediatric infectious disease, maternal/ child health, and preventive medicine. RESULTS: Respondents were more likely to refer to public vaccine clinics those children without insurance (P < .001) or with Medicaid (P < .001) than children with insurance. Almost all (> 90%) respondents thought that vaccine efficacy was high and that the likelihood of serious side effects was low. However, only 37% gave estimates that corresponded with the literature regarding the likelihood of an infant with pertussis to need hospitalization. Many respondents used invalid vaccine contraindications; for instance, 37% would not administer MMR to a boy whose mother was pregnant. Many respondents (21%) would not administer four vaccines simultaneously. CONCLUSIONS: If the Healthy People 2000 goal to eliminate indigenous cases of measles is to be achieved, free vaccine supplies and increased provider education are needed.
Attitude of Health Personnel↗