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Biomedical subjects

W E Wilkinson

Publications and source records attributed to W E Wilkinson.

At least 73 records · Page 4Linked to original sources
PubMed1984

Alzheimer's disease: a study of epidemiological aspects.

A case-control study was performed to determine the possible roles of various environmental factors, prior illnesses, drug use, and personal habits in the development of Alzheimer's disease. Such information was collected from 40 patients with onset of dementia prior to age 70 and from 80 community control subjects matched for age, sex, and race. No significant differences were found between patients and control subjects in toxic environmental exposures, animal contacts, smoking, drinking, or unusual dietary habits. A significantly higher frequency of prior thyroid disease was found in women patients than in women control subjects (25.0% and 7.1%, respectively). A history of severe head injury was also obtained significantly more often among the patients than among the controls (15.0% and 3.8%, respectively). Aside from these differences, which may prove to be important associative factors in this illness, there appeared to be no major premorbid demographic or clinical factors associated with this form of dementia. There was evidence, however, of a genetic factor that was manifested in an excess of dementia and mental retardation (including Down's syndrome) in families of patients with Alzheimer's disease.

Alzheimer Disease↗
PubMed1984

Hormonal and personal effects on estrogen receptors in breast cancer.

Since high estrogen receptor protein in breast cancer tissue has a favorable effect on patient prognosis, factors influencing estrogen receptor levels are the focus of this research. From April 1977 to December 1978, 246 histologically confirmed primary breast cancer patients from three North Carolina hospitals were interviewed and provided with photographic displays of hormonal products. Their tumor tissue was analyzed for estrogen receptor protein by the sucrose density gradient assay. Data were analyzed by multiple regression and logistic regression techniques. No statistically significant relationship was found between gonadal hormone usage and estrogen receptor levels, although recent users of either oral contraceptives or replacement estrogens had lower receptor levels. Users of progestogen-predominant and -intermediate types of oral contraceptives also had lower estrogen receptor protein. An effect of menopausal status, independent of age, was not evident. Statistically significant associations involved age and race among postmenopausal patients. With black breast cancer patients aged less than 70 years as the reference group, the relative odds of having high estrogen receptor protein (greater than 10 fmol/mg of cytosol protein) were 2.4 times greater among whites aged less than 70, 1.6 times greater in blacks aged greater than or equal to 70, and 12.8 times greater in whites greater than or equal to 70 years. These differences in estrogen receptor protein may contribute to the black-white differential in breast cancer survival.

Adult↗
PubMed1984

Improving drug prescribing in a primary care practice.

A model for improving physician prescribing that utilizes computerized feedback was studied in a family medicine residency practice. Resident and faculty physicians were stratified by level of experience and randomized into two groups. For 9 months the experimental group received monthly printouts identifying drugs they had prescribed by brand name with estimates of cost savings that might have been realized by prescribing generic drugs. The control group received no feedback. Prescription monitoring of both groups continued for 12 months after all feedback had ceased. Median weighted rates of generic prescribing for the experimental physicians were 14% for the baseline, 67% for the feedback, and 54% for the follow-up periods. Rates for the control physicians for the three periods were 32%, 37% and 31%, respectively. The increase in generic prescribing by physicians in the experimental group was significantly greater than for control physicians (P = 0.01). The feedback model improved rates of generic prescribing but should be evaluated for broader areas of physician prescribing.

Computers↗
PubMed1984

Risk of ischemic heart disease in patients with TIA.

A prospective study was made of the morbidity and mortality from ischemic heart disease in 390 patients with focal TIA caused by atherosclerotic vascular disease. The 5-year cumulative rate of myocardial infarction or sudden death in these patients was 21.0%, a rate only slightly less than that of fatal or nonfatal cerebral infarction (22.7%). Risk factors including diabetes, angina, and ECG abnormalities were associated with an increase in morbidity and mortality from ischemic heart disease. A major factor associated with these cardiac events was the presence of atherosclerotic obstructive or ulcerative lesions in the carotid arteries. These observations indicate that focal TIA caused by carotid atherosclerosis is a predictor not only of cerebral infarction, but also of serious cardiac disease and death.

Adult↗
PubMed1983

Alzheimer's disease: genetic aspects and associated clinical disorders.

Genetic aspects and associated clinical disorders were studied in a consecutive series of 68 men and women in whom Alzheimer's disease appeared at or before age 70. Secondary cases of dementia were found in 17 (25%) of the families, affecting 22 of the probands' siblings and parents. The cumulative incidence of Alzheimer's disease in these relatives was approximately 14% at age 75. An increased frequency of Down's syndrome was observed among relatives of the probands: a rate of 3.6 per 1,000, as compared with an expected rate of 1.3 per 1,000. A history of thyroid disease was established in 9 (19.6%) of the 46 female probands, a frequency greater than that reported in the general population. There was no excess of hematological malignancies among the blood relatives, and parental age at the time of birth of the probands did not differ from the norm. The results of this study indicate that early-onset Alzheimer's disease is associated with a genetic factor manifested in a substantial familial aggregation of dementia, a probable excess of Down's syndrome in the probands' relatives, and a possible association with thyroid dysfunction in women with this form of dementia.

Aged↗
PubMed1982

Breast cancer and estrogen replacement therapy.

Concern over the possible effect of estrogen replacement therapy on the subsequent development of breast cancer prompted us to compare 199 postmenopausal breast cancer patients with 451 hospital control subjects and 852 community control subjects on their prior use of estrogens. Estrogen use did not increase the breast cancer risk for women with a surgical menopause. Among women with a natural menopause, estrogens administered by all routes were associated with breast cancer risks of 1.7 of 1.8. There was no coherent pattern of changing risks with varying durations of use, different daily dosages, years since first use of estrogen, or years since most recent use. When women who usually received estrogen by injection were excluded, the risk estimates for oral estrogens were 1.3 (case subjects compared to community control subjects) and 1.2 (case subjects compared to hospital control subjects). These increases were not statistically significant. Use of injectable estrogens produced a fourfold increase in breast cancer risk among naturally postmenopausal women.

Administration, Oral↗
PubMed1980

Correlation of estrogen and progesterone receptors with histologic differentiation in mammary carcinoma.

Using a modification of the histologic grading system of the NSABP, we observed a trend towards higher levels of estrogen (E2R) and progesterone receptor (PR) content in well (grade I) and moderately (grade II) differentiated mammary carcinomas. This relationship between receptor content and histologic grade is enhanced by considering estrogen and progesterone receptor simultaneously. The rank correlation between the quantitative levels of E2R and PR was 0.74 among histologic grade I tumors and 0.64 among histologic grade II tumors. Among the grade III carcinomas, the majority of tumors displayed either a paucity of measurable receptor or a divergence between levels of estrogen versus progesterone receptor (r = 0.19). The use of ultrastructural evaluation of features of differentiation is discussed in the evaluation of grade III tumors and in the evaluation of specific histologic types of mammary carcinoma.

Adenocarcinoma↗
PubMed1980

Risk of stroke in asymptomatic persons with cervical arterial bruits: a population study in Evans County, Georgia.

A survey of the rural community in Evans County, Georgia, revealed cervical arterial bruits in 72 (4.4 per cent) of 1620 persons 45 years of age of older without previous stroke, transient ischemic attacks, or overt ischemic heart disease. The prevalence of such asymptomatic bruits increased with age and was greater in women and persons with hypertension. We estimated the risk of stroke associated with cervical bruits during a six-year follow-up period, taking age and blood pressure into account. The presence of asymptomatic bruits was associated with a significantly higher risk of stroke in men but not in women, with odds ratios of 7.5 and 1.6, respectively. Despite the high risk of stroke among men with bruits, the correlation between the location of the bruits and the type of subsequent stroke was poor. Moreover, cervical bruits in men were a risk factor for death from ischemic heart disease. We suggest that asymptomatic cervical bruits are an indication of systemic vascular disease and do not themselves justify invasive diagnostic procedures or surgical correction of underlying extracranial arterial lesions.

Age Factors↗
PubMed1980

Logistic model estimation of death attributable to risk factors for cardiovascular disease in Evans County, Georgia.

Linear logistic analysis of the relationship of cardiovascular disease risk factors to an overall measure of health effect, ten-year mortality, revealed significant associations of death with systolic blood pressure, age, sex, diabetes mellitus, smoking, cholesterol, obesity (Quetelet index), race and social index. Attributable risk and population attributable risk estimates were derived from the model by changing actual variable values to target values. The results confirmed systolic hypertension and smoking as major public health problems and diabetes mellitus as a powerful risk factor for death. The small detrimental effect of cholesterol on probability of death limits the potential for an overall beneficial effect of preventive intervention. In fact, drug intervention in two reported trials of cholesterol reduction had negative overall effects. Demonstration of the association of a characteristic with a specific disease state does not alone justify attempts to eliminate the high risk state from a population. An overall detrimental health effect must be documented by suitable studies before trials of preventive intervention are undertaken or recommendations made to the public.

Adult↗