Biomedical subjects

B Rosner

Publications and source records attributed to B Rosner.

At least 181 records · Page 10Linked to original sources

PubMed1991

Estimating the effect of the run-in on the power of the Physicians' Health Study.

In the Physicians' Health Study, a randomized, placebo-controlled, double-blind trial of aspirin in the reduction of cardiovascular mortality and beta-carotene in decreasing cancer incidence, 33,223 subjects were eligible and willing to enter the trial. Instead of randomizing this group immediately, all participants received identical calendar packs that contained active aspirin and beta-carotene placebo. Following an 18-week run-in, only 22,071 subjects who remained eligible and willing and had taken at least 2/3 of their pills were randomized. We estimated the effect of the run-in as follows: pill taking compliance increased 20-41 per cent; sample size decreased 34 per cent; duration of follow-up decreased 7 per cent which resulted in a 7 per cent decrease in the expected event rate for the placebo group. To estimate these changes, we made assumptions about compliance and outcome risk for those excluded by the run-in. Our conclusion, however, about the net effect of the run-in on the power of the study remains constant across variations in a number of those assumptions. The power with the run-in, with 22,071 good compliers was typically higher, and never more than negligibly lower, than the power without the run-in, with 33,223 good and poor compliers. In addition, savings from enrolling 11,152 fewer subjects in the trial resulted from the use of the run-in.

Aspirin↗

PubMed1991

Parental age at birth and risk of breast cancer in daughters: a prospective study among US women.

We examined the relation between parental age at birth and risk of breast cancer among daughters in a population of 118,309 US women who were 30 to 55 years of age in 1976 and without prior diagnosis of cancer. During 1,140,239 person-years of follow-up, we documented 1,799 incident cases of breast cancer in this population. After adjusting for established breast cancer risk factors, we observed only a weak and nonsignificant trend in risk of breast cancer with increasing maternal age at birth and no relation for paternal age. After adjusting for other risk factors, the chi trend was 1.10, P = 0.27 for increasing maternal age at birth. Daughters born to mothers 30 to 34 years of age had an age-adjusted relative risk of breast cancer of 1.11 (95% confidence interval: 0.89, 1.37) compared to daughters born to mothers less than 20 years of age. The weak positive trend in risk with increasing maternal age was present among both pre- and postmenopausal women. These findings suggest that there is little or no association between maternal age and risk of breast cancer, and that paternal age is not related to risk of breast cancer.

Adult↗

PubMed1991

A prospective study of body mass, height, and smoking on the risk of colorectal cancer in women.

Female registered nurses in the United States who responded to a questionnaire in 1976 that inquired about height, weight, and smoking history were followed for the development of colon or rectal cancers through May of 1984. Among the 118,404 respondents free of cancer in 1976, 191 colon cancers and 49 rectal cancers were observed during 916,170 person-years of follow-up. After omitting cases diagnosed within two years of weight report, we found little overall relation of body mass (Quetelet's) index to colon cancer risk; however there was a suggestion of elevated risk for the heaviest category of body mass index (greater than or equal to 29 kg/m2, relative risk (RR) = 1.5; 95 percent confidence interval = 0.8 - 2.7) relative to the lowest category (less than 21 kg/m2). Self-reported body mass index from adolescence had a slightly more pronounced, although not significant, association with risk of colon cancer. Increasing height was significantly associated with colon cancer (RR = 1.6, 95 percent confidence interval = 1.1 - 2.5 for the tallest category [greater than or equal to 168 cm] versus the shortest (less than 160 cm], trend, P = 0.04). Measures of current or past smoking failed to demonstrate any consistent relationship with colon cancer.

Adult↗

PubMed1991

Judging the effectiveness of antihypertensive therapy in an individual patient.

The physician's decision as to whether a hypertensive drug has produced satisfactory blood pressure lowering is more difficult than it is usually perceived to be. Variability of blood pressure, regression to the mean and habituation to the taking of blood pressure all conspire to blur the significance of the observed drop. We present algorithms outlining the number of visits before and after the initiation of therapy and the mmHg drop required for determination with acceptable certainty that any response to the hypotensive drug has occurred. Our conclusion is that the variability of blood pressure limits the clinician's ability to confidently conclude that antihypertensive therapy is effective unless the change in blood pressure exceeds a relatively high threshold and/or the number of visits both before and after the initiation of antihypertensive therapy is large. Because regression to the mean will be minimized, fewer visits and/or a lesser blood pressure fall in the treated patient changing or adding medications will be necessary to determine that a real decline has occurred.

Algorithms↗

PubMed1991

Issues in the early termination of the aspirin component of the Physicians' Health Study. Data Monitoring Board of the Physicians' Health Study.

The Physicians' Health Study is a randomized, double-blind, placebo-controlled prevention trial of 22,071 US physicians, using a factorial design to evaluate the role of aspirin in the prevention of cardiovascular mortality and beta carotene in the reduction of cancer incidence. After approximately 5 years of follow-up, the aspirin component was terminated, 3 years ahead of schedule. Several factors were considered in the decision to terminate, including a cardiovascular mortality rate markedly lower than expected in both aspirin and placebo subjects, precluding the evaluation of the primary aspirin hypothesis, and a highly significant (P < .00001) and impressive (44%) reduction in the risk of first myocardial infarction in the aspirin group. Issues in the decision to terminate are described in this report.

Adult↗

PubMed1991

Epidemiologic study of analgesic abuse: mortality study in 7275 working women (1968-1987).

In a prospective, longitudinal investigation over a period of 20 years in 7275 working women 30 to 49 years old, we examined the effect of the ingestion of analgesics on cause-specific mortality. Evidence of intake of phenacetin and salicylate containing analgesics was obtained at a urine screening in 1967 and was shown to relate to intake between 1968 to 1978. Life table analysis of the effect of phenacetin intake on overall mortality showed significant differences between the groups of women with intake (N = 613) versus no intake (N = 4175): for total [relative risk (RR) = 2.1, P less than 0.001], urorenal (RR = 24.4, P less than 0.001), cardiovascular (RR = 4.5, P less than 0.001), and cancer mortality (RR = 1.9, P less than 0.001). No significant effects on overall or cause-specific mortality were found for salicylate intake. These results make a causal relationship between the amount of analgesic containing phenacetin consumed and the risk of death from urorenal disease likely. Furthermore, the data show an elevated risk for cardiovascular disease and cancer for phenacetin intake. No such relationships are demonstrable for the use of salicylate.

Acetaminophen↗

PubMed1991

Caffeine, moderate alcohol intake, and risk of fractures of the hip and forearm in middle-aged women.

In 1980, 84,484 US women aged 34-59 y completed an independently validated dietary questionnaire. During the ensuing 6 y, 593 forearm and 65 hip fractures occurred in association with mild to moderate trauma. We observed a positive relation between caffeine intake and risk of hip but not forearm fracture. After potential risk factors were controlled for the relative risk (RR) of hip fracture for women in the top quintile of caffeine consumption was 2.95 (95% CI = 1.18-7.38, P, trend = 0.003). Alcohol intake was independently associated with increased risk of both hip and forearm fractures and with a dose-response relation. Compared with nondrinkers, women consuming greater than or equal to 25 g alcohol/d had an RR of 2.33 (95% CI = 1.18-4.57) for hip fractures and an RR of 1.38 (95% CI = 1.09-1.74) for forearm fractures. These prospective data suggest that caffeine and alcohol consumption both increase the risk of osteoporotic fractures in middle-aged women.

Adult↗

PubMed1991

Alcohol intake in relation to diet and obesity in women and men.

We studied relations between alcohol intake, body mass index, and diet in 89,538 women and 48,493 men in two cohort studies. Total energy increased with alcohol consumption (partial r = 0.11, P less than 0.001), and carbohydrate intake decreased from 153 g/d in abstainers to 131 g/d in women drinking 2.5.0-49.9 g alcohol/d. The decrease in carbohydrate intake was due mainly to decreased sugar consumption with higher alcohol intake (partial r = -0.05, P less than 0.001), reflecting decreased energy consumption from sources excluding alcohol. In men total energy increased with alcohol consumption (partial r = 0.19, P less than 0.001), from 7575.6 (abstainers) to 9821.5 kJ/d (greater than 50 g alcohol/d). Energy intake excluding alcohol varied little with alcohol intake (partial r = 0.003, P = 0.48) but sucrose intake decreased with higher alcohol intake. These data suggest that calories from alcohol were added to energy intake from other sources in men, and that in women, energy from alcohol intake displaced sucrose. The consumption of candy and sugar is inversely related to alcohol intake, raising the possibility that it is related to appetite for alcohol.

Adult↗

PubMed1991

A prospective study of reproductive history and exogenous estrogens on the risk of colorectal cancer in women.

Among 118,404 female registered nurses who responded to a mailed questionnaire and had no history of cancer in 1976, 191 colon cancers and 49 rectal cancers were diagnosed during 8 years of follow-up. We observed no material association between parity and colon cancer risk; women who bore four or more children had a risk similar to that of nulliparous women (age-adjusted RR = 1.1, 95% confidence limits (CL): 0.6, 1.9). No consistent patterns of colorectal cancer risk were associated with age at menarche or at first birth. Current or past use of oral contraceptives did not appreciably alter the risk of colorectal cancer; past use of postmenopausal estrogens was associated with a reduced risk of colorectal cancer (RR = 0.5, 95% CL: 0.3, 1.0). These and other data do not support any substantial effect of reproductive history or oral contraceptive use on the risk of large bowel cancer; however, the possible protective role of postmenopausal estrogen therapy merits further investigation.

Adult↗

PubMed1991

Maternal prenatal dietary potassium, calcium, magnesium, and infant blood pressure.

We studied the association between the prenatal diets of 212 mothers assessed by a semiquantitative food frequency questionnaire and the blood pressure of their infants. Prenatal potassium, calcium, and magnesium intakes were measured and adjusted for total caloric intake. Infant blood pressure was measured at 2-3 days and at 1, 6, and 12 months of age by using an ultrasonic-auscultatory device and was adjusted for cuff size, observer, and sleep/activity status, age in days in neonates, and weight at 6 and 12 months. Maternal prenatal potassium intake was inversely related to diastolic pressure at 6 months (r = -0.28, p less than 0.01) and at 12 months (r = -0.30, p less than 0.05). After adjustment for neonatal breast versus formula feeding, maternal prenatal calcium intake was inversely related to systolic blood pressure at 1 month (r = -0.21, p less than 0.01), and to diastolic blood pressure at 6 months (r = -0.27, p less than 0.01) and 12 months (r = -0.24, p less than 0.05). Maternal prenatal magnesium intake was inversely related to 6-month systolic blood pressure (r = -0.20, p less than 0.05). In multivariable models with all three cations, maternal prenatal potassium intake was independently and inversely related to diastolic blood pressure at 6 and 12 months. Maternal prenatal calcium intake was independently related to 1-month systolic and 6-month diastolic blood pressure. Age-specific infant blood pressure differences between the upper and lower quartiles of maternal prenatal cation intakes ranged from 3 to 7 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗

PubMed1991

The influence of age and level of pulmonary function on nonspecific airway responsiveness. The Normative Aging Study.

The relationship of age and prechallenge FEV1 to methacholine airway responsiveness was examined among 914 male participants of the Normative Aging Study (age range 41 to 86 yr). Methacholine airway responsiveness was analyzed as both a continuous (dose-response slope) and categorical (PD20 FEV1 greater than 8.6 mumol; PD20 FEV1 less than or equal to 8.6 mumol) variable. Methacholine responsiveness, as assessed by dose-response slope, displayed a significant inverse relationship to the prechallenge level of FEV1 (p less than 0.001). The dose-response slope was directly related to age among former smokers (p = 0.003) but not among current and never smokers. Using a categorical variable rather than the dose-response slope to characterize responder status yielded very similar results. A logistic regression model of the data predicts an approximately threefold greater odds of a positive methacholine challenge test in association with a 500 ml lower FEV1. The model predicts that among former smokers a 20-yr increase in age is associated with an approximately fivefold increase in the odds of a positive methacholine challenge test. This analysis suggests that nonspecific airway responsiveness increases with advancing age among former smokers even after adjustment for prechallenge level of FEV1.

Adult↗

PubMed1991

Is it useful to distinguish between asthma and chronic obstructive pulmonary disease in respiratory epidemiology.

Disagreement exists on how to define asthma in population studies. Features characteristic of asthma also have been demonstrated in nonasthmatic subjects. For example, although in a random sample of 339 subjects investigated in the Netherlands, subjects with a history of asthmatic attacks, wheeze and/or dyspnea, or chronic dry cough on average were the most responsive (mean PD20 values for histamine of 11.5, 17.0, and 15.0 mg/ml) and asymptomatic subjects were the least responsive (mean PD20, 45.4 mg/ml), the distributions of PD20 values in all groups overlapped considerably. The best way to investigate the association between exposure and disease is in a cohort study. It is argued that follow-up studies in patients may have limited meaning because of a high risk for selection bias. Furthermore, in general, diagnostic disease entities will not represent homogeneous exposure groups. It is concluded that end points of disease should be defined as objectively as possible, for instance, as the level of FEV1, or as simple respiratory symptoms such as dyspnea, wheeze, or chronic cough. Terms such as "asthma," "COPD," or "CNSLD" will not be helpful in defining end points because there is a risk that they could introduce bias, misclassification, and hence confusion.

Asthma↗

PubMed1991

Methacholine airway responsiveness and 24-hour urine excretion of sodium and potassium. The Normative Aging Study.

Prior studies have suggested a direct relationship between dietary sodium intake and nonspecific airway responsiveness. The relationship of dietary sodium and potassium intake to methacholine airway responsiveness was examined among 273 male participants of the Normative Aging Study (age range 44 to 82 yr) using 24-h urinary excretion of these cations as a surrogate for intake. Methacholine airway responsiveness was analyzed as dose-response slope, a continuous measure of responsiveness that represents the slope of a line connecting the origin to the last point of the dose-response plot. Greater airway responsiveness to methacholine was associated with greater potassium excretion. A significant relationship between methacholine dose-response slope and potassium excretion (p = 0.014) was observed in multivariate analysis that took into account other covariates, including age, percentage of predicted FEV1, cigarette smoking, and skin test reactivity. In contrast, methacholine airway responsiveness did not appear related to urinary sodium excretion. These data suggest that dietary potassium may have an influence on airway responsiveness of middle-aged and older men.

Adult↗

PubMed1991

Logistic regression for clustered binary data in proband studies with application to familial aggregation of sleep disorders.

Estimation is considered for the class of conditional logistic regression models for clustered binary data proposed by Qu et al. (Communications in Statistics, Series A 16, 3447-3476, 1987) when clusters are sampled on the basis of the outcome for one or more cluster members. The problem is suggested by data from a study designed to investigate familial aggregation of sleep disorders. After appropriate consideration of the mode of ascertainment of "cases" and "controls," it is shown that the model is preserved under this form of sampling, and a method of estimation is presented. The inconsistency of two alternative methods is demonstrated, and an example is provided.

Biometry↗

PubMed1991

Use of multiple visits to increase blood pressure tracking correlations in childhood.

Previous studies of childhood blood pressure have shown tracking correlations, which estimate the magnitude of association between initial and subsequent measurements, to be lower than corresponding adult values. Inasmuch as this disparity could arise from failing to account for a larger week-to-week variability in children, blood pressure was measured for 4 successive years, on four weekly visits in each year, and with three measurements at each visit, using a random-zero sphygmomanometer, in a cohort of 333 schoolchildren aged 8 through 15 at entry. Ninety percent of subjects had measurements in 1 or more years of follow-up. For all follow-up periods (1, 2, and 3 years from baseline), the Pearson correlation coefficient (r) for both systolic and diastolic blood pressure rose substantially with the number of weekly visits used to calculate each subject's yearly blood pressure (P less than .0001). For systolic pressure, the 3-year r values for 1, 2, 3, and 4 visits were .45, .55, .64, and .69, respectively. For diastolic pressure (Korotkoff phase 4), the corresponding values were .28, .41, .47, and .54. These higher multiple-visit estimates of tracking approximate published adult values and raise the possibility that prediction of adult blood pressure from childhood measurements may be improved by averaging readings from multiple weekly visits.

Adolescent↗

PubMed1991

A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women.

We examined the relationship of maturity-onset clinical diabetes mellitus with the subsequent incidence of coronary heart disease, stroke, total cardiovascular mortality, and all-cause mortality in a cohort of 116,177 US women who were 30 to 55 years of age and free of known coronary heart disease, stroke, and cancer in 1976. During 8 years of follow-up (889 255 person-years), we identified 338 nonfatal myocardial infarctions, 111 coronary deaths, 259 strokes, 238 cardiovascular deaths, and 1349 deaths from all causes. Diabetes was associated with a markedly increased risk of nonfatal myocardial infarction and fatal coronary heart disease (age-adjusted relative risk [RR] = 6.7; 95% confidence interval [CI], 5.3 to 8.4), ischemic stroke (RR = 5.4; 95% CI, 3.3 to 9.0), total cardiovascular mortality (RR = 6.3; 95% CI, 4.6 to 8.6), and all-cause mortality (RR = 3.0; 95% CI, 2.5 to 3.7). A major independent effect of diabetes persisted in multivariate analyses after simultaneous control for other known coronary risk factors (for these end points, RR [95% CI] = 3.1 [2.3 to 4.2], 3.0 [1.6 to 5.7], 3.0 [1.9 to 4.8], and 1.9 [1.4 to 2.4], respectively). The absolute excess coronary risk due to diabetes was greater in the presence of other risk factors, including cigarette smoking, hypertension, and obesity. These prospective data indicate that maturity-onset clinical diabetes is a strong determinant of coronary heart disease, ischemic stroke, and cardiovascular mortality among middle-aged women. The adverse effect of diabetes is amplified in the presence of other cardiovascular risk factors, many of which are modifiable.

Adult↗

PubMed1990

Prospective study of estrogen replacement therapy and risk of breast cancer in postmenopausal women.

We prospectively examined the use of estrogen replacement therapy in relation to breast cancer incidence in a cohort of women 30 to 55 years of age in 1976. During 367 187 person-years of follow-up among postmenopausal women, 722 incident cases of breast cancer were documented. Overall, past users of replacement estrogen were not at increased risk (relative risk, 0.98; 95% confidence interval, 0.81 to 1.18), including even those with more than 10 years since last [corrected] use (relative risk after adjustment for established risk factors, 0.70; 95% confidence interval, 0.45 to 1.10). However, the risk of breast cancer was significantly elevated among current users (relative risk, 1.36; 95% confidence interval, 1.11 to 1.67). Among current users, a stronger relationship was observed with increasing age but not with increasing duration of use. These data suggest that long-term past use of estrogen replacement therapy is not related to risk of breast cancer but that current use may modestly increase risk.

Adult↗

PubMed1990

A prospective study of obesity and risk of coronary heart disease in women.

We examined the incidence of nonfatal and fatal coronary heart disease in relation to obesity in a prospective cohort study of 115,886 U.S. women who were 30 to 55 years of age in 1976 and free of diagnosed coronary disease, stroke, and cancer. During eight years of follow-up (775,430 person-years), we identified 605 first coronary events, including 306 nonfatal myocardial infarctions, 83 deaths due to coronary heart disease, and 216 cases of confirmed angina pectoris. A higher Quetelet index (weight in kilograms divided by the square of the height in meters) was positively associated with the occurrence of each category of coronary heart disease. For increasing levels of current Quetelet index (less than 21, 21 to less than 23, 23 to less than 25, 25 to less than 29, and greater than or equal to 29), the relative risks of nonfatal myocardial infarction and fatal coronary heart disease combined, as adjusted for age and cigarette smoking, were 1.0, 1.3, 1.3, 1.8, and 3.3 (Mantel-extension chi for trend = 7.29; P less than 0.00001). As expected, control for a history of hypertension, diabetes mellitus, and hypercholesterolemia--conditions known to be biologic effects of obesity--attenuated the strength of the association. The current Quetelet index was a more important determinant of coronary risk than that at the age of 18; an intervening weight gain increased risk substantially. These prospective data emphasize the importance of obesity as a determinant of coronary heart disease in women. After control for cigarette smoking, which is essential to assess the true effects of obesity, even mild-to-moderate overweight increased the risk of coronary disease in middle-aged women.

Adolescent↗