Leptospirosis in the United States.
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Biomedical subjects
Publications and source records attributed to C W Heath.
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The idea that exposure to power-frequency electric and magnetic fields might contribute to cancer causation has been under investigation for nearly two decades. A number of epidemiologic studies have been undertaken, but findings have been weak, inconsistent, and inconclusive. This article provides an updated survey of epidemiologic information and considers those data in relation to the many scientific uncertainties that still persist.
Although cancer remains a major public health burden for African Americans, progress is being achieved. For both genders, stomach cancer mortality and mortality related to Hodgkin's disease showed large decreases over the past 30 years. Among African-American females, large decreases in cancer mortality occurred for nonmelanoma skin cancers, rectal cancers, and cervical and other uterine cancers. Tobacco use continues to decline among African Americans and, at present, is significantly lower among African-American youths than among their white counterparts. Despite these successes, additional work remains. Increased patient education regarding self-examinations and improved access to cancer screening are necessary to reduce the high percentage of cancers diagnosed at late stages among African Americans. Improved screening ultimately would increase survival and decrease cancer mortality. Some research has suggested that the increased morbidity and mortality in African Americans are related to poverty, lower education, and inadequate access to care as opposed to inherent racial characteristics. A recent study of black-white differences according to stage at diagnosis of breast cancer confirms some of these factors but also suggests that multiple factors may explain these differences, including mammograms, having a breast examination by a physician, and a history of patient delay. Such observations point to the importance of enacting broad social policies and establishing support mechanisms to diminish the impact of cancer in the African-American community.
Key findings on cancer incidence and mortality are presented for five racial and ethnic groups in the United States--African Americans, American Indians, Asians and Pacific Islanders, Hispanics, and whites. Information on the prevalence of cancer risk factors and screening examinations among these racial and ethnic groups is also included.
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In a pilot study to explore the feasibility of surveillance of cases of infectious mononucleosis, data were collected on 8,258 positive specimens. These specimens had been submitted to six State laboratories--Connecticut, Georgia, Iowa, South Carolina, Virginia, and Wisconsin--during a 2-year period. April 1974-March 1976. Case reporting varied in completeness and geographic coverage. Data concerning case occurrence, by age, sex, and race of patients and month of specimen collection, confirmed previous observations regarding the descriptive epidemiology of the disease. The results indicated that the public health usefulness of extensive surveillance of infections mononucleosis laboratory tests is limited.
To increase the use of mammography among women 40 years of age and older, the American Cancer Society (ACS) designed a telephone intervention strategy (the "Tell A Friend" program) that relied on ACS volunteers. During a half-day training session, each volunteer provided a list of 10 women she was willing to contact over a 6-month period and encourage to have a mammogram. Each list was randomized, and five names were returned to each volunteer for inclusion in the intervention. The other women served as controls and were not contacted by the volunteers. All women were subsequently interviewed at the end of the intervention period. Forty-nine percent of the women in the intervention group (n = 289) had received their most recent mammogram since the start of the intervention period, whereas 34% of control women (n = 305) received mammograms during the same time period (p < or = .001, rate ratio = 1.4, 95% confidence interval = 1.2, 1.7). The effectiveness of the intervention remained after controlling for demographic characteristics. The strategy was effective for both black and white women of all ages, but principally among women with annual household incomes of less than $40,000. We conclude that a telephone intervention strategy of personal contacts between acquainted women can significantly increase mammography use, particularly among women with low-to-moderate income.
Using data from the National Health Interview Survey Cancer Control Supplements, we examined the trends in mammogram and Pap smear test screening between 1987 and 1992 and the demographic characteristics associated with the use of those screening tests in 1992. In 1992, 67% of women 40 years of age and older reported ever having had a mammogram compared with 36% in 1987. A mammogram within the past year was reported by 29% of women in 1992, an increase from 14% in 1987. Among women 18 and older, 91% had ever had a Pap smear test in 1992, and 43% had one within the past year, an increase from 89% and 38%, respectively, in 1987. These changes represented significant increases in the use of both mammograms and Pap smear tests between 1987 and 1992 (P < .05). Race was not significantly associated with underutilization of mammograms, but income showed a significant relationship, with a declining likelihood of mammogram use as income decreased (odds ratio [OR] = 0.4, 95% confidence interval [CI] = 0.3, 0.6 for the income less than poverty level). Pap smear tests were less likely to be reported by older women ( > or = 65), widows, and never-married women, African-American women were more likely than Caucasian women to have had a Pap smear test, and women of other races were the least likely of any race/ethnic group to have ever had one (OR = 0.2, 95% CI = 0.1, 0.4). Women with less than 12 years of education had about a 40% decreased risk of having had a recent mammogram or Pap smear test. Women without a usual source of medical care also underutilized both screening procedures. Significant gains in the use of mammograms were found for all groups between 1987 and 1992. However, for the Pap smear test, some groups reported no differences during the five-year period. Although race and ethnic differences in the rates of screening use have been reduced somewhat, socioeconomically disadvantaged women and those with poor access to health care are still important target populations for increasing screening, particularly mammograms.
PURPOSE: Population-based estimates of cervical cancer incidence and screening are described. DESCRIPTION OF STUDY: Data from the Surveillance Epidemiology and End Results and from the 1992 National Health Interview Survey Cancer Control Supplement were used to examine differences in disease rates, stage at diagnosis, and screening practices among population groups. RESULTS: The overall age-adjusted incidence rate for invasive cervical cancer was 8.5 per 100,000 women in 1988-1992. Rates for black women were 66% higher than those for white women. At the youngest ages, rates were similar for both races--about 2.0 per 100,000. At older ages, rates diverged, increasing to 17.2 for white women ages 60 to 64 and 47.0 for black women aged 85 and older. Most cervical cancers were diagnosed at the localized stage, and older women and minority women were more likely to be diagnosed with advanced stage disease. Almost 25% of women reported they had not had a Papanicolaou smear test within the past 3 years. Among women younger than 45, whites were more likely than blacks not to have been screened. Among black women, there were regional differences in the use of Papanicolaou test, with those who lived in the South most likely not to be screened. CLINICAL IMPLICATIONS: Although rates for some groups appear to be converging, disparities still exist. Targeted approaches to screening, follow-up, and treatment are necessary to ensure that trends in cervical cancer incidence continue to improve.