The relationship between conjugated estrogen(s) (CE) and breast cancer was investigated by the examination of the records of 345 women with newly diagnosed breast cancer and 611 healthy controls belonging to a prepaid health plan. Use of CE was associated with a 40% elevation in risk [relative risk (RR) = 1.4; 95% confidence interval-1.0-2.0]. The RR was 1.3 for menopausal women with intact ovaries and 1.5 for those with ovaries removed. There was statistically significant evidence of a dose-response relationship with the three measures of dose evaluated. RR's rose to about twofold for women with 10 or more CE prescriptions noted in their charts, for those with 5 years or more between their first and last prescription, and for those with a usual daily dose of 1.25 mg or more. The RR associated with having ever used CE and with long-term use was highest among those women with a family history of breast cancer. These data support the hypothesis that long-term use of CE is associated with increased breast cancer risk.

Breast Neoplasms↗

PubMedDate not supplied

[Ocular motility and flight safety].

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Accidents, Aviation↗

PubMedDate not supplied

The content of adult primary care episodes.

In a research project undertaken to describe the content of adult primary care, episodes of illness for six common primary care conditions were analyzed: URI (upper respiratory infection, UTI (urinary tract infection), HYP (hypertension), AP (abdominal pain), CP (chest pain), and PE (physical examination). Data from the Kaiser-Permanente Medical Care Program-Oregon Region were used in the project. Episode of the six conditions studied tended to be of brief duration; at least half of the episodes of each condition except hypertension involved only a single medical visit. The physical examination episodes typically involved both laboratory and radiology services, but these services were less frequently used for the other five conditions. Few episodes involved a referral to a consultant physician, the use of sophisticated ancillary procedures, repeat tests, or a hospitalization. If patients had been billed for the episode-related care involved in treating each episode, the average charge incurred (in 1980 dollars) would have bee: URI $38.67, UTI and HY $52.27 each, AP $66.59, CP $46.54, and PE $91.65, excluding the costs of pharmaceuticals. Ancillary services accounted for one-third or more of the costs for each type of episode except URI. The results suggest that cost savings in primary care are likely to depend less on the control of sophisticated medical technology than on efficiently meeting patient-initiated demands for care and on influencing physician-generated ordering of simple ancillary procedures. The results also suggest the utility of analyzing the distinctive demands on the medical care system that are generated by diverse primary care conditions.

Abdomen↗