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Biomedical subjects

D M Winn

Publications and source records attributed to D M Winn.

At least 55 records · Page 3Linked to original sources
PubMed1988

Smoking and drinking in relation to oral and pharyngeal cancer.

A case-control study of oral and pharyngeal cancer conducted in four areas of the United States provided information on the tobacco and alcohol use of 1114 patients and 1268 population-based controls. Because of the large study size, it could be shown that the risks of these cancers among nondrinkers increased with amount smoked, and conversely that the risks among nonsmokers increased with the level of alcohol intake. Among consumers of both products, risks of oropharyngeal cancer tended to combine more in a multiplicative than additive fashion and were increased more than 35-fold among those who consumed two or more packs of cigarettes and more than four alcoholic drinks/day. Cigarette, cigar, and pipe smoking were separately implicated, although it was shown for the first time that risk was not as high among male lifelong filter cigarette smokers. Cessation of smoking was associated with a sharply reduced risk of this cancer, with no excess detected among those having quit for 10 or more years, suggesting that smoking affects primarily a late stage in the process of oropharyngeal carcinogenesis. The risks varied by type of alcoholic beverage, being higher among those consuming hard liquor or beer than wine. The relative risk patterns were generally similar among whites and blacks, and among males and females, and showed little difference when oral and pharyngeal cancers were analyzed separately. From calculations of attributable risk, we estimate that tobacco smoking and alcohol drinking combine to account for approximately three-fourths of all oral and pharyngeal cancers in the United States.

Black or African American↗
PubMed1986

The reemergence of smokeless tobacco.

Smokeless tobacco (snuff and chewing tobacco) is reemerging as a popular form of tobacco, particularly among male adolescents. In different regions of the United States, from 8 to 36 percent of male high-school students are regular users. The use of smokeless tobacco has been shown to cause oral-pharyngeal cancer. The strongest link is with cancers of the cheek and gum. White mucosal lesions (leukoplakia) are found in 18 to 64 percent of users, often at the site where the tobacco was held. Other associations have been suggested for cancers of the esophagus, larynx, and pancreas. Nitrosamines, found in high concentrations in smokeless tobacco, most likely have a role in its carcinogenicity. Other health problems include periodontal disease, acute elevations of blood pressure, and dependence. In early 1986, after action at the state level, Congress enacted a federal law requiring health-warning labels on packages of smokeless tobacco and a ban on electronic advertising. Other regulatory measures under consideration include raising state and federal excise taxes, tightening controls on advertising, and prohibiting sales to minors. In view of the recent growth of this problem, policy makers are taking the opportunity to intervene with preventive measures to protect a new generation of tobacco users.

Adolescent↗
PubMed1985

Decreased helper T lymphocytes in homosexual men. I. Sexual contact in high-incidence areas for the acquired immunodeficiency syndrome.

In June 1982, sexual and other behavioral patterns were examined in 245 homosexual men in relationship to T-lymphocyte phenotypes that are characteristic of the acquired immunodeficiency syndrome (AIDS). Mean helper T-cell counts in New York City (579 +/- 32 cells/mm3) and Washington, DC, homosexual men with sexual contacts in areas at high risk (endemic) for AIDS (567 +/- 24 cells/mm3) were significantly lower than in Washington, DC, residents without such contacts (672 +/- 36 cells/mm3, p = 0.04 by analysis of variance). Helper T-cell counts in the Washington men were inversely correlated with a greater number of endemic-area homosexual contacts (p = 0.005), even after adjustment for multiple confounding variables (p = 0.02). The 31 Washington men with more than 15 endemic-area partners had a mean helper T-cell count of 517 +/- 44 cells/mm3, and 12 of those 31 men had helper T-cell counts less than 400 cells/mm3. AIDS patients are known to have a marked reduction in the number and function of helper T-lymphocytes. The data suggest that deficits of helper T lymphocytes can be acquired by homosexual contact with men in cities where AIDS is common. This supports the hypotheses that low helper T-cell counts may be caused by a sexually transmissible agent and that frequent homosexual exposure to residents of high-risk areas for AIDS may be an important means of spread of this agent.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Decreased helper T lymphocytes in homosexual men. II. Sexual practices.

In June 1982, the sexual practices of 245 homosexual male outpatients of private physicians were evaluated in relationship to decreased numbers of helper T lymphocytes, an abnormality that is characteristic of the acquired immunodeficiency syndrome (AIDS). Three risk groups were defined a priori--85 high-risk men from central Manhattan ("New York"), 96 intermediate-risk men from Washington, DC, with AIDS-area homosexual contacts ("Washington-exposed"), and 64 low-risk Washington, DC, men without such contacts ("Washington-unexposed"). An increasing number of homosexual partners was correlated with decreasing helper T-cell counts (R = -0.29, p = 0.009) and decreasing helper:suppressor T-cell ratios (R = -0.32, p = 0.005) in the entire study group combined and in New York subjects separately. Suppressor T-cell counts were unrelated to the number of partners in all three groups. Increasingly frequent receptive anal intercourse correlated with decreasing helper T-cell counts most clearly in the New York City group (R = -0.23, p = 0.04), somewhat less so in the Washington-exposed group (R = -0.18, p = 0.07), and not at all in the Washington-unexposed group (R = -0.09, p = 0.48). This association persisted in the New York and Washington-exposed groups after adjusting for seven other sexual practices, the number of homosexual partners, and five other potentially confounding variables. A transmissible agent associated with receptive anal intercourse best explains these data. The cause of these low helper T-cell counts may also be the cause of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Second cancer following cancers of the buccal cavity and pharynx in Connecticut, 1935-1982.

Patients diagnosed in Connecticut from 1935 to 1982 with cancers of the tongue, gum, floor, and other parts of the mouth, or pharynx experienced twofold to threefold increased risks of developing a second primary cancer. The excesses were most prominent [relative risk (RR) greater than or equal to 10] for subsequent oral and esophageal cancers but also were observed for cancers at other sites in the digestive and respiratory tracts. The increased risks, which affected both men and women and persisted over time, are most likely related to increased alcohol and tobacco consumption in the patients developing second primaries. The proportion of persons developing a new primary was 9% among the 2,120 patients with cancer of the tongue, 14% for the 3,063 patients with cancer in the gum, floor, or other parts of the mouth, and 8% among the 2,637 persons with pharynx cancer. If one considers that the average length of follow-up was only 3.4 years, these percentages are high and indicate the need for continued surveillance of patients with oral and pharyngeal cancers. Small overall excesses of subsequent cancer occurred among patients with initial lip (RR = 1.3) or salivary gland cancers (RR = 1.2), with twofold risks of oral and respiratory cancers evident for both tumors.

Connecticut↗
PubMed1985

Second cancer following cancer of the digestive system in Connecticut, 1935-82.

The risk of developing a second primary cancer was evaluated in approximately 64,000 persons diagnosed with cancer of the digestive system in Connecticut during 1935-82. Significant excesses of all second cancers combined were observed following cancer of the esophagus (58 observed vs. 33 expected), small intestine (41 vs. 24), and colon (2,268 vs. 1,714). A slight excess of multiple primaries was observed following cancer of the liver and biliary tract (47 vs. 40). The observed number of second cancers was nearly equal to the expected number for persons initially diagnosed with cancers of the stomach (251 vs. 258), rectum (952 vs. 941), and pancreas (40 vs. 40). Persons with initial cancers of the small intestine, colon, and rectum also had excess second cancers arising primarily in the colon, which suggested the influence of common etiologic factors or possibly misclassified metastases in some. Shared dietary, socioeconomic, or hormonal factors may explain the excess of uterine and ovarian cancers among patients with colon cancer and the excess of breast cancer among patients with colon and rectal cancers. Oral and respiratory cancers occurred more frequently than expected in persons with an initial esophageal cancer, which is likely due to common risk factors of cigarette smoking or alcohol intake, or both. The elevations in cancer of the prostate among males with cancers of the esophagus, small intestine, colon, rectum, liver/biliary, and pancreas are probably artifacts associated with increased medical surveillance of cancer patients. The prostate cancer excesses were limited to the first year after diagnosis of the initial cancer or decreased over time for all but cancer of the colon and small intestines. Increased medical surveillance may also contribute to the excess renal and bladder cancers seen within 5 years of diagnosis of stomach cancer. Excesses were also seen for second pancreatic cancer among small intestine and liver/biliary cancer patients and second kidney and brain cancers among those with colon cancer. The deficits of stomach and rectal cancer among persons initially diagnosed with the same tumors, respectively, were anticipated because surgical removal of the organ is the primary form of treatment. Patients with rectal cancer also had deficits of stomach and pancreatic cancers. Future research should clarify the role of diet, alcohol, metabolic and endocrine factors, and host susceptibility on the risk of second neoplasms following cancer of the digestive system.

Colonic Neoplasms↗
PubMed1984

Determinants of retrovirus (HTLV-III) antibody and immunodeficiency conditions in homosexual men.

A cohort of homosexual men at high risk of the acquired immunodeficiency syndrome (AIDS) was monitored to examine the relation between lifestyle, clinical conditions, T-lymphocyte subsets, and antibody to the AIDS-associated human retrovirus, human T-cell leukaemia virus III (HTLV-III). HTLV-III antibodies were present in 35 (53%) of the 66 subjects tested in June, 1982. 4 of the seronegative subjects had HTLV-III antibodies when re-tested one year later, a seroconversion rate of 1.2% per month. In the HTLV-III seropositive subjects, AIDS developed at a rate of 6.9% per year (minimum incidence of AIDS = 4.6% per year) and other clinical signs of immunodeficiency (lesser AIDS) at 13.1% per year. All 6 of the AIDS cases and at least 8 of the 10 lesser AIDS cases had detectable HTLV-III antibodies 1 week to 21 months before diagnosis. Of 24 other subjects with stable lymphadenopathy, 19 (79%) had or acquired HTLV-III antibodies. Lower helper T-cell counts were very closely related to HTLV-III seropositivity (r = -0.53, p = 0.0001), even in the 26 healthy subjects with no clinical abnormalities (r = -0.37, p = 0.07). In both univariate and multivariate analyses, the lifestyle risk factors for HTLV-III seropositivity were large number of homosexual partners (p less than or equal to 0.03) and receptive anal intercourse (p less than or equal to 0.03), with an apparent synergistic interaction between these two activities (chi 2 = 8.71, p = 0.003). These data suggest that frequent receptive anal intercourse with many homosexual partners predisposes to HTLV-III infection with the consequent emergence of lymphadenopathy and the various manifestations of lesser and fully fledged AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1984

A case-control study of cancers of the nasal cavity and paranasal sinuses.

To examine occupation, smoking, and other risk factors for nasal cancer, a case-control study was conducted among 160 patients, who were admitted to four hospitals in North Carolina and Virginia between 1970 and 1980, and 290 controls. Employment in the furniture industry was not associated with squamous cell tumors, but such employment increased the risk of nasal adenocarcinoma by fivefold. In addition, approximately threefold excess risks of adenocarcinoma were observed for those employed in other industries involving possible exposure to wood dust. Elevated risks among males were also associated with occupational exposures to chromates (relative risk (RR) = 5.1) and chemicals (RR = 2.7). Among females, an excess risk was associated with employment in the textile industry, particularly for jobs involving dust exposure (RR = 2.3). Although there was no evidence that alcohol consumption affected risk, heavy cigarette smokers were at a two- to threefold excess risk (predominantly for squamous cell tumors); in addition, there was evidence that there was an elevated risk associated with the use of snuff. Elevated risks were also associated with histories of nasal polyps (RR = 8.3), recurrent nose bleeds (RR = 2.0), and sinus trouble (RR = 2.7). These findings provide leads for further studies, and underscore the importance of distinguishing between histologic types.

Adult↗
PubMed1984

Diet in the etiology of oral and pharyngeal cancer among women from the southern United States.

A case-control interview study involving 227 women in North Carolina with oral cavity or pharyngeal cancer and 405 matched controls showed a protective effect of a usual adult diet high in fruits and vegetables. The relative risks of 0.65 for moderate and 0.52 for high (relative to 1.0 for infrequent) consumption of fruits and vegetables were statistically significant and remained after controlling for demographic characteristics, tobacco and alcohol use, relative weight, and intake of other food groups. Risks were lower with higher bread and cereal intake but higher for those women with the lightest weights, adjusted for height. The inverse associations between oral and pharyngeal cancer and intake of fruits and vegetables and intake of breads and cereals could not be attributed to an association with general nutritional status, since meat and fish consumption was related to an increased risk of oral and pharynx cancer. Moreover, dairy and egg consumption was generally unrelated to cancer risk. The reduction in risk with greater fruit and vegetable consumption is consistent with the hypothesis that vitamin C and/or beta-carotene intake is associated with a reduced risk of oral and pharyngeal cancer.

Aged↗
PubMed1983

Oral cancer and mouthwash.

As part of a case-control study in North Carolina involving 206 women with oral and pharyngeal cancers and 352 controls, questions were asked concerning the patterns of mouthwash use. No significant overall increase in risk was found among users; the relative risk, adjusted for snuff dipping and smoking habits, was 1.15 [lower, upper limits of the 95% confidence interval (95% Cl) = 0.8, 1.7]. The relative risk associated with mouthwash use was increased to 1.94 (95% Cl = 0.8, 4.7), however, among women abstaining from tobacco. Although consistent dose-response relationships were not observed for this subgroup, these findings and other reports of an increased risk among persons ordinarily at low risk of this disease raise the possibility that mouthwash may contribute to oral and pharyngeal cancers.

Aged↗
PubMed1982

Occupation and oral cancer among women in the South.

A case-control interview study among 232 North Carolina women with oral or pharyngeal cancer and 410 matched controls evaluated the contribution of occupation to the high risk of this cancer among females in the South. Review of detailed occupational histories found no overall elevated odds ratios for employment in the textile, apparel, or hosiery industry, the major employer of women in the area. Risks also did not increase with years worked in the industry. The findings thus fail to confirm an association reported in surveys in the United States and Great Britain. A new clue to occupational factors was suggested by the excess risk associated with the electronics industry in coastal North Carolina, independent of the participants' tobacco habits.

Dust↗
PubMed1981

Snuff dipping and oral cancer among women in the southern United States.

A case-control study in North Carolina involving 255 women with oral and pharyngeal cancer and 502 controls revealed that the exceptionally high mortality from this cancer among white women in the South is primarily related to chronic use of snuff. The relative risk associated with snuff dipping among white nonsmokers was 4.2 (95 per cent confidence limits, 2.6 to 6.7), and among chronic users the risk approached 50-fold for cancers of the gum and buccal mucosa--tissues that come in direct contact with the tobacco powder. In the absence of snuff dipping, oral and pharyngeal cancer resulted mainly from the combined effects of cigarette smoking and alcohol consumption. The carcinogenic hazard of oral snuff is of special concern in view of the recent upswing in consumption of smokeless tobacco in the United States.

Black or African American↗
PubMed1979

Identification of a clinical subset of systemic lupus erythematosus by antibodies to the SM antigen.

The clinical and renal histologic attributes of 135 systemic lupus erythematosus (SLE) patients with DNA and/or Sm antibodies were compared to determine if the presence of the Sm antibodies served as a marker for a specific subset of SLE. Although Raynaud's phenomenon was more frequent in patients with Sm antibodies (P less than 0.005), serious central nervous system disease was over three times as common in patients with DNA antibodies (P less than 0.005). Only one of 23 patients with Sm antibodies had diffuse proliferative glomerulonephritis on renal biopsy, whereas 6 of 14 patients with only DNA antibodies had this histologic finding (P = 0.01). The Sm antibody system may therefore identify a subset of SLE patients with milder central nervous system and renal disease.

Antibodies, Antinuclear↗
PubMed1979

Characterization of a distinct nuclear acidic protein antigen (MA) and clinical findings in systemic lupus erythematosus patients with MA antibodies.

Circulating antibodies against certain nuclear acidic protein antigens have been shown to have diagnostic and prognostic importance in connective tissue disease. We describe a new precipitin system found in the sera of patients with systemic lupus erythematosus. The antigen, called MA, was prepared from calf thymus nuclei, and was shown to be distinct from other nuclear acidic protein antigens by physicochemical and immunologic techniques. MA antibodies were detected in the serum of 12 of 66 lupus patients and in none of 554 sera from normal controls or patients with other rheumatic diseases. Lupus patients having MA antibodies had more severe disease than did lupus patients with Sm or native DNA antibodies, manifested by recalcitrant skin rashes and a significantly greater incidence of hypocomplementemia, serious renal disease, hypertension, hepatosplenomegaly, lymphadenopathy, and neurological disease (P values range from 0.025 to 0.005). The presence of circulating MA antigen was demonstrated in three lupus patients immediately before a flare of nephritis. These data suggest that MA is a nuclear acidic protein antigen that may identify a subset of lupus patients with very severe disease. The presence of the antigen in the circulation before clinical flares suggests a possible biologic role for the MA system in an immune complex nephritis.

Antibodies, Antinuclear↗
PubMedDate not supplied

A method for determining the sampling ratio in epidemiologic studies.

This paper presents a new method for determining the optimal sampling ratio and sample size in different types of study designs involving binary exposure and disease variables. The sampling ratio is optimized by maximizing cost efficiency, which is the ratio of the precision in effect estimation to the total sampling cost. One may easily compute the optimal sampling ratio with a hand calculator, and it is independent of the sample sizes of the compared groups. Optimal sample sizes obtain from use of the optimal sampling ratio in the appropriate asymptotic power function for comparing two proportions or rates with unequal sample sizes. We illustrate the method with a case-control design, compare it with other methods for optimizing the sampling strategy, and discuss it in a practical context.

Cost-Benefit Analysis↗
PubMedDate not supplied

Smokeless tobacco and cancer in women: implications for cancer research.

Smokeless tobacco, particularly snuff, is a recognized risk factor for cancer of the oral cavity. This conclusion rests in large part on epidemiologic studies of oral cancer in women, especially in the American South, where the oral cancer death rate in females has been high. The research focus on studies of women led to the identification of the hazards from smokeless tobacco use; the strategies used are broadly applicable to studies of the etiology of other cancers in both women and men. High levels of nitrosamines, which are potent carcinogens, are found in smokeless tobacco products. Steps should be taken to reverse the alarming increase in their use by men and boys. More research attention also should be directed to understanding new emerging trends in oral cancer mortality among women.

Adolescent↗