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Biomedical subjects

D Slone

Publications and source records attributed to D Slone.

At least 37 records · Page 2Linked to original sources

Use of thyroid supplements in relation to the risk of breast cancer.

We conducted a case-control study to determine whether the use of thyroid supplements increases the risk of breast cancer. We compared 659 women with breast cancer and 1,719 control subjects. The rates of use of thyroid supplements were 9.1% and 8.7%, respectively (age-standardized rate ratio, 1.0; 95% confidence interval, 0.7 to 1.3). There was no evidence of an association when women known to be at increased risk for breast cancer (eg, nulliparae) were examined, even when thyroid supplements were taken for more than 15 years. Overall, there were no grounds to suggest that the long-term use of thyroid supplements increases the risk of breast cancer.

Adult↗

Thiazides and acute cholecystitis.

An association between acute cholecystitis and the use of thiazide-containing drugs was observed during routine screening of data from a case-control drug-surveillance program. Evaluation of this relation among 419 patients with acute cholecystitis and 1676 control patients yielded a relative risk estimate of 2.0 for subjects who had used thiazides in the month before admission, as compared with subjects who had never used these drugs (95 per cent confidence interval, 1.4 to 2.7). There was a significant trend of increasing relative risk with increasing duration of use (P < 0.01), and the estimate for subjects who had used thiazides for five or more years was 2.9. The association was not explained by confounding due to the indications for thiazide use, such as hypertension, or other factors, such as obesity or the use of other drugs. No single epidemiologic study can eliminate chance or bias as an explanation for an association; the relation found here should be regarded as a hypothesis that requires independent confirmation.

Acute Disease↗

Recent and past use of conjugated estrogens in relation to adenocarcinoma of the endometrium.

It has been suggested that the reported association between estrogen use and endometrial cancer may have been biased because estrogens provoke uterine bleeding in women with otherwise asymptomatic disease. To evaluate this hypothesis we compared 149 patients with endometrial cancer and 402 control subjects with other conditions with reference to the time when they had last used conjugated estrogens. In women who had last used conjugated estrogens two or more years previously and who had taken them for at least five years, the rate-ratio estimate was 3.3 (95 per cent confidence interval, 1.4 to 8.0) relative to women who had never used them. Uterine bleeding, and hence the diagnosis of otherwise asymptomatic cancer, cannot be attributed to estrogen use that ceased in the distant past. Our results suggest that such use has a residual effect on the risk of endometrial cancer; this effect is not accounted for by biased selection of cases according to estrogen use.

Adenocarcinoma↗

Noncontraceptive estrogens and myocardial infarction in young women.

The effect of noncontraceptive estrogens on the risk of myocardial infarction (MI) in women aged 30 to 49 years was investigated in 477 women with first infarctions and in 1,832 hospital control subjects. There was little evidence of an effect: overall, the estimated relative risk of acute MI for women who had used noncontraceptive estrogens in the preceding month, after allowance for potential confounding factors, was 1.0 (95% confidence intervals, 0.6 to 1.7); the corresponding estimate for women who had discontinued use more than one month previously was 1.2 (0.8 to 1.8). There was also no apparent association in various subgroups, including women who smoked heavily and those who had no identified predisposition.

Adult↗

Intrauterine contraceptive device use and pelvic inflammatory disease.

We examined the relationship between use of IUD's and PID, based on 44 women who were admitted to hospitals with first episodes of PID and 259 hospital control subjects. All the women used either IUD's or oral contraceptives. The age-adjusted relative risk for those using IUD's at the time of admission was 6.5 (95% confidence interval, 3.2 to 13.0). The association remained when several variables, and particularly parity, were taken into account. There was a suggestion that users who had had an IUD in place for at least 5 years had a higher risk of PID than did users of shorter duration. The data also suggest that copper-containing IUD's may be safer than other devices.

Adult↗

Cigarette smoking in relation to the risk of myocardial infarction in young women. Modifying influence of age and predisposing factors.

We evaluated the relation between myocardial infarction (MI) and cigarette smoking in women 30 to 49 years of age. Among 318 women who had survived recent first infarctions and 1272 age-matched controls, the proportions of cigarette smokers were 83% and 54%, respectively (p < 0.001). The estimated relative risk rose progressively with amount smoked: compared with women who had never smoked, the estimate was 1.8 for smokers of less than 15 cigarettes per day and 6.9 for smokers of 35 or more cigarettes per day. At each level of smoking, the relative increase in risk was greater at younger ages and among those not apparently predisposed from other factors. Although MI is a rare disease in young women, our data indicate that the risks faced by those who smoke heavily are appreciable.

Adult↗

Coffee drinking and myocardial infarction in young women.

The effect of consumption of caffeine-containing coffee on the risk of myocardial infarction in women 30-49 years of age was investigated. In this study 487 patients with first infarctions were compared with 980 controls whose admissions were for acute emergencies. Overall and in various subgroups, coffee drinking and myocardial infarction were weakly and not significantly associated: the overall estimated relative risk for women drinking at least five cups daily, compared with women drinking none, was 1.4 after control for all identified potential confounding factors (95% confidence interval, 1.0-1.9). Also, the frequency of coffee drinking was greater among controls, whose admissions were for acute emergencies, than among other patients without myocardial infarction, most of whom had been admitted for chronic conditions. If patients of the latter type tend to avoid coffee, then their inclusion in the control series of previous hospital-based studies may have led to overestimation of the magnitude of the association between coffee and myocardial infarction.

Acute Disease↗

Factors associated with oral contraceptive use.

We studied factors associated with oral contraceptive (OC) use among 1,855 premenopausal women who were admitted to hospital with conditions unrelated to OC use. Among this group, 15 per cent reported having used OCs within the preceding year and 35 per cent reported having last used them more than a year previously. A higher estrogenic dose (more than 60 micrograms) was reported by past users; the relationship of numerous other variables to past and present OC use is reported.

Adolescent↗

Cigarette smoking and age at natural menopause.

In a cohort of 656 naturally postmenopausal women who were interviewed at age 60 to 69 years, and was had reached their menopause between the ages of 35 and 59 years, the mean age at menopause declined with increasing number of cigarettes smoked, from 49.4 years of age among women who had never smoked to 47.6 years of age among women who smoked at least 15 cigarettes per day (p less than 0.02). The relationship was not attributable to the onset of menopause inducing women to take up smoking.

Adult↗

Oral-contraceptive use in relation to myocardial infarction.

The effect of oral-contraceptive use on the risk of myocardial infarction and, in particular, the possible accentuation of that effect by cigarette smoking, was investigated in 234 premenopausal women with a first infarction and 1742 hospital controls. The overall rate ratio estimate of acute myocardial infarction for women who had used oral contraceptives in the preceding month was 4.0 (95% confidence interval, 2.5--6.3). Women who smoked heavily and used oral contraceptives had a point estimate of 39 (lower two-sided 95% confidence limit, 22) compared with those who did neither. This value was appreciably larger than could be accounted for by the separate effects of cigarettes and oral contraceptives, and this suggests a considerable accentuation by cigarette smoking of the effect of oral contraceptive use on myocardial infarction.

Acute Disease↗

Patterns and determinants of conjugated estrogen use.

In view of the carcinogenic potential and widespread use of conjugated estrogens (CEs), this study evaluated patterns and determinants of oral ambulatory CE use. Among 1273 women 30 to 69 years of age interviewed in Greater-Boston hospitals, there were 161 (13%) ever-users of CEs; 88 (7%) had used the drug within the preceding year. The median duration of use was three years. Prominent determinants of use were age, menopause and history of menopausal symptoms. Physician prescription survey data from an independent source suggest that CE use has been common throughout the United States, and may have declined after the reports linking CEs to endometrial cancer were published in 1975. If CE use indeed increases the risk of endometrial cancer some fivefold, an important public health problem exists.

Adult↗

Drug utilization and reported adverse reactions in hospitalized children.

An intensive drug surveillance program has been developed to study the clinical effects of drugs in hospitalized children. This program collects information on drug exposures and the occurrence of adverse clinical events. The 1669 children monitored to date received an average of 7.6 drugs during an average hospital stay of 8.4 days. A group of specified adverse clinical events, whether or not drug attributed, occurred in 45.7% of the patients; drug-attributed events (adverse drug reactions) occurred in 16.8%. Both drug use and reported adverse reactions tended to increase with age, except that newborns received many drugs but had the lowest reported adverse reaction rates. Newborns, however, had the highest rate of adverse events not attributed to drugs, suggesting that perhaps some of these latter events include presently unrecognized adverse drug reactions.

Adolescent↗

Drug evaluation after marketing.

After marketing, drugs should be evaluated for safety and for efficacy. Present national systems are inadequate for both tasks. Safety can be evaluated by means of nonexperimental research, whereas evaluation of efficacy in a variety of settings representing normal medical practice generally requires experiments, randomized and blinded. Research into safety requires the maintenance of routine, yet flexible, multipurpose data systems, different for established and newly marketed drugs. Ad hoc studies on safety and on efficacy can be mounted more swiftly and economically through the maintenance of "standby" capabilities, in addition to maximal use of resources outside the actual national system.

Drug Evaluation↗

Drugs and pregnancy.

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Abnormalities, Drug-Induced↗

Relation of cigarette smoking to myocardial infarction in young women.

To examine the relation between myocardial infarction and cigarette smoking in young women, we investigated the smoking habits of women under the age of 50 who had survived a recent myocardial infarction. They had not been using oral contraceptives, and other identifiable risk factors were excluded. Among 55 such women and 220 control matched for age and area of residence, the proportions of cigarette smokers were 89 per cent and 55 per cent respectively (P less than 0.001). A dose-response relation was evident; among women smoking 35 or more cigarettes per day the rate of myocardial infarction was estimated to be some 20-fold higher than among those who had never smoked. This study demonstrates that cigarette smoking is a risk factor for myocardial infarction in young women who are otherwise apparently healthy.

Adult↗