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Biomedical subjects

G D Friedman

Publications and source records attributed to G D Friedman.

At least 145 records · Page 8Linked to original sources
PubMed1985

Respiratory morbidity in smokers of low- and high-yield cigarettes.

To study the association between smoking cigarettes with a low yield of tar and nicotine (tar less than 15.0 mg per cigarette and nicotine less than 1.0 mg) and respiratory disease, we reviewed the medical records of 4,610 current, regular cigarette smokers and 2,035 persons who had never used any form of tobacco and who were enrolled in a smoking study. In the year after recruitment to the study, the percentage of subjects with pneumonia or influenza was lower in female but not in male smokers of low-yield cigarettes. The percentage of subjects with any disease of the respiratory tract was lower in both male and female smokers of low-yield cigarettes. In multiple logistic regression analyses in which tar was included as a continuous variable and in which we also controlled for age, sex, race, and number of cigarettes smoked per day, smoking lower tar cigarettes was associated with lower risk for pneumonia or influenza, but not with the risk for other acute respiratory infections, other diseases of the upper respiratory tract, chronic obstructive pulmonary disease and allied conditions, or all respiratory diseases considered as a group. In other multiple logistic regression analyses, in which we controlled for age, race, and sex, smokers of low-yield cigarettes had a higher risk for pneumonia or influenza and chronic obstructive pulmonary disease when compared with subjects who had never used tobacco. We conclude that, with regard to pneumonia and influenza seen in an outpatient setting, smoking low-yield cigarettes is probably less hazardous than smoking high-yield cigarettes, but it still represents a considerable hazard compared with not smoking cigarettes at all.

Female↗
PubMed1984

Exogenous estrogen and breast cancer after bilateral oophorectomy.

Estrogen use in 119 women in whom breast cancer developed after surgically induced menopause was compared to use among an equal number of controls matched for age, date of bilateral oophorectomy, and duration of follow-up. No increased risk for estrogen use versus no use was evident (relative risk = 0.7). When the authors examined three measures of estrogen dose--number of chart notations of estrogen use, time since first use, and duration between first and last use--only those with greater than or equal to 5 notations had any significantly elevated risk (relative risk = 2.1; confidence limits 1.2-3.6), and there was a significant trend toward increasing risk with more notations (P = 0.03). Use specifically of conjugated estrogens was also associated with an increasing risk with more notation of estrogen use (P = 0.07). However, the other two measures of dose did not confirm this trend. Matched multiple logistic analysis suggested that number of notations of estrogen use conferred increased breast cancer risk (relative risk = 1.7), in dose-response relationships, but this result could have occurred by chance. Because of a lack of consistency, the generally low and statistically nonsignificant relative risks, and the lack of consistent effect modification in high-risk groups, the authors were unable to demonstrate a clear increased risk of breast cancer associated with replacement estrogen use.

Adult↗
PubMed1984

Twin studies of disease heritability based on medical records: application to acne vulgaris.

Establishment of the Kaiser-Permanente Twin Registry permitted the study of disease heritability in twins based on review of the twins' medical records. The records of 930 pairs of twins were reviewed. Based on previous questionnaires, 342 pairs were MZ, 345 were DZ and 243 were of unknown zygosity. Because of the age distribution of these twins and the time period in which they received care, conditions of youth, such as acne vulgaris were most reliably studied. Heritability of acne was assessed in three ways; all indicated a substantial genetic influence. Certain problems with twin studies using medical records became apparent: 1) Zygosity information is often lacking; 2) Differing times and durations of observation of the two twins in each pair must be accounted for; 3) Categorization by diagnosis is difficult and strict criteria for diagnosis may be impractical; 4) Patients' behavior that affects assessment of disease concordance must be considered; 5) The order in which records are reviewed may influence apparent concordance.

Acne Vulgaris↗
PubMed1984

Risk factors for benign breast disease: a case-control study of discordant twins.

The influences of potential risk factors for benign breast disease were assessed using women twins in a matched pair design. Two groups of cases from the Kaiser-Permanente Twin Registry were considered: 1) 90 pairs of female twins in which one twin reported a history of benign breast disease confirmed by biopsy and her twin reported no history of benign breast disease, and 2) 48 pairs of female twins in which the case had clinically diagnosed fibrocystic benign breast disease and her twin was free of disease at examination and reported no history of the disease. Results were similar in these two samples. A significant positive association was found between benign breast disease and coffee consumption. Oral contraceptive use and greater body mass were inversely associated with benign breast disease after controlling for possible confounding variables by matched-pairs multiple logistic analysis. All associations were stronger for monozygotic than for dizygotic pairs. Twin pairs discordant for disease provide an excellent sample in which to assess the importance of potential risk factors while controlling for early environmental and genetic backgrounds.

Adult↗
PubMed1984

The role of alcohol in the epidemiology of hypertension--is alcohol associated hypertension a common preventable disease?

It has become evident from a series of epidemiologic studies that an association exists between regular use of large amounts of alcoholic beverages and hypertension. In most studies, regular intake of smaller amounts of alcohol is not associated with hypertension but a possible threshold cannot be precisely defined at present. The relationship between alcohol and blood pressure is not attributable to demographic characteristics, obesity, reported salt use, smoking, or coffee use nor can it be explained by underreporting of alcohol consumption. If the relationship is causal then the pathogenesis is not yet firmly established. Multiple mechanisms, including direct effects of alcohol or of withdrawal from alcohol, are possible explanations. Alcohol shows a positive association with some sequelae of hypertension, but not to others. The most important exception is CHD, which is negatively associated with alcohol intake. Health professionals should not ignore the role of alcohol intake as a possible factor raising blood pressure in a certain proportion of hypertensive persons.

Black People↗
PubMed1984

Some obstacles to the evaluation and effective performance of health appraisals.

Certain obstacles exist in evaluating screening tests and health examinations. When a voluntarily screened group is compared with an unscreened group and when the survival of cases detected in these two groups is compared, self-selection bias, lead-time bias, length bias and overdiagnosis confuse the evaluation and usually make an examination seem better than it really is. A randomized controlled trial overcomes these biases; one group is offered screening, the other is not and the outcomes in both entire groups are observed. Unavoidable crossovers between the groups tend to obscure any benefit of the examination, however. Evaluations of screening tests have tended to emphasize the value of positive results and have neglected the value of negative results. In obtaining maximum benefit from health appraisals, attention needs to be directed at self-selection, nonmedical threats to life and health, risk factors in addition to early disease and tailoring an examination to the needs of individual patients.

Adult↗
PubMed1983

Rauwolfia and breast cancer: no relation found in long term users age fifty and over.

It has been suggested that conflicting findings regarding rauwolfia drugs as predisposing factors for breast cancer can be explained by the hypothesis that use for a long duration predisposes to breast cancer occurring after age 50. In a follow-up study of 2077 women who received prescriptions for rauwolfia drugs there was no excess risk for breast cancer diagnosed at age 50 or greater (morbidity ratio = 0.9 compared to 1.0 expected). In comparing 35 patients in this age group with 168 women who received rauwolfia but remained free of breast cancer, there was no excess risk for long (greater than or equal to 5 yr) duration of use (relative risk = 0.9). Thus, the hypothesis could not be confirmed in this study group. It is likely that the excess risk among long-duration rauwolfia users, if present at all, is less than 2-fold.

Aged↗
PubMed1983

Psychological questionnaire score, cigarette smoking, and myocardial infarction: a continuing enigma.

The ability of a group of 94 psychological questions to discriminate between men in whom cigarette smoking was associated with increased risk of myocardial infarction and men in whom smoking was not so associated remains puzzling. Further analyses, controlling for reported alcohol consumption and for a questionnaire item that might reflect physical activity, failed to alter this finding. This interaction of the questionnaire responses with smoking was not found with two other major coronary risk factors, serum cholesterol and systolic blood pressure. Believing that these observations may provide (a) a clue to how cigarette smoking affects risk of myocardial infarction, or (b) some means of identifying greater or lesser susceptibility to the effects of smoking, we invite other investigators to join in the pursuit of this matter. A list of ten selected yes-or-no questions with strong interaction with smoking is provided to assist others in studying this phenomenon; these are similar to ten items on the Minnesota Multiphasic Personality Inventory.

Adult↗
PubMed1983

Vasectomy and the incidence of hospitalized illness.

To determine the long-term effects of vasectomy on health we studied the incidence of hospitalized illness in 4,385 vasectomized and 13,155 age and race-matched nonvasectomized men. In none of the 16 disease groupings we examined was the incidence of hospitalized illness in the vasectomized men significantly different from that in the nonvasectomized men, considering men with all durations of vasectomy. Neither the incidence of acute myocardial infarction, other ischemic heart disease nor that of all atherosclerotic diseases considered as a group was significantly different between the vasectomized and nonvasectomized men, even in those whose duration of vasectomy was 10 years or more. These data are reassuring, providing no evidence for an adverse health effect of vasectomy in men.

Hospitalization↗
PubMed1983

Evidence for compensation in smokers of low yield cigarettes.

To determine the relation of smoking low yield cigarettes (tar yield less than 15.0 mg and nicotine yield less than 1.0 mg per cigarette) to the number of cigarettes smoked per day, we analysed information provided on self-administered questionnaires by 7706 current, regular cigarette smokers. The mean age at starting to smoke and the mean number of years of smoking were not consistently different in smokers of low yield compared with smokers of high yield cigarettes. In contrast, at all ages in both men and women, smokers of low yield cigarettes smoked significantly more cigarettes per day than smokers of high yield cigarettes. The differences in the number of cigarettes smoked per day between smokers of low and high yield cigarettes were small--about 3 cigarettes per day in men and about 1 1/2 cigarettes per day in women. However, these small differences might translate to the smoking of as many as one billion more packs of cigarettes per year in the United States alone. The potential beneficial effect of the smoking of cigarettes whose yield per cigarette is lower must be weighed against a possible adverse effect of the smoking of more cigarettes if the relation between smoking low yield cigarettes and smoking more cigarettes is causal.

Adult↗
PubMed1983

The rarity of cryptococcosis in Northern California: the 10-year experience of a large defined population.

The incidence of clinically manifest cryptococcosis was determined among over one million subscribers to the Kaiser-Permanente Medical Care Program in Northern California during the 10-year period 1971-1980. A total of 10 persons developed the disease, of whom two had no underlying immunosuppressive disease or therapy. The overall incidence was 0.8 per million persons per year; for nonimmunosuppressed individuals the incidence was estimated to be 0.2 per million per year. Incidence increased with age into the seventh decade of life and was greater in men than in women. The overall case fatality rate was 40 per cent. The data are not consistent with the view that cryptococcosis usually occurs in persons without obvious predisposing factors.

Adult↗
PubMed1983

Racial patterns of alcoholic beverage use.

Among 59,766 persons who had routine health examinations in the years 1978 through 1980, the proportions reporting drinking among self-classified racial groups were: white, 89.5%; Latin, 84.8%; Japanese, 81.9%; black, 79.8%; Chinese, 68.1%; Filipino, 63.9%. Reported use of 3 or more drinks daily was similar in whites, Latins, and blacks but was much lower in the Asian groups. Men of all races reported more drinking than women. A large proportion of drinkers in all race-sex subgroups reported use of small amounts of alcohol, and most nondrinkers reported lifelong abstinence. Wine drinking (2+ days/week) was favored over spirits or beer by whites of both sexes and women of most races; beer use was favored by men of all races except white. All race-sex groups reported a strong alcohol-cigarette smoking association. Comparison with data collected 15 years earlier showed a substantial decline in reported proportions of abstainers and heavier (3+) drinkers as well as apparent narrowing of race-sex differences.

Adult↗
PubMed1983

Prevalence and correlates of passive smoking.

The duration per week of exposure to others' tobacco smoke in different locations was tabulated from the questionnaire responses of 37,881 non-smokers and ex-smokers who received multiphasic health checkups in 1979 and 1980. Altogether 63.3 per cent of subjects reported some exposure, 34.5 per cent were exposed at least 10 hours per week, and 15.9 per cent at least 40 hours per week. Duration of exposure per week was weakly correlated with serum thiocyanate level in a small test group. Exposure was strongly related to age with a peak of 78.2 per cent in the twenties decade and an accelerating decline thereafter to 13.9 per cent in those age 80 and over. Sex and race were related to passive smoking only to a relatively small degree. Persons reporting longer exposures were more apt to report greater use of alcohol and marijuana, exposure to occupational hazards, and being currently not married. Lack of college education was most frequent among those denying exposure but was directly related to exposure duration among those reporting some passive smoking. Studies of the health effects of passive smoking should take into account these associated factors. Although the reported passive smoking of married persons was strongly related to their spouses' habits, categorization by spouses' smoking resulted in considerable misclassification.

Adolescent↗
PubMed1983

Alcohol intake and hypertension.

In several studies, persons drinking relatively large amounts of alcohol were found to have higher average blood pressures. The association between alcohol and blood pressure is not explained by adiposity; reported use of salt, coffee, or cigarettes; or by under-reporting of alcohol intake. We examined 12-year follow-up data on two matched groups of 850 hypertensive patients each; one group reported an intake of at least three alcoholic drinks per person per day, and the other group, fewer than three per day or none. Except for a lower rate of hospitalization for coronary disease, for which alcohol may be protective, cardiovascular complications leading to hospitalization or death had similar frequency in the two groups. These preliminary findings suggest that presumed alcohol-induced hypertension is as harmful as other forms of hypertension. A method for distinguishing alcohol-induced from non-alcohol-induced hypertension in drinkers is needed.

Alcohol Drinking↗
PubMed1983

Screening for possible drug carcinogenicity: second report of findings.

Cancer development was followed up through 1978 in 143,574 outpatients who were identified on the basis of computer-stored drug-dispensing data as users of various medicinal drugs during the 4-year period starting in July 1969. Screening analyses were repeated for the 95 most commonly used drugs and drug groups, which were reported previously after a shorter follow-up, and it was found that several drug-cancer associations had either gained or lost statistical significance since the report. Screening of 120 additional less commonly used drugs revealed one negative and 43 positive drug-cancer associations. A few of these associations suggested interesting new hypotheses about possible drug effects, but further study is required before conclusions on causality can be drawn. The absence of association with cancer for many drugs provides some provisional assurance for the absence of carcinogenicity, but further follow-up is needed to rule out later effects.

California↗
PubMed1982

Peptic ulcer disease and the tar and nicotine yield of currently smoked cigarettes.

In order to examine the association of smoking cigarettes with a lower tar and nicotine yield to peptic ulcer disease, a common disease associated in past studies with cigarette smoking. We used questionnaire information provided by 9009 current regular cigarette smokers. The percentage who ever had peptic ulcer disease in smokers whose current cigarette yielded 0.00-0.81, 0.81-0.99, 1.00-1.27 and 1.28 + milligrams of nicotine per cigarette were 8.5, 9.2, 9.2 and 9.5, respectively . The percentages who ever has peptic ulcer in smokers whose current cigarette yielded 0.0-11.9, 12.0-15.9, 16.0-18.9 and 19.0+ milligrams of tar per cigarette were 8.6, 9.1, 8.9 and 10.8 per 100, respectively. In contrast, the percentages who ever had peptic ulcer disease increased with the smoking of a greater number of cigarettes, being 5.9, 8.8, 9.0, 11.8 and 10.5 in smokers of less than 10, 10-19, 20-29, 30-39 and 40+ cigarettes, respectively. In multiple logistic regression analyses, peptic ulcer disease was significantly (p = 0.002) associated with number of cigarettes (RR = 1.12 per 10 cigarettes; 95% CI 1.08, 1.16), age and sex. There was no significant association (both p's less than 0.10) either with the current cigarette's tar yield (RR = 1.09 per 10 milligrams; 95% CI 0.96, 1.25) or with its nicotine yield (RR = 1.15 per milligram; 95% CI 0.94, 1.42).

Adult↗