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Biomedical subjects

G L Rubin

Publications and source records attributed to G L Rubin.

At least 37 records · Page 2Linked to original sources
PubMed1992

Underreporting of AIDS, New South Wales, 1988-1989.

OBJECTIVE: To determine the completeness of medical practitioner reporting of patients with acquired immunodeficiency syndrome (AIDS) in New South Wales and the reasons for underreporting. DESIGN: We compared the number of patients with AIDS reported to the National AIDS Register by medical practitioners from 1 July 1988 to 23 November 1989 with numbers detected from the National Zidovudine Register, AIDS specialist medical practitioner records, death certificates and the Sydney AIDS Prospective Study database. We asked the AIDS specialist medical practitioners to suggest why some patients may not be reported. MAIN OUTCOME MEASURE: The number of persons known to have AIDS and the source from which they were detected. RESULTS: We found 457 recorded cases of AIDS in which the diagnosis was made during the study period. Of these 457 cases, 373 (81.6%) had been reported by medical practitioners and 84 had not. Of these 84 cases, 40 were detected from the National Zidovudine Register, 24 from the records of AIDS specialist medical practitioners, 18 from death certificates and two from the Sydney AIDS Prospective Study. Reporting rates among hospitals ranged from 38.5% to 95.7%. We estimated that the true number of persons diagnosed with AIDS in New South Wales over the study period was 476. The main reasons given by the doctors for not reporting persons with AIDS were difficulties with reporting procedures and the complicated AIDS case definition, concerns about maintaining patient confidentiality and inadequate Health Department feedback on AIDS surveillance data. CONCLUSIONS: At least 18.4% of the AIDS cases we detected were not reported by medical practitioners in New South Wales. More accurate information on the incidence of AIDS could be obtained if the Health Department regularly contacted AIDS specialist medical practitioners for unreported cases, simplified the reporting process, stressed the confidentiality provisions for AIDS reporting and provided feedback to reporting medical practitioners.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Histologic types of benign breast disease and the risk for breast cancer. The Cancer and Steroid Hormone Study Group.

Specific histologic types of benign breast disease (BBD) may increase breast cancer risk. The authors analyzed data from a population-based, case-control study of women aged 20 to 54 with newly diagnosed breast cancer and control subjects randomly selected from the general population. A panel of pathologists classified the histologic findings of biopsy slides for 433 women with breast cancer and 261 control subjects, all of whom had a history of biopsy for BBD, as to the presence of epithelial hyperplasia, atypia, and other histologic features. When compared with women who had never had a breast biopsy, women with BBD without hyperplasia had an odds ratio of 1.5 (95% confidence limits [CL] 1.3 to 1.9), women with hyperplasia without atypia had an odds ratio of 1.8 (CL = 1.3, 2.4), and women with hyperplasia and atypia had an odds ratio of 2.6 (CL = 1.6, 4.1). Fibroadenoma was an independent risk factor for breast cancer (odds ratio = 1.7; CL = 1.1, 2.5). These findings suggest that women with BBD with epithelial hyperplasia either with or without atypia and women with fibroadenoma should be monitored carefully because of their elevated risk for breast cancer.

Adenofibroma↗
PubMed1992

Teenage pregnancy and fertility in New South Wales: an examination of fertility trends, abortion and birth outcomes.

This paper reviews the data available in New South Wales on teenage fertility rates and pregnancy outcomes. Teenage births comprise six per cent of all births in New South Wales, but they constitute a significant public health problem because they are associated with elevated rates of adverse pregnancy outcomes, which include low birthweight, perinatal death and pre-eclampsia. Risk is concentrated in females under 18 years of age. Pregnancy outcomes for females aged 18 to 19 years are similar to those of women aged 20 to 24 years. Teenage fertility rates have remained stable since the mid-1980s, following a decline which began in the early 1970s. There are large geographic variations in teenage fertility within the state, with the highest rates in the far west of New South Wales and in western Sydney. Teenage pregnancy in New South Wales (as distinct from fertility which reflects births) cannot be assessed accurately because of the lack of information on terminations of pregnancy. However, available data suggest that teenage pregnancy rates have not increased during the 1980s.

Abortion, Induced↗
PubMed1991

Improving surveillance of infectious diseases in New South Wales.

OBJECTIVE: To determine the feasibility of laboratory reporting of infectious diseases and to compare the value of this system with the existing medical practitioner notification system. DESIGN: A sample of notifications was selected from medical practitioner notifications and was compared for both completeness and timeliness of notification with a sample of notifications obtained through the Laboratory Infectious Diseases Surveillance Project. SETTING: The New South Wales Health Department and the Public Health Unit of the Eastern Sydney Area Health Service. PARTICIPANTS: Medical practitioners forwarding notifications of infectious diseases to the New South Wales Health Department and laboratories participating in the Laboratory Infectious Diseases Surveillance Project. MAIN OUTCOME MEASURES: We counted the number of infectious diseases reported by medical practitioners and participating laboratories and estimated the proportion of these diseases which were common to both sources of data. We also estimated the time taken between the diagnosis of a notifiable infectious disease and the receipt of the notification by the Medical Officer of Health. RESULTS: There was substantial underreporting of notifiable infectious diseases by medical practitioners. During the study there were 461 cases of a notifiable disease reported by either medical practitioners or by participating laboratories. Of these cases, 75% were reported only by laboratory staff, 20.2% were reported by medical practitioners alone and 4.8% of cases were reported by both laboratory staff and medical practitioners. The Medical Officer of Health received the reports from the participating laboratories within a significantly shorter time than the notifications from medical practitioners. CONCLUSION: The use of infectious disease notifications by laboratories can substantially improve the surveillance of infectious diseases.

Communicable Disease Control↗
PubMed1991

Measures of sexual behavior and the risk of pelvic inflammatory disease.

A women's sexual behavior affects her risk of acquiring pelvic inflammatory disease, but the risks have not been well characterized. To study the association between pelvic inflammatory disease and sexual behavior, we analyzed data from a multicenter, case-control study involving 712 women hospitalized with an initial episode of pelvic inflammatory disease and 2719 hospitalized control women without a history of pelvic inflammatory disease. Study participants provided information on their frequency of intercourse, number of recent sexual partners, and previous history of gonorrhea. Logistic regression methods were used to adjust for confounding factors. Women who reported having four or more sexual partners were over three times more likely to be hospitalized for pelvic inflammatory disease (relative risk 3.4; 95% confidence interval 2.2-5.3) than were women who reported only one recent sexual partner. To a lesser extent, frequent sexual intercourse and history of gonorrhea also increased a woman's risk of pelvic inflammatory disease. Frequent intercourse was a strong risk factor for pelvic inflammatory disease among a subgroup of women who were at low risk for acquiring a sexually transmitted disease: Married women with one recent sexual partner with intercourse six or more times per week had a risk of pelvic inflammatory disease of 3.2 (1.4-7.2) compared with similar women having intercourse less than once per week. Frequent intercourse, which does not by itself increase the risk of acquiring a sexually transmitted disease, may increase a woman's risk of pelvic inflammatory disease.

Adult↗
PubMed1990

Estrogen replacement therapy and the risk of endometrial cancer: remaining controversies.

To examine the relationship between exogenous estrogen administration and endometrial cancer, we used data from the Cancer and Steroid Hormone Study, a multicenter, population-based case-control study. Estrogen replacement therapy for greater than or equal to 2 years was associated with an increased risk of both localized and extrauterine cancer (relative risk = 2.8, 95% confidence limits 1.6, 4.6; relative risk = 2.9, 95% confidence limits 0.9, 9.4, respectively). However, the latter finding was based on a small number of cases in which estrogen was used. Women who underwent estrogen replacement therapy for greater than or equal to 2 years had significantly elevated risks of endometrial cancer (2.1 for 2 to 5 years and 3.5 for greater than or equal to 6 years). An elevated risk persisted for greater than or equal to 6 years after discontinuation of therapy. Women who exclusively used conjugated equine estrogen preparations less than or equal to 0.625 mg had no increased risk of endometrial cancer. A history of oral contraceptive use appeared to reduce the risk of endometrial cancer associated with estrogen replacement therapy. However, these latter two potentially important findings were based on a small number of cases in which hormones were used.

Adult↗
PubMed1990

Pregnancy, breast feeding, and oral contraceptives and the risk of epithelial ovarian cancer.

To quantify the effects of cumulative months of pregnancy, breast feeding, and oral contraceptive use on the risk of developing epithelial ovarian cancer, the authors used data collected for the Cancer and Steroid Hormone Study--a multicenter, population-based, case-control study. Detailed reproductive histories were obtained from 436 women aged 20-54 with epithelial ovarian cancer newly diagnosed between December 1980 and December 1982, and from 3833 women aged 20-54 selected at random from the same geographic areas. Estimated relative risks of epithelial ovarian cancer were 0.6 (95% confidence interval (CI) 0.5-0.8) for women who had ever been pregnant, 0.6 (95% CI 0.5-0.8) for women who had ever breast fed, and 0.5 (95% CI 0.5-0.7) for women who had ever used oral contraceptives. Logistic regression analysis revealed a strong trend in decreasing risk of epithelial ovarian cancer with increasing cumulative months of pregnancy; this effect was less pronounced in women aged 50-54 than in younger women. In contrast, a marked reduction in risk was associated with ever having breast fed or used oral contraceptives, while the decrease in risk from additional months of either of these exposures was less than that for pregnancy.

Adult↗
PubMed1989

The independent associations of parity, age at first full term pregnancy, and duration of breastfeeding with the risk of breast cancer. Cancer and Steroid Hormone Study Group.

Although the important influence of a woman's reproductive history on her risk of breast cancer is widely recognized, it is not clear whether this is wholly accounted for by the age at her first full-term pregnancy, or whether there are additional, independent influences of breastfeeding or number of children. To examine the respective contributions to the risk of breast cancer of these reproductive factors, we used logistic regression methods to analyze data from a multicenter case-control study, the Cancer and Steroid Hormone Study. Included in the analysis were 4599 women, 20-55 years of age, identified as having an initial diagnosis of breast cancer by one of eight collaborating population-based cancer registries. The 4536 controls were women of similar ages selected by random dialing of households with telephones in the same eight areas. As expected, age at first full-term pregnancy exerted a strong influence on the risk of breast cancer. However, after it and other potentially confounding factors had been controlled for, parity and duration of breastfeeding also had a strong influence on the risk of breast cancer. Compared with women of parity one, women of parity seven or greater had an adjusted relative risk of breast cancer of 0.59 (95% CL, 0.44-0.79). Compared with parous women who never breastfed, women who had breastfed for 25 months or more had an adjusted relative risk of 0.67 (0.52-0.85). These results do not support the supposed preeminent importance of age at first full-term pregnancy among the reproductive determinants of breast carcinogenesis. Resolution of this issue may have important implications for elucidating hormonal influences on breast cancer and for projecting future trends in the disease.

Adult↗
PubMed1989

Research on infertility: definition makes a difference. The Cancer and Steroid Hormone Study Group.

Although different definitions of infertility are used, research findings based on various definitions have not been systematically compared. To contrast the impact of five definitions of infertility on research findings, the authors analyzed data from the control group (randomly selected US women aged 20-54 years) of the Cancer and Steroid Hormone Study (1980-1983). For all definitions, an absence of recognized conception was the outcome of interest. Specifically, the authors examined the effect of various definitions of infertility on demographic characteristics of women classified as infertile, prevalence of a history of infertility, age at infertility classification, and cumulative incidence of conception after infertility classification. Results indicated that women classified as infertile by definitions based on unprotected intercourse for 12 months and unprotected intercourse for 24 months were more likely to be black, less educated, and classified as infertile at younger or older ages that women classified by alternative definitions. The prevalence of a history of infertility ranged from 6.1% (physician diagnosis) to 32.6% (unprotected intercourse for 12 months). For the definitions based on unprotected intercourse for 12/24 months and for physician diagnosis, the cumulative incidence of conception by greater than 120 months after infertility classification was 86.3%, 76.7%, and 75.4%, respectively. The authors conclude that the definition of infertility has an impact on research findings related to which and how many women are classified as infertile, the age at infertility classification, and the probability of future conception.

Adult↗
PubMed1988

Hysterectomy, tubal sterilization, and the risk of breast cancer.

Studies suggest that hysterectomy and tubal sterilization may alter the function of the remaining ovaries. Conceivably, this effect could alter breast cancer risk. To investigate whether these surgeries affect breast cancer risk, the authors analyzed data collected between December 1, 1980, and April 30, 1983, in a population-based, case-control study of women aged 20-54 years, the Cancer and Steroid Hormone Study. Compared with never-sterilized women, women with hysterectomy and no remaining ovaries had a decreased risk of breast cancer (relative risk (RR) = 0.7, 95% confidence interval (CI) = 0.6-0.8). Risk was lowest in women who had their surgery before age 40 years or 15 or more years in the past; surgery at an early age provided greater protection than surgery in the distant past. Hysterectomy with one or two remaining ovaries was also inversely associated with breast cancer risk (RR = 0.8, 95% CI = 0.7-0.9), but no relation was found with age at surgery or time since surgery. Women with tubal sterilization had a slightly increased risk of breast cancer, which was of borderline statistical significance (RR = 1.2, 95% CI = 1.0-1.3). However, no relation was found with age at surgery or time since surgery. The data suggest that hysterectomy with bilateral oophorectomy decreases the breast cancer risk in women aged less than 55 years, possibly by curtailing ovarian function at a critical period. However, neither hysterectomy without bilateral oophorectomy nor tubal sterilization appears to substantially alter breast cancer risk in women of this age.

Adult↗
PubMed1988

The intrauterine device and pelvic inflammatory disease revisited: new results from the Women's Health Study.

To examine whether the risk of pelvic inflammatory disease associated with intrauterine device (IUD) use varies with a woman's sexual behavior, we analyzed data from the Women's Health Study, a hospital-based, case-control study carried out in the United States from 1976-1978. The cases were 657 women hospitalized with pelvic inflammatory disease; controls were 2566 women hospitalized with nongynecologic conditions. After controlling for confounding factors, we found no consistent differences in the risk of pelvic inflammatory disease associated with IUD use among women in different categories of gonorrhea history, frequency of intercourse, or number of recent sexual partners. However, among women with only one sexual partner, married and cohabiting women had little appreciable increased pelvic inflammatory disease risk associated with IUD use compared with those using no contraception, whereas previously and never-married women using IUDs had relative risk estimates of 1.8 and 2.6, respectively. These results suggest that women at low risk of acquiring sexually transmitted infections have little increase in the risk of pelvic inflammatory disease from use of an IUD.

Adolescent↗
PubMed1987

Consistency and plausibility in epidemiologic analysis: application to breast cancer in relation to use of oral contraceptives.

Consistency and plausibility are fundamental criteria for judging cause and effect from observational studies. They are applied here to the interpretation of data from a population-based case-control study of oral contraceptives and breast cancer. A preliminary analysis of oral contraceptive use in young nulliparous women, who had no family history of either breast cancer or benign breast disease, showed a statistically significant dose-response, with long-term users (49 months or more) having an apparent 4-fold elevation in risk of early breast cancer. Further analyses, however, revealed striking inconsistencies which were biologically implausible. These effectively undermine cause and effect as an explanation for the initial finding.

Adult↗
PubMed1987

Cigarette smoking and the risk of epithelial ovarian cancer.

Cigarette smoking may affect each of the currently proposed mechanisms of ovarian carcinogenesis. Whether cigarette smoking has any effect on the development of ovarian cancer has not been adequately evaluated. To study this issue, the authors examined data from the Cancer and Steroid Hormone Study, a multicenter, case-control study of gynecologic cancers conducted between December 1, 1980, and December 31, 1982, in eight geographic areas of the United States. This analysis utilized data on 494 women with newly diagnosed epithelial ovarian cancer and 4,238 population-based control women 20-54 years of age. There was no association of epithelial ovarian cancer with dose of cigarette smoking, age smoking started, time since smoking started, or time since smoking last occurred. Simultaneous adjustment for age, parity, history of oral contraceptive use, and other potentially confounding factors did not alter these results.

Adult↗
PubMed1987

Complications of vasectomies in the United States.

Physicians in the United States were surveyed in 1983 to gather information concerning the number of vasectomies they performed in 1982 as well as their use of anesthesia and complications of those vasectomies. Most urologists performed vasectomies, whereas family physicians and general surgeons were less likely to do so. As expected, most physicians used local anesthesia, occasionally in combination with a sedative; however, 22 percent of physicians reported using general anesthesia for at least some vasectomies. Complication rates were in the ranges reported by previous case series. Physicians who performed between one and ten vasectomies in 1982 had higher rates of hematoma and hospitalization for treatment of a complication than physicians who performed more vasectomies. Maintenance of surgical skills appears to be important in preventing complications of this usually low-risk procedure.

Anesthesia, General↗