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Biomedical subjects

H Morgenstern

Publications and source records attributed to H Morgenstern.

At least 37 records · Page 2Linked to original sources
PubMed1999

The effect of comorbidity on care seeking for back problems in the United States.

PURPOSE: We assess the effect of comorbidity on self-reported use of health care for back problems in the United States. METHODS: Data from the 1989 National Health Interview Survey (NHIS) were used to perform cross-sectional analyses of adults who reported a back-related condition. The presence of one or more nonback-related conditions (and associated disability and health care) were the primary predictor variables. Weighted logistic regression modeling was performed to estimate odds ratios (ORs) adjusted for the effects of covariates. RESULTS: The 1989 NHIS included 84,572 adults, of which 4790 (5.7%) reported at least one back-related condition. Of these, 931 (19.6%) sought health care for their back condition during the 2-week reference period. Among all adults with reported back problems, those with disabling comorbidities and those who sought care for their comorbidities during the reference period were less likely to have sought back care than were those with no comorbidities. Subjects with back-related disabilities who reported nondisabling comorbidities without associated health care were much more likely to have sought back care than were similar subjects without any comorbidities. CONCLUSIONS: The decision to seek care for a back problem is a complex process that depends upon the presence and impact of other conditions and the use of care for these conditions. Comorbid back problem sufferers may not seek back care when afflicted with other disabling conditions or conditions that may be perceived to be more amenable to care.

Adult↗
PubMed1999

Chemical exposures of rocket-engine test-stand personnel and cancer mortality in a cohort of aerospace workers.

We conducted a retrospective cohort study of 6107 aerospace workers to examine whether exposure to chemicals--primarily hydrazine fuels--during rocket-engine fueling and testing affects cancer mortality. When conditional logistic regression analysis was applied and adjusted for confounding variables, the estimated rate ratio for lung cancer mortality, comparing exposed to unexposed workers from the same facility, ranged from 1.68 (95% confidence interval, 1.12 to 2.52) to 2.10 (95% confidence interval, 1.36 to 3.25), depending on job-duration threshold (6 or 24 months) and lag (0 to 15 years). Similar results were obtained for hemato- and lymphopoietic cancer and for bladder and kidney cancer mortality, but estimates for these cancers were imprecise. We concluded that occupational exposure to hydrazine or other chemicals associated with rocket-engine testing jobs increased the risk of dying from lung cancer, and possibly other cancers, in this population of aerospace workers; however, our results need to be replicated in other populations.

Carcinogens↗
PubMed1999

Randomised double-blind comparison of the incidence of tardive dyskinesia in patients with schizophrenia during long-term treatment with olanzapine or haloperidol.

BACKGROUND: Tardive dyskinesia is important in the side-effect profile of antipsychotic medication. AIMS: The development of tardive dyskinesia was evaluated in patients treated with double-blind, randomly assigned olanzapine or haloperidol for up to 2.6 years. METHODS: Tardive dyskinesia was assessed by the Abnormal Involuntary Movement Scale (AIMS) and Research Diagnostic Criteria for Tardive Dyskinesia (RD-TD), it was defined as meeting RD-TD criteria at two consecutive assessments. The risk of tardive dyskinesia, the relative risk, incidence rate, and incidence rate ratio were estimated. RESULTS: The relative risk of tardive dyskinesia for the overall follow up period for haloperidol (n = 522) v. olanzapine (n = 1192) was 2.66 (95% CI = 1.50-4.70). Based on data following the initial six weeks of observation (during which patients underwent medication change and AIMS assessments as frequently as every three days), the one-year risk was 0.52% with olanzapine (n = 513) and 7.45% with haloperidol (n = 114). The relative risk throughout this follow-up period was 11.37 (95% CI = 2.21-58.60). CONCLUSION: Our results indicated a significantly lower risk of tardive dyskinesia with olanzapine than with haloperidol.

Antipsychotic Agents↗
PubMed1999

Elevated asthma morbidity in Puerto Rican children: a review of possible risk and prognostic factors.

Latino children represent a significant proportion of all US children, and asthma is the most common chronic illness affecting them. Previous research has revealed surprising differences in health among Latino children with asthma of varying countries of family origin. For instance, Puerto Rican children have a higher prevalence of asthma than Mexican American or Cuban American children. In addition, there are important differences in family structure and socioeconomic status among these Latino populations: Cuban Americans have higher levels of education and family income than Mexican-Americans and Puerto Ricans; mainland Puerto Rican children have the highest proportion of households led by a single mother. Our review of past research documents differences in asthma outcomes among Latino children and identifies the possible genetic, environmental, and health care factors associated with these differences. Based on this review, we propose research studies designed to differentiate between mutable and immutable risk and prognostic factors. We also propose that the sociocultural milieus of Latino subgroups of different ethnic and geographic origin are associated with varying patterns of risk factors that in turn lead to different morbidity patterns. Our analysis provides a blue-print for future research, policy development, and the evaluation of multifactorial interventions involving the collaboration of multiple social sectors, such as health care, public health, education, and public and private agencies.

Asthma↗
PubMed1999

Age at exposure modifies the effects of low-level ionizing radiation on cancer mortality in an occupational cohort.

In a cohort of 4,563 nuclear workers followed retrospectively from 1950 to 1994, we found that age at exposure modified the effects of external radiation dose on cancer mortality. Analyses involved application of conditional logistic regression to risk sets of age- and calendar time-matched cancer deaths, with covariates treated as time dependent and with cumulative radiation doses divided according to the age intervals in which exposure occurred. After adjustment for confounding factors, we found that workers exposed to external radiation after the age of 50 years experienced exposure-related elevations in mortality from cancer at any site [rate ratio (RR) = 1.98; 95% confidence interval (CI) = 0.63-6.26], radiosensitive solid cancer (RR = 3.29; 95% CI = 1.10-9.89), and lung cancer (RR = 3.89; 95% CI = 1.23-12.3) substantially greater (1.6- to 3.5-fold greater) than were seen in coworkers exposed at all earlier ages. In contrast, all of the radiation doses contributing to mortality from cancers of the blood and lymph system were received before age 50 (for age <50, RR = 2.73 and 95% CI = 1.46-5.10; for age > or =50, RR = 0.24 and 95% CI = 0.00-687). Our results for cancer of any site are consistent with the results of previous studies examining the effects of exposure age in nuclear workers. Thus, effects of low-level radiation doses may depend on exposure age, and furthermore, patterns of effect modification by age may differ by type of cancer.

Age Factors↗
PubMed1999

Marijuana use and increased risk of squamous cell carcinoma of the head and neck.

Marijuana is the most commonly used illegal drug in the United States. In some subcultures, it is widely perceived to be harmless. Although the carcinogenic properties of marijuana smoke are similar to those of tobacco, no epidemiological studies of the relationship between marijuana use and head and neck cancer have been published. The relationship between marijuana use and head and neck cancer was investigated by a case-control study of 173 previously untreated cases with pathologically confirmed diagnoses of squamous cell carcinoma of the head and neck and 176 cancer-free controls at Memorial Sloan-Kettering Cancer Center between 1992 and 1994. Epidemiological data were collected by using a structured questionnaire, which included history of tobacco smoking, alcohol use, and marijuana use. The associations between marijuana use and head and neck cancer were analyzed by Mantel-Haenszel methods and logistic regression models. Controlling for age, sex, race, education, alcohol consumption, pack-years of cigarette smoking, and passive smoking, the risk of squamous cell carcinoma of the head and neck was increased with marijuana use [odds ratio (OR) comparing ever with never users, 2.6; 95% confidence interval (CI), 1.1-6.6]. Dose-response relationships were observed for frequency of marijuana use/day (P for trend <0.05) and years of marijuana use (P for trend <0.05). These associations were stronger for subjects who were 55 years of age and younger (OR, 3.1; 95% CI, 1.0-9.7). Possible interaction effects of marijuana use were observed with cigarette smoking, mutagen sensitivity, and to a lesser extent, alcohol use. Our results suggest that marijuana use may increase the risk of head and neck cancer with a strong dose-response pattern. Our analysis indicated that marijuana use may interact with mutagen sensitivity and other risk factors to increase the risk of head and neck cancer. The results need to be interpreted with some caution in drawing causal inferences because of certain methodological limitations, especially with regard to interactions.

Adult↗
PubMed1998

Neutropenia is a risk factor for gram-negative bacillus bacteremia in human immunodeficiency virus-infected patients: results of a nested case-control study.

A previous cohort study demonstrated a relation between neutropenia and bacteremia due to gram-negative bacilli among patients infected with human immunodeficiency virus (HIV). To explore further the relation between neutropenia and bacteremia due to Escherichia coli, Klebsiella pneumoniae, or Pseudomonas aeruginosa among HIV-infected patients, controlling for confounding factors, the authors conducted a nested case-control study with matching and risk-set sampling of controls. The cohort included 1,645 HIV-infected patients followed at the University of California, San Diego, Medical Center in San Diego, California, between 1991 and 1995. Absolute neutrophil count (ANC) was summarized as mean ANC during the 7-day interval preceding the index date of bacteremia. Covariates were ascertained by medical record review. The matching ratio was 6:1 (controls:cases). Odds ratios were estimated using conditional logistic regression. Forty-four incident cases of bacteremia were identified. After adjustment for covariates, the estimated odds ratio for the effect of neutropenia (ANC=500 vs. >500/microl) during the 7 days preceding the index date was 8.1 (95% confidence interval confidence interval 1.5-43.1). The rate of bacteremia due to E. coli, K. pneumoniae, or P. aeruginosa is increased eightfold if the average current-week ANC is less than or equal to 500/microl compared with more than 500/microl.

AIDS-Related Opportunistic Infections↗
PubMed1998

Birth weight and renal disease in Pima Indians with type 2 diabetes mellitus.

Congenital retardation of renal development may increase the risk of renal disease, and this risk may be enhanced by diseases, such as diabetes, that damage the kidney. In this study, the prevalence of urinary albumin excretion, determined in 308 Pima Indians with type 2 diabetes, was 63% in subjects with low birth weight (<2,500 g), 41% in those with normal birth weight (2,500-4,499 g), and 64% in those with high birth weight (> or =4,500 g). When examined as a continuous variable by generalized additive logistic regression, birth weight had a U-shaped association with the prevalence of elevated urinary albuminuria (p = 0.04) after adjustment for age, sex, duration of diabetes, glycosylated hemoglobin, and blood pressure. The odds of elevated albuminuria in subjects of low birth weight was 2.3 times (95% confidence interval 0.72-7.2) that in subjects of normal birth weight, and the odds in subjects of high birth weight was 3.2 times (95% confidence interval 0.75-13.4) as high. Sixty-four percent of the subjects with high birth weight and none of those with low birth weight were offspring of diabetic mothers. After maternal diabetes during pregnancy was controlled for, the odds of elevated albuminuria in subjects of high birth weight was no longer higher (odds ratio = 1.0, 95% confidence interval 0.22-4.9). The higher prevalence of elevated albuminuria in diabetic Pima Indians with high birth weight may be due to intrauterine diabetes exposure, whereas the higher prevalence in those with low birth weight may be due to the effects of intrauterine growth retardation.

Adolescent↗
PubMed1998

An epidemic of proteinuria in Pima Indians with type 2 diabetes mellitus.

BACKGROUND: The risk of proteinuria in Type 1 diabetes declined > or = 30% over the past 50 years, and improvements in metabolic control are believed to be largely responsible. Little is known about secular changes in the risk of proteinuria in Type 2 diabetes. METHODS: We examined trends in the incidence rate of proteinuria in Pima Indians > or = 20 years of age with diabetes diagnosed between January 1, 1955 and December 31, 1994. RESULTS: Among 1305 initially non-proteinuric diabetic subjects, 433 developed proteinuria during a median follow-up of 8.0 years (range 0.8 to 30.2 years). With subjects with diabetes diagnosed between 1955 and 1964 serving as the reference group, the rate of proteinuria was similar (rate ratio 1.0; 95% confidence interval, 0.79 to 1.3) in the cohort diagnosed between 1965 and 1974, 1.5 times as high (95% confidence interval, 1.1 to 2.0) in the cohort diagnosed between 1975 and 1984, and 1.9 times as high (95% confidence interval, 1.1 to 3.0) in the cohort diagnosed between 1985 and 1994, after adjusting for potential confounders in a generalized additive proportional hazards model. Between the first and last cohorts, plasma glucose concentration declined, on average, by 17% (P = 0.0001) and the mean arterial pressure declined by 11% (P = 0.0001). CONCLUSIONS: The incidence rate of proteinuria in Pima Indians with Type 2 diabetes increased nearly twofold in the last 40 years, despite improvements in plasma glucose and blood pressure. Rapidly changing environmental or behavioral factors must play an important role in the pathogenesis of diabetic renal disease in this population.

Adult↗
PubMed1998

Alcoholic beverage consumption and lung cancer risk among residents of Los Angeles County.

Although studies generally support a positive association between alcohol consumption and lung-cancer risk, the relationship between specific alcoholic beverages and lung-cancer risk has been inconsistent. We examined recent and past alcoholic beverage intake among 261 incident cases and 615 population controls enrolled in a lung-cancer case-control study of African Americans and Caucasians in Los Angeles County between 1991 and 1994. An in-person interview elicited information about past alcohol intake from ages 30 to 40 y, smoking, other lung-cancer risk factors, as well as recent intake of alcohol, and recent dietary intake. An association was observed between recent hard-liquor consumption and lung-cancer risk. The odds ratio (OR) for 1 or more drinks (1.5 oz or 0.051 mL) per day of hard liquor compared with infrequent liquor drinking (0-3 drinks per month), adjusted for smoking, the matching factors, saturated fat and other alcoholic beverages was 1.87 [95% confidence interval (CI) = 1.02-3.42]. No appreciable association was observed for total alcohol, whereas small inverse associations were observed for beer and wine, although confidence intervals were wide. An elevated lung-cancer risk was also observed for past liquor consumption (between ages 30 and 40 y). The adjusted OR for 1 or more drinks per day of liquor compared with infrequent drinkers was 1.83 (95% CI = 1. 06-3.15). Confounding of the association between alcohol and lung cancer by smoking was apparent. Although we devoted considerable efforts to adjusting for smoking in our analyses, residual confounding is still possible because smoking and alcohol are closely associated. In addition, case-control studies including this study should be viewed with caution because of possible selection bias. An increased risk of lung cancer might occur with moderate drinking of hard liquor but confirmation is required in larger studies.

Alcohol Drinking↗
PubMed1998

Intrauterine diabetes exposure and the risk of renal disease in diabetic Pima Indians.

The association between the diabetic intrauterine environment and renal disease was examined cross-sectionally in 503 Pima Indians with type 2 diabetes. Subjects were selected from participants in an ongoing study of diabetes and its complications in the Gila River Indian Community of Arizona. Subjects' exposure to diabetes in utero was established from periodic examinations conducted as part of the study. The prevalence of elevated urinary albumin excretion (UAE) (albumin-to-creatinine ratio > or = 30 mg/g) was 40% (83 of 207) in the offspring of nondiabetic mothers, 43% (105 of 246) in the offspring of prediabetic mothers (i.e., women who were not diabetic at the time of the pregnancy but who developed diabetes after the pregnancy), and 58% (29 of 50) in the offspring of mothers who had diabetes during pregnancy. After controlling for age, sex, duration of diabetes, HbA1c, and mean arterial pressure in the offspring in a logistic regression analysis using generalized estimating equations, maternal diabetes during pregnancy was strongly associated with elevated UAE. The odds of elevated UAE in the offspring of mothers who had diabetes during pregnancy was 3.8 times (95% CI 1.7-8.4) that of the offspring of prediabetic mothers; the odds of elevated UAE in the offspring of nondiabetic and prediabetic mothers were similar (odds ratio of 0.94; 95% CI 0.59-1.5). We concluded that exposure to a diabetic intrauterine environment increases the risk of elevated UAE in diabetic Pima Indians. The effect of this exposure appears to be independent of other susceptibility factors that lead to nephropathy in diabetes.

Adolescent↗
PubMed1998

Female breast cancer and trihalomethane levels in drinking water in North Carolina.

Some studies indicate that chlorination by-products in drinking water may contribute slightly to breast cancer risk. This ecologic study describes the association between total trihalomethane levels in publicly supplied water and the incidence of female invasive breast cancer. We included 71 North Carolina water suppliers serving at least 10,000 customers in the summer of 1995 as the units of analysis. We estimated incidence rates using 6,462 cases who were either white or black and between 35 and 84 years old and were linked by zip codes to the water supplier. We treated ecologic measurements of age, income, education, urban status, and race as potential confounders. Total trihalomethane levels were not associated materially with breast cancer risk, adjusting for potential confounders. The rate ratio for 80.0 parts per billion (ppb) or more vs less than 40.0 ppb total trihalomethanes was 1.1 [95% confidence interval (CI) = 0.9-1.2]. When stratified by race, the observed association for the aforementioned total trihalomethane category was not very different in black women (rate ratio = 1.2; 95% CI = 0.8-1.8) than in white women (rate ratio = 1.1; 95% CI = 0.9-1.3). These ecologic data are compatible with trihalomethanes in drinking water being either unrelated or weakly related to breast cancer risk.

Adult↗
PubMed1998

Recent use of hormone replacement therapy and the prevalence of colorectal adenomas.

The etiological role of hormone replacement therapy (HRT) (including estrogen only, combined estrogen-progesterone, and progesterone only) in colorectal neoplasia remains unclear. Several large studies have reported a reduced risk of colorectal cancer among HRT users; however, other studies have given inconsistent results. We examined the association between HRT and colorectal adenomatous polyps, precursors of colorectal cancer, among female participants in a case-control study. Subjects were members of a prepaid health plan in Los Angeles who underwent sigmoidoscopy in 1991-1993. Participants received an in-person interview and completed a food frequency questionnaire. A total of 187 histologically confirmed cases and 188 controls, ages 50-75 years, were included in the analysis. Compared with women who did not use HRT during the year before sigmoidoscopy, recent users had an adjusted odds ratio of 0.57 (95% confidence interval, 0.35-0.94). Duration of use was inversely related to the prevalence of colorectal adenomas, with a multivariate-adjusted odds ratio of 0.49 (95% confidence interval, 0.25-0.97) for use of 5 years or more. These results support a protective effect of HRT on colorectal adenomatous polyps.

Adenomatous Polyps↗
PubMed1997

The effects of comorbidity and other factors on medical versus chiropractic care for back problems.

STUDY DESIGN: This study is a cross-sectional analysis of adults in the United States who reported at least one back-related visit to a health care professional during a 2-week reference period. OBJECTIVES: To estimate and compare the effects of comorbidity and other factors on self-reported use of medical and chiropractic care for back problems in the United States. SUMMARY OF BACKGROUND DATA: Although back pain is the second most frequent primary symptom reported by patients seeking medical care and the most frequent primary symptom among chiropractic patients, there is a dearth of research on the predictors of chiropractic and medical care among back pain patients. METHODS: Data from the 1989 National Health Interview Survey were used to perform a cross-sectional analysis of adults who sought care for a back-related condition. The primary predictor variables included comorbidity and associated disability, sociodemographic variables, and back-problem-related variables. Weighted logistic regression modeling was performed to estimate odds ratios adjusted for the effects of covariates. RESULTS: Of the 4790 adults with reported back problems, 931 sought health care for their back condition during the 2-week reference period. Adults with disabling comorbidities and back-related restricted-activity days were relatively less likely to use chiropractic care than primary medical care. Those who were male, high-school educated, single, employed, and with more than nine doctor visits during the previous 12 months were relatively more likely to use chiropractic care than primary medical care. CONCLUSIONS: The presence of comorbidity-related or back-related disability, as well as other factors, affect the type of care sought for back conditions among adults in the United States.

Adolescent↗
PubMed1997

Behaviors as risk factors for rehospitalization: implications for predicting and preventing admissions among the seriously mentally ill.

This case-control study investigated the extent to which aberrant behaviors, in contrast to more traditional clinical factors (such as symptoms and alcohol abuse), place individuals with schizophrenia at increased risk for rehospitalization. One hundred and one recidivists (cases) were matched to 101 non-recidivists (controls) on gender, race, and time since index hospitalization. Key informants, usually family members, were interviewed to assess behaviors during a 2-week period. After controlling for possible confounding variables, we found that each aberrant behavior increased the risk for rehospitalization, but highly disruptive or dangerous behaviors (such as threatening others, acting very bizarrely, or attempting suicide) conveyed a markedly high degree of risk (adjusted odds ratio = 83.9). It is possible that service providers may be able to avert the fiscal and emotional cost of hospitalization by collaborating more closely with family members to identify these behaviors and intervene before hospitalization becomes unavoidable.

Adult↗
PubMed1997

Correlates of back problems and back-related disability in the United States.

The purpose of this study is to identify correlates of back problems and back disability in the adult population of the United States. Cross-sectional analyses were performed using data from the 1989 National Health Interview Survey (NHIS). Weighted polytomous logistic regression modeling was performed to estimate odds ratios adjusted for the effects of covariates. The prevalence of a disabling back condition, vs. no back condition, was relatively higher among subjects aged 25-64 years, male, non-high-school graduates, unemployed, living in the West, with disabling non-back morbidities, and with body mass index and weight above the 50th percentile. Among workers, those in technical, sales, clerical, private household, service, precision production and repair, or transportation occupations were relatively more likely to report disabling back conditions, compared to workers in professional occupations. Among adults with back problems, age greater than 34 years, weight above the 50th percentile, and history of back trauma were associated with chronic back disability. Although the magnitudes of the associations are not large, they may have enormous public health implications because of the high prevalence of back problems and related disability.

Adult↗