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Biomedical subjects

J R Daling

Publications and source records attributed to J R Daling.

At least 127 records · Page 7Linked to original sources
PubMed1994

Non-contraceptive hormones and the risk of rheumatoid arthritis in menopausal women.

BACKGROUND: Several reproductive factors appear to affect a women's risk of developing rheumatoid arthritis. This study's purpose was to determine whether use of non-contraceptive hormones is among them. METHODS: A population-based case-control study was conducted in King County, Washington and Group Health Cooperative of Puget Sound, a prepaid health plan. New cases of rheumatoid arthritis in peri- or postmenopausal women (n = 135) were verified through clinical examination and compared with 592 controls. Both groups were interviewed in person about hormone use and demographic and reproductive factors. RESULTS: The age-adjusted relative risk (RR) among women who had ever used non-contraceptive oestrogens was 1.04 (95% confidence interval [CI]: 0.70-1.55), and among women who had ever used progestins it was 0.66 (95% CI: 0.40-1.08). For current users of oestrogen only, the RR was 0.97 (95% CI: 0.62-1.53), and among current users of oestrogen plus progestin it was 0.81 (95% CI: 0.45-1.45). Multivariate analyses yielded similar results. There was little evidence of a dose-response relationship with duration of use or with frequency of progestin use. CONCLUSIONS: Use of non-contraceptive oestrogens appears to have little effect on the risk of developing rheumatoid arthritis in menopausal women. There may be a modest reduction in risk among progestin users.

Adolescent↗
PubMed1994

Aspartame ingestion and headaches: a randomized crossover trial.

To examine whether ingestion of aspartame is associated with headaches, we conducted a double-blind crossover study using volunteers with self-identified headaches after using aspartame. Of the 32 subjects randomized to receive aspartame (approximately 30 mg/kg/d) and placebo in a two-treatment, four-period crossover design, 18 completed the full protocol, seven completed part of the protocol before withdrawing due to adverse effects, three withdrew for other reasons, two were lost to follow-up, one was withdrawn due to noncompliance, and one withdrew and gave no reason. Each experimental period was 7 days long. Subjects reported headaches on 33% of the days during aspartame treatment, compared with 24% on placebo treatment (p = 0.04). Subjects who were "very sure" prior to the study that aspartame triggered some of their headaches reported larger treatment differences (aspartame = 0.37 headache-days, placebo = 0.18 headache-days; p < 0.001) than subjects who were "somewhat sure" (aspartame = 0.29 headache-days, placebo = 0.22 headache-days; p = 0.51) or "not sure" (aspartame = 0.33 headache-days, placebo = 0.39 headache-days; p = 0.51). There was no significant treatment difference in the length or intensity of headaches or in the occurrence of side effects associated with the headaches. This experiment provides evidence that, among individuals with self-reported headaches after ingestion of aspartame, a subset of this group report more headaches when tested under controlled conditions. It appears that some people are particularly susceptible to headaches caused by aspartame and may want to limit their consumption.

Adult↗
PubMed1994

Exposure to hair-coloring products and the risk of multiple myeloma.

An interview study of persons diagnosed with multiple myeloma between 1977 and 1981 and suitable control subjects was conducted to test the hypothesis that exposure to hair dyes increases the risk of multiple myeloma. Among women, there was little evidence that prior regular use of hair dyes (odds ratio [OR] = 1.0; 95% confidence interval [CI] = 0.70, 1.4) or prior employment as a hairdresser (OR = 1.1; 95% CI = 0.43, 2.7) increased risk; however, the former comparison was limited by the lack of detailed information concerning the exposure. Among men, there was a modest association of regular use of hair dyes (OR = 1.5; 95% CI = 0.75, 2.9) with myeloma, but this was based on a small number of exposed persons.

Beauty Culture↗
PubMed1994

Pregnancy risk factors and birth outcomes in Washington State: a comparison of Ethiopian-born and US-born women.

This study compared birth outcomes of three cohorts of women with singleton live births in Washington State between 1980 and 1991: all Black Ethiopian-born women (n = 264) and samples of US-born Black (n = 526) and White (n = 546) women. Ethiopians were older, more likely to be married, and less likely to smoke than were US-born women, and they were less likely to have anemia than US-born Blacks. The adjusted low-birthweight risk among Ethiopians was similar to that of US-born Blacks (relative risk [RR] = 0.9) and Whites (RR = 1.1). Ethiopians were more likely to have high-birthweight infants than were US-born Blacks (RR = 4.0). Cultural and behavioral etiologies may explain these favorable birth outcomes.

Adolescent↗
PubMed1994

Hormonal factors in vulvar cancer. A case-control study.

As part of a case-control study of vulvar cancer, we examined the role of reproductive history, menstrual history, exogenous estrogen use and body mass in the etiology of this disease. A total of 330 women with vulvar squamous cell cancer (259 in situ, 81 invasive), aged 18-79 years, who were diagnosed with this tumor during 1980-1990 were interviewed. Their responses were compared to those of 1,010 women who were selected from the general population by means of random digit dialing. Cases and controls did not differ regarding age at menopause, parity, number of prior pregnancies or number of prior births, history of miscarriage or use of noncontraceptive estrogens. Women diagnosed with vulvar cancer were slightly more likely to have experienced menarche at < 12 years (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.2-2.7, in situ cancer; OR = 1.6, 95% CI = 0.8-3.1, invasive cancer), to have excess weight (invasive cancer only, OR = 2.9, 95% CI = 1.5-5.8 for highest tertile of Quetelet's index) and, among gravid women, to have had their first pregnancy after age 24 (in situ cancer only, OR = 1.5, 95% CI = 0.9-2.5). These data, together with similar results from previous studies and quantitative studies of hormone receptors in vulvar tissue, suggest that in situ and invasive vulvar cancer are not strongly hormone dependent tumors.

Adolescent↗
PubMed1994

Smoking, obesity, alcohol consumption, and the risk of rheumatoid arthritis.

There is some evidence that sex hormones may influence the incidence of rheumatoid arthritis. Obesity has been found to increase endogenous estrogens, particularly among postmenopausal women. Although the association of endogenous hormones with smoking and alcohol use is less clear, we examined the relation of these three factors with rheumatoid arthritis in women. We conducted a population-based case-control study of rheumatoid arthritis in King County, WA, and Group Health Cooperative of Puget Sound. We compared 349 incident cases of rheumatoid arthritis with 1,457 controls selected by random digit dialing or by random selection from the enrollment files of Group Health Cooperative. We conducted personal interviews to collect data on weight, smoking, alcohol history, reproductive variables, and other demographic variables. Women with 20 or more pack-years of smoking had a relative risk of 1.5 [95% confidence interval (CI) = 1.0-2.0] compared with never-smokers. Post-menopausal women who averaged more than 14 alcoholic drinks per week had a reduced risk of rheumatoid arthritis (relative risk = 0.5; 95% CI = 0.2-1.7). Women in the highest quartile of body mass index had a risk of 1.4 (95% CI = 1.0-2.0) relative to women with lowest body mass index.

Adolescent↗
PubMed1994

Risk factors for breast cancer in younger women.

Epidemiologic studies of breast cancer that have included younger, premenopausal women in their populations have found that factors that predict altered risk of breast cancer after menopause can have different or even reversed effects before menopause. We have reviewed the literature on risk factors for breast cancer and their associations with breast cancer in general, and compared the risks for younger women with those for women diagnosed at older ages. Race, parity, and large body size are factors that may have opposite effects on breast cancer risk in younger and older women. Other factors of particular significance in the etiology of early-onset breast cancer include a late age at first birth, never having lactated, oral contraceptive use at early ages or of long duration, a family history of breast cancer, and a history of proliferative benign breast disease.

Adult↗
PubMed1993

History of lactation and breast cancer risk.

A self-administered questionnaire was completed by 1,018 women diagnosed with breast cancer during 1988-1989 identified through the British Columbia Cancer Registry and by 1,025 controls selected at random from the Provincial Voters List. Parous premenopausal women who had never nursed (odds ratio (OR) = 1.3, 95% confidence interval (CI) 0.9-2.0) or who had lactated for 1 month or less (OR = 1.8, 95% CI 1.3-2.5) had an increased risk of breast cancer adjusted for age and parity, compared with women who had breast-fed 2 months or longer. The risk was particularly elevated (OR = 3.0, 95% CI 1.6-5.4) among women who reported having tried to nurse, but who were unsuccessful. Among women who nursed for at least 2 months, there was an indication of decreasing risk with increasing duration of nursing. Among postmenopausal parous women, no relation between lactation history and breast cancer risk was evident.

Adult↗
PubMed1993

History of circumcision, medical conditions, and sexual activity and risk of penile cancer.

BACKGROUND: Epidemiological evidence suggests lack of neonatal circumcision as the strongest risk factor for penile cancer, but the role of sexually transmitted diseases in the etiology of penile cancer has remained unclear. PURPOSE: To further clarify risk factors for penile cancer, we examined the role of circumcision, personal characteristics and habits (such as smoking), sexually transmitted diseases, past sexual activity, and medical conditions of the penis. METHODS: A population-based, case-control study was conducted in western Washington state and in the province of British Columbia. We interviewed 110 men with penile cancer diagnosed from January 1979 to July 1990 and 355 control subjects from the general population, frequency matched to case subjects on age and date of diagnosis. Tumor tissue from 67 case subjects was tested for human papillomavirus (HPV) DNA by polymerase chain reaction. Results of blood tests from 69 case subjects and 208 control subjects were available for study. STATISTICALLY SIGNIFICANT RESULTS: Relative to men circumcised at birth, the risk for penile cancer was 3.2 times greater among men who were never circumcised and 3.0 times greater among men who were circumcised after the neonatal period. For current smokers, the risk was 2.8 times that of men who never smoked. The risk among men reporting a history of genital warts was 5.9 times that of men reporting no such history. Of 67 tumors tested for HPV DNA, 49% were positive; the majority of these positive tumors (70%) were type 16, which has been associated with anogenital carcinoma. Relative risks (RRs) associated with a reported history of penile rash or penile tear were 9.4 and 3.9, respectively. Among men not circumcised at birth, RRs associated with presence of smegma and difficulty in retracting the foreskin were 2.1 and 3.5, respectively. Twenty-eight percent of case subjects, compared with only 10% of control subjects, reported 30 or more sexual partners, and men with HPV-positive tumors were more likely to report a greater number of sexual partners. CONCLUSIONS: These results suggest that the absence of neonatal circumcision and potential resulting complications are associated with penile cancer. Additionally, medical conditions of the penis, sexual activity, infection with HPV, and smoking may increase the risk for penile cancer. IMPLICATIONS: A larger study would allow examination of interrelationships of circumcision, infection with HPV, and smoking as risk factors.

Aged↗
PubMed1993

Fecundity before disease onset in women with rheumatoid arthritis.

OBJECTIVE: To examine fecundity prior to disease onset in women with rheumatoid arthritis (RA). METHODS: Two hundred fifty-nine RA patients with an opportunity for pregnancy were compared with 1,258 control women as part of a prospective case-control study of recent-onset RA in women. RESULTS: A 12-month or longer interval to pregnancy was found in 42% of RA cases compared with 34% of controls (odds ratio = 1.44, 95% confidence interval 1.10, 1.91). This difference was not accounted for by an older age when attempting to become pregnant among the RA cases compared with the controls. The result was unrelated to rheumatoid factor or HLA-DR4 status. CONCLUSION: Women with RA were found to have decreased fecundity prior to disease onset, compared with control women.

Adolescent↗
PubMed1993

Epidemiology of the M-component immunoglobulin types of multiple myeloma.

The purpose of this population-based case-control study was to learn whether risk factors differ for the individual immunoglobulin types of multiple myeloma. In particular, we sought to determine whether IgA and IgG myeloma were related to a history of exposure to reported IgA- and IgG-stimulating conditions, respectively, or to a history of selected occupational and physicochemical exposures. The M-component immunoglobulin type was determined from immunoelectrophoresis as reported in medical records, and exposure status was obtained through in-person interviews. IgG (56 percent) and IgA (22 percent) M-components predominated. For 17 percent of cases, no peak was found on immunoelectrophoresis; they were presumed to have light-chain myeloma. Persons with these three types of myeloma did not differ with respect to distributions of age or race, but a somewhat higher proportion of light-chain cases were women (58 percent cf 45 percent of all other cases). Detailed analysis of the IgA and IgG subtypes provided little evidence that they differ with respect to prior immune stimulation or employment in several specific jobs. IgA myeloma, but not IgG myeloma, was associated modestly with a history of exposure to chest and dental X-rays. Our study provides little evidence that IgA and IgG myeloma differ with respect to the risk factors examined.

Benzene↗
PubMed1993

The association between Chlamydia trachomatis serology and pelvic damage in women with tubal ectopic gestations.

OBJECTIVE: To determine whether pelvic damage is associated with positive Chlamydia trachomatis serology in women with tubal ectopic pregnancy. DESIGN: Cross-sectional retrospective study. SETTING: A prepaid health maintenance organization. PATIENTS: Two-hundred eighty-one women admitted with confirmed tubal ectopic pregnancy were interviewed for history of sexually transmitted diseases. Chlamydia serology was obtained for 135 subjects, and operative findings were available for 121 of these. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Pelvic damage, as determined by review of operative findings of the pelvis at the time of ectopic surgery. RESULTS: Pelvic damage was associated with positive chlamydia serology with an adjusted odds ratio of 4.2 (95% confidence interval: 1.8 to 9.7). Moderate and severe pelvic damage were more strongly associated with positive serology than mild damage. CONCLUSIONS: Women with ectopic pregnancies and antibodies to C. trachomatis are more likely to have damaged pelves than women with ectopic pregnancies without such antibodies. Prevention or early treatment of C. trachomatis infection may reduce pelvic damage and, therefore, reduce incidence of ectopic pregnancy.

Adult↗
PubMed1993

Low birthweight in twins: black and white differences.

Washington State birth certificate data for the years 1984-1988 were analyzed for 2,804 mothers of twins in order to determine whether black mothers of twins have a higher risk of delivering a low birthweight twin infant than white mothers. Seventy four percent of black mothers of twins gave birth to an infant weighing < 2500 grams (white 52.9%), while slightly less than 20% gave birth to an infant weighing < 1500 grams (white 9.4%). After adjustment for maternal age, parity and marital status, the risk of black mothers giving birth to at least one twin infant < 2500 grams relative to white mothers was 1.3 (95% confidence interval, 1.2, 1.5). When this analysis was restricted to very low birthweight babies (< 1500 grams), the relative risk for infants of black mothers compared to white mothers adjusted for the same factors was 2.1 (95% confidence interval, 1.5, 3.0). The frequency of neonatal mortality in the study population was also assessed. The overall frequency of mortality in black twin infants was double that in white twin infants. When stratified by birthweight category, the frequency was higher in white infants (30.2%) than in black infants (24.1%) weighing less than 1500 grams at birth. However, within higher birthweight categories, (> or = 1500 grams to < 2500 grams and > 2500 grams), relative frequencies of neonatal mortality were higher in black infants. This analysis reveals that black mothers of twins are more likely to deliver low birthweight twin infants than white mothers. The increased risk is even more pronounced in very low birthweight twin pairs. However, the additional risks for low birthweight black twin pairs and very low birthweight twin pairs found in this study are lower than the risk increase commonly reported for the respective birthweight categories in black singleton infants relative to white singleton infants. This implies that while black twin pregnancies require many of the same special antepartum considerations given to black singleton pregnancies, the increased baseline risks associated with low birthweight and very low birthweight twin deliveries offset racial disparities traditionally seen in singleton infants.

Adolescent↗
PubMed1993

Past use of an intrauterine device and risk of tubal pregnancy.

We assessed risk of tubal pregnancy associated with past use of an intrauterine device (IUD). Cases were 256 members of Group Health Cooperative of Puget Sound who experienced a tubal pregnancy between 1981 and 1986. Controls were 666 female members of the Cooperative at risk of ectopic pregnancy who were similar to cases with respect to age and county of residence, but otherwise selected at random. The presence of antibody to Chlamydia trachomatis was assessed in a sample of 134 cases and 182 controls. Women who had previously used an IUD for 3 or more years were more than twice as likely as women who had never used an IUD to have a tubal pregnancy (adjusted relative risk = 2.5, 95% confidence interval = 1.5-4.3). Among these long-term users of an IUD, risk of tubal pregnancy remained elevated for many years after the device was removed. Also, among long-term users, women known to have more than one IUD insertion were no more likely than women with one known insertion to develop a tubal pregnancy. When we restricted our analyses to women who used only copper-containing devices, the results were nearly identical. We conclude that extended past use of an IUD, including use of a copper device, increases the risk of tubal pregnancy.

Adolescent↗
PubMed1993

Current use of an intrauterine device and risk of tubal pregnancy.

Using data from a population-based, case-control study, we assessed risk of tubal pregnancy associated with use of an intrauterine device (IUD) at the time of conception. Cases were 249 members of Group Health Cooperative of Puget Sound who experienced a tubal pregnancy between 1981 and 1986. Controls were 831 members at risk of ectopic pregnancy who were similar to cases with respect to age and county of residence, but otherwise selected at random. Risk of tubal pregnancy associated with current IUD use was compared separately to that among users of various other (or no) contraceptive methods. Tubal pregnancy was more likely to occur among IUD users than among women using oral contraceptives [relative risk (RR) = 3.8, 95% confidence interval (CI) = 1.5-9.9] or barrier methods (RR = 3.6, 95% CI = 1.6-8.1), or, to a lesser extent, among women who had been surgically sterilized (RR = 1.6, 95% CI = 0.8-3.5). In contrast, IUD users were much less likely to experience a tubal pregnancy (RR = 0.2, 95% CI = 0.1-0.4) than were women who were currently not contracepting. For most women, the decision to use an IUD occurs within the context of choosing among various contraceptive methods. Our results indicate that, for these women, the decision to use an IUD results in increased risk of ectopic pregnancy while the device is in use.

Adolescent↗
PubMed1993

Association of anal dysplasia and human papillomavirus with immunosuppression and HIV infection among homosexual men.

OBJECTIVE: To examine and quantify the association between anal squamous intraepithelial lesions (ASIL), anal human papillomavirus (HPV) infection and immunosuppression among HIV-seropositive and HIV-seronegative homosexual men. DESIGN: Cross-sectional study among homosexual men presenting at a community-based clinic for HIV serologic screening. RESULTS: Anal HPV DNA was detected in 55 and 23% of 285 HIV-seropositive and 204 HIV-seronegative men, respectively, by Southern transfer hybridization (STH) [odds ratio (OR), 4.0; 95% confidence interval (CI), 2.7-6.2], and in 92 and 78% by polymerase chain reaction (PCR) (OR, 3.1; 95% CI, 1.6-5.8). ASIL was noted in 26% of HIV-seropositive men and in 8% of HIV-seronegative men (compared with men with negative cytologic findings: OR, 5.6; 95% CI, 3.0-10.5), with high-grade lesions noted in 4% of HIV-seropositive and in 0.5% of HIV-seronegative men. Among HIV-infected men, ASIL, detection of specific anal HPV types, and detection of high levels of anal HPV DNA (i.e., levels of HPV DNA detectable by both STH and PCR) were all associated with immunosuppression. Nevertheless, HIV-seropositive men with CD4 counts > 500 x 10(6)/l had a higher prevalence of both anal HPV and ASIL than men without HIV infection. Overall, detection of HPV at high levels was associated with ASIL. However, after adjustment for level of detectable HPV DNA, the risk of ASIL among HIV-seropositive men with CD4 counts < 500 x 10(6)/l was increased 2.9-fold (95% CI, 1.4-6.2) over that of HIV-seropositive men with CD4 counts > 500 x 10(6)/l. CONCLUSION: Given the high rates of ASIL in HIV-seronegative and both immunosuppressed and non-immunosuppressed HIV-seropositive homosexual men, natural history studies are now needed to assist in the development of strategies for the detection and management of such lesions. The increased prevalence of ASIL seen among immunosuppressed HIV-seropositive men may be the result of both a non-specific increase in productive HPV infection and HIV-induced immune alterations of HIV-related neoplasia.

Adolescent↗
PubMed1993

Concordance of parental race/ethnicity in relation to the risk of sudden infant death syndrome (SIDS).

It has been reported that parental human leukocyte antigen (HLA) compatibility is associated with certain adverse reproductive outcomes such as multiple spontaneous fetal losses and malformations, particularly among women without a prior livebirth. In order to study the relation between parental HLA compatibility and the risk of SIDS, a population-based case-control study was conducted using 1982-1990 Washington State linked birth and death certificate data. Concordance of parental race/ethnicity combined with prior maternal fetal loss was used as surrogate measures of parental HLA compatibility. The relation was evaluated separately among infants with and without a prior live-born sibling. Among first liveborn infants, those of racially discordant parents were at reduced risk of SIDS compared with those of racially concordant parents (relative risk [RR] = 0.57, 95% confidence interval = 0.34-0.96). Infants of white-minority parents were all at lower risk of SIDS than infants of white-white parents. Infants of racially concordant parents with two or more prior fetal losses were at increased risk of SIDS (RR = 2.44, 1.07-5.56), relative to infants of racially discordant parents. No such associations were observed among infants with prior live-born siblings. In fact, in this latter population, infants of racially concordant parents tended to have a lower risk of SIDS than those of discordant parents. This study suggests that a portion of SIDS cases, particularly among first live-born infants, may be due to parental HLA sharing. However, final determination of the existence of this relationship requires actual HLA typing of parents of both cases and controls.

Adult↗