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Biomedical subjects

J R Palmer

Publications and source records attributed to J R Palmer.

At least 19 recordsLinked to original sources
PubMed2006

Mortality in women given diethylstilbestrol during pregnancy.

We used Cox regression analyses to assess mortality outcomes in a combined cohort of 7675 women who received diethylstilbestrol (DES) through clinical trial participation or prenatal care. In the combined cohort, the RR for DES in relation to all-cause mortality was 1.06 (95% CI = 0.98-1.16), and 1.11 (95% CI = 1.02-1.21) after adjusting for covariates and omitting breast cancer deaths. The RR was 1.07 (95% CI = 0.94-1.23) for overall cancer mortality, and remained similar after adjusting for covariates and omitting breast cancer deaths. The RR was 1.27 (95% CI = 0.96-1.69) for DES and breast cancer, and 1.38 (95% CI=1.03-1.85) after covariate adjustment. The RR was 1.82 in trial participants and 1.12 in the prenatal care cohort, but the DES-cohort interaction was not significant (P = 0.15). Diethylstilbestrol did not increase mortality from gynaecologic cancers. In summary, diethylstilbestrol was associated with a slight but significant increase in all-cause mortality, but was not significantly associated with overall cancer or gynaecological cancer mortality. The association with breast cancer mortality was more evident in trial participants, who received high DES doses.

Adult↗
PubMed2006

Birth weight and breast cancer risk.

Exploring whether the positive association between birth weight and breast cancer risk differs by other breast cancer risk factors may help inform speculation about biological mechanism. In these data, high birth weight was associated with breast cancer risk in younger and in more educated women, but was not associated overall.

Adult↗
PubMed2003

Assessment of strategies for identifying diagnosed cases of systemic lupus erythematosus through self-report.

The objective of this work was to assess the optimal way to identify potential systemic lupus erythematosus (SLE) cases in large epidemiologic studies through self-reported information about diagnosis of SLE, symptoms and medications, and to investigate the utility of a criteria checklist sent directly to participants' physicians. We used data collected in 1997 from 53322 participants in a study of African-American women, the Black Women's Health Study, including a lupus screening questionnaire (LSQ) and questions about SLE diagnosis and medications. We confirmed self-reported SLE through medical records and criteria checklists sent to participants' physicians. Among those for whom we received medical records and/or criteria checklists, we compared the predictive value and proportion of missed cases of several algorithms using combinations of self-reported SLE diagnosis, LSQ score and medication use to self-reported SLE diagnosis alone. We obtained a physician checklist or medical chart for 251 individuals who reported SLE, of whom 212 (84%) fulfilled ACR criteria for definite or probable SLE, or had clinical lupus (SLE diagnosis recorded in medical charts plus appropriate medication use). The use of LSQ score or medication use in addition to self-report of SLE tended to decrease the false positive rate but also to reduce the proportion of true cases identified. Checklists of ACR criteria completed by subjects' physicians documented more criteria than medical records. In conclusion, among participants who consented to medical record review, SLE prediction algorithms using questions about lupus symptoms and medications offered slightly higher predictive value for detecting cases than self-reported diagnosis alone, but at the cost of case detection. SLE case confirmation strategies can be complemented by the use of criteria checklists sent directly to participants' physicians.

Adult↗
PubMed2001

Follow-up of a large cohort of Black women.

High retention rates in follow-up studies reduce the potential for biased data due to selective losses. The Black Women's Health Study began in 1995 when 64,500 participants aged 21-69 years enrolled by completing postal health questionnaires. Follow-up is carried out biennially. On the basis of data collected between enrollment and completion of the first follow-up, the authors assessed the usefulness of various follow-up methods and compared the characteristics of respondents, nonrespondents, and women lost to follow-up because of an unknown address. The 1997 questionnaire was completed by 82.8% of the participants. The study population was highly mobile: 56.5% moved at least once, and 1.5% moved at least four times. Moving was associated with younger age: A total of 71.7% of participants aged 21-29 years moved at least once compared with 43.2% of women aged 50-69. The most successful and cost-effective method for eliciting completed questionnaires from participants was sending multiple waves of questionnaires. Telephone calls to nonrespondents were successful but were highly labor intensive. Demographic and health characteristics of the women were similar regardless of which mailing was completed, except that early respondents had higher levels of education. Respondents were more highly educated and older than were nonrespondents and lost subjects but were quite similar in all other characteristics. These data suggest that follow-up of a mobile population of African-American women can be successful.

Adult↗
PubMed2001

Infertility among women exposed prenatally to diethylstilbestrol.

Although it is well established that women exposed to diethylstilbestrol in utero have an increased risk of spontaneous abortion, ectopic pregnancy, and preterm delivery, it is not known whether they also have an increased risk of infertility. The authors assessed this question in data from a collaborative follow-up study of the offspring of women who took diethylstilbestrol during pregnancy. In 1994, 1,753 diethylstilbestrol-exposed and 1,050 unexposed women from an ongoing cohort study (National Cooperative Diethylstilbestrol Adenosis Study and Dieckmann cohorts) provided data on difficulties in conceiving and reasons for the difficulty. Age-adjusted relative risks were computed for the association of diethylstilbestrol exposure with specific types of infertility. A greater proportion of exposed than unexposed women were nulligravid (relative risk (RR) = 1.3, 95% confidence interval (CI): 1.1, 1.5), and a greater proportion had tried to become pregnant for at least 12 months without success (RR = 1.8, 95% CI: 1.6, 2.1). Diethylstilbestrol exposure was significantly associated with infertility due to uterine and tubal problems, with relative risks of 7.7 (95% CI: 2.3, 25) and 2.4 (95% CI: 1.2, 4.6), respectively. The present findings indicate that diethylstilbestrol-exposed women have a higher risk of infertility than do unexposed women and that the increased risk of infertility is primarily due to uterine or tubal problems.

Adult↗
PubMed2001

Low-dose oral contraceptive use and the risk of myocardial infarction.

BACKGROUND: Studies of oral contraceptives (OCs) containing 50 microg or more of estrogen suggest an increased risk of myocardial infarction (MI) among current users, particularly if they smoke heavily. OBJECTIVE: To assess whether use of the newer lower-dose OCs increases the risk of MI. METHODS: A case-control study was conducted from January 1985 through March 1999 in 75 hospitals in the greater-Boston and greater-Philadelphia areas. Data on OC use and MI risk factors were obtained by interview from 627 women with a nonfatal first MI (cases) and 2947 female hospital controls younger than 45 years. RESULTS: The overall odds ratio (OR) for current OC use relative to never used was 1.3 (95% confidence interval [CI], 0.8-2. 2). The OR was elevated, 2.5 (95% CI, 0.9-7.5), among heavy smokers (>/=25 cigarettes per day) but close to 1.0 among lighter smokers (OR = 0.8) and nonsmokers (OR = 1.3). For current OC use together with heavy smoking relative to nonuse and nonsmoking, the OR was 32 (95 % CI, 12-81), considerably greater than that for heavy smoking alone, 12 (95% CI, 8.6-16). The ORs did not vary according to the type of formulation or the dose of estrogen; there were too few users to assess the new 20-microg preparations. Past OC use was unrelated to risk. CONCLUSION: Current use of low-dose OCs in the United States is unrelated to an increased risk of MI among nonsmokers and light smokers, but users who smoke heavily may be at greatly increased risk.

Adult↗
PubMed2001

Cancer risk in men exposed in utero to diethylstilbestrol.

BACKGROUND: An association between prenatal diethylstilbestrol (DES) exposure and cancer in men, especially testicular cancer, has been suspected, but findings from case-control studies have been inconsistent. This study was conducted to investigate the association between prenatal DES exposure and cancer risk in men via prospective follow-up. METHODS: A total of 3613 men whose prenatal DES exposure status was known were followed from 1978 through 1994. The overall and site-specific cancer incidence rates among the DES-exposed men were compared with those of the unexposed men in the study and with population-based rates. The relative rate (RR) was used to assess the strength of the association between prenatal DES exposure and cancer development. All statistical tests were two-sided. RESULTS: Overall cancer rates among DES-exposed men were similar to those among unexposed men (RR = 1.07; 95% confidence interval [CI] = 0.58 to 1.96) and to national rates (RR = 0.99; 95% CI = 0.65 to 1.44). Testicular cancer may be elevated among DES-exposed men, since the RRs for testicular cancer were 3.05 (95% CI = 0.65 to 22.0) times those of unexposed men in the study and 2.04 (95% CI = 0.82 to 4.20) times those of males in the population-based rates. The higher rate of testicular cancer in the DES-exposed men is, however, also compatible with a chance observation. CONCLUSIONS: To date, men exposed to DES in utero do not appear to have an increased risk of most cancers. It remains uncertain, however, whether prenatal DES exposure is associated with testicular cancer.

Carcinogens↗
PubMed2001

A comparison of intrauterine versus intracervical insemination in fertile single women.

OBJECTIVE: To compare the efficacy of intrauterine insemination (IUI) and intracervical insemination (ICI) when used by fertile single women in a donor insemination program. DESIGN: Prospective randomized crossover study. SETTING: Donor insemination program (not an infertility clinic). PATIENT(S): Single fertile women choosing to inseminate with frozen donor semen. INTERVENTION(S): Clients received procreative counseling and screening and were then randomly assigned to begin office insemination with ICI or IUI. If additional insemination cycles were required, the clients used the method opposite their previous method of insemination until pregnancy was achieved. MAIN OUTCOME MEASURE(S): Monthly fecundity rate was compared between the two methods of insemination. RESULT(S): Sixty-two women contributed a total of 189 cycles, 94 by IUI and 95 by ICI. The monthly fecundity rate for IUI was 15%, as compared with 9% for ICI, (P=0.14). When the analysis was confined to cycles in which only one insemination was performed (64 IUI and 65 ICI cycles), the monthly fecundity rates were 14% for IUI and 5% for ICI (P=0.04). CONCLUSION(S): Intrauterine insemination with frozen donor sperm is more effective than intracervical insemination for single women without known fertility problems.

Adult↗
PubMed2001

Height and breast cancer risk: results from the Black Women's Health Study (United States).

OBJECTIVES: Numerous studies, but not all, have yielded positive associations between adult height and risk of breast cancer. There are few data on black women. We evaluated adult height in relation to breast cancer in data from the Black Women's Health Study, a prospective cohort study of 64,530 African-American women aged 18-69 years at baseline in 1995. METHODS: A total of 910 cases of breast cancer were analyzed: 700 prevalent cases reported at baseline and 210 incident cases that occurred during the first 2 years of follow-up. A comparison group of controls frequency-matched on 5-year category of birth year was chosen from among participants who had not developed breast cancer. Odds ratios (OR) were calculated for various categories of adult height compared to a reference category of height less than or equal to 61 inches (155 cm), with control for current age, age at menarche, and years of education. RESULTS: Increased height was associated with an increased risk of breast cancer overall (p trend = 0.001); the OR for the highest category of height, > 69 inches (175 cm), was 1.6 (95% confidence interval 1.1-2.3). The association was stronger among premenopausal women and women who had less than 16 years of education. Results were similar for prevalent and incident cases. CONCLUSION: The present findings indicate that height is associated with breast cancer risk in African-American women.

Adolescent↗
PubMed2001

Incidence of squamous neoplasia of the cervix and vagina in women exposed prenatally to diethylstilbestrol (United States).

OBJECTIVES: Women exposed prenatally to diethylstibestrol (DES) have an excess risk of clear-cell adenocarcinoma of the vagina and cervix, but the effect on the incidence of squamous neoplasia is uncertain. The purpose of the current study was to evaluate the long-term risk of developing high-grade squamous neoplasia of the genital tract among women exposed prenatally to DES. METHODS: A cohort comprising 3,899 DES-exposed and 1,374 unexposed daughters was followed for 13 years (1982 1995) for pathology-confirmed diagnoses of high-grade squamous intraepithelial neoplasia (HSIL) of the genital tract. Poisson regression analysis was used to compute relative risks (RR) and 95% confidence intervals (95% CI), adjusting for age, calendar year, and other covariates. RESULTS: The RR (95% CI) among DES-exposed versus unexposed, based on 111 cases of high-grade disease, was 2.1 (1.2-3.8). Adjustment for screening history estimated by the number of years since the last Pap smear had little effect. Risk estimates were higher with earlier intrauterine exposure; the RR (95% CI) for exposure within 7 weeks of the last menstrual period was 2.8 (1.4-5.5). Only two cases of invasive squamous cervical cancer occurred in total, precluding separate analysis. CONCLUSIONS: The findings support an association between in-utero DES exposure and high-grade squamous neoplasia, although a role for more intensive screening among DES-exposed women in the production of this excess could not be completely ruled out.

Carcinoma, Squamous Cell↗
PubMed2000

Continued follow-up of pregnancy outcomes in diethylstilbestrol-exposed offspring.

OBJECTIVE: To evaluate long-term pregnancy experiences of women exposed to diethylstilbestrol (DES) in utero compared with unexposed women. METHODS: This study was based on diethylstilbestrol-exposed daughters, the National Collaborative Diethylstylbistrol Adenosis cohort and the Chicago cohort, and their respective nonexposed comparison groups. Subjects who could be traced were sent a detailed questionnaire in 1994 that contained questions on health history, including information on pregnancies and their outcomes. We reviewed 3373 questionnaires from exposed daughters and 1036 questionnaires from unexposed women. RESULTS: The response rate was 88% among exposed and unexposed women. Diethylstilbestrol-exposed women were less likely than unexposed women to have had full-term live births and more likely to have had premature births, spontaneous pregnancy losses, or ectopic pregnancies. Full-term infants were delivered in the first pregnancies of 84.5% of unexposed women compared with 64. 1% of exposed women identified by record review (relative risk [RR] 0.76, confidence interval [CI] 0.72, 0.80). Preterm delivery of first births occurred in 4.1% of unexposed compared with 11.5% of exposed women, and ectopic pregnancies in 0.77% of unexposed compared with 4.2% of exposed women. Spontaneous abortion was reported in 19.2% of DES-exposed women compared with 10.3% in control women (RR 2.00, CI 1.54, 2.60). According to complete pregnancy histories (many women had more than one pregnancy), preterm births were more common in DES-exposed women (19.4% exposed versus 7.5% unexposed (RR 2.93 CI 2.23, 3.86). Second-trimester spontaneous pregnancy losses were more common in DES-exposed women (6.3% versus 1.6%; RR 4.25, CI 2.36, 7.66). More first-trimester spontaneous abortions occurred in DES-exposed women than in controls (RR 1.31, CI 1.13, 1.53), and DES-exposed women had at least one ectopic pregnancy more often than unexposed women (RR 3.84, CI 2.26, 6.54). CONCLUSION: Pregnancy outcomes in DES-exposed women were worse than those in unexposed women.

Abortion, Spontaneous↗
PubMed2000

Risk of ovarian cancer according to use of antidepressants, phenothiazines, and benzodiazepines (United States).

OBJECTIVES: An association of increased risk of ovarian cancer with use of antidepressants or benzodiazepine tranquilizers has been reported from a case-control study. We assessed the association between ovarian cancer risk and the use of tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), phenothiazine antipsychotics, and benzodiazepines, in data from the Case-Control Surveillance Study. METHODS: From 1976 through 1998, data were collected from hospital patients in Boston, New York, Philadelphia, and Baltimore based on demographic factors, reproductive and medical history, and medication use. In the present analyses, cases of epithelial ovarian cancer (n = 748) were compared with cancer controls (n = 1496) and noncancer controls admitted for trauma and acute infection (n = 1496). We estimated Mantel-Haenszel odds ratios adjusted for age, study center, and year of interview. RESULTS: Odds ratios for regular use (at least 4 days/week for at least 1 month) were compatible with 1.0 for every drug class. For tricyclics and benzodiazepines the upper 95% confidence limits were less than 1.6. For phenothiazines the upper limit was 2.6 with cancer controls and 1.4 with noncancer controls. Only five cases used SSRIs, yielding unstable results. Odds ratios were not increased among women who had used any drug class for at least 5 years, nor among women who had first used them 10 or more years previously. CONCLUSIONS: These data do not support an association between regular use of any of the drugs under study with ovarian cancer risk.

Adult↗
PubMed2000

Nonsteroidal anti-inflammatory drugs and risk of digestive cancers at sites other than the large bowel.

Regular continuing nonsteroidal anti-inflammatory drug (NSAID) use has been associated with a reduction in risk of large bowel cancer in many studies, including our Case-Control Surveillance Study of medication use and cancer risk. We assessed the relation of NSAID use to the risk of digestive cancers at sites other than the large bowel in this database. Nurse-interviewers administered questionnaires to patients admitted to hospitals in four centers from 1977 to 1998. Cases comprised 1149 patients with cancers of the pancreas (n = 504), stomach (n = 254), esophagus (n = 215), gallbladder (n = 125), or liver (n = 51). Controls were 5952 patients admitted for trauma or acute infection. History of NSAID use was elicited by questions about indications for use. Multiple logistic regression models were used to calculate odds ratios (ORs) for categories of regular NSAID use (at least 4 days/week for at least 3 months) relative to never use. The OR for regular use initiated at least 1 year before admission and continuing into that year was reduced for stomach cancer (OR = 0.3; 95% confidence interval, 0.1-0.6) and was compatible with 1.0 for other sites. The ORs for regular continuing use of at least 5 years duration were < 1.0 for cancers of the stomach, pancreas, esophagus, and gallbladder but were statistically significant only for stomach cancer. These data suggest that regular continuing NSAID use may be associated with reduced risk of stomach cancer. For the other sites, the data are consistent with no effect of NSAID use.

Aged↗
PubMed2000

A case-control study of use of postmenopausal female hormone supplements in relation to the risk of large bowel cancer.

Postmenopausal female hormone use has been associated with a reduced risk of colon cancer. We assessed the relation of use of these supplements to the risk of large bowel cancer. The data were collected in a case-control study of large bowel cancer conducted in Massachusetts. Control subjects were matched to incident cases of carcinoma of the colon or rectum on age, gender, and town precinct. The analysis was restricted to women who experienced a natural menopause or had had a hysterectomy with or without removal of the ovaries (292 colon cancer cases and 112 rectal cancer cases and their matched controls). Use of female hormone supplements was associated with a decreased risk of colon cancer among recent users (odds ratio, 0.6; 95% confidence interval, 0.4-1.0) and long duration (5+ years) of use (odds ratio, 0.5; 95% confidence interval, 0.3-0.9). The association with long duration of use appeared to be independent of recency of use and screening practices and was apparent for late-stage cancer. Hormone supplement use was not associated with a reduced risk of rectal cancer. Our results add to the evidence for a decreased risk of colon cancer associated with use of female hormone supplements.

Adult↗
PubMed2000

Risk factors for diethylstilbestrol-associated clear cell adenocarcinoma.

OBJECTIVE: To assess the influence of postnatal factors on the development of clear cell adenocarcinoma in women exposed to diethylstilbesterol (DES), particularly factors related to exogenous or endogenous hormone exposures, and to reassess the relation of season of birth. METHODS: For the analysis of postnatal factors, 244 cases were compared with 244 age-matched DES-exposed women. Information was obtained from telephone interviews, with questions asked in reference to an index age, the age at which clear cell adenocarcinoma was diagnosed. For the analysis of season of birth, 604 cases, living or deceased, were compared with 1749 DES-exposed women. RESULTS: Neither oral contraceptive (OC) use nor pregnancy was associated with risk of clear cell adenocarcinoma: the odds ratios (OR) were 1.1 (95% confidence interval [CI] 0.7, 1.8) for OC use and 1.3 (95% CI 0.7, 2.3) for pregnancy. The OR for fall season of birth relative to all other seasons was 1.2 (95% CI 0.9, 1.4). CONCLUSION: Pregnancy and OCs do not increase risk of DES-associated clear cell adenocarcinoma. In addition, season of birth does not appear to be a material factor; the previous finding of an increased risk for fall season of birth is most likely not valid and probably a chance finding due to small sample size.

Adenocarcinoma, Clear Cell↗
PubMed2000

A case-control study of analgesic use and ovarian cancer.

A recent case-control study raised the hypothesis that acetaminophen use 1 day or more per week for at least 6 months reduces the risk of epithelial ovarian cancer. We assessed analgesic use in relation to epithelial ovarian cancer risk using data from our case-control surveillance study of medication use and cancer. Patients were interviewed in hospitals in Baltimore, Boston, New York, and Philadelphia during 1976-1998. We compared 780 women with epithelial ovarian cancer to 2053 cancer controls and 2570 noncancer controls. For acetaminophen use 1 day or more per week for at least 6 months, the odds ratio estimate was 0.9 (95% confidence interval, 0.6-1.4) derived with cancer controls and 1.0 (0.6-1.5) with noncancer controls. Estimates for more frequent and longer term use were also compatible with 1.0. The odds ratios among patients with metastatic ovarian cancer were reduced but not statistically significant. The odds ratio for use of nonsteroidal anti-inflammatory drugs 4 or more days per week for at least 5 years, 0.5, was statistically significant. The present results provide only weak support for a reduction in the risk of epithelial ovarian cancer among acetaminophen users. They raise the possibility of an inverse association with long-term nonsteroidal anti-inflammatory drug use.

Acetaminophen↗