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Biomedical subjects

J W Gardner

Publications and source records attributed to J W Gardner.

At least 37 records · Page 2Linked to original sources

Fatal rhabdomyolysis presenting as mild heat illness in military training.

A 30-year-old black male soldier with sickle cell trait presented with fatal exertional rhabdomyolysis (which was unrecognized during 14 hours at a field clinic). After prompt treatment for heat exhaustion, his symptoms seemed mild and he was afebrile. His clinical course illustrates the potential for severe illness in the absence of fever, the importance of assessing mental dysfunction, indications for laboratory evaluation, the need for comprehensive management of severe dehydration and acidosis, common laboratory features of acute renal failure and exertional rhabdomyolysis, and the increased risk of exercise-related death in those with sickle cell trait.

Adult↗

Accumulation of aliphatic amines in gastric juice of acute renal failure patients. Possible cause of hypergastrinemia associated with uremia.

In this study we analyzed by gas chromatographic headspace analysis the composition and concentration of gastrin-stimulatory volatile aliphatic amines in the gastric juice of healthy subjects and acute renal failure patients. We demonstrated that although these aliphatic amines are present in the gastric juice of normal subjects in trace amounts, they accumulate in the gastric juice of uremic subjects. This 30-40-fold elevation in gastric juice amine concentration agreed favorably with the 40-50-fold augmentation in serum gastrin levels in acute renal failure, with a significant association (r = 0.87) existing between these two parameters. It was also determined that a 2-hr hemodialysis procedure resulted in a modest nonparallel decline in both gastric amine and serum gastrin levels. These results support the hypothesis that the accumulation of volatile aliphatic amines in the gastric juice of uremic individuals may induce an activation of the antral G cells, resulting in hypergastrinemia.

Acute Kidney Injury↗

Personal renewal.

After John Gardner's presentation on "Self-Renewal" to THE WESTERN JOURNAL OF MEDICINE Editors' Meeting, (*) Joseph Murphy, MD, Special Editor for Wyoming, asked the former Secretary of Health, Education, and Welfare, "Where are you in your life's cycle?" Dr Gardner, who is 80 years old, answered, "When Chief Justice Oliver Wendell Holmes, Jr, was in his 90s, he was asked a similar question and said, ;I'm like a race horse cantering along after the race is over, cooling down.' Well, I'm nowhere near cantering! I'm still in the race, pushing the world." race, pushing the world."John Gardner, who received his undergraduate degree from Stanford and PhD from the University of California, Berkeley, taught at the college level for several years before he joined the Carnegie Foundation. As president of Carnegie Corporation and Carnegie Foundation for the Advancement of Teaching, he began to "push the world" toward education and in 1964 received the country's highest civilian honor, the Presidential Medal of Freedom. He has also pushed it toward political reform by founding Common Cause, toward grass-roots political action by founding the Urban Coalition, toward leadership training by founding the White House Fellows program, and toward volunteerism by founding the Independent Sector (a coalition of for-profit and not-for-profit organizations and foundations). His books, including Excellence, Self-Renewal, No Easy Victories, and On Leadership, have pushed readers to new understanding of themselves and of organizations to higher levels of creativity and energy to get important work done. His current research focuses on discovering and defining the characteristics of healthy, vital communities. His call to "keep on keeping on," indeed, to push the world, leads to constructive change. Active people become effective people, infused with the energy and optimism that good hard work inspires. I think you will find this paper as invigorating to read as it was to hear.

Aging↗

Is vaginal douching related to cervical carcinoma?

The association between cervical carcinoma and vaginal douching was examined in a population-based case-control study conducted in the low-risk population of Utah between 1984 and 1987. The authors compared 266 cases of in situ and invasive cervical carcinoma with 408 group-matched controls by vaginal douching behavior, controlled for age, lifetime number of sex partners, cigarette smoking history, religious activity, and educational level. Essentially no association was found in women who douched once per week or less, but in those who douched more than once per week, a consistent relation was demonstrated (adjusted odds ratio = 4.7, 95% confidence interval 1.9-11). Few differences were found with type of douching preparation used. The authors hypothesize that frequent douching alters the vaginal chemical environment, making the cervix more susceptible to pathologic change.

Carcinoma↗

Evidence for a role of volatile amines in the development of neonatal hypergastrinemia.

We investigated the presence of volatile aliphatic amines by fluorescamine and gas chromatographic-head space analysis in human breast milk and amniotic fluid to assess their role in neonatal hypergastrinemia. These volatile nitrogenous amino acid metabolites have been previously demonstrated to stimulate gastrin release in in vivo and in vitro laboratory preparations. In the present study we demonstrated that these gastrin-stimulatory volatile amines were present in significant concentrations in breast milk during the first several weeks after parturition and in amniotic fluid. The individual amines that were identified in both human milk and amniotic fluid samples were methylamine, dimethylamine, ethylamine, trimethylamine, propylamine, isobutylamine, and butylamine. This study provides indirect evidence to support the possibility that the hypergastrinemia measured in the fetus/neonate during the period immediately before and after birth may be attributable, in part, to the ingestion of fluid containing high concentrations of gastrin-stimulating amines.

Amines↗

Risk factors for cervical carcinoma: does detection bias play a role?

We explored the impact of detection bias on cervical carcinoma risk factors in a population-based case-control study in Utah. Risk estimates for most cervical carcinoma risk factors were virtually the same in women who reported frequent Pap tests as those obtained from the population at large. Women who reported infrequent Pap tests, however, had higher estimates of risk than the general population. The largest difference was observed for those who used frequent vaginal douching, where a risk estimate of 9.5 was observed among women who reported infrequent Pap tests compared with 2.7 for women who reported frequent Pap tests.

Adult↗

Dietary vitamins A, C, and E and selenium as risk factors for cervical cancer.

The relation between cervical cancer and dietary intake of vitamins A, C, and E, beta-carotene, and selenium was examined in a population-based case-control study in Utah. Cervical cancer cases (n = 266) and population-based controls (n = 408) were interviewed between 1984 and 1987. Protective effects were observed for vitamins A, C, and E and beta-carotene but were attenuated by age, level of education, and lifetime cigarette use. Associated risk (comparing highest with lowest quartiles of intake) went from 0.53 (crude) to 0.71 (adjusted) for vitamin A; from 0.55 (crude) to 0.82 (adjusted) for beta-carotene; from 0.45 (crude) to 0.55 (adjusted) for vitamin C; from 0.58 (crude) to 0.60 (adjusted) for vitamin E; and from 0.95 (crude) to 0.70 (adjusted) for selenium. Adjustment for number of sex partners and church attendance, factors significantly related to cervical cancer risk, only slightly attenuated these adjusted risk estimates.

Adult↗

Years of potential life lost (YPLL)--what does it measure?

The concept of years of potential life lost (YPLL) involves estimating the average time a person would have lived had he or she not died prematurely. This measure is used to help quantify social and economic loss owing to premature death, and it has been promoted to emphasize specific causes of death affecting younger age groups. YPLL inherently incorporates age at death, and its calculation mathematically weights the total deaths by applying values to death at each age. The method of calculating YPLL varies from author to author, each producing different rankings of leading causes of premature death. One can choose between heart disease, cancer, or accidents as the leading cause of premature death, depending on which method is used. Confusion in the use of this measure stems from a misunderstanding of the value system inherent in the calculation, as well as from differing views as to values that should be applied to each age at death.

Adolescent↗

Cigarette smoking and exposure to passive smoke are risk factors for cervical cancer.

Personal cigarette smoking and exposure to passive smoke as risk factors for cervical cancer were examined in a population-based, case-control study conducted in Utah. Personal cigarette smoking was found to increase the risk of cervical cancer, after adjusting for age, educational level, church attendance, and sexual activity. The adjusted risk estimate associated with being a current smoker was 3.42 (95% confidence interval [Cl], 2.10 to 5.57); for having smoked for 5 or more pack-years, it was 2.81 (95% Cl, 1.73 to 4.55); and for having smoked at least 100 lifetime cigarettes, it was 2.21 (95% Cl, 1.44 to 3.39). The adjusted risk estimate (also adjusted for actual cigarettes smoked) associated with passive smoke exposure for 3 or more hours per day was 2.96 (95% Cl, 1.25 to 7.03). Risk from passive smoking was greater in women who were not smokers (odds ratio, 3.43; 95% Cl, 1.23 to 9.54) than in women who smoked (odds ratio, 2.59; 95% Cl, 0.23 to 29.24).

Adult↗

Energy intake: its relationship to colon cancer risk.

A case-control study was conducted to assess the role of diet in the etiology of colon cancer. Diet was measured by means of a comprehensive quantifiable food frequency history instrument in 246 cases and 484 controls drawn from the general population of Utah. Each subject's diet was described by major nutrient groups and total energy based on the nutritional content of foods reported. Cases reported higher daily food intake 5 years preceding diagnosis than controls [men, rate ratio (RR) = 2.5; women, RR = 3.6], as measured by total energy content of the diet. Higher risk of colon cancer with increasing energy intake was independent of stage of disease at diagnosis and obesity, as measured by body mass. Fat, protein, and carbohydrate intake all had elevated RRs but could not be assessed as risk factors independent of energy intake because of their strong correlations with total calories. Due to the higher energy intake of the cases, odds ratios for the daily intake of dietary fiber and vitamins A and C were also greater than 1. However, adjusting for caloric intake removed this effect, and dietary fiber showed a weak protective effect. Total energy intake must be evaluated before attempting to assign a causal role to any food or nutrient that may be postulated to play a role in colon cancer.

Adult↗

Head and neck cancer survival and life-style change.

A retrospective analysis using patient and family questionnaires and chart review was done on 269 patients with head and neck neoplasms. Sixty-nine with tumors at sites known to be unrelated to tobacco and alcohol use served as controls. Two hundred patients with epidermoid carcinoma of the oral cavity, pharynx, and larynx constituted the study group. Alcohol use alone increased the risk of acquiring the study cancer 3.6 times; smoking alone increased the risk 5.8 times. Both factors combined increased the risk 19 times. Those who continued to smoke after diagnosis had a fourfold increase in the recurrence rate over those who did not smoke, and double that of those who stopped smoking. Survival was also the lowest in those who continued to smoke, while persistent alcohol use did not affect survival.

Alcohol Drinking↗

Smoking and carcinoma in situ of the uterine cervix.

We carried out a case-control study of 217 cases of in situ carcinoma of the uterine cervix and 243 controls chosen from the general population of Utah. We found a relative risk of 3.0 for cigarette smoking after controlling for sexual and socioeconomic risk factors. The smoking association was strongest in the youngest age group (ages 20-29), reaching seventeenfold, and was weaker in the older age groups. These data suggest that cigarette smoking may be an independent risk factor for cancer of the uterine cervix, after considering sexual behavior and other well-established risk factors.

Adult↗

Methodological issues in epidemiological studies of diet and cancer.

We review the goals of epidemiological nutritional studies and evaluate methods of dietary data collection in terms of these goals. Special problems for the cancer epidemiologist studying diet are then reviewed, including methods of data collection, quantification of food intake, and analysis of nutritional data. Food frequency methods are generally best for collection of dietary data in epidemiological studies, and the use of food data banks enables the study of specific dietary components. The major problems in analysis stem from the complex interrelationships among nutrients and their high correlation with each other.

Data Collection↗

Cancer in Utah Mormon men by lay priesthood level.

Mormons have been shown to have low cancer rates at several common sites, particularly those associated with tobacco and alcohol use. This likely reflects adherence to their Church doctrines advocating abstention from the use of these substances. All Mormons, however, do not adhere to the health practices of their Church, and this study classifies Utah Mormon men by their lay priesthood offices, which reflect degree of adherence to Church doctrines. Follow-up cancer rates for 1966-1970 indicate that the most devout group (Seventies and High Priests) have lung cancer rates 80% lower than those of the least devout group. The same was seen for all smoking- and alcohol-associated cancer sites combined. Cancer of the stomach and the leukemias and lymphomas also had lower rates in the most devout group. Cancers of the colon-rectum, prostate, and pancreas showed little difference in rates when classified by lay priesthood office. These data provide a demonstration of the effects of a healthy lifestyle on cancer occurrence in men.

Adolescent↗

Cancer in Utah Mormon women by church activity level.

In light of low cancer rates by the Mormon Church, this study classifies female Mormon cancer patients in Utah according to measures of adherence to Church doctrines. The distribution by Church activity level is compared for each site to a group of other cancer sites felt to represent the overall activity level distribution of Utah Mormon women. Mormon women classified as having the strongest adherence to Church doctrines had lung cancer rates during 1966-1970 much lower than did women with the weakest adherence. The relationship was not as strong, however, as that seen in Mormon men when classified by lay priesthood office. Cancer of the uterine cervix also showed lower rates in the more active groups, but this finding was not statistically significant. Cancers of the breast and ovary did not show consistent associations with Church activity level, nor did most of the gastrointestinal cancers. These data suggest that some of the differences in cancer incidence between Mormons and non-Mormons may not be explained by adherence to specific Church doctrines.

Adult↗