Search PubMed⌕ Search

Biomedical subjects

M C Costanza

Publications and source records attributed to M C Costanza.

At least 37 records · Page 2Linked to original sources
PubMed1991

Estimation of the design effect in community intervention studies.

This paper considers the estimation of the variance of a mortality rate in community intervention studies with little or no replication of intervention regimens. Our approach in estimation of this cluster sampling variance is to determine the variance for simple random sampling and multiply it by a design effect which we calculate with use of information obtained from other sources. When the county is the unit of randomization and the outcome is mortality, we calculate the design effect as the ratio of the age adjusted mortality rates for single stage cluster sampling relative to simple random sampling; we use information from all counties in a state in the calculations. We apply this approach empirically for breast cancer mortality. We found that these design effects were dependent on length of time for accumulation of deaths (1.1 for one year up to 3.5 for eight years) and were quite consistent for the three states and nine years considered in the investigation. We present a model that accounts for the time dependence of the design effect and we show it provides a good representation of the observed relationship.

Adult↗
PubMed1990

A community-wide program in breast self-examination training and maintenance.

This study reports on the effects of innovative community-wide breast self-examination education approaches in increasing breast self-examination frequency and quality, and ability to detect breast lumps during a 1-year training program and a second-year maintenance program. Four Vermont communities were randomly assigned to receive breast self-examination training plus maintenance, training alone, control (with full measurement), and low-measurement control. Random digit dialing telephone surveys were conducted at baseline and at 1- and 2-year follow-up with a panel of 637 women representing all adult women in the first three communities. The low-measurement control community received only baseline and second-year follow-up surveys with a panel of 238 women. Home interviews to determine breast self-examination palpation skills and lump detection on silicone breast models were conducted in first- and second-year follow-up surveys. Results of the first-year follow-up survey indicated significant increases in breast self-examination frequency, quality, and number of lumps detected for women in communities receiving the training program compared with controls; in the second year, women in the community also receiving breast self-examination maintenance showed greater improvement in reported breast self-examination quality and detected more breast lumps than did women in other communities.

Adult↗
PubMed1988

Development of a smoking prevention mass media program using diagnostic and formative research.

The process of developing a mass media campaign to prevent smoking among adolescents is described in detail. This campaign supplements a school smoking prevention program and shares educational objectives with the school program but is otherwise independent. It comprises various television and radio 30- and 60-sec "spot" messages. The campaign development process includes identifying educational objectives and strategies for appealing to young people; conducting diagnostic surveys and focus groups to determine target audience interests and perceptions about smoking and media content; suggesting approaches to producers to create preliminary television and radio messages for testing; conducting formative pretests with target groups to select optimal messages and suggest improvements to those messages; producing final messages for media presentation; and developing a media exposure plan to place messages in local media at optimal times for reception by target audiences. The media campaign is being evaluated in a 5-year project with 5,500 adolescents in four communities to determine the additional effect of mass media over a school program alone in preventing smoking.

Adolescent↗
PubMed1987

Breast self-examination practices and attitudes of women with and without a history of breast cancer.

Breast self-examination (BSE) practices and attitudes of three groups of women were compared using a mailed survey. Subjects were 59 women with previous breast cancer, 33 women with previously treated benign breast lump(s), and 80 general-population women with no history of breast disease. Groups were compared on frequency, proficiency, and knowledge of BSE. Determinants of practice were examined using attitudinal variables from the Health Belief Model. Results indicated that the breast cancer group had significantly higher rates of BSE frequency, proficiency, and knowledge than did the general-population group. The breast cancer group perceived cancer to be significantly less threatening than did the other two groups, although the general-population group reported significantly less susceptibility to breast cancer. Within-group analyses revealed that barriers to BSE practice accounted for the greatest amount of variance in BSE frequency in all three groups. These results are discussed.

Attitude to Health↗
PubMed1986

Using medical records for older patient education in ambulatory practice.

The effectiveness of sharing medical records in improving physician-older patient communication was evaluated in 203 ambulatory chronically ill older patients (mean age, 70.1 years) by a randomized controlled trial. Ninety-five experimental group patients received copies of their physicians' progress notes 1 week after their last office visit, and 108 control patients did not. After 1-2 weeks, knowledge of health problems, medication, and nonmedication treatments was assessed by interview. Experimental group patients knew 74.1% of their health problems, compared with 64.1% in the control groups (P less than 0.05). There was no difference in knowledge of medications or adherence to medication regimens. Experimental group patients displayed higher treatment knowledge scores than control group patients (P less than 0.01). Less-educated patients showed greater adherence to nonmedication treatments. Shared medical records can enhance physician-older patient communication about health problems and nonmedication treatments, but they do little to enhance medication knowledge or adherence to medication regimens.

Aged↗
PubMed1985

Adverse relationship between blood transfusions and survival after colectomy for colon cancer.

Random-donor blood transfusions are deliberately given before cadaver renal allografting to improve allograft survival. Since host modifications that improve the outcome of an allograft might be associated with a decreased ability of the host to control cancer growth, the relationship between blood transfusions and the outcome of 146 Dukes' stages A, B, and C colon cancers treated by resection during the years 1974 to 1979 was studied. It was found that 65 patients (45%) had been transfused and that at 5 years, overall survival was significantly better in the nontransfused patients compared to the transfused patients (0.68 and 0.51 5-year product limit survival fractions respectively; P = 0.03 for unadjusted log-rank comparison of entire survival curves). Relative risk of death due to cancer in transfused patients versus nontransfused patients was 2.3 (P = 0.05) when controlled for sex, age, stage, histologic differentiation, cancer location, and pre-resection hemoglobin level using Cox regression analysis. Thus, blood transfusion appears to be an additional important prognostic variable. The hypothesis suggested but not proven by these data that the outcome for some malignancies may be related to the immunomodulating effects of blood transfusions needs further study.

Aged↗
PubMed1985

Blood transfusions and survival after lung cancer resection.

The immunosuppressive effects of blood transfusions in renal transplantation patients are now well documented. The question arises as to whether the possible immunosuppressive effects of blood transfusions in cancer patients cause a more favorable host environment for tumor growth. One hundred fifty-five patients undergoing resection for lung carcinoma were analyzed retrospectively, and it was shown that the use of blood transfusions was associated with a significant decrease in survival time in patients undergoing curative resection of lung carcinoma despite multivariate adjustments for age, sex, cell type, right lung versus left lung location, type of operation, and stage. This association supports, but does not prove, the hypothesis that blood transfusions, possibly through an immunosuppressive mechanism, are responsible for a poorer prognosis in patients who undergo resection for carcinoma of the lung.

Adenocarcinoma↗
PubMed1984

Breast self-examination practices and breast cancer survival.

To determine the relation between breast self-examination and survival of breast cancer patients, the authors studied 1004 newly diagnosed invasive breast cancer patients in Vermont general hospitals from 1 July 1975 to 31 December 1982. More frequent breast self-examination was associated with a greater likelihood of the patient's detecting her own cancer, less delay from first symptom to histologic diagnosis, earlier clinical stage, smaller pathologic tumor size, and fewer axillary node metastases. At a median follow-up time of 52 months (maximum follow-up, 92 months), 14% of the breast self-examination performers had died of breast cancer versus 26% of the nonperformers (P less than 0.001 based on chi-square). The product limit survival curve for breast self-examination performers (N = 424) was significantly better (P less than 0.001 by log-rank test) than for breast self-examination nonperformers (N = 411). Survival at 5 years was 75% for breast self-examination performers versus 57% for the nonperformers. The significant survival differences persisted after adjusting for any combination of the covariates age, method of detection, family history of breast cancer, and delay in treatment (P less than 0.002). Lead-time would have to be at least 3 years to negate the apparent beneficial effects of breast self-examination on survival. The authors conclude that in this population of breast cancer patients, breast self-examination was related to earlier detection and improved survival.

Age Factors↗
PubMed1984

Blood transfusions and survival after surgery for breast cancer.

Numerous reports have demonstrated that blood transfusions given prior to renal allografting have an immunomodulating effect that leads to increased graft survival. To determine if blood transfusions would adversely affect the outcome for patients with breast cancer, we examined 226 patients with invasive breast cancer who had a mastectomy and found 65 (29%) had received transfusions. The patients who had transfusions and those who did not were similar in age, clinical tumor-node-metastasis stage, and number of histologic nodal metastases. At a median follow-up of 52 months for surviving patients, 48 (21%) of the patients were dead. Log-rank and Cox regression analyses that compared patients who had transfusions v those who did not showed no excess of either overall deaths or deaths due to cancer in the group that received transfusions. The hypothesis that blood transfusions might have an adverse effect on survival was not supported by this study. Additional studies involving other groups of patients with malignant neoplasms and other blood donor populations are needed.

Adult↗
PubMed1984

Relationship between breast self-examination and death from breast cancer by age groups.

To quantitate the relationship between breast self-examination and survival from breast cancer, we have studied 1,003 newly diagnosed patients with invasive breast cancer in Vermont general hospitals since July 1, 1975. Death certificates, autopsy reports, and hospital records were reviewed to determine the cause of death. Examination of product limit survival curves by three age groups demonstrated that death due to breast cancer was less likely in breast cancer patients who had performed breast self-examination than in nonperformers in each of the three age groups. The associated lead-time would have to exceed 36 months to negate the apparent beneficial effects of breast self-examination in decreasing the likelihood of death from breast cancer. We conclude that in this population of breast cancer patients, breast self-examination probably contributed to earlier detection and thereby improved survival.

Adult↗
PubMed1983

Content and context in health education: persuading women to perform breast self-examination.

Content in a breast self-examination (BSE) education program was tested according to three motivational approaches with 923 women in Vermont women's clubs. The program was a slide-tape presentation using one of the three approaches and a BSE demonstration followed by a group discussion led by a nurse. A post-test of 374 women 6 months later showed a significant increase in monthly BSE performance from 40 to 71% regardless of motivational approach and an increase in breast cancer knowledge that was somewhat varied by approach, but was significant across all three approaches. Women who did not adopt monthly BSE after the program had an increase in knowledge similar to those who had adopted it. After the program, older women had somewhat less knowledge but performed BSE as often as younger women. Women with a family history of breast cancer were somewhat less likely to perform monthly BSE than other women, and women admitting to inhibitions about BSE were significantly less likely to adopt the practice than other women, yet their monthly BSE also increased as a result of the program. The significant positive change in BSE and knowledge across all groups appeared to be more a result of the supportive women's club context than of variations in program content. Thus, to achieve desired changes in prevention-oriented health behavior, it is suggested that health educators emphasize structuring a favorable context for the presentation of recommended actions such as BSE.

Adult↗
PubMed1982

Analyses of sequential bronchoalveolar lavage samples from healthy human volunteers.

Subsegmental bronchoalveolar lavage of human subjects provides an accessible sample of cells and secretions from the lower respiratory tract for clinical and research study. Technical factors that may modify lavage results have received little attention. The effects of lavage volume on the patterns of recovered cells and biochemical components were studied by separately analyzing each of 4 sequential 60-ml syringes of saline instilled into a subsegment of the right middle lobe. Fourteen healthy normal subjects volunteered for lavage. Recovery of cells from both nonsmokers and smokers increased and then remained essentially constant in subsequent syringes, suggesting elution of adherent macrophages from the alveolar surface. Protein, carbohydrate, lipid, and potassium appeared in decreasing concentrations in sequential syringes, but different constituents followed separate patterns. Simple mixing models do not explain the observed results. Measured values for the components in a "small" 120-ml lavage may be substantially different from the values in a "large" 240-ml lavage. Further study of the kinetics of recovery of selected lavage components may provide better understanding of the origins and functions of these substances in the lung.

Adolescent↗
PubMed1980

Review of the 4-hexylresorcinol procedure for acrolein analysis.

The purpose of this paper is to present laboratory results showing major problems with the 4-hexylresorcinol method used for acrolein analysis. A discrepancy in the analytical procedure described by ASTM and NIOSH gives rise to underestimation of acrolein levels based on the length of time the mixed reagents have been prepared prior to sampling. Underestimations by as much as 35% may occur due to the problems in the existing methodologies.

Acrolein↗
PubMed1978

Breast self-examination practices and breast-cancer stage.

To determine the relation between breast self-examination performance and the clinical and pathological stage of breast cancer at first diagnosis, we studied 335 patients with breast cancer. Approximately one fourth of the patients reported that they had been practicing monthly breast self-examination, and half that they had never practiced breast self-examination. More frequent performance of breast self-examination was associated with more favorable clinical stage and fewer axillary-lymph-node metastases on histologic examination. On pathological examination, the age-adjusted maximum tumor diameter of patients practicing monthly breast self-examination was 1.97 +/- 0.22 cm (mean +/- S.E.M.) as compared to 2.47 +/- 0.20 for those performing self-examination less often than monthly and 3.59 +/- 0.15 for patients never performing breast self-examination. These data associating more favorable clinical and pathological stages of breast cancer with more frequent breast self-examination need to be extended by determination of the survival rates of the various self-examination groups.

Adult↗