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M Sloan

Publications and source records attributed to M Sloan.

At least 19 recordsLinked to original sources
PubMed2006

Clinical experience with Alloderm: a one-staged composite dermal/epidermal replacement utilizing processed cadaver dermis and thin autografts.

UNLABELLED: Alloderm has been advocated for the management of acute burns. However, few studies have demonstrated the feasibility of this technique. METHODS: We reviewed the medical records of all patients treated in our burn center who received Alloderm since 1999. RESULTS: Alloderm was used in 21 burn patients and 6 patients with traumatic skin loss. The average size of Alloderm used in the burn patients was 517+/-144 cm(2) (range 24-3000 cm(2)). The average Alloderm thickness used was 0.008 in. and autografts were harvested at an average of 0.007 in. Overall, Alloderm was used in a variety of locations including the face in 3 patients (2 burns, 1 traumatic skin loss) and hands in 7 patients (6 burns, 1 traumatic skin loss). Successful take was observed in 26/27 patients. CONCLUSIONS: Alloderm can be used successfully in patients with acute burns requiring grafting.

Adolescent↗
PubMed2001

Misclassification of exposure: coffee as a surrogate for caffeine intake.

This study was conducted to assess the effect of exposure misclassification when coffee is used as a surrogate measure of caffeine exposure. Subjects were randomly selected from the telephone directories of four regional municipalities in southern Ontario, CANADA: Data on daily caffeine intake from foods, beverages, and medications were collected from June to November 1995 through self-administered, mailed questionnaires from 481 men and women aged 30-75 years. Although coffee was the main source of caffeine, cross-tabulations of exposure to coffee by total caffeine intake showed that assessment of coffee alone severely underestimated caffeine intake by at least one exposure level. A hypothetical 10-fold increase in risk was completely obscured when only coffee was used to estimate total caffeine intake. The results of this study suggest that measuring coffee instead of caffeine intake may contribute to a lack of positive findings in studies of coffee as a risk factor for disease occurrence, if in fact caffeine is the exposure of interest. On the other hand, measurement of coffee, tea, and cola soft drink intake in the present study appeared to approximate caffeine intake sufficiently and not affect risk estimates adversely.

Adult↗
PubMed2001

Hormonal factors and pancreatic cancer in women.

PURPOSE: The aim of the study was to evaluate hormonal risk factors for carcinoma of the exocrine pancreas among postmenopausal women. METHODS: Mailed questionnaire data from 52 cases and 233 population-based controls in Ontario were used to assess parity, age at first birth, and other hormonal factors on pancreatic cancer risk. RESULTS: Reduced risk was seen with three or more pregnancies [adjusted odds ratio (OR) = 0.22, 95% confidence interval (CI) = 0.07-0.65] and use of oral contraceptives (adjusted OR = 0.36, 95% CI = 0.13-0.96), whereas no significant associations were found for age at menarche or menopause, or estrogen replacement therapy. Among parous women, later age at first full-term pregnancy significantly increased the risk of this cancer (adjusted OR = 4.05, 95% CI = 1.50-10.92 for ages 25-29 years, adjusted OR = 3.78, 95% CI = 1.02-14.06 for ages 30+ years). CONCLUSIONS: Our data support the hypothesis that pancreatic cancer is, at least in part, an estrogen-dependent disease; there is growing epidemiological evidence that aspects of reproductive history and hormonal exposure are associated with risk of this disease.

Adolescent↗
PubMed2001

Nonsteroidal anti-inflammatory drug use and breast cancer risk.

Findings from previous epidemiological studies are inconclusive, though they suggest nonsteroidal anti-inflammatory drug (NSAID) use is associated with a reduction in breast cancer risk. In addition, animal studies report that NSAIDs inhibit mammary tumor development. The association between NSAID use and breast cancer risk was evaluated using a case-control study design. Cases were a random sample of women diagnosed with a first primary cancer of the breast, aged 25-74 years, identified through the Ontario Cancer Registry, and diagnosed between July 1996 and September 1998. Controls were an age-matched random sample of the female population of Ontario. Cases (n = 3133) and controls (n = 3062) completed a mailed questionnaire with information on their past use of NSAID and other medications, as well as many risk factors thought to be associated with breast cancer. Multivariate logistic regression analysis was used to obtain adjusted odds ratio (OR) estimates. Use of any NSAID medication (daily use for > or =2 months) was found to be associated with a significant 24% reduction in breast cancer risk (OR = 0.76; 95% confidence interval: 0.66, 0.88). The reduced risk was strongest for use lasting > 8 years, compared with nonusers (OR = 0.68; 95% confidence interval: 0.54, 0.86). No marked trends were observed for time since first use or last use or age at first use. Our results suggest a reduction in breast cancer risk associated with any regular NSAID use. NSAID use is a modifiable factor, and any protective effect attributed to its use could be of great public health importance.

Adult↗
PubMed1999

The risk of breast cancer following reproductive surgery.

Alteration of exposure to ovarian hormones, by eliminating or impairing the function of one or both ovaries, may affect the risk of breast cancer. To assess the relationship between reproductive surgical procedures and breast cancer risk, we conducted a retrospective cohort study involving 524,709 Ontario women who underwent tubal ligation or other salpingectomy, hysterectomy and/or ovariectomy between 1979 and 1993. Data on type and year of surgery were obtained from hospital records and linked with breast cancer diagnoses recorded in the Ontario Cancer Registry. Observed breast cancers were compared with age- and calendar-period expected rates in Ontario. A decreased risk of breast cancer was observed among women who had undergone either hysterectomy (observed/expected [O/E] = 0.87, P < 0.001) or unilateral ovariectomy (O/E = 0.74, P < 0.001). Bilateral ovariectomy and tubal ligation were associated with reduced risk when the surgery occurred before the age of 45 years, and tubal ligation was protective if performed after the age of 54 years. There was no trend in risk with increasing follow-up. Our data support the hypothesis that reduced levels of endogenous oestrogen may be protective for breast cancer in women.

Adolescent↗
PubMed1999

Establishing research priorities in etiologic epidemiology.

PURPOSE: A major goal of epidemiology is to discover the causes of disease in populations. The aim of this study was to develop a method for establishing research priorities within this very broad area of scientific inquiry. METHODS: While the approach is applicable to many diseases, cancer was used here, in part because of its importance to both individuals and governments. Measures of disease were estimated from data in the Ontario Cancer Registry, and combined to yield a single assessment of impact for each cancer site. Measures of exposure prevalence were identified from recent population health surveys. Cross-classification by disease and exposure rankings yielded a matrix of scores of "relative importance" for each cancer-exposure combination. Onto this matrix was overlaid: 1) estimates of statistical power for examining each association; 2) biological plausibility of each association; and 3) strength of the epidemiological evidence supporting each association. RESULTS: The disease-exposure matrix, viewed in light of statistical power, biological plausibility, and current epidemiological evidence, yielded, in the examples shown, some potentially interesting yet understudied associations (e.g., non-Hodgkin lymphoma (NHL) and certain aspects of dietary intake). CONCLUSIONS: The associations identified within the research hierarchy suggest not only new avenues for etiologic research, but also priorities for research focus.

Environmental Exposure↗
PubMed1999

Breast cancer found at the time of breast reduction.

In a recent study involving 27,500 women who had breast reduction surgery in Ontario, Canada, 17 women who were diagnosed as having breast cancer at the time of their breast reduction surgery were identified. The aims of this study were to (1) describe a population-based series of patients who had breast cancer diagnosed at the time of breast reduction, (2) describe the treatment of these cancers, and (3) compare their survival rate with survival in patients in the general population who had breast cancer. Information about these women, their treatment, and outcome was extracted from hospital records, pathology reports, and reports from regional cancer centers. The chance of finding an invasive breast cancer at the time of breast reduction was 0.06 percent, which is lower than what has been reported previously. Sixty-seven percent of these women were treated with total mastectomy. In the remaining 33 percent, who were treated with partial mastectomy, the entire tumor was removed at the time of breast reduction. Fifty percent of the women were treated with radiation, and 25 percent were treated with chemotherapy or hormonal therapy. Compared with women in the general population of Ontario who have breast cancer, women whose breast cancer is discovered during breast reduction surgery are more likely to be treated with complete mastectomy and less likely to be treated with radiotherapy or chemotherapy. Seventy-one percent of the breast reduction group were axillary node-negative at diagnosis, compared with 58 percent in the general population of women with breast cancer. Survival from breast cancer in women diagnosed at the time of breast reduction (88 percent, 5-year survival) was better than survival from breast cancer in the general population (77 percent). These findings suggest that cancers found in women at the time of breast reduction are less advanced, possibly because they are diagnosed at an earlier stage.

Breast Neoplasms↗
PubMed1999

A follow-up study of 105 women with breast cancer following reduction mammaplasty.

Reduction mammaplasty is one of the most common procedures performed by plastic surgeons in Canada. In a recent study of 27,500 women in the province of Ontario who underwent breast reduction surgery, 105 women were identified who developed breast cancer after reduction mammaplasty. The purpose of this study was to compare women who had breast cancer and had a previous breast reduction with women who had breast cancer but did not have a breast reduction. Specifically, we wanted to document patient demographics, cancer type, surgical and nonsurgical treatment, and eventual outcome. A comparison group of non-breast reduction women was taken from the cohort of breast cancer patients in the province of Ontario, and the two groups were matched for age, year of diagnosis, and place of diagnosis. It was found that (1) the average age at diagnosis of breast cancer is significantly younger for women who have had previous breast reduction surgery than for those who have not; (2) the median interval between breast reduction and cancer is 5 years; (3) the type, location, and side of breast cancers are similar in the two groups of women; (4) breast reduction does not significantly increase or decrease survival rate from breast cancer; and (5) women who have had breast reduction receive the same treatment for their breast cancer as women who have not had reduction mammaplasty.

Adult↗
PubMed1997

Surgical procedures associated with risk of ovarian cancer.

BACKGROUND: This historical cohort study was conducted to examine the relationship between gynaecological surgery and ovarian cancer risk. METHODS: Women were included if they had had tubal ligation, hysterectomy, or unilateral ovariectomy in Ontario between March 1979 and April 1993. The cohort was linked to the Ontario Cancer Registry and the Ontario mortality file. Person-years in the cohort were accumulated until death, the removal of both ovaries, a diagnosis of ovarian cancer, or the end of the study period 31 December 1993. Observed cancers were compared to expected based on Ontario age- and calendar period-specific incidence rates. RESULTS: For tubal ligation and hysterectomy, fewer ovarian cancers were observed than were expected by age, calendar year of procedure, and length of follow-up; the observed/expected ratios were generally statistically significant. In contrast, no protective effect was evident for unilateral ovariectomy; in fact statistically significant excess cancers were seen in early follow-up periods. Observed/expected ratios were nearly identical and somewhat protective for the two strata defined by whether or not the ovaries were visualized. Disruption of the ovarian pathway conferred a protective effect, while no disruption significantly increased risk. CONCLUSIONS: The data do not support screening bias although short-term follow-up data indicate the possibility of detection bias. The long-term follow-up data, as well as the data on pathway disruption, are consistent with the hypothesis that the surgical procedures themselves may produce a protective effect against ovarian cancer, through alteration of the hormonal environment and/or by physical destruction of a carcinogen's route to the ovary.

Adolescent↗
PubMed1996

Traditional risk factors and ischemic stroke in young adults: the Baltimore-Washington Cooperative Young Stroke Study.

OBJECTIVE: To determine the association of hypertension, diabetes, and cigarette smoking with incidence of ischemic stroke in young adults. DESIGN: Case-control study. SETTING: Population-based sample of cases and controls. SUBJECTS: The study included 296 cases of incident ischemic stroke among black and white adults aged 18 to 44 years in central Maryland counties from the Baltimore-Washington Cooperative Young Stroke Study and 1220 black and white adults aged 18 to 44 years from the Maryland Behavioral Risk Factor Survey, a telephone survey of a random sample of the same region, to serve as controls. MAIN OUTCOME MEASURES: Logistic regression models were developed to determine the age-adjusted odds ratios for each risk factor. Population-attributable risk percent were computed based on the odds ratios and prevalence of each risk factor. RESULTS: The age-adjusted odds ratios (95% confidence intervals) for white men (WM), white women (WW), black men (BM), and black women (BW) were as follows: current cigarette smoking: WM, 2.0 (1.1-3.8), WW, 2.1 (1.1-4.3), BM, 3.3 (1.6-6.6), and BW, 2.2 (1.3-3.9); history of diabetes mellitus: WM, 22.9 (5.8-89.6), WW, 6.2 (1.9-20.2), BM, 4.2 (0.8-21.9), and BW, 3.3 (1.4-7.7); and history of hypertension: WM, 1.6 (0.7-3.2), WW, 2.5 (1.1-5.9), BM, 3.8 (1.8-7.9), and BW, 4.2 (2.4-7.5). The population-attributable risk percent (95% confidence intervals) were as follows: current cigarette smoking: WM, 22.6 (3.1-38.2), WW, 17.2 (4.0-34.0), BM, 40.5 (23.1-54.0), and BW, 29.1 (13.5-41.9); history of diabetes mellitus: WM, 19.0 (8.2-28.5), WW, 15.8 (3.8-26.3), BM, 13.2 (5.3-20.4), and BW, 22.1 (12.5-30.7); and history of hypertension: WM, 21.7 (6.2-34.6), WW, 21.3 (5.4-34.5), BM, 53.5 (39.0-64.4), and BW, 50.5 (37.1-61.1). CONCLUSIONS: Hypertension, diabetes mellitus, and current cigarette smoking are important risk factors in a biracial young adult population. Cigarette smoking and hypertension, the 2 most modifiable risk factors, were particularly important risk factors in young blacks.

Adolescent↗
PubMed1994

The relationship between cigarette smoking and the risk of endometrial neoplasms.

BACKGROUND: Endometrial carcinoma and endometrial hyperplasia share a number of risk factors, particularly exposure to oestrogen stimulation. Studies have shown that cigarette smoking protects against carcinoma. This study was undertaken to confirm this finding in carcinoma, and to extend the investigation to hyperplasia. METHODS: Data from a previously published population-based case-control study, conducted in Toronto, Ontario were used to model risk estimates. RESULTS: Smoking modestly reduced the risk, (although not statistically significantly), for hyperplasia among pre- and postmenopausal women, and for carcinoma among postmenopausal women. In contrast, smoking appeared to elevate risk for carcinoma among premenopausal women, although the number of cases upon which these estimates are based are very small. CONCLUSIONS: Among the shared risk factors for endometrial hyperplasia and endometrial carcinoma is cigarette smoking. As these results are consistent with other studies, it seems apparent that the mechanism of action for cigarette smoking may be different in premenopausal women. Hyperplasia could provide a useful model for studying the smoking effect on endometrial neoplasms in premenopausal women.

Adult↗
PubMed1993

Important nurse caring behaviors: perceptions of oncology patients and nurses.

The concept of care or caring is considered to be a salient feature of nursing practice yet there has been little systematic investigation of caring as related to nursing. This study used a correlational, comparative design to explore rankings of nurse caring behaviors by oncology patients and nurses including the investigation of differences between subscale scores of these caring behaviors. Forty two patients and 46 nurses participated in the study. The results demonstrate differences and similarities between these two groups in their ranking of nurse caring behaviors. Five new subscales were identified and labelled according to kinds of caring demonstrated by the nurse. Patients ranked as most important the clinical aspects of care followed by the empathetic manner of caring. Nurses chose as most important the empathetic manner of caring followed by the continuity of caring. This study provides increased understanding of the perceptions of oncology patients and nurses about nurse caring behaviors.

Adolescent↗
PubMed1992

Cigarette, alcohol, and coffee consumption and spontaneous abortion.

We analyzed data from a survey of occupational factors and pregnancy outcome to examine the effects of cigarette, alcohol, and coffee consumption on pregnancy outcome. Clear and statistically significant associations were found between cigarette and alcohol consumption and spontaneous abortion. There was a weaker but statistically significant association with coffee consumption: If the associations were casual, 11% of the spontaneous abortions could be attributed to smoking, 5% to alcohol, and 2% to coffee.

Abortion, Spontaneous↗
PubMed1992

Cigarette, alcohol, and coffee consumption and prematurity.

We analyzed data from a survey of occupational and other factors in pregnancy to assess the effects of cigarette, alcohol, and coffee consumption on pregnancy outcome. The risk of low birth weight for gestational age was found to increase substantially with smoking. Occasional consumers of alcohol had a slightly reduced risk relative to total abstainers. In more frequent drinkers, there was a small increase in risk. Risk increased slightly with coffee consumption.

Adult↗