Biomedical subjects
P A Buffler
Publications and source records attributed to P A Buffler.
Feasibility study of surveying the adverse drug reaction surveillance systems in a large community of hospitals.
OBJECTIVE: To determine the feasibility of accurately assessing the types of hospital adverse drug reaction (ADR) surveillance systems. DESIGN: Cross-sectional survey by mailed, self-administered questionnaire followed by selected verification interviews. SETTING: Harris County, Texas. PARTICIPANTS: All hospitals in the county with different pharmacy directors. MAIN OUTCOME MEASURE: Self description of surveillance system and number of ADRs reported. RESULTS: Forty-nine of 61 hospitals (80 percent) responded to a questionnaire. Forty-seven (96 percent) of the responding hospitals collected information on ADRs with 11 (22 percent) describing their surveillance system as active. Those individuals most often cited as responsible for ADR surveillance included pharmacists, quality assurance personnel, and nurses. Data were verified by personal interviews for 10 hospitals. The number of ADRs reported during the interviews was significantly lower than that reported in the questionnaires. Overall, the reporting of fatal and severe ADRs were more reliable than the reporting of moderate ADRs. These differences were the result of inadequate documentation and the lack of a uniform definition of ADRs. CONCLUSIONS: These data suggest that a large-scale ongoing survey of surveillance systems and reported adverse event rates has limitations and the reliability of data derived from a questionnaire should be verified. To improve the accuracy of surveys used to monitor hospital ADR surveillance systems, it is essential to develop reliable definitions for classifying ADRs and surveillance methods, as well as accurate measures of ADR documentation procedures.
Genetic epidemiology of childhood brain tumors.
The study goal was to determine the genetic (heritable) contribution to childhood brain tumors (CBT) which cause nearly one quarter of all childhood cancer deaths. Their etiology remains unknown, but previous studies have suggested a proportion of CBT may be heritable. In this study we collected family histories of 243 confirmed CBT patients referred to The University of Texas M. D. Anderson Cancer Center between the years 1944 and 1983, diagnosed before age 15, and residents of the United States or Canada. Family histories were obtained for all the probands' first degree relatives (parents, siblings, and offspring) and extended to include selected second degree relatives (aunts, uncles, grandparents) using sequential sampling. To determine if these CBT families exhibited excess cancer, we compared their cancer experience to age-, race-, sex-, and calendar-year specific rates from the Connecticut Tumor Registry. No cancer excess was observed among 1,099 first and second degree relatives [39 cancers observed (O) and 44 expected (E) for a standardized incidence ratio (SIR) of 0.88]. For colon cancer, although small numbers, five cases were observed among the probands' first degree relatives with 1.6 expected, for a significant SIR of 3.10. Segregation analysis demonstrated that chance alone could not account for the observed cancer distribution with a multifactorial model providing the best overall explanation of the data. Overall, heredity played a role in the etiology of CBT in 4% of the study families: four (1.7%) due to known hereditary syndromes (nevoid basal cell carcinoma syndrome and von Recklinghausens neurofibromatosis--NF-1), four (1.7%) with multifactorial inheritance, and two additional families with cancers aggregating similar to the clinical criteria described for the Li-Fraumeni cancer family syndrome.
Lung cancer risk associated with cancer in relatives.
Family history data from an incident case-control study of lung cancer conducted in the Texas Gulf Coast region between 1976 and 1980 were analyzed to evaluate the contribution of cancer in first-degree relatives to lung cancer risk. Odds ratios (OR) increased slightly as the number of relatives with any cancer increased (reaching 1.5 with 4 or more relatives with cancer). Risks were higher for tobacco-related cancers (OR = 1.5 for 2 or more relatives with these tumors) and greatest for first-degree relatives with lung cancer (OR = 2.8 for lung cancer in 2 or more relatives). For cases of squamous cell carcinoma and adenocarcinoma of the lung, risks with 3 or more relatives with any cancer were increased 2-fold (OR = 1.8 and 1.9 respectively), and a significantly elevated risk was found for having a first-degree relative with lung cancer for each histologic type (ORs from 1.7-2.1). Having a spouse with lung cancer increased lung cancer risk (OR = 2.5), and cases with lung cancer reported in a first-degree relative were diagnosed at an earlier age, as were case siblings with lung cancer.
Physicians' management of health effects related to industrial exposures: two case reports.
Although physicians play a vital role in diagnosing and treating health effects related to industrial exposures, most physicians have limited training in occupational and environmental medicine. Two cases of industrial exposure, one affecting an individual and the other, a community, are described to illustrate the need for physicians' awareness of such exposure and their need to know how to manage potential health effects. Resources to assist in identifying and managing these exposures and their related conditions are discussed.
A surveillance system for assessing health effects from hazardous exposures.
A statistical procedure for monitoring the health status of a community potentially exposed to a hazardous environment is presented. It utilizes two levels of investigation. Level I studies monitor routinely collected vital statistics and routes of community exposure whereas level II studies require additional data collection and are further distinguished by their design and duration. In a level I study, routine vital statistics for specified end points over a specified period of time are monitored, and the observed number of events is compared with the expected number of events for a given population. The statistical model used with this procedure employs a two-step decision rule based on the standardized mortality ratio for the study community. An "alert status" is invoked when the number of events exceeds a prescribed excess. An "action status" is indicated if the excess noted in the initial period persists or if the observed number of events in the initial period greatly exceeds expectation. Should an "action status" be justified, level II studies to determine the likely explanation for the significant excess are initiated. This could include the conduct of a "case-control" study using the exposure data available from monitoring the community.
Risk of colorectal cancer among automotive pattern and model makers.
Twofold to threefold increases in risk for colorectal cancer associated with pattern and model making in the automobile industry have been suggested by several reports. This paper reports the investigation of a cohort of 7545 General Motors pattern and model makers originally defined for the purpose of cancer screening. All-cause mortality for this cohort was lower than that of the US population (standardized mortality ratio [SMR] = 0.7; 95% confidence limits 0.6, 0.8). There were 22 colon cancer deaths v 10.9 expected, resulting in a significantly elevated SMR of 2.0 (95% confidence limits of 1.3, 3.0), consistent with previous studies. The colon cancer SMR for nonparticipants in the screening programs was 4.0 (95% confidence limits of 2.2, 6.7), emphasizing the importance of complete follow-up for all members of a defined cohort.
Effect of smoking and alcohol consumption on laryngeal cancer risk in coastal Texas.
Data from case-control studies of respiratory cancer conducted in the Texas Gulf Coast region between 1975 and 1980 were used to examine the effects of smoking and alcohol on laryngeal cancer risk. Analyses were limited to living white males, aged 30-79, which included 151 histologically confirmed incident laryngeal cancer cases and 235 population-based controls. A dose-dependent effect for cigarette smoking was observed, with odds ratios ranging from 4.4 for ever smoking up to one-half pack daily, to 10.4 for smoking more than two packs per day. Risks were strongest for current smokers and declined markedly following smoking cessation. Higher risks were associated with smoking nonfiltered than filtered cigarettes. No significantly elevated risks were associated with the use of other tobacco products. Odds ratios for alcohol beverages did not increase linearly with increasing use; instead risks were twofold for consumption of four or more drinks weekly. Patterns of risk associated with beer and hard liquor were not consistent and few participants drank wine. Although the data were sparse, a dose-response effect for alcohol intake was suggested for tumors of the supraglottis (n = 23), while for nonsupraglottic cases, alcohol risks were elevated but did not increase beyond those observed for four drinks per week. Predicted risks for the combined effects of cigarette and alcohol use were intermediate between an additive and multiplicative form of interaction.
Geographic distribution of deaths due to sentinel health event (occupational) causes.
This report describes the Compressed Mortality File available from the National Center for Health Statistics that can be used to easily and efficiently generate annual mortality rates for geographic areas as small as counties for any period from 1968 to 1985. Several ways of presenting geographic variation in mortality rates due to potentially work-related deaths and changes in these rates over time are discussed for the 15-year period from 1969 through 1983. Causes of death that are potentially work-related were identified using the sentinel health events (occupational) [SHE(O)] concept. Data are given for nine diagnostic groups of occupationally related disorders, and maps are presented for bladder cancer, acute myeloid leukemia, and pneumoconioses. Significant changes in age-adjusted mortality rates were noted for pneumoconioses and acute myeloid leukemia that could not be due to changes in the disease coding of death certificates. Racial differences in mortality rates due to pneumoconioses may be due to differences in employment patterns. The use of SHE(O) codes to search the Compressed Mortality File may be helpful in identifying areas for public health concern, even if only as a monitoring signal for subsequent time periods. This file also provides an easy way to generate reference population mortality rates for epidemiologic studies.
The evaluation of negative epidemiologic studies: the importance of all available evidence in risk characterization.
The importance of publishing and utilizing all available epidemiologic evidence in risk assessment is recognized. This recognition includes the findings from negative epidemiologic studies, described as well designed and executed studies where the hypothesized association with an adverse health effect was not found or found to be very weak. In assessing negative evidence, the random (chance) and nonrandom (bias, confounding) sources of variation need to be considered as well as dilution effects, dose-response patterns, biologic plausibility, and methods for data pooling (meta-analysis). Meta-analysis may be a useful statistical approach for a systematic review of results from multiple studies, but cannot overcome the bias of missing evidence.
Epidemiologic aspects of childhood mesothelioma.
Our calculation provides the first population-based incidence rate of childhood mesothelioma in the United States. Based on these data and on our pathology review, we conclude that mesothelioma occurs rarely in children and that this diagnosis is difficult to establish. A more systematic approach to identifying mesothelioma cases in children, as well as adults, will be facilitated by increasing state surveillance of cancer incidence and by the proposed addition of a unique code for mesothelioma in the Tenth Revision of the ICD. There is a critical need for histopathological verification of mesothelioma cases. The increased use of a uniform, reproducible histopathologic classification and mesothelioma panels should address this problem. A thorough microscopic study of individual cases needs to be supplemented by a careful assessment of the clinical findings and environmental factors. The available data thus far do not support an association between childhood mesothelioma and asbestos exposure. However, the ubiquitous nature of asbestos exposures, the known association of asbestos with adult mesothelioma, the unreliability of the diagnosis, and the lack of adequate data regarding asbestos exposures, all indicate that asbestos involvement cannot be categorically ruled out, especially in older children with the potential for a longer duration of exposure and a plausible induction period. Mesothelioma in children, as well as in adults, is likely to have a multifactorial etiology. Radiation, prenatal medications, and genetic factors are all possible etiologic agents in childhood mesothelioma. In addition, other, as of yet unspecified environmental factors may play a role in this disease. When cases are diagnosed, the physician should inquire about the history of exposure to asbestos or other hazardous materials in the patient's environment, prior radiation exposure, medication exposure pre- and postnatally, prior cancer diagnoses, and a family history of cancer. An interdisciplinary approach, combining the diagnostic skills of the pathologist and the analytic skills of the epidemiologist, will be of value and of special relevance in the study of mesotheliomas.
Asbestos-associated disease: a review.
Asbestos and its potential for adversely affecting health remain a source of concern to several sectors of society. Since it rarely occurs in the absence of occupational exposure to asbestos, and because it is potentially preventable, asbestosis was recently defined as a reportable occupational disease in Texas. An overview of the cardinal characteristics of the asbestos minerals and their associated health effects is presented. The role of the primary physician in diagnosis and counseling of individuals with asbestos-associated diseases is addressed.
Health characteristics by occupation and industry of longest employment.
Includes estimates on length of longest job held, limitation of activity, disability days, incidence of acute conditions, persons injured, hospitalizations, and utilization of medical and dental services of persons aged 17 years and over in the civilian noninstitutionalized population. These estimates are presented by occupation and industry of longest employment for those who had ever worked. Estimates are based on data collected in the National Health Interview Survey of 1980.
Occupational risk factors for laryngeal cancer on the Texas Gulf Coast.
Analyses are reported from a case-control interview study of incident laryngeal cancer on the Gulf Coast of Texas. Study subjects were 183 white men with squamous cell carcinoma of the larynx and 250 frequency matched controls. Occupational exposures were examined controlling for potential confounding by cigarette smoking and alcohol consumption. Significantly elevated risks were seen for men employed in the public services industry [transportation, communication, utilities, sanitary service; relative risk (RR), 1.6]; in metal fabricating (RR, 2.1), construction (RR, 1.7), and maintenance (RR, 2.7) occupations; and for workers potentially exposed to paint (RR, 1.8) and diesel or gasoline fumes (RR, 1.5). Elevated risks of border-line significance were seen for men employed as woodworkers/furniture makers (RR, 8.1) and for those with occupational exposure to asbestos (RR, 1.5). When asbestos was categorized by intensity of exposure, a significant positive gradient was found.
Lung cancer mortality among women employed in high-risk industries and occupations in Harris County, Texas, 1977-1980.
Lung cancer is rapidly becoming the leading cause of cancer mortality among women. Interviews conducted with 259 women with lung cancer and 278 women without lung cancer or with their next-of-kin in Harris County, Texas from July 1, 1977 to June 30, 1980 revealed that 12 (4.6%) of the women with lung cancer had never smoked cigarettes. The odds ratio (OR) for current smoking was 15.7. Odds ratios for smoking for living women (OR = 17.5) were higher than for those who were deceased (OR = 12.6). Lifetime occupational histories were classified a priori into high- and low-risk categories. Data were stratified according to employment in a high-risk industry or occupation, a high-risk industry, a high-risk occupation, or both a high-risk industry and occupation. Although not statistically significant, odds ratios for employment in high-risk categories support earlier estimates that attributed 5% of lung cancer mortality in women to employment in hazardous occupations. Employment of a husband or household member in selected industries and occupations yielded significantly increased odds ratios. More cases (15.9%) than controls (6.9%) reported a family history of lung cancer (OR = 2.4). No significant increase in smoking-adjusted odds ratios was found for the use of hair spray, hand-held dryers, or alcohol, or for having lived with a household member who smoked cigarettes.
Air pollution and lung cancer mortality in Harris County, Texas, 1979-1981.
Elevated lung cancer mortality rates in Harris County, Texas compared with other US counties and previously published reports that suggested a causal relation between air pollution and lung cancer in Houston prompted this ecologic analysis. A weighted regression analysis was used to examine the air pollution-lung cancer mortality relation for white males in Harris County, Texas, 1979-1981. The regression model included the following census tract-specific characteristics: median age for white males, two social and demographic factors not strongly correlated with pollution (family life cycle and migration), an age-dependent smoking index, and a pollution measure based on total suspended particulates. This model indicated a statistically significant contribution of the pollution measure in explaining the intracounty variation in lung cancer mortality rates. The relation between air pollution and lung cancer mortality, however, appeared to be highly dependent on which social and demographic factors were selected for inclusion in the analysis. Air pollution was not demonstrated to be a strong determinant of lung cancer mortality in this study in that the presence of air pollution accounted for less than 5% of the total variation in intraurban lung cancer mortality. In addition, the interpretation of geographic analysis must be guarded due to the introduction of potential bias due to aggregation. The hypothesis that air pollution is contributory to lung cancer cannot be tested until other, stronger individual risk factors for lung cancer can be better measured and controlled in studies of this association.
Carotene intake and the risk of laryngeal cancer in coastal Texas.
Between 1976 and 1980, data were collected for a case-comparison study of laryngeal cancer in white males aged 30-79 years in six Texas counties using all histologically confirmed incident cases and a population-based comparison group. Dietary interviews were obtained from 151 living cases and 178 living comparison subjects. A significant inverse association (odds ratio (OR) = 2.1) was found between low carotene intake and the risk of laryngeal cancer, but no association was found with total vitamin A or retinol intake. The inverse association with carotene intake was strongest among those who had stopped smoking 2-10 years before (OR = 5.9). The same risk for vitamin A intake was found by using a short list of foods based on contribution to variation in intake as was found by using a longer list based on per cent contribution to total intake. Definition of carotene as that which comes only from plant sources gives an estimate similar to a more complex method that takes into account carotene derived from both plant and animal sources.
The status of status inconsistency.
Explore the source record for details and available documents.