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R Ballard-Barbash

Publications and source records attributed to R Ballard-Barbash.

At least 37 records · Page 2Linked to original sources
PubMed1998

Trends and outcomes of outpatient mastectomy in elderly women.

BACKGROUND: Considerable public attention has focused on the use of outpatient mastectomy and has resulted in numerous legislative proposals to mandate a minimum hospital stay following mastectomy. To date, only limited scientific data are available regarding the use and the outcomes of outpatient mastectomy. The purpose of this study was to provide population-based information on trends and outcomes for outpatient mastectomy in elderly women. METHODS: Medicare data for elderly women with fee-for-service coverage were examined for trends and regional variation in the use of outpatient mastectomy. Logistic regression was used to identify patient and provider characteristics associated with having an outpatient mastectomy, and outcomes were assessed by calculating the risk of being rehospitalized and the reasons for rehospitalization. RESULTS: From 1986 through 1995, the proportion of mastectomies performed on an outpatient basis increased from virtually 0% to 10.8%. Outpatient mastectomies were more likely to be performed on women with no coexisting health problems in hospitals that were for-profit or non-teaching or in large metropolitan statistical areas. Women undergoing outpatient mastectomy had substantially higher rates of rehospitalization within 30 days than women with a 1-day stay in the hospital. Both groups had comparable rates of rehospitalization for complications definitely related to their surgery. The percentage of women who required rehospitalization was low, and the actual number of women rehospitalized was relatively small. CONCLUSIONS: We conclude that the risks from outpatient mastectomy are modest, although ongoing monitoring of outcomes and assessment of patient satisfaction are needed.

Aged↗
PubMed1998

Breast cancer screening programmes in 22 countries: current policies, administration and guidelines. International Breast Cancer Screening Network (IBSN) and the European Network of Pilot Projects for Breast Cancer Screening.

BACKGROUND: Currently there are at least 22 countries worldwide where national, regional or pilot population-based breast cancer screening programmes have been established. A collaborative effort has been undertaken by the International Breast Cancer Screening Network (IBSN), an international voluntary collaborative effort administered from the National Cancer Institute in the US for the purposes of producing international data on the policies, funding and administration, and results of population-based breast cancer screening. METHODS: Two surveys conducted by the IBSN in 1990 and 1995 describe the status of population-based breast cancer screening in countries which had or planned to establish breast cancer screening programmes in their countries. The 1990 survey was sent to ten countries in the IBSN and was completed by nine countries. The 1995 survey was sent to and completed by the 13 countries in the organization at that time and an additional nine countries in the European Network. RESULTS: The programmes vary in how they have been organized and have changed from 1990 to 1995. The most notable change is the increase in the number of countries that have established or plan to establish organized breast cancer screening programmes. A second major change is in guidelines for the lower age limit for mammography screening and the use of the clinical breast examination and breast self-examination as additional detection methods. CONCLUSION: As high quality population-based breast cancer screening programmes are implemented in more countries, they will offer an unprecedented opportunity to assess the level of coverage of the population for initial and repeat screening, evaluation of performance, and, in the longer term, outcome of screening in terms of reduction in the incidence of late-stage disease and in mortality.

Adult↗
PubMed1997

Breast cancer survival and treatment in health maintenance organization and fee-for-service settings.

BACKGROUND: Enrollment in health maintenance organizations (HMOs) has increased rapidly during the past 10 years, reflecting a growing emphasis on health care cost containment. To determine whether there is a difference in the treatment and outcome for female patients with breast cancer enrolled in HMOs versus a fee-for-service setting, we compared the 10-year survival and initial treatment of patients with breast cancer enrolled in both types of plans. METHODS: With the use of tumor registries covering the greater San Francisco-Oakland and Seattle-Puget Sound areas, respectively, we obtained information on the treatment and outcome for 13,358 female patients with breast cancer, aged 65 years and older, diagnosed between 1985 and 1992. We linked registry information with Medicare data and data from the two large HMOs included in the study. We compared the survival and treatment differences between HMO and fee-for-service care after adjusting for tumor stage, comorbidity, and sociodemographic characteristics. RESULTS: In San Francisco-Oakland, the 10-year adjusted risk ratio for breast cancer deaths among HMO patients compared with fee-for-service patients was 0.71 (95% confidence interval [CI] = 0.59-0.87) and was comparable for all deaths. In Seattle-Puget Sound, the risk ratio for breast cancer deaths was 1.01 (95% CI = 0.77-1.33) but somewhat lower for all deaths. Women enrolled in HMOs were more likely to receive breast-conserving surgery than women in fee-for-service (odds ratio = 1.55 in San Francisco-Oakland; 3.39 in Seattle). HMO enrollees undergoing breast-conserving surgery were also more likely to receive adjuvant radiotherapy (San Francisco-Oakland odds ratio = 2.49; Seattle odds ratio = 4.62). CONCLUSIONS: Long-term survival outcomes in the two prepaid group practice HMOs in this study were at least equal to, and possibly better than, outcomes in the fee-for-service system. In addition, the use of recommended therapy for early stage breast cancer was more frequent in the two HMOs.

Aged↗
PubMed1997

Evening eating and subsequent long-term weight change in a national cohort.

OBJECTIVE: To examine the association of proportion of daily energy consumed in the evening with weight change over 10 y of follow-up. DESIGN: The data used were from the First National Health and Nutrition Examination Survey (NHANES I, 1971-75) Epidemiologic Follow-up Study (NHEFS, 1982-84). The analytic cohort included 2580 men and 4567 women aged 25-74 y at baseline (NHANES I, 1971-75). The proportion of energy consumed in the evening (after 5 pm) was estimated from a 24 h dietary recall obtained a baseline. Weight change was defined as the difference between the follow-up and baseline weights. RESULTS: Mean +/- s.e. of percent energy from evening food intake was 46 +/- 0.29 in the analytic cohort. After adjustment for multiple covariates, percent energy from evening food intake and weight change were unrelated in both men and women. CONCLUSION: Extent of evening eating was not a significant predictor of 10 y weight change in the NHEFS cohort.

Adult↗
PubMed1997

Characterizing food intake patterns of American adults.

Food-pattern analysis provides a way to examine diets in a multidimensional context. This study examined the diets of 8181 adults in the 1989-1991 Continuing Survey of Food Intakes by Individuals and evaluated whether they met the federal recommendations for each of five food groups. The sample was partitioned among 32 different food-intake patterns, six of which represented 44% of the population. Nutrient profiles associated with each of the patterns indicated that failure to meet one or more of the food-group recommendations was associated with nutrient inadequacy, macronutrient imbalance, or both. A reexamination of the data to account for low energy reporters did not alter these findings. The pattern of meeting all five of the food-group recommendations was among the least common, accounting for only 1% of adults' intakes.

Adult↗
PubMed1997

Perspectives on integrating experimental and epidemiologic research on diet, anthropometry and breast cancer.

Three perspectives on the integration of experimental and epidemiologic research on diet, anthropometry and breast cancer are presented. 1) Although body weight and height have been linked to breast cancer risk by epidemiologic research, their roles have not been directly explored with animal models. However, basic, clinical and epidemiologic research on obesity and associated metabolic alterations may be pertinent. Individual differences in the timing and magnitude of weight gain and loss during adult life need to be considered in epidemiologic studies of adiposity and breast cancer, along with individual differences in the pattern of body fat deposition, the hormonal and metabolic changes that accompany the adiposity, and family history of obesity-related chronic diseases. Animal models with genetic predispositions to obesity, diabetes and breast cancer merit further exploration, as well as models that can evaluate exposures occurring after puberty. 2) The synergy between experimental and epidemiologic studies on fat and energy intake and breast carcinogenesis has been productive because each discipline has had to incorporate recent findings of the other. Dietary studies utilizing animals with different genetic profiles are promising, but require identification of the critical genes in human carcinogenesis. 3) Controlled dietary intervention studies with human participants using intermediate endpoints can bridge the gap between animal and epidemiologic studies, but generally accepted intermediate endpoints for breast cancer need to be developed. Such studies would permit better control of diet than large clinical trials and the opportunity to explore mechanisms.

Adult↗
PubMed1997

Food intakes of US children and adolescents compared with recommendations.

OBJECTIVES: To determine the proportion of youth meeting national recommendations for food group intake and to identify food intake patterns. DESIGN: The US Department of Agriculture's 1989-1991 Continuing Surveys of Food Intakes by Individuals were used to estimate food intake. Intake was determined from 3 days of diet by disaggregating foods into their component ingredients and using weights that correspond to servings. PARTICIPANTS: The sample included 3307 youth, 2 to 19 years of age, living in the 48 conterminous United States. Main Outcome Measures. Mean number of servings and percentage of individuals meeting national recommendations for food group intake according to demographic characteristics, patterns of intake, and nutrient profiles associated with each pattern. RESULTS: Mean numbers of servings per day were below minimum recommendations for all food groups except the dairy group (ages 2 to 11). Percentages of youth meeting recommendations ranged from approximately 30% for fruit, grain, meat, and dairy to 36% for vegetables. Sixteen percent of youth did not meet any recommendations, and 1% met all recommendations. The pattern of meeting all recommendations resulted in nutrient intakes above the recommended dietary allowances and was high in fat. Conversely, meeting none of the recommendations resulted in intakes well below the recommended dietary allowances for some nutrients. Total fat and added sugars averaged 35% and 15% of energy, respectively, and levels were similar among most demographic groups. CONCLUSION: Children and teens in the United States follow eating patterns that do not meet national recommendations. Nutrition education and intervention are needed among US children.

Adolescent↗
PubMed1996

Factors associated with surgical and radiation therapy for early stage breast cancer in older women.

BACKGROUND: In addition to demographic and health care-related characteristics, the age and physiologic status of women at the time of breast cancer diagnosis have been reported to influence receipt of standard treatments. Previous studies of the influence of age and comorbidity have not examined whether other patient-, region-, or health care-related characteristics altered the association of age and comorbidity with type of treatment received. PURPOSE: This study examined factors associated with receipt of breast-conserving surgery and radiation therapy, both of which are recommended treatments for breast cancer, among a cohort of 18,704 women aged 65 years or more who had breast cancer diagnosed during the period from 1985 through 1989. METHODS: A data file linking Medicare claims records to data from the Surveillance, Epidemiology, and End Results (SEER) Program of the U.S. National Cancer Institute was utilized. Logistic regression analysis was used to examine associations between patient, region, and hospital characteristics and the receipt of specific treatments. The likelihood test was used to assess the significance of observed associations (expressed as odds ratios [ORs]). Because of multiple comparisons, only those ORs with two-sided P values <.01 were considered statistically significant. RESULTS: The frequency of breast-conserving surgery was highest (54%) among women aged 80 years or more, who had two or more comorbid conditions and stage I disease. However, in general, the receipt of radiation therapy among women undergoing breast-conserving surgery declined markedly with age, irrespective of comorbidity status and disease stage. Between the ages of 65-69 years and 80 years or older, radiation therapy declined from 77% to 24% among women with no comorbid conditions and from 50% to 12% among women with two or more comorbid conditions. In regression models that included hospital, region, and patient characteristics as variables, age and comorbidity remained independently associated with the receipt of radiation therapy (OR = 0.12 and 95% confidence interval [CI] = 0.10-0.14 for women aged 80 years or more compared with women 65-69 years of age and OR of 0.33 [95% CI = 0.24-0.46] for women with two or more comorbid conditions versus no comorbid conditions). CONCLUSIONS: After adjustment for multiple clinical and nonclinical factors influencing treatment, chronologic age remains an important independent factor associated with the receipt of radiation therapy after breast-conserving surgery among women aged 65 years or more who were diagnosed with early stage breast cancer. IMPLICATIONS: Future studies should determine whether these differences in treatment patterns among older women result in increased morbidity (e.g., from recurrence), shortened disease-free or overall survival, or decreased quality of life.

Age Factors↗
PubMed1996

Body weight: estimation of risk for breast and endometrial cancers.

Consistent, positive, and independent associations between body weight or body mass index (BMI), weight gain, and various measures of central adiposity and the incidence of endometrial cancer exist. Increases in relative risks of 2-3.5 are reported for women with BMIs (in kg/m2) > or = 28-30, for women in the fourth compared with the first quartile of measures of central adiposity, and for women with weight gains from young adulthood to middle age of > or = 27 kg. Furthermore, endometrial cancer mortality is increased in heavier and taller women. Associations between breast cancer incidence and these measures of adiposity vary by age and menopausal status at the time of diagnosis. Heavier women appear to be at decreased risk for developing premenopausal breast cancer; relative risks of approximately 0.6 were reported for women with BMIs > or = 26-27. Conversely, heavier women are at increased risk of developing and dying from postmenopausal breast cancer. Although contradictory findings have been observed in cohort studies, modest increases in relative risks on the order of 1.2-1.5 were reported in older postmenopausal women with BMIs of > or = 28-30. Furthermore, adult weight gain and increased central adiposity have been consistently and independently associated with an increased risk for postmenopausal breast cancer. No significant associations have been observed between weight loss and postmenopausal breast cancer incidence. These findings indicate that avoidance of weight gain and accumulation of central body fat during adult life may reduce risk of both endometrial and postmenopausal breast cancer.

Adult↗
PubMed1996

Contribution of dieting to the inverse association between energy intake and body mass index.

OBJECTIVE: To examine the association of energy and % energy from fat with body mass index (BMI) and determine if self-reported dieting altered observed associations. DESIGN: Dietary intake data based on dietary recalls from four nonconsecutive days over a 1 year period were examined relative to BMI. The relation between energy intake and % energy from fat and BMI was examined by linear regression analysis. SUBJECTS: The sample included 1854 free-living women aged 19-50 years who participated in the 1985-6 Continuing Surveys of Food Intakes by Individuals conducted by the United States Department of Agriculture. RESULTS: Reported energy intake was inversely associated with BMI (regression coefficient (beta) = -0.001 24, standard error (s.e.) = 0.000 31). Controlling for low energy dieting alone reduced the inverse energy intake-BMI association by approximately 20% (beta = -0.001 00, s.e. = 0.000 31), compared to reductions of 16%, 13% and 10%, respectively, when health status, age and education were added individually to the energy intake-BMI linear regression. Physical activity, smoking status, % energy from fat and report of low fat dieting did not reduce the energy intake-BMI association. Controlling for nondietary factors related to BMI and potentially influencing energy intake reduced the inverse energy intake-BMI association by approximately 22% (beta = -0.000 97, s.e. = 0.00025). Further adjustment for low energy dieting on day 1 reduced the inverse energy intake-BMI association by 40% (beta = -0.000 74, s.e. = 0.000 26), suggesting that intermittent energy restriction was a significant factor in the reduced energy intake reported among overweight women. Percent energy from fat was not associated with BMI (beta = 0.049, s.e. = 0.025, P = 0.055). Exclusion of 37 women reporting poor health status further attenuated the inverse association between energy intake and BMI (beta = -0.000 64), s.e. = 0.000 26), while it strengthened the previously non-significant positive association between % energy from fat and BMI (beta = 0.062; s.e. = 0.024). CONCLUSION: Intermittent energy restriction appeared to be a significant factor in the reduced energy intake reported among overweight women in this sample. Adequate assessment of energy expenditure is required to correctly interpret the association of energy intake to body weight.

Adult↗
PubMed1996

Recall of body weight and body size estimation in women enrolled in the breast cancer detection and demonstration project (BCDDP).

OBJECTIVE: To examine the relationship between body mass index (BMI) and pictorial representations of body size in women from young adulthood to late mid-life. DESIGN: Retrospective, descriptive study of BMI and pictorial estimation of body size. SUBJECTS: 5,807 women age 33-77 years enrolled in the National Cancer Institute's and American Cancer Society Breast Cancer Detection and Demonstration Project (BCDDP). MEASUREMENTS: Body weight and height were measured in 1973. In 1977, a subset of the cohort recalled their usual height and weight at 10 y intervals starting at age 20. In 1987, subjects reported their usual and current weight and selected one of nine pictorials best representing their body size at ages 15, 25, 40, 50 and +60 y. RESULTS: For the cohort, and among White women, Pearson correlations between recalled BMI (Kg/M2) and pictorials for each decade ranged from 0.62-0.67 and was 0.80 for current BMI and current pictorial. The range of correlations between pictorials and recalled BMI for other race/ethnic groups were 0.72-0.87 (Black), 0.53-0.75 (Hispanic) and 0.28-0.87 (Asian). Among a subset of women with data on measured BMI, recalled BMI and pictorials at specific ages, the correlation between pictorials and measured BMI was 0.75, compared to the correlation between recalled BMI and measured BMI which was 0.89. CONCLUSION: Correlations are higher between recalled BMI and measured BMI compared to the correlation between pictorials and measured BMI. Therefore, estimates of body size by pictorials alone may not be appropriate for epidemiological investigations. Alternate uses of pictorials may include assessment body weight in low literate populations or in instances where body weight is not or has not been measured.

Adult↗
PubMed1996

The polyp prevention trial II: dietary intervention program and participant baseline dietary characteristics.

The Polyp Prevention Trial (PPT) is a multicenter randomized controlled trial to evaluate whether a low-fat, high-dietary fiber, high-fruit and -vegetable eating pattern will reduce the recurrence of adenomatous polyps of the large bowel. Men and women who had one or more adenomas removed recently were randomized into either the intervention (n = 1037) or control (n = 1042) arms. Food frequency questionnaire data indicate that PPT participants at the beginning of the trial consumed 36.8% of total energy from fat, 9.7 g of dietary fiber/1000 kcal, and 3.8 daily servings of fruits and vegetables. Baseline dietary characteristics, including intake of fat, fiber, and fruits and vegetables, as well as other macro- and micronutrients, were similar in the two study groups. The intervention participants receive extensive dietary and behavioral counseling to achieve the PPT dietary goals of 20% of total energy from fat, 18 g/1000 kcal of dietary fiber, and 5-8 daily servings (depending on total caloric intake) of fruits and vegetables. Control participants do not receive such counseling and are expected to continue their usual intake. Dietary intake in both groups is mentioned annually using a 4-day food record (also completed at 6 months by intervention participants only) and a food frequency questionnaire, with a 10% random sample of participants completing an annual unscheduled 24-h telephone recall. Blood specimens are drawn and analyzed annually for lipids and carotenoids. This article provides details on the rationale and design of the PPT dietary intervention program and describes the participant baseline dietary intake data characteristics.

Adenomatous Polyps↗
PubMed1995

Evening eating and its relation to self-reported body weight and nutrient intake in women, CSFII 1985-86.

OBJECTIVE: We investigated the association of extent of daily energy intake from evening food intake with self-reported body weight and nutrient intake. DESIGN: Using data from the 1985-86 CSFII, we estimated the proportion of daily energy from foods/beverages reportedly consumed after 5 p.m. on 4 non-consecutive days by 1802 women, aged 19-50 years. RESULTS: The mean +/- SE of 4-day average energy from evening food intake was 46 +/- 0.4%. Body mass index was not associated with percent energy from evening food intake in unadjusted or multiple-covariate-adjusted regression analyses. In multiple-covariate-adjusted regression models, percent energy from fat, protein, and grams of alcohol reported were positively associated with percent energy from evening food intake (p < 0.05); while percent energy from carbohydrate, and percent RDA of vitamins C, B-6, and folate were inversely associated with evening eating. CONCLUSIONS: The results do not support the hypothesis regarding the association of relative weight with percent energy from evening food intake. However, statistically significant differences in intake of some nutrients in relation to extent of evening food intake were noted.

Adult↗
PubMed1995

Proportion of energy intake from fat and subsequent weight change in the NHANES I Epidemiologic Follow-up Study.

We examined the association of percent energy intake from fat with subsequent weight change in 2580 men and 4567 women, using data from the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study (NHEFS). Weight change was defined as the difference between the follow-up weight (NHEFS, 1982-1984) and the baseline weight (NHANES I, 1971-1974). Fat intake was estimated from a 24-h dietary recall obtained at baseline. Regression analyses adjusted for potential confounders showed no significant association of percent fat energy with weight change in men. Among women aged < 50 y, the inverse relation of percent fat energy with weight change was significant (beta = -0.052, P = 0.04). After exclusion of respondents with any morbidity from the analytic cohort, percent fat energy and weight change were positively associated in men (beta = 0.046, P = 0.05), but not in women. In conclusion, percent fat energy intake and weight change were inversely related in women aged < 50 y in the NHEFS cohort, but positively associated in men without any morbidity.

Adult↗
PubMed1995

Frequency of eating occasions and weight change in the NHANES I Epidemiologic Follow-up Study.

OBJECTIVE: To examine the association of frequency of eating occasions with prospective, and retrospective weight change. DESIGN: Data from the NHANES I (1971-75) Epidemiologic Follow-up Study (NHEFS, 1982-84) (n = 7147) was used. Weight change was defined as the difference between the weight measured at follow-up in 1982-84 and the weight measured at baseline in 1971-75. Baseline frequency of eating occasions was estimated by summation of actual times at which food was reported consumed in a 24-h dietary recall. Follow-up frequency of eating was estimated from subject responses at follow-up to number of meals and snacks consumed daily. RESULTS: Men and women reported (mean +/- s.e.) baseline frequency of 5.3 +/- 0.06 and 4.9 +/- 0.03 eating occasions, respectively. Frequency of eating occasions at follow-up was 3.6 +/- 0.02 occasions in both men and women. Baseline body mass index and frequency of eating were inversely related in multivariate regression analyses in both men and women (P < 0.02). Regression analyses adjusted for multiple covariates showed no association between weight change and frequency of eating at baseline or follow-up. CONCLUSION: Baseline frequency and subsequent weight change or follow-up frequency and preceding weight change were unrelated in the NHEFS cohort.

Adult↗