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Biomedical subjects

R R Monson

Publications and source records attributed to R R Monson.

At least 55 records · Page 3Linked to original sources
PubMed1990

A prospective study of obesity and risk of coronary heart disease in women.

We examined the incidence of nonfatal and fatal coronary heart disease in relation to obesity in a prospective cohort study of 115,886 U.S. women who were 30 to 55 years of age in 1976 and free of diagnosed coronary disease, stroke, and cancer. During eight years of follow-up (775,430 person-years), we identified 605 first coronary events, including 306 nonfatal myocardial infarctions, 83 deaths due to coronary heart disease, and 216 cases of confirmed angina pectoris. A higher Quetelet index (weight in kilograms divided by the square of the height in meters) was positively associated with the occurrence of each category of coronary heart disease. For increasing levels of current Quetelet index (less than 21, 21 to less than 23, 23 to less than 25, 25 to less than 29, and greater than or equal to 29), the relative risks of nonfatal myocardial infarction and fatal coronary heart disease combined, as adjusted for age and cigarette smoking, were 1.0, 1.3, 1.3, 1.8, and 3.3 (Mantel-extension chi for trend = 7.29; P less than 0.00001). As expected, control for a history of hypertension, diabetes mellitus, and hypercholesterolemia--conditions known to be biologic effects of obesity--attenuated the strength of the association. The current Quetelet index was a more important determinant of coronary risk than that at the age of 18; an intervening weight gain increased risk substantially. These prospective data emphasize the importance of obesity as a determinant of coronary heart disease in women. After control for cigarette smoking, which is essential to assess the true effects of obesity, even mild-to-moderate overweight increased the risk of coronary disease in middle-aged women.

Adolescent↗
PubMed1990

Interpregnancy interval and risk of preterm labor.

In 1977-1980, over 12,000 pregnant women being followed at the Boston Hospital for Women were interviewed and had their medical records reviewed. The effect of interpregnancy interval on the risk of preterm labor was estimated in 4,467 of these women whose previous pregnancy had resulted in a full-term live birth. The rate of preterm birth after the spontaneous onset of labor in this cohort was 3.8 percent. While the possibility of an increased risk of preterm labor for interpregnancy intervals of 3 months or less cannot be definitely excluded (adjusted odds ratio = 2.0, 95 percent confidence interval 0.7-5.4), no relation was found between other interpregnancy intervals and the risk of preterm labor. Earlier work from this same cohort showed a strong negative association between interpregnancy interval and small-for-gestational-age birth. Combining this with the results from the present study reinforces the importance of differentiating low birth weight due to preterm birth from that due to intrauterine growth retardation.

Birth Intervals↗
PubMed1990

Paternal military service in Vietnam and the risk of late adverse pregnancy outcomes.

To investigate the relationship between paternal military service in Vietnam and the risk of late adverse pregnancy outcomes, we conducted a case-control study of women who delivered infants from August 1977 until March 1980 at Boston Hospital for Women. Paternal military service history among 857 congenital anomaly cases, 61 stillbirth cases, and 48 neonatal death cases were compared with that of 998 normal controls. Military service veterans were identified by crossmatching identifying information from obstetric records with state and national military records. After controlling for confounding variables, we found that the Vietnam veterans' relative risk of fathering an infant with one or more major malformations was 1.7 (95% CI = 0.8, 3.5) compared to non-Vietnam veterans. The increased risk was present in several organ systems and did not seem to be related to a particular type of defect. No associations or highly unstable associations were found between paternal military service in Vietnam and the occurrence of congenital anomalies overall, minor malformations, normal variants, stillbirths, and neonatal deaths. These findings should be viewed with caution since maternal and delivery characteristics appear to have contributed to the etiology of several of the major malformations among the Vietnam veterans' children.

Boston↗
PubMed1990

Cancer mortality following radium treatment for uterine bleeding.

Cancer mortality in relation to radiation dose was evaluated among 4153 women treated with intrauterine radium (226Ra) capsules for benign gynecologic bleeding disorders between 1925 and 1965. Average follow up was 26.5 years (maximum = 59.9 years). Overall, 2763 deaths were observed versus 2687 expected based on U.S. mortality rates [standardized mortality ratio (SMR) = 1.03]. Deaths due to cancer, however, were increased (SMR = 1.30), especially cancers of organs close to the radiation source. For organs receiving greater than 5 Gy, excess mortality of 100 to 110% was noted for cancers of the uterus and bladder 10 or more years following irradiation, while a deficit was seen for cancer of the cervix, one of the few malignancies not previously shown to be caused by ionizing radiation. Part of the excess of uterine cancer, however, may have been due to the underlying gynecologic disorders being treated. Among cancers of organs receiving average or local doses of 1 to 4 Gy, excesses of 30 to 100% were found for leukemia and cancers of the colon and genital organs other than uterus; no excess was seen for rectal or bone cancer. Among organs typically receiving 0.1 to 0.3 Gy, a deficit was recorded for cancers of the liver, gall bladder, and bile ducts combined, death due to stomach cancer occurred at close to the expected rate, a 30% excess was noted for kidney cancer (based on eight deaths), and there was a 60% excess of pancreatic cancer among 10-year survivors, but little evidence of dose-response. Estimates of the excess relative risk per Gray were 0.006 for uterus, 0.4 for other genital organs, 0.5 for colon, 0.2 for bladder, and 1.9 for leukemia. Contrary to findings for other populations treated by pelvic irradiation, a deficit of breast cancer was not observed (SMR = 1.0). Dose to the ovaries (median, 2.3 Gy) may have been insufficient to protect against breast cancer. For organs receiving greater than 1 Gy, cancer mortality remained elevated for more than 30 years, supporting the notion that radiation damage persists for many years after exposure.

Adolescent↗
PubMed1990

Leukemia following radiotherapy for uterine bleeding.

Mortality due to leukemia among 4483 women treated with radiation to control uterine bleeding between 1925 and 1965 was twice as high as expected based on U.S. population rates (standardized mortality ratio (SMR) = 2.0; 95% confidence interval (CI): 1.4 to 2.8). Women were followed for an average of 26.4 years. Relative risk was highest 2 to 5 years after treatment (SMR = 8.1) and among women over 55 years at irradiation (SMR = 5.8). The usual method of treatment was intrauterine radium. Average radiation dose to active bone marrow was estimated on the basis of original radiotherapy records (median, 53 cGy). A linear dose-response model provided an adequate fit to the data. The average excess relative risk was 1.9% per cGy (95% CI: 0.8 to 3.2), and the average absolute risk was 2.6 excess leukemia deaths per million women per year per cGy (95% CI: 0.9 to 4.8). Chronic myeloid leukemia predominated during the first 15 years following exposure, whereas acute leukemias and chronic lymphatic leukemia were most common thereafter. The radiation doses experienced during treatment of benign gynecologic disease appear to result in greater leukemia risk per cGy average marrow dose than the considerably higher doses used to treat malignant disease, perhaps because of a decreased likelihood of killing potentially leukemic cells.

Adolescent↗
PubMed1989

Cancer mortality in a radiation-exposed cohort of Massachusetts tuberculosis patients.

The mortality experience of 13,385 tuberculosis patients treated between 1925 and 1954 in Massachusetts was determined through August 1986. Among 6,285 patients examined by X-ray fluoroscopy an average of 77 times during lung collapse therapy and followed for up to 50 yr (average = 25 yr), no increase in the total number of cancer deaths occurred [standardized mortality ratio (SMR) = 1.05, n = 424]. In contrast, the 7,100 patients treated by other means were at significant risk of dying from cancer (SMR = 1.3), especially of sites linked to cigarette smoking and alcohol use. Among the irradiated patients, estimates of mean radiation doses to the breast, lung, esophagus, and active bone marrow were 0.75, 0.84, 0.80, and 0.09 Gy, respectively. Cancers of the breast (SMR = 1.4, n = 62) and esophagus (SMR = 2.1, n = 14) were significantly increased. The risk of esophageal cancer, however, decreased with time since exposure. Lung cancer (SMR = 0.8, n = 69) and leukemia (SMR = 1.2, n = 17) were not elevated. Despite a wide range of doses to the lung, reaching over 8 Gy, there was no evidence of a dose response. Lung cancer risk also did not vary by time since exposure or age at exposure. Adjustment for smoking and the amount of lung tissue at risk did not appreciably modify these findings. These data suggest that frequent exposures to low doses of radiation over a period of several years increase the occurrence of cancer of the breast. When compared with studies of atomic bomb survivors, however, the fractionated exposures experienced by this cohort appear less effective in causing lung cancer than single exposures of the same total dose.

Adult↗
PubMed1989

Breast cancer after multiple chest fluoroscopies: second follow-up of Massachusetts women with tuberculosis.

A second follow-up was conducted of 1742 women with tuberculosis who were treated in one of two sanatoria in Massachusetts between 1930 and 1956. One hospital treated only children under the age of 17. Patient follow-up was extended from 1975 through 1980, and an additional 18 breast cancers were identified from hospital records, death certificates, and responses to a mailed questionnaire. Vital status was established for 97% of the subjects. Among 1044 women who were examined an average of 101 times with X-ray fluoroscopies during lung collapse therapy, 55 breast cancers were observed in contrast to 35.8 expected, based on incidence rates from the general population. No excess was found for 698 women treated by other means (19 observed versus 22.8 expected). Excess breast cancer risk did not appear until 15 years after initial exposure and was present at the end of 50 years of observation. Risk appeared to decrease with increasing age at exposure. Estimates of radiation dose to the breast for individuals (mean = 96 rad) were based on the most current information for the numbers of fluoroscopies, reconstruction of exposure conditions, and absorbed dose calculations. The relation between dose and breast cancer risk was consistent with linearity up to 400 rads (4 Gy). For 10-year survivors, the absolute excess risk was 5.5/1 million woman-year-rad, the excess relative risk per rad was 0.73%, and the relative risk at 100 rad was 1.7. These data indicate that a woman's lifetime risk of breast cancer is influenced by events occurring in early reproductive life, that low-dose fractionated exposures are as effective as single exposures of the same total dose in inducing breast cancer, and that risk of radiogenic breast cancer persists for many years, and perhaps for life.

Adolescent↗
PubMed1989

Mortality risk and psychiatric disorders. Results of a general physician survey.

As part of the Stirling County Study (Canada), general physicians were interviewed to identify the psychiatric disorders experienced by a sample of adults selected in 1952. Based on information about vital status gathered 16 years later, we found that those with a psychiatric disorder at the beginning of the study experienced 1.6 times the expected number of deaths. The effect in regard to premature mortality and accidental deaths was particularly strong. Four of six categories of psychiatric diagnoses were significantly associated with mortality. In terms of standardized mortality ratios, depression had the highest and anxiety the lowest risk in this general population. The findings are discussed as providing historical background from the 1950s and 1960s for studying trends.

Cause of Death↗
PubMed1989

Paternal military service in Vietnam and risk of spontaneous abortion.

To investigate the relationship between paternal military service in Vietnam and the risk of spontaneous abortion, we compared the military service history among husbands of 201 women having a spontaneous abortion through 27 weeks' gestation with that of women having full-term live-born infants at Boston Hospital for Women from July 1976 until February 1978. Paternal military veterans were identified by cross-matching identifying information from obstetric records with state and national military records. Compared with men with no known military service, the adjusted relative odds of spontaneous abortion through 27 weeks' gestation was 0.88 for the wives of Vietnam veterans (95% confidence interval, 0.42 to 1.86) and 0.74 (95% confidence interval, 0.46 to 1.17) for wives of non-Vietnam veterans. These data suggest that the risk of spontaneous abortion was not increased in this population of married US Vietnam veterans.

Abortion, Spontaneous↗
PubMed1989

Mortality among pulp and paper workers in Berlin, New Hampshire.

Cause specific mortality was analysed among 883 white male workers from a paper company in Berlin, New Hampshire. Subjects were assigned to different exposure groups on the basis of their having worked in the pulp mill, the paper mill, or elsewhere in the paper company. A standardised mortality ratio (SMR) analysis was used to compare death rates for each of the exposure groups with United States national rates. For all the subjects, deaths due to all causes, all malignant neoplasms, and lung cancer were close to the number expected and excesses were noted for cancers of the digestive system and leukaemia. Among pulp mill workers, the number of cancers of the digestive system was raised and the SMR for pancreatic cancer was especially high (SMR = 305, 95% CI = 98-712). Among paper mill workers, more deaths were due to leukaemia and cancers of the digestive system than expected. These results are consistent with the findings from other studies that employment in pulp and paper mills is associated with excess mortality due to digestive and lymphopoietic cancers.

Aged↗
PubMed1989

Prodromes of depression and anxiety. The Stirling County study.

A longitudinal investigation of psychiatric epidemiology in a general population (the Stirling County study) has indicated that the incidence of depression and anxiety disorders is low relative to prevalence, because these disorders have long durations. In an average year approximately nine adults among 1,000 experience a first-ever episode of one of these disorders. Incident cases over the course of a 16-year follow-up were more likely to have had premonitory symptoms than to have been asymptomatic at the beginning of the study. Among the relatively small number of people who exhibited the clearest prodromal manifestations, incidence was 20 per 1,000 annually. It might be possible to intervene before such disorders become fully formed and persistent if the precursors are given attention.

Adult↗
PubMed1989

The association of inter-pregnancy interval with small for gestational age births.

The association between small for gestational age (SGA) birth at term and inter-pregnancy interval was examined in a hospital cohort of 4489 multiparous women. The greatest risk of SGA birth was found in women with the shortest inter-pregnancy intervals. Even after adjusting for multiple confounding factors, women whose inter-pregnancy interval was 18 or fewer months (over one-third of women in the cohort) remained at twice the risk of giving birth to a term SGA infant when compared with women whose inter-pregnancy interval was 24-36 months. In a logistic regression analysis examining the occurrence of SGA birth in women with inter-pregnancy intervals of 36 months or less, a strong linear association was noted between these two factors. The association of term SGA birth with short inter-pregnancy interval could result from one or more physiologic factors that might act to limit fetal growth. In that case, short inter-pregnancy interval would represent a potentially preventable cause of SGA birth.

Birth Intervals↗
PubMed1988

Association of maternal hematocrit with premature labor.

An examination of the association of maternal hematocrit with the occurrence of premature birth revealed a continuous relationship between these two factors with an increasing rate of prematurity occurring with decreasing maternal hematocrit. The lowest risk of premature birth was found when maternal hematocrit was between 41% and 44%. Statistically increases in prematurity were noted at all hematocrit levels of less than or equal to 38%. A woman with a hematocrit of 37% had twice the risk of having a premature birth as a woman whose hematocrit was between 41% and 44% (p less than 0.01). In a logistic regression analysis with premature birth as the dependent variable and hematocrit as the only predictor variable, it was noted that decreasing the hematocrit by a single point was associated with a 24% increase in the risk of prematurity (odds ratio = 1.24) while a five-point decrease in hematocrit was associated with a tripling in the risk of prematurity (odds ratio = 2.98). In a multivariable logistic regression analysis hematocrit was noted to explain more of the variation in prematurity than any of the other risk factors included in the model. An investigation of this association in specific groups at high risk of having premature births revealed that 46% of the increased risk of prematurity in black women and 49% of the increased risk of prematurity in women receiving welfare was related to hematocrit or some factor associated with hematocrit.

Adult↗
PubMed1988

Radioactive iodine therapy and breast cancer. A follow-up study of hyperthyroid women.

A follow-up study of 1,762 hyperthyroid women who were treated at the Massachusetts General Hospital Thyroid Unit between 1946 and 1964 was conducted. The average length of follow-up was 17.2 years. A 1978 mailing address or a death certificate was located for 92% of the women, and 88% of 1,058 living patients responded to a mail questionnaire. The standardized mortality ratio (SMR) for all causes of death was 1.3 (95% confidence interval (CI) 1.2-1.4). The standardized mortality ratios for all malignant neoplasms and for breast cancer were 0.9 (95% CI 0.7-1.1) and 1.3 (95% CI 0.8-1.9), respectively. More deaths than expected were observed from endocrine and metabolic diseases (SMR = 1.8, 95% CI 1.2-2.7), circulatory system diseases (SMR = 1.4, 95% CI 1.3-1.6), and respiratory system diseases (SMR = 1.9, 95% CI 1.3-2.6). The standardized incidence ratios (SIR) for all malignant neoplasms and for breast cancer were 0.9 (95% CI 0.8-1.1) and 1.2 (95% CI 0.9-1.5), respectively. A nonsignificant excess breast cancer risk was observed 10 years after the onset of thyroid symptoms and was present at the end of 30 years of observation. A statistically significant excess number of pancreatic cancer cases (SIR = 2.0, 95% CI 1.0-3.7) and a nonsignificant excess of brain cancer cases (SIR = 2.3, 95% CI 0.7-5.3) were observed. Eighty per cent of the women were treated with radioactive iodine. When age at treatment and year of treatment were controlled, women who were ever treated with radioactive iodine had a standardized rate ratio for breast cancer of 1.9 (95% CI 0.9-4.1), compared with those who were never treated with radioactive iodine. Women who developed hypothyroidism as a result of their treatment for hyperthyroidism did not have an increased risk of developing breast cancer (SIR = 1.1, 95% CI 0.8-1.6).

Adult↗
PubMed1988

A second follow-up of mortality in a cohort of pesticide applicators.

A cohort of 16,124 male pesticide applicators was matched with Social Security Administration and National Death Index (NDI) files through December 31, 1984. In all, 1,082 deaths were ascertained, and death certificates were obtained for 994 (92%). The standardized mortality ratio (SMR) for all causes of death was 98. Although a number of specific causes of death showed SMRs significantly below 100, only one category of cause of death showed a significantly elevated SMR--cancer of the lung, with an SMR of 135. Termite control operators (TCO)--the group with the greatest likelihood of exposure to chlordane and heptachlor--had an SMR for lung cancer of 97, compared with 158 for other pesticide operators. The excess of lung cancer in the non-TCO workers was limited to operators employed as such for less than five years.

Cause of Death↗