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Biomedical subjects

R Y Demers

Publications and source records attributed to R Y Demers.

At least 19 recordsLinked to original sources
PubMed2001

Trends in the utilization of androgen-deprivation therapy for patients with prostate carcinoma suggest an effect on mortality.

BACKGROUND: After a surge in the incidence of prostate carcinoma in the early 1990s, diminishing rates of mortality became apparent in 1993. This decrease in mortality is unlikely to be explained entirely by treatment with curative intent alone following screen-detected cases, because the time frame between detection and mortality remains relatively brief. METHODS: This study used incidence and initial treatment data from the Detroit area SEER registry between 1973 and 1998 in addition to mortality data covering the Metropolitan Detroit area obtained from the Michigan Department of Community Health. Data for Caucasian and African-American men were analyzed. The use of androgen-deprivation therapy, which evolved during the study period, was evaluated in conjunction with mortality and incidence trend data for consideration of etiologic contributions. RESULTS: The incidence of prostate carcinoma, as noted previously in national data, increased sharply in 1988, peaking in 1992 in Southeast Michigan, whereas mortality rates began to decrease in approximately 1993, with a sustained decrease to the latest recorded data in 1998. These trends were identical in Caucasians and African Americans. A sharp increase in the use of androgen-deprivation therapy began in 1990. This use of androgen-deprivation therapy is high and sustained for patients with early-stage disease, increases for several years, and then diminishes for patients with regional disease. The use also diminished through the 1990s for patients with late-stage disease, paralleling the decrease in the incidence rate for late-stage disease. CONCLUSIONS: The pattern of androgen-deprivation therapy usage was consistent with that for hormonal monotherapy and adjuvant and neoadjuvant therapy. These findings suggest that androgen-deprivation therapy may contribute, along with advances in diagnostic techniques and curative therapy with radiation or surgery, toward decreasing prostate carcinoma mortality rates in Southeast Michigan.

Adult↗
PubMed2000

Consistency of occupational exposure history from pattern and model makers.

This study investigates the consistency of occupational histories reported by the same men in 1985 and again in 1988. Detroit-area pattern and model makers participating in a colorectal cancer screening program that was offered at 3-year intervals completed a career length occupational exposure questionnaire at each screening. Analysis of the data from the 243 men who participated in both screening programs provided the opportunity to examine the consistency with which these workers reported the extent of their exposure to 13 substances commonly found in their work environment. Workers were asked to provide a work history, and for each different pattern or model maker job they had held, to estimate the percentage of time they were exposed to the 13 substances. The data indicated that over the 3-year study period, pattern and model makers were highly consistent in reporting whether or not they were exposed to the 13 substances. In addition, their first estimates of the percentage of time they were exposed to each substance were within 10% of their second estimates more than 70% of the time. This concordance was somewhat diminished after excluding those who reported no exposure. These findings suggest that skilled tradesman can provide occupational exposure information that is likely to be useful for physicians in considering an occupational cause for a presenting health concern.

Adult↗
PubMed1998

The Henry Ford Health System.

The Henry Ford Health System is a large, vertically integrated health care delivery system, with its core service delivery team comprised of a 1000-person salaried medical group. Oncology services are coordinated through its Cancer Center, which organizes regional distribution of oncology services for residents of southeast Michigan. Oncology services are delivered through five regionally distributed sites, affording a vast majority of cancer services to be provided for patients a short distance from their homes. The System owns the largest health maintenance organization in Michigan (Health Alliance Plan) and its organizational structure affords the opportunity of offering purchasers specific oncology service contracting opportunities. Advantages of providing comprehensive oncology services through an integrated health system include: 1) standardized cancer care guidelines, 2) medical information exchange through an electronic medical record, 3) interdisciplinary cancer care provided by salaried physicians, minimizing potentially conflicting financial issues in treatment decisions, 4) state-of-the-art care afforded through availability of involvement in a large number of National Institutes of Health-sponsored clinical trials, 5) high standards of credentialing for oncology physicians, and 6) integrative managed care perspectives and continuous attention to cost and quality of care issues.

Cancer Care Facilities↗
PubMed1997

Incidence of colorectal adenocarcinoma by anatomic subsite. An epidemiologic study of time trends and racial differences in the Detroit, Michigan area.

BACKGROUND: Colorectal adenocarcinoma may represent more than one disease process. Numerous epidemiologic studies suggest that rates of occurrence of colorectal adenocarcinoma at particular anatomic subsites (e.g., right colon, left colon, and rectum) may be associated with distinctive geographic, demographic, and risk factor profiles. This study explored time trends over a 22-year period of the incidence of adenocarcinoma of the colon and rectum at various subsites among patients of different race, gender, and stage of disease. METHODS: Data on the incidence of colorectal adenocarcinoma were obtained from a population-based cancer registry in the Detroit, Michigan area funded by the National Cancer Institute. Age-adjusted incidence rates were analyzed by year of diagnosis. Relative survival rates were also obtained for different race and gender categories, along with disease stage at diagnosis. RESULTS: A major rise was revealed in the incidence of adenocarcinoma in the right colon among African American men and women between the mid-1970s and the early 1980s. The rise was greatest among African American men and accounts for increases in late stage disease among them. Corresponding decreases in survival among African American men were noted. CONCLUSIONS: These findings indicated widely differing disease patterns based on anatomic subsite and patient demography and also indicated a need for targeted efforts at early detection of adenocarcinoma of the right colon among African Americans.

Adenocarcinoma↗
PubMed1996

Neurobehavioral and health-related deficits in solvent-exposed painters.

The health status of 133 solvent-exposed painters was evaluated using the Neurobehavioral Evaluation System (NES) and blood test results from a physical exam. The comparison group consisted of 51 sheetmetal workers, minimally exposed to solvents. Degree of solvent exposure was calculated using three different indices derived from questionnaire responses. Multivariate analyses, adjusted for age, alcohol consumption, and smoking, indicated that painters performed less well on the symbol digit learning and vocabulary tasks. Evidence was also found for a dose-effect relationship, particularly when several features of the work environment were considered in estimating exposure. Degree of solvent exposure predicted levels of serum lead, BUN, and SGOT. These findings indicate that questionnaire-based measures of solvent exposure can be useful predictors of neurobehavioral and health-related deficits. Verbal ability, often used by researchers as a measure of premorbid functioning, may be adversely affected by solvent exposure.

Adult↗
PubMed1996

Environmental medicine content in medical school curricula.

BACKGROUND: The Institute of Medicine has recommended basic clinical competence in environmental medicine (EM) for all physicians. However, the amount and content of instruction in EM currently offered in U.S. medical schools is unknown. METHOD: This cross-sectional study was based on responses to a questionnaire regarding the EM curriculum content of U.S. medical schools, mailed in June 1994 with the Association of American Medical Colleges curriculum survey. RESULTS: Of the 126 schools, 119 (94%) responded. Of these, 29 (24%) reported no required EM content in the curriculum. Schools with EM content averaged seven hours of instruction. Eighty-one schools (68%) had faculty with environmental and occupational medicine expertise, primarily within the departments of medicine, preventive medicine, and family medicine. CONCLUSION: There is a need for increased instruction in EM in medical school curricula for students to acquire the knowledge and skills to prevent, diagnose, and treat health problems with an environmental exposure component. For those schools without EM content in the curriculum, the necessary expertise to develop EM curriculum may be available in current faculty.

Cross-Sectional Studies↗
PubMed1996

Increasing incidence of adenocarcinomas and carcinoid tumors of the small intestine in adults.

Malignant neoplasms of the small intestine are relatively rare and have received little study. We report on trends in the age-adjusted, sex-, and race-specific incidence rates of adenocarcinomas and carcinoid tumors of the small intestine in the United States from 1973 through 1991. Data were derived from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. There were statistically significant increases in the incidence rates of both adenocarcinomas and carcinoid tumors during the time frame of the study. Rates increased most dramatically in black males, with 2- and 4-fold increases in adenocarcinomas and carcinoid tumors, respectively. The only rates that remained relatively unchanged were those of adenocarcinoma among white females. It remains to be determined if changing environmental factors are important causes of these observed trends. If environmental factors are involved in the etiology of small intestine cancers, analytic studies conducted while the disease is increasing in incidence may provide useful insights.

Adenocarcinoma↗
PubMed1995

Prostate-specific antigen in a community screening program.

BACKGROUND: This study was designed to determine who participates in community-based prostate-specific antigen (PSA) screening programs and what serum PSA levels can be expected. METHODS: A descriptive analysis of men who participated in an annual community health screening program was used to compare men who chose PSA screening with those who did not. The relationship of demographic variables to PSA level was evaluated by multivariate regression analysis. Data were available on 5548 men, 6% of whom were black. RESULTS: The population of PSA screening participants included proportionately more middle-aged white men with higher median income, as compared with men who did not participate. Those who did not participate in the screening were more likely to be either very old or very young. PSA levels increased with age, and the percentage of men with elevated PSA levels increased with age. One tenth (9.6%) of all participants had PSAs between 4 ng/mL and 10 ng/mL, and 1.9% had levels greater than 10 ng/mL. Within 1 year of the screening, 1.7% of the screened participants had a diagnosis of prostate cancer. The mean PSA in this group was 15.9 ng/mL. CONCLUSIONS: These data confirm the need for age-specific PSA reference ranges. It is likely that the same reference range can be used for all racial ethnic populations.

Black or African American↗
PubMed1994

Increasing incidence of cancer of the prostate. The experience of black and white men in the Detroit metropolitan area.

BACKGROUND: Prostate cancer mortality and incidence rates have been gradually increasing for decades in the United States, with an accelerated increase in incidence noted in the past several years. This study explores in detail the occurrence of prostate cancer in southeast Michigan from 1973 through 1991. METHODS: Data from the National Cancer Institute Surveillance, Epidemiology, and End Results program are analyzed with emphasis on time trends by race, age, stage, and treatment. RESULTS: Population-based rates for prostate cancer increased by 70% between 1988 and 1991. Increases are most pronounced for early stage disease and among whites compared with blacks. Corresponding increases in treatment with radical prostatectomy are also observed. CONCLUSION: Increased incidence of prostate cancer is likely a result of widespread use of prostate-specific antigen.

Black or African American↗
PubMed1994

Colorectal cancer incidence in pattern and model makers: evidence from a screening program.

This study is designed to evaluate the efficacy of colorectal cancer screening in a high risk population of pattern and model makers. The cohort of 1,641 white male automotive pattern and model makers was identified in 1981, and offered colorectal cancer screening. The program involved periodic 60 cm flexible sigmoid examination, stool occult blood testing, and digital rectal examination. Screening was offered in 1981, 1982, 1985, 1988, and 1991. Approximately 60% of those eligible participated in at least one screening examination. Nonparticipants showed a relative risk for incident colorectal cancer of over 10, compared to those who participated at least once in the screening. Cohort tracking has accumulated 10 years; results suggest a benefit to colorectal cancer screening in this population.

Adult↗
PubMed1994

Lymphocytopenia and occupational exposures among pattern and model makers.

OBJECTIVES: The study was performed to examine the relationship between a high prevalence of lymphocytopenia observed during a cancer screening program for pattern and model makers, who produce industrial prototypes and patterns, and 15 occupational exposures. METHODS: The cases (N = 83) were workers with lymphocyte counts of less than 1000, while the referents (N = 529) had counts of 1500 or higher. Exposures at the current workplace, and at up to 19 previous pattern and model shops, were assessed with the use of a questionnaire. RESULTS: Elevated risks were associated with exposure to epoxy resins [odds ratio (OR) 1.94, 95% confidence interval (95% CI) 1.02-3.70) and plastic dusts (OR 2.60, 95% CI 1.19-5.68) after adjustment for age and smoking status. No clear associations were found with duration of exposure or percentage of time potentially exposed. Although the results were based upon small numbers, epoxy resins and wood dust displayed the most consistent relationships in an analysis of changes in lymphocyte count and exposure status over time. CONCLUSION: While firm conclusions cannot be drawn, the strongest associations observed in this study were for exposure to epoxy resins.

Adult↗
PubMed1994

Construction occupations, asbestos exposure, and cancer of the colon and rectum.

Colorectal cancer affects more than 157,000 Americans annually. Occupational risk from exposure to asbestos dust has been implicated, leading us to explore further the possible association between colorectal cancer and asbestos. Two hundred sixty-one cases of colon and rectal cancer and 183 control cases were identified within a large, population-based case-control study conducted in southeast Michigan. Employment in occupations historically known to involve heavy exposure to asbestos was used as a surrogate for asbestos exposure. Cancers of the colon showed reduced odds ratios. Our findings differ substantially from those of the previous studies showing elevated risk. Further study is needed to address the same question, with specified asbestos exposure assessment and control for potentially significant confounders such as physical activity and diet.

Adult↗
PubMed1994

Significance of the inability to reproduce pulmonary function test results.

In 1985, 864 patternmakers participated in a voluntary union-sponsored health screening program that included an evaluation of respiratory symtomatology and dysfunction. Pulmonary function test (PFT) measurements included a minimum of three readings of forced expiratory volume at 1 second (FEV1). A "reliable" test was one where the two best volumes were within 5%. Medical history and respiratory symptoms were assessed on a standardized questionnaire. Fifty-nine of the 864 tested were unable to reproduce their best FEV1 result. Although these 59 case subjects had significantly lower PFT results than the other 805 tested (P < .01), the mean values for FEV1 and forced vital capacity for the case subjects were greater than 90% of predicted values. The case subjects were more likely to experience wheezing and dyspnea and have a history of emphysema than the rest of the group screened (n = 805). They also had a higher mean age and more years in the trade. Twenty-one of the 59 case subjects were among the 602 who participated in a similar health screening program offered 3 years later. To minimize the effects of age and smoking status on PFT performance, these 21 case subjects were each matched on age and smoking with two comparison subjects who had reliable tests. At follow-up, the 21 case subjects and 41 comparison subjects both had a decline in ventilatory capacity that was significantly greater than would be expected by advancing age alone. A number of methodological issues that impact the interpretation of these data are discussed.

Adult↗
PubMed1993

Family practice in Cuba: evolution into the 1990s.

A group of practising physicians, family practice academicians and medical students visited Cuba in 1991. The purpose of this visit was to assess the current status of the discipline of family medicine in the country. Numerous interviews were conducted with practising family physicians, Cuban medical physicians in other medical specialties, the medical school faculty, patients and officials from the Ministry of Public Health. A summary of the content of these interviews constitutes the following paper. The authors conclude that the Cubans have developed a medical care system that has its basis in family practice, and provides a model which could be emulated not only in less developed, but also in more developed countries.

Cause of Death↗
PubMed1992

The home visit in resident education: program description and evaluation.

A home visit rotation was developed to provide family practice residents with a more comprehensive understanding of the effect of patient life-style on health status. The rotation emphasizes geriatric, community, and rehabilitative medicine. In addition, the curriculum addresses issues related to patient compliance, assessment of activities of daily living, patient psychosocial needs, community services, and exposure to medical equipment of potential use to homebound individuals. Over a three-year period, 209 home visits were made. Program evaluation data suggest that at the end of the three-month rotation, residents were less concerned with personal safety and more likely to agree that home visits were an important part of residency training. A comparison of pre- and post-test knowledge scores indicated significant increases in geriatric medicine, patient compliance issues, patient functional status, and community services. A follow-up telephone interview with patients found that some patients experienced anxiety when the home visit was scheduled, but the majority were positive about the experience.

Aged↗
PubMed1991

Peripheral vibratory sense deficits in solvent-exposed painters.

Peripheral neuropathy, as exhibited by the decrease in vibratory sense, is believed to be one of the manifestations of the peripheral nervous effects of solvent exposure. A solvent-exposed group of commercial painters (n = 28) was compared with a nonexposed group of boilermakers (n = 20) for differences in vibrotactile sensitivity. Differences in vibrotactile measurements of upper and lower extremities were compared between the two groups. Painters had lower vibration perception in all four extremities with statistically significant differences noted in four of seven analytical categories. Findings from this study suggest there are significant vibration perception differences between the studied painters and boilermakers and these differences are likely to be associated with occupational exposure to organic solvents.

Humans↗