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Biomedical subjects

S Shapiro

Publications and source records attributed to S Shapiro.

At least 361 records · Page 20Linked to original sources
PubMed1987

Risk factors for breast cancer in black women.

Risk factors for breast cancer were examined in black women in a hospital-based case-control study of 529 black women with breast cancer and 589 controls. Late age at menarche was associated with a reduced risk of breast cancer. Women having 5 or more children had a reduced risk relative to that of women with fewer or no children. Late age at first birth was associated with an elevated risk of breast cancer. Among postmenopausal black women, obesity [as measured by body mass index (BMI)] was associated with an increased risk; among premenopausal women, there was no association of breast cancer with BMI. Women whose menopause occurred at or after age 50 were at increased risk relative to those whose menopause occurred earlier. There was no association between number of years of education and breast cancer in black women. History of benign breast disease and history of breast cancer in mother or sisters both were risk factors. The risk factor profile for breast cancer in black women was similar to that observed in whites.

Adult↗
PubMed1987

Hydralazine and breast cancer.

Hydralazine (CAS: 86-54-4; 1-hydrazinonaphthalazine) is a well-established antihypertensive agent. There are no conclusive data on the drug as a human carcinogen, but one of its metabolites, hydrazine (CAS: 302-01-2), has been shown to be carcinogenic in rats and mice. To assess the relationship of hydralazine to human breast cancer, 3,419 women with breast cancer and 3,219 hospital control subjects were studied. Data were obtained by interview in hospitals in the United States and Canada. A total of 1.4% of the cases and 1.2% of the controls had used hydralazine. Compared with never use, the relative risk (RR) estimate for hydralazine that was first used at least 18 months before admission was 0.9 [95% confidence interval (CI), 0.5-1.7] after risk factors for breast cancer and the use of other antihypertensive drugs and diuretics were taken into account by multivariate analysis. The RR estimate for hydralazine use lasting at least 1 year was 0.9 (95% CI, 0.5-1.7). RR estimates for longer durations of use (up to 5 or more yr), and for use within strata of risk factors for breast cancer, were close to 1.0. The results suggest that hydralazine does not increase the risk of breast cancer in humans in the short term. Whether the risk is increased after latent intervals of many years could not be evaluated.

Adult↗
PubMed1987

Venous thromboembolism in relation to oral contraceptive use.

The relation of the risk of venous thromboembolism to the use of oral contraceptives was assessed in a hospital-based study of 61 women suffering from a first episode of idiopathic deep vein thrombosis or pulmonary embolism (cases) and 1278 women admitted for trauma or respiratory infections (controls). Twenty (33%) of the cases and 121 (9%) of the controls had used oral contraceptives within the previous month, yielding an age-adjusted relative risk estimate of 8.1 (95% confidence interval 3.7 to 18) for recent users relative to never-users. For women using oral contraceptives containing less than 50 micrograms estrogen, the relative risk estimate was 11 (3.7 to 22); for preparations with 50 micrograms estrogen, it was 5.5 (2.1 to 15); and for preparations with more than 50 micrograms estrogen, it was 11 (3.9 to 30). Past use of oral contraceptives was not associated with an increased risk. The data suggest that the risk of venous thromboembolism is increased for recent oral contraceptive users relative to nonusers, even if women use oral contraceptives containing low doses of estrogen. Confidence intervals were wide, however, so that a reduction in the risk for users of lower dose formulations relative to users of higher dose formulations cannot be ruled out. Selection bias, if present, would have resulted in overestimation of the relative risk, but should not have distorted the comparisons according to dosage.

Adolescent↗
PubMed1986

Heparin use as a risk factor for intraventricular hemorrhage in low-birth-weight infants.

In a systematic review of data on drug use and adverse clinical events in infants with birth weights under 2000 g, we observed an association between germinal matrix-intraventricular hemorrhage and the use of heparin to maintain the patency of vascular catheters. Sixty-six infants with germinal-matrix (periventricular) or intraventricular hemorrhage or both (cases) were matched with 254 infants with other conditions (controls), and analysis, taking the matching factors into account, yielded an odds ratio of 14.0 (95 percent confidence interval, 5.4 to 34). When potential confounding factors were taken into account, the odds ratio was 3.9 (1.4 to 11). The association did not appear to vary according to the severity of hemorrhage or to the method of administration or dose of heparin. The data suggest that the routine use of heparin in neonatal intensive care units is associated with a four-fold increase in the risk of germinal matrix-intraventricular hemorrhage. Because of the possibility that confounding may have been incompletely controlled for, the true risk cannot be determined from these data, and a controlled clinical trial of heparin use in low-birth-weight infants is recommended.

Catheterization↗
PubMed1986

A comparison of the requirements for primary care physicians in HMOs with projections made by the GMENAC.

We compared staffing patterns in primary care specialties in three large health maintenance organizations (HMOs) with the national requirements for physicians in 1990 projected by the Graduate Medical Education National Advisory Committee (GMENAC). The HMOs varied in their use of nonphysician providers, family practice specialists, and subspecialists in internal medicine. Nevertheless, projections based on the average experience of these HMOs suggest that 20 percent fewer primary care physicians for children and 50 percent fewer primary care physicians for adults will be needed to meet national primary care needs in 1990 than projected by the GMENAC. As enrollment in HMOs continues to grow, their impact on national requirements for medical personnel will increase. The variety of staffing patterns found among HMOs operating in highly competitive markets suggests the importance of considering alternative configurations for meeting national requirements for primary care.

Boston↗
PubMed1986

Patterns of mortality from selected causes in an urban population.

Mortality data for selected non-cancer causes for the period 1974-1980 were analyzed for the City of Philadelphia to examine spatial patterns. Four categories of conditions--ischemic heart disease (including acute myocardial infarction), chronic liver disease and cirrhosis, cerebrovascular disease, and external causes--demonstrated significant variation in death rates. Moreover, neighborhoods with high levels of mortality for these conditions appeared in significant clusters. With the exception of ischemic heart disease, neighborhoods with high levels of mortality were characterized by below average levels of SES. A group of predominantly black neighborhoods in the central part of the city had extremely high rates for five or more of the nine causes investigated in this paper. In an earlier analysis, all but one of these neighborhoods were found to have the highest level of overall cancer mortality. These findings support the hypothesis that there are social and behavioral factors that are associated with a wide range of disease conditions, and many of these factors are associated with socioeconomic status.

Chronic Disease↗
PubMed1986

Effect of questionnaire design on recall of drug exposure in pregnancy.

Case-control studies of antenatal drug exposure and birth defects often rely on maternal recall of drug use in pregnancy. Differential recall among mothers of cases and controls can lead to information bias ("maternal recall bias"), and the opportunity for such bias increases as ascertainment of drug exposure diminishes. The effect of questionnaire design on the ascertainment of drug use in pregnancy was examined in two studies. In a pilot interview study of 532 women in obstetric/gynecologic practices, information on drug use in the past year was obtained by means of three questions asked in sequence: The first question was open-ended, the second asked about drug use for selected indications, and the third asked about use of specifically named drugs. Among obstetric patients who reported use of any of five drugs, less than 50% did so in response to the open-ended question, and approximately 20-40% reported use only when the specific drug name was asked. In a case-control Birth Defects Study of 5,435 mothers of malformed children, information on drug use in pregnancy was obtained by asking questions in sequence about indications and specifically named drugs. Among the women who reported use of any of 11 drugs, 6-40% did so only when asked about the specific drug by name. These findings suggest that completeness of ascertainment of antenatal drug exposure varies according to how the mother is questioned and is directly related to the specificity of the questions asked.

Abnormalities, Drug-Induced↗
PubMed1986

The risk of myocardial infarction 10 or more years after vasectomy in men under 55 years of age.

To evaluate whether vasectomy is associated with a subsequent increase in the incidence of myocardial infarction 10 or more years after surgery and whether an effect is more pronounced in those already predisposed to a myocardial infarction, a hospital-based case-control study was carried out in men aged less than 55 years. The men were interviewed during 1980-1983 in 78 hospitals in Massachusetts, Rhode Island, Connecticut, and New York. Among 2,238 men with first episodes of myocardial infarction, 332 (15%) had undergone vasectomy, compared with 572 (16%) of 3,361 controls. Vasectomy greater than or equal to 10 years earlier was reported by 150 cases and 180 controls, to yield a multivariate relative risk estimate of 1.0 after allowance for potential confounding factors (95% confidence interval (Cl) = 0.8-1.3); for vasectomy greater than or equal to 15 years before, based on 34 cases and 33 controls, the estimate was 1.1 (95% Cl = 0.7-2.0). In men predisposed to myocardial infarction because of more advanced age, cigarette smoking, elevated cholesterol level, hypertension, angina pectoris, or other risk factors, vasectomy did not appear to increase the risk further, even after intervals of greater than or equal to 10 years. The results provide evidence against an increased risk of myocardial infarction greater than or equal to 10 years after vasectomy overall and in those known to be predisposed because of other risk factors.

Adult↗
PubMed1986

Does gallbladder removal protect against subsequent myocardial infarction?

It has been suggested that gallbladder removal may protect against subsequent development of myocardial infarction because of increased gastrointestinal cholesterol excretion resulting from increased enterohepatic cycling. To test this hypothesis, the authors used data from two large case-control studies of myocardial infarction--one conducted in 1976-1979 in 155 US hospitals and one conducted in 1980-1983 in 78 US hospitals. First, 550 female myocardial infarction cases were compared to 1,658 controls. Simultaneously adjusting for possible confounding variables using logistic regression, the odds ratio for development of a myocardial infarction subsequent to cholecystectomy was 0.8 (95% confidence interval, 0.5-1.1). Second, 1,511 male myocardial infarction cases were compared to 3,837 controls. With similar adjustments, the odds ratio was 0.8 (95% confidence interval, 0.5-1.2). The risk did not decline as the interval following cholecystectomy increased. The present data are compatible with a protective effect of cholecystectomy on the risk of subsequent myocardial infarction, but they are not conclusive.

Adult↗
PubMed1986

Psychiatric diagnosis and behavioral characteristics of phenylketonuric children.

This study evaluated the psychiatric characteristics and the behavioral effects of an acute load of phenylalanine on phenylketonuric children. The sample consisted of 13 normal-IQ children who were identified at birth as having phenylketonuria and were subsequently treated with a strict low phenylalanine diet. After baseline measurements, the subjects were loaded with placebo or phenylalanine following a double-blind design. Behavioral and metabolic variables were monitored at hourly intervals for five subsequent hours. The effects of acute loading were measured by changes in a standardized Continuous Performance Task (CPT). Psychiatric symptoms were compiled through a structured psychiatric interview of the child and the parent. Results demonstrated that phenylalanine loading, compared to placebo, caused a nonsignificant decrement in performance on CPT testing. Psychiatric disorders were found in six of the 13 subjects with three currently meeting criteria for attention deficit disorder (ADD). In addition, six other subjects were diagnosed in the past as having ADD using DSM-III criteria.

Adjustment Disorders↗
PubMed1986

Predicting posttrauma functional disability for individuals without severe brain injury.

The utility of the Abbreviated Injury Scale (AIS), the most widely used anatomic scale for rating severity of injuries, and its derivative for assessing the combined effect of multiple injuries, the Injury Severity Score (ISS), were tested for their ability to predict functional disability at time of discharge from the hospital and 6 months after discharge. The ISS has been shown to correlate well with mortality and length of stay, but the relationship to levels of subsequent disability has not been examined. Five hundred and ninety-seven patients (aged 16-45 years) were interviewed at time of discharge and 6 months after discharge to ascertain functional disability along three dimensions: activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility. The authors report on the relationship between severity and functional disability at time of discharge and 6 months after discharge for a subset of 473 patients who did not suffer a severe brain injury. The results show that the relationship between ISS and status at discharge and 6 months after discharge is not monotonically increasing, as it is with mortality and length of stay (LOS). Rather, the proportion of people with severe injuries who report limitations is lower than for those with moderately severe injuries as defined by the ISS. Further, it is shown that the AIS of the most severe extremity and spinal cord injury carry considerably more weight when predicting functional status at discharge and 6 months after discharge than do the AIS scores of injuries to any other body region, although the relative explanatory power of each type of injury varies with the nature of the functional disability and the time interval between the initial insult and assessment.

Activities of Daily Living↗
PubMed1986

Postpartum psychosis in the male.

The occurrence of postpartum psychosis in a male patient after the birth of a child is described in this case report. An association with the phenomenon of the couvade syndrome that is observed in all cultures is made. Also, the stressful life event of pregnancy in a partner related to the onset and development of psychotic disturbance is reported. Emotional disorders which develop in women during pregnancy are compared and contrasted with the variable responses which men manifest. Signs and symptoms heralding the onset of a more pathological pregnancy response in men are offered. The authors suggest that the experience of couvade be defined as a spectrum disorder of pathological responses in males ranging from physical symptoms to psychosis as a reaction to pregnancy. This case represents the extreme end of that spectrum and suggestions are made for early identification and treatment.

Adult↗
PubMed1986

Mental health and social characteristics of the homeless: a survey of mission users.

Selected mental health and social characteristics of 51 homeless persons drawn as a probability sample from missions are compared to those of 1,338 men aged 18-64 years living in households from the NIMH Epidemiologic Catchment Area survey conducted in Eastern Baltimore. Differences between the two groups were small with respect to age, race, education, and military service but the differences in mental health status, utilization patterns, and social dysfunction were large. About one-third of the homeless scored high on the General Health Questionnaire which measures distress. A similar proportion had a current psychiatric disorder as ascertained by the Diagnostic Interview Schedule (DIS), with the homeless exhibiting higher prevalence rates in every DIS/DSM III diagnostic category compared to domiciled men. Homeless persons reported higher rates of hospitalization than household men for both mental (33 per cent vs 5 per cent) and physical (20 per cent vs 10 per cent) problems but a lower proportion received ambulatory care (41 per cent vs 50 per cent). Social dysfunction among the homeless was indicated by fewer social contacts and higher rates of arrests as adults than domiciled men (58 per cent vs 24 per cent), including multiple arrests (38 per cent vs 9 per cent) and felony convictions (16 per cent vs 5 per cent). Implications of these findings are discussed in terms of research and health policy.

Adolescent↗
PubMed1986

Development and cross-validation of a short form impairment index.

The Brain Age Quotient (BAQ) is an actuarial combination of four Halstead-Reitan neuropsychology test battery scores (Category errors. Tactual Performance Test- Total Time, Tactual Performance Test-Location Score and Trails-B Score) and two performance subtests for the Wechsler Adult Intelligence Scale (Block Design and Digit Symbol). The present studies investigated the value of a short form of the BAQ, the Short Form Impairment Index (SFII), composed of the Trails-B Score and two subtests of the Wechsler and also twice cross-validated the short form. Statistical analysis yielded a Pearson r =.90, for both the initial study and each of the cross-validations. Further research and clinical considerations are discussed.

Journal Article↗