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Sharon Hensley Alford

Publications and source records attributed to Sharon Hensley Alford.

8 recordsLinked to original sources
PubMed2006

An observational study examining the impact of capecitabine on warfarin antithrombotic activity and bleeding complications.

OBJECTIVE: The objectives of this study are to quantify the frequency of concomitant use of capecitabine and warfarin, and to quantify the rate of bleeding events and elevated international normalized ratio (INR) among concomitant users of warfarin and capecitabine. RESEARCH DESIGN AND METHODS: We conducted a retrospective population-based study within the Henry Ford Health System (Detroit, MI) and the Kaiser Permanente Medical Care Program of Northern California (Oakland, CA). The study population included patients prescribed concomitant capecitabine and warfarin from 1 April 1997 through 31 July 2002. Data from the medical records of concurrent users were extracted through 31 August 2002. MAIN OUTCOME MEASURES: Concomitant use of capecitabine and warfarin, bleeding events, and INR laboratory results, collected from computerized databases and medical record review. RESULTS: Overall, 11% of capecitabine users also received warfarin (99 / 883). Among 17 patients who received warfarin for venous access device prophylaxis, one bleeding event occurred during concomitant capecitabine/warfarin use (rate = 35.7 bleeding events per 100 person-years, 95% confidence interval [CI] 0.9-198.9), and no events occurred during use of warfarin alone (95% CI 0.0-136.2) (p = 0.50). Among patients prescribed warfarin for indications other than port prophylaxis, no bleeding events occurred during concomitant use of capecitabine and warfarin (95% CI 0.0-34.6), and one event occurred during warfarin use alone (rate = 9.2 bleeding events per 100 person-years, 95% CI 0.2-51.3) (p = 0.54). We found one INR elevation > 3.0 among concomitant capecitabine/warfarin users receiving warfarin for port prophylaxis (rate = 35.7 per 100 person-years) and no INR elevations > 3.0 during use of warfarin alone (p = 0.46). Among patients using warfarin for indications other than port prophylaxis, the rates of INR > 3.0 were 309.7 per 100 person-years (95% CI 213.2-434.9) during concomitant capecitabine/warfarin use and 193.5 events per 100 person-years (95% CI 119.8-295.8) during use of warfarin alone (p = 0.09). CONCLUSIONS: The results of our study show a low prevalence of capecitabine and warfarin concomitant use. We did not find large differences in the rates of bleeding events and elevated INR in patients receiving concomitant capecitabine and warfarin when compared with use of warfarin alone. While these results do not imply a lack of biologic interaction, our findings indicate that patients appear to be appropriately managed in clinical practice.

Aged↗
PubMed2005

Antibiotic exposure in early infancy and risk for childhood atopy.

BACKGROUND: The increase in pediatric allergy and asthma parallels the increase in use of antibiotics. Antibiotics disturb the flora of the gastrointestinal tract, possibly perturbing the developing immune system. OBJECTIVE: We evaluated whether antibiotic use during early infancy increased the risk for atopy. METHODS: Antibiotic prescriptions documented in medical records were collected from a birth cohort born from 1987 through 1989 (n = 725). At 6 to 7 years of age, 448 were followed by means of examination, including skin prick tests and serum IgE measurements to common allergens. RESULTS: Adjusted odds ratios (aORs) and 95% CIs were calculated comparing children with any versus those with no antibiotic use in the first 6 months and the outcomes of atopy (any positive skin test response), seroatopy (any positive specific IgE test result), either atopy or seroatopy, and both atopy and seroatopy. Atopy increased with antibiotic use approaching statistical significance (aOR, 1.48; 95% CI, 0.94-2.34; P = .09); however, the risk was concentrated among children with less than 2 pets in the home (aOR, 1.73; 95% CI, 1.07-2.80; P = .024) and children breast-fed for 4 or more months (aOR, 3.02; 95% CI, 1.27-7.17; P = .013). The aORs were generally in the same direction for seroatopy and the combined categories. CONCLUSION: Antibiotic use in early life appears to contribute to increased risk for atopy in certain subgroups of children.

Animals↗
PubMed2005

Racial and age differences in colon examination surveillance following a diagnosis of colorectal cancer.

PURPOSE: The purpose of this analysis is to describe factors associated with colorectal surveillance following diagnosis and treatment of nonmetastatic colorectal cancer. METHODS: Subjects were identified as part of the HMO Cancer Research Network's study of colorectal cancer survivors. To be eligible for the main study, patients had to be part of the staff model components of health maintenance organizations in southeastern Michigan and Minnesota. Using computerized databases, individuals were identified who were 40 years or older with incident nonmetastatic colorectal cancer diagnosed between January 1, 1990, and December 31, 2000. Using data current through 2002, we analyzed the cohort using chi-square test statistics, life tables, and Cox proportional hazards models to understand variations in posttreatment surveillance practices. Subjects were followed up from date of diagnosis to date of recurrence, death, disenrollment from the health plan, or loss to follow-up, which ever came first. We assessed factors associated with colorectal surveillance at 1, 3, and 5 years after treatment. We also included an analysis comparing those who received an exam and those who didn't regardless of exam timing. RESULTS: A total of 908 patients were eligible for the main study. Of these, we excluded subjects who were not white or African American (n = 27), resulting in an analytic sample of 881 (97% of the eligible cohort). Twenty-five percent of subjects were African American, 43% were female, and 48% were aged 70 years or older. The proportion who received an exam at 1 year was 18%, at 3 years was 60%, and at 5 years was 67%. Chi-square tests showed that African Americans were statistically significantly less likely than whites to receive an exam at all three time points. The Cox proportional hazards model for examinations regardless of timing and adjusted for confounders showed that African Americans were still less likely than whites to receive an exam (hazard ratio = 0.62; 95% confidence interval [CI] = 0.51 to 0.75). The same trend in undersurveillance was also observed for those 80 years of age or older at diagnosis, with an adjusted hazard ratio of 0.39 (95% CI = 0.26 to 0.57). CONCLUSION: Our data indicate that colorectal cancer survivors who are African American or aged 80 years or more at diagnosis are less likely to receive posttreatment colorectal surveillance. Whether these differences are due to system or patient level barriers needs further study.

Adult↗
PubMed2004

Parental history of atopic disease: disease pattern and risk of pediatric atopy in offspring.

BACKGROUND: Family history is an important risk factor for atopic disease. However, most studies assess only limited information on family history. Because atopic disease can exhibit transient or persistent patterns, it may be useful to assess information on patterns of disease within families. This approach has been applied in other diseases, such as cancer, to discriminate between predominantly inherited versus environmentally caused (sporadic) cases. OBJECTIVE: In a cohort of children who were followed from birth until age 6 to 7 years, we examined the relationship between parental onset (ie, childhood and adulthood) and duration of atopic disease (ie, persistent disease) and the risk of pediatric atopic disease. Our hypothesis was that different parental disease patterns would be important to pediatric risk of disease. METHODS: Data from 476 families in the ongoing Childhood Allergy Study in Detroit, Mich, were analyzed by using logistic regression. We examined the association between parental patterns of disease and disease onset in their children. Results Father's disease history, particularly asthma history, was more strongly related to pediatric outcomes than mother's history. Asthma status in the fathers, whether it was childhood-only, adulthood-only, or persistent, was associated with current asthma in the children. Childhood-only and persistent asthma in fathers conferred a higher risk of atopy in the study children, whereas adulthood-only disease did not. There was also a significant relationship between persistent allergy in the father and atopy in the study children. CONCLUSION: Our data support the hypothesis that there are complex inheritance patterns for allergy and asthma. Therefore, a detailed family history of atopy, including childhood and adulthood experiences, is critical to identifying and classifying risk and disease phenotypes.

Adult↗
PubMed2002

Do animals on the farm and in the home reduce the risk of pediatric atopy?

Recent evidence suggests that proximity to pets and farm animals early in life may decrease the risk of developing atopy. Studies investigating the etiology of atopy and asthma have been especially challenging due to difficulties in ascertaining and classifying incident cases. Nevertheless, cross-sectional and cohort studies described in this paper reported across various populations, among children and adults, tended to demonstrate inverse associations between the presence of indoor cats and dogs or frequent exposure to livestock during the first years of life and sensitization to pet and pollen allergens, hay fever, and to a lesser degree, asthma. The biological mechanisms of this protection is unknown, as are the factors associated with pet keeping and livestock farming that may play a role. In the meantime, it appears that counseling prospective parents that avoidance of exposure to animals in the first years of life will prevent atopy may not be sage advice.

Adult↗
PubMedDate not supplied

Guidelines for breast and ovarian cancer genetic counseling referral: adoption and implementation in HMOs.

PURPOSE: To describe referral guidelines for hereditary breast and ovarian cancer (HBOC) counseling among a group of Health Maintenance Organizations (HMOs) and awareness of such among primary care clinicians. METHODS: An organizational assessment of plan policies and a primary care clinician survey. RESULTS: Five of the 7 HMOs reported having HBOC referral guidelines. Differences between plan's criteria included age of breast cancer onset, inclusion of male breast cancer, and second-degree relatives. Of the 91% clinicians responding, only half were aware of the HBOC guidelines. Awareness was higher in the plan with the most intense implementation effort (OR=3.0, 1.5-5.9) and among gynecologists (OR=2.8, 1.5-5.4). CONCLUSIONS: Although HBOC counseling guidelines within participating HMOs identify persons for referral that can be easily incorporated into routine practice, continued work is needed to better understand how to help primary care providers identify high-risk persons, and new models of providing genetic services may need to be considered.

Breast Neoplasms↗