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Biomedical subjects

W D King

Publications and source records attributed to W D King.

At least 37 records · Page 2Linked to original sources
PubMed1996

Case-control study of bladder cancer and chlorination by-products in treated water (Ontario, Canada).

Chlorine is by far the most commonly used chemical for the disinfection of water supplies in North America. However, chlorine reacts with organic material in the raw water producing a number of halogenated hydrocarbon by-products. This population-based case-control study in Ontario, Canada examined the relationship between bladder cancer and exposure to chlorination by-products in public water supplies. Residence and water source histories and data from municipal water supplies were used to estimate individual exposure according to water source, chlorination status, and by-product levels (represented by trihalomethane [THM] concentration). Exposures were estimated for the 40-year period prior to the interview, using 696 cases diagnosed with bladder cancer between 1 September 1992 and 1 May 1994 and 1,545 controls with at least 30 years of exposure information. Odds ratios (OR) adjusted for potential confounders were used to estimate relative risk. Those exposed to chlorinated surface water for 35 or more years had an increased risk of bladder cancer compared with those exposed for less than 10 years (OR = 1.41, 95 percent confidence interval [CI] = 1.10-1.81). Those exposed to an estimated THM level > or = 50 micrograms/liter for 35 or more years had 1.63 times the risk of those exposed for less than 10 years (CI = 1.08-2.46). These results indicate that the risk of bladder cancer increases with both duration and concentration of exposure to chlorination by-products, with population attributable risks of about 14 to 16 percent. Chlorination by-products represent a potentially important risk factor for bladder cancer.

Case-Control Studies↗
PubMed1996

Piercing injury hospitalization in children.

Injuries from piercing or cutting instruments or objects are commonly seen in the pediatric emergency department. In this study, we present the epidemiology of piercing injuries resulting in hospitalization. Medical records for a one-year period with E-codes 920.0-920.9 were reviewed for victim-related demographic data, anatomic injury location, vehicle of injury, treatment, and hospital charges. The Abbreviated Injury Scale (AIS) was used to ascertain injury severity. The most common vehicles of injury were glass (n = 24, 34%), nails (n = 11, 16%), and needles (n = 10, 14%). The median AIS score was significantly higher for hand injuries compared to the sample median AIS. Piercing injuries from consumer-related products were associated with the highest AIS scores (median = 2.5). Although the mean AIS for all injuries was only 1.5, these injuries resulted in significant costs, with a mean hospitalization charge of $3884 +/- 3528. Surgical procedures under general anesthesia were required in 81% of the patients.

Abbreviated Injury Scale↗
PubMed1996

Effectiveness of child-resistant packaging on toxin procurement in young poisoning victims.

The objective of this study was to determine how often and how children < 5 y-of-age involved in unintentional poisonings gained access to those poisons by opening properly secured child-resistant packages. From June 1994 through February 1995 we surveyed caretakers of children < 5 y-of-age presenting with the chief complaint of ingestion, inhalation, or ocular or dermal exposure of potential or perceived toxins. Excluded were exposures to plants, bites or stings, or patients inadvertently overdosed by a caretaker. The survey was administered to caretakers of 168 patients. Mean age was 26 mo (range 9 mo to 56.9 mo). The toxin was in its original container in 71% and transferred to another container or found outside of its container in 29% of cases; 33% involved a child-resistant closure. The child gained access by opening a properly closed child-resistant closure in 20% of the exposures and in 18.5% by opening a properly closed non-child-resistant closure. Child-resistance did not ensure child impenetrability. This suggests the need to reevaluate child-resistant closure testing protocols or retest currently used closures. Packaging misuse, including improper closure use or transferring medications or household products from the original container accounts for a large percentage of pediatric toxin exposures, thus emphasizing the importance of poison prevention education.

Child Health Services↗
PubMed1995

Dystonic reaction following recommended use of a cold syrup.

A healthy 3-year-old boy presented to our emergency department with sudden onset of abnormal movement. This patient had been treated for 2 days with conventional doses of an antihistamine/decongestant cold preparation for upper respiratory infection symptoms. The child was confused and restless, with posturing of limbs. Cranial nerve function was intact. Gastric lavage yielded an aspirate the same color as the cold syrup the child had ingested. A diagnosis of dystonic reaction was made, and the child was treated with benztropine, which effected resolution of his symptoms. This is the first reported case in the literature of dystonia induced by an antihistamine and treated with benztropine.

Benztropine↗
PubMed1995

Herbs and HIV: the health food industry's answer.

Patients with tragic diseases such as AIDS (acquired immunodeficiency syndrome) may be at risk for using herbal remedies and other alternative medical therapies. To ascertain what products may be available for use among AIDS patients in our community, we surveyed 20 local health food stores. Store employees were asked the question, "What do you recommend for people with AIDS?" Many herbal products, as well as other alternative medicinal preparations, were being recommended by store employees. Physicians caring for patients with AIDS should be aware of the potential for herbal use among their patients and the possible side effects of these products.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Percentage scattergram to depict changes in large amounts of data over time.

Graphical representation of changes in epidemiologic or clinical parameters over time is difficult when a large amount of data is involved. The traditional methods either cannot incorporate all necessary information (bar graphs, pie charts, tables) or are unable to depict information on more than a limited number of individuals (scattergrams). We have designed an effective way of visual presentation of the changes a variable demonstrates over time. The percentage scattergram provides accurate and complete depiction of any number of data points, allowing comprehensive and rapid analysis.

Data Display↗
PubMed1995

A comparison of cathartics in pediatric ingestions.

OBJECTIVE: To compare the mean time to first stool, number of stools, and side effects of three commonly used cathartics in pediatric ingestions. DESIGN: This prospective clinical trial was a randomized, double-blinded comparison of sorbitol, magnesium citrate, magnesium sulfate, and water, administered with activated charcoal in the treatment of pediatric patients 1 to 5 years of age with acute ingestions. Outcome parameters were mean time to first stool, mean number of stools during 24 hours, and side effects. RESULTS: One hundred sixteen patients completed the study. Significant differences in mean time to the first stool were detected among cathartic agents (F = 9.29), with sorbitol-treated patients having a shortest mean time to the first stool (mean, 8.48 hours). Sorbitol produced a significantly higher number of stools (mean, 2.79) in the 24-hour follow-up period than other cathartics (F = 3.49). The most common side effect of cathartic administration was emesis, which occurred more commonly in sorbitol-treated patients. CONCLUSION: Sorbitol, when administered with activated charcoal in the treatment of children with acute ingestions, produced a shorter time to first stool and more stools than magnesium citrate, magnesium sulfate, or water.

Cathartics↗
PubMed1995

Inappropriate discharge instructions for youth athletes hospitalized for concussion.

OBJECTIVE: To evaluate the medical care, especially the discharge instructions regarding return to participation, received by youth athletes hospitalized for a closed head injury. METHODS: We examined the records of all patients admitted over a 5-year period (1987 through 1991) to The Children's Hospital of Alabama for a sports-related closed head injury. Descriptive information was recorded and discharge instructions reviewed. Injury severity was graded according to guidelines current during the study period, as well as those outlined most recently by the Colorado Medical Society, which have been endorsed by a number of organizations including the American Academy of Pediatrics. Discharge instructions recorded for each patient were then compared with those recommended in the guidelines. RESULTS: We identified 33 patients with sports-related closed head injuries. Grade 1 concussions (least severe) occurred in 8 patients (24.2%), grade 2 in 10 (30.3%), and grade 3 (most severe) in 15 (45.4%). Overall, discharge instructions were appropriate for only 10 patients (30.3%), including all with grade 1 concussions, but only 2 with a grade 2 (20.0%) and none with a grade 3 concussion. CONCLUSION: All who care for youth athletes must become familiar with the guidelines for management of concussion to provide appropriate care and counseling and to avoid a tragic outcome.

Adolescent↗
PubMed1994

Urban/rural differences in child passenger deaths.

Motor vehicle crashes are the leading cause of death for Alabama children. This fact persists despite a child restraint law and an amendment designed to prevent such deaths in preschoolers. This study compared cumulative motor vehicle-passenger death rates by county and by urban and rural residence. Rural children had twice the rate of death of urban children. Additionally, these death rates demonstrated a sharp negative gradient when residence areas were ordered by increasing population densities (rural agricultural, rural manufacturing, suburban, and urban, respectively). Because child passenger death rates are significantly higher among rural children, future research should focus on hazards associated with the rural environment. A list of key study elements is provided.

Accidents, Traffic↗
PubMed1993

Paternal radiation exposure and leukaemia in offspring: the Ontario case-control study.

OBJECTIVES: To test the hypothesis that there is an association between childhood leukaemia and the occupational exposure of fathers to ionising radiation before a child's conception. DESIGN: Case-control study with eight matched controls per case. SETTING: Regions of Ontario, Canada, with an operating nuclear facility. SUBJECTS: Cases were children (age 0-14) who died from or were diagnosed as having leukaemia from 1950 to 1988 and were born to mothers living in the vicinity of an operating nuclear facility. Controls were identified from birth certificates, matched by date of birth and residence at birth. There were 112 cases and 890 controls. MAIN OUTCOME MEASURES: Paternal radiation exposure was determined by a record linkage to the Canadian National Dose Registry. RESULTS: Six fathers of cases and 53 fathers of controls had had a total whole body dose > 0.0 mSv before the child's conception, resulting in an odds ratio of 0.87 (95% confidence interval 0.32 to 2.34). There was no evidence of an increased leukaemia risk in relation to any exposure period (lifetime or six months or three months before conception) or exposure type (total whole body dose, external whole body dose, or tritium dose), except for radon exposure to uranium miners, which had a large odds ratio that was not significantly different from the null value. CONCLUSIONS: The findings of this study in Ontario did not support the hypothesis that childhood leukaemia is associated with the occupational exposure of fathers to ionising radiation before the child's conception.

Adolescent↗
PubMed1993

Response of a cancer registry to reports of disease clusters.

A protocol has been developed to investigate and report perceived clusters of cancer using a population-based cancer registry. The protocol comprises a series of steps which lead to assessment of the cluster's importance on the basis of three criteria: (1) statistical evidence of clustering; (2) documentation of the existence of exposure to a carcinogen; and (3) biological plausibility of the relationship between the exposure and the cancer of interest. The evaluation of these criteria results in one of three recommendations: further study, surveillance only, or no action. The protocol provides a systematic approach for investigation, makes efficient use of available cancer registry data, and responds to public concerns. The protocol is demonstrated by its application to an inquiry concerning an apparent excess of lung cancer in a small Ontario town and the possible role of radon gas exposure. The public health importance and limitations of addressing perceived disease clusters are discussed.

Cluster Analysis↗
PubMed1992

Use of host factors to identify people at high risk for cutaneous malignant melanoma .

OBJECTIVE: To determine which host characteristics are risk factors for cutaneous malignant melanoma in order to aim prevention and early detection programs at people at high risk. DESIGN: Case-control study. SETTING: Southern Ontario. SUBJECTS: The 583 case subjects were aged 20 to 69 years and had had malignant melanoma newly diagnosed between Oct. 1, 1984, and Sept. 30, 1986. The 608 control subjects were randomly selected from a list of residents in the study area and were stratum matched for age, sex and municipality. INTERVENTION: Through in-person interviews the interviewer ascertained exposure to putative external risk factors and assessed skin colour and number of nevi on the arm, and the subject reported his or her natural hair colour at age 20 years, eye colour, skin reaction to repeated sun exposure, and freckle and whole-body nevus densities. RESULTS: Although all the host factors mentioned were significantly associated with melanoma risk when considered separately, only hair colour, skin reaction to repeated sun exposure, and self-reported freckle and nevus densities remained significant after backward logistic regression analysis. The odds ratio for melanoma was estimated to be 10.7 in people who had many nevi compared with those who had none (95% confidence interval [CI] 6.6 to 17.4), 4.0 in people who had red hair compared with those who had black hair (95% CI 1.9 to 8.2), 1.9 in people who had many freckles compared with those who had none or few (95% CI 1.3 to 2.8) and 1.4 respectively in people who burned and had a subsequent increase in tan and those who burned and had no increase in tan after repeated sun exposure compared with those who did not burn [corrected]. CONCLUSIONS: Four risk factors for malignant melanoma have been identified. Prospective evaluation of their predictive value should be done. In the meantime, however, these factors should be used to identify people apparently at high risk for malignant melanoma, who can then be targeted for early detection and prevention programs.

Adult↗
PubMed1992

Variables predicting the need for a pediatric critical care transport team.

To determine when a pediatric critical care transport team is required to transport a patient to a referral center, this cross-sectional study evaluated 369 consecutive pediatric transports by stepwise multiple logistic regression analysis of six variables: age, vital signs, seizure activity, current endotracheal intubation, respiratory distress, and respiratory diagnosis. Models were developed for three outcome variables: 1) Major procedures were required in 8.9% of cases. The predicted probability of needing a major procedure was increased for intubated patients (probability of 12.9%), patients less than 1 year of age with unstable vital signs (12.9%), and patients meeting both these criteria (23.2%). 2) A posttransport assessment of need for a physician on the team was positive in 43% of cases. The probability of needing a physician was increased for intubated patients (probability of 68.8%), patients less than 1 year of age with unstable vital signs (58.7%), and patients meeting both these criteria (79.9%). 3) Category 1 drugs, ie, medications requiring ICU monitoring, were used in 19% of transports. The probability of this occurring was increased for intubated patients with stable vital signs (probability of 24.7%) and for intubated patients with unstable vital signs (41.4%). None of the other pretransport variables, alone or in pairs, was a significant predictor of any of the three outcome variables. The data indicate that intubation, age, and vital sign status can be used in predicting whether a transport team is needed.

Age Factors↗
PubMed1992

Racial differences in childhood hospitalized pedestrian injuries.

This research provides an epidemiologic analysis of pedestrian-related injury discharges from The Children's Hospital of Alabama in Birmingham, utilizing a case-control design. Evidence is provided supporting the racial disproportionality of serious, nonfatal pedestrian injuries in children. These data indicate that pedestrian injuries resulting in hospitalization are more common among black children than among white children (odds ratio = 2.95) when compared with an age- and gender-matched control group of other hospitalized injuries. This racial association with pedestrian injury remained significant when the data were stratified by payment class, a proposed surrogate measure of socioeconomic status (adjusted odds ratio = 2.59). A catalog of harmful environmental factors that may be pervasive in black children's lives is provided as an aid in planning intervention programs and their evaluation.

Accidents, Traffic↗
PubMed1992

Albuterol overdose: a case report and differential diagnosis.

The increase in the use of selective beta 2 agonists as first-choice agents in the therapy of asthma has resulted in a concomitant increase in overdoses and other therapeutic misadventures. This case describes a 22-month-old child who ingested a large overdose of albuterol, resulting in an acute syndrome consisting of agitation, tremulousness, marked hyperglycemia of > 320 mg/dl (17.8 mmol/L), ketonuria, and hypokalemia. Such toxicity has generally been reported only in diabetics or pregnant patients. These findings and a brief review of the pharmacology and toxicology of beta 2 agonists are detailed, with special emphasis on the differential diagnosis of overdoses characterized by hyperglycemia, hypokalemia, agitation, and tremulousness. A system of ordering the relative toxicity of these (and other) drugs is proffered using the exposure-case fatality rate (ECFR) as a crude measure of clinical toxicity (while delineating its shortcomings). Applying the ECFR (using American Association of Poison Control Centers' data base) to beta 2 agonist overdoses indicates that the resulting clinical syndrome, while troublesome, generally results in a benign outcome.

Albuterol↗
PubMed1992

The OPQ: a proposed instrument for predicting poisoning accident recurrence in young children.

A 26-item self-report questionnaire for parents/guardians was constructed for potential use with first-exposure childhood poisoning victims to predict high risk for subsequent poisoning episodes. Data were obtained from 185 subjects served by 1 of 5 US regional poison control centers. The resulting device was labeled the OPQ. Its retrospective validity (R = 0.71) and test-retest reliability (0.81) are viewed as sufficient. The test itself, with accompanying scoring key and norms, are provided here in the hope that other clinicians and researchers will join in subjecting the OPQ to prospective validity studies and other forms of Scale refinement.

Child, Preschool↗
PubMed1991

Steroid receptor status and the epidemiology of breast cancer.

This case-control study examined risk factors for breast cancer according to tumor estrogen receptor (ER) status and progesterone receptor (PR) status. The data included 607 case patients and 1214 control subjects matched by age and residence. Of 528 case patients with steroid receptor information, 67% had ER-positive tumors and 55% had PR-positive tumors. Odds ratios for ER-positive and ER-negative breast cancer were similar with respect to menopausal status, age at menarche, history of cystic breast disease, and Quetelet Index. Family history of breast cancer was a stronger risk factor for ER-negative than for ER-positive breast cancer and the odds ratios for number of births were suggestive of a different effect. While ER and PR status were highly correlated, there were some differences in their associations with risk factors. Odds ratios for PR-positive and PR-negative breast cancer differed for number of births and were suggestive of differences with respect to menopausal status, Quetelet Index, and family history of breast cancer. These findings do not suggest different causal pathways for ER-positive and ER-negative breast cancer. However, they do indicate that PR status may play a role in the etiology of breast cancer.

Adult↗