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Dietary fats and lung cancer risk among women: the Missouri Women's Health Study (United States)

In a population-based case-control study of women in Missouri (United States), most of whom were smokers, we obtained information on adult diet to evaluate the effects of dietary fats in relation to lung cancer risk. All newly diagnosed, primary lung cancer cases among women 35 to 84 years of age reported to the Missouri Cancer Registry from 1 January 1993 to 31 January 1994 were invited to participate, as were population-based controls. The analysis focused on interviews obtained from 624 controls and 587 cases. In-person interviews were obtained from 99.0 percent of controls and 60.6 percent of cases. Age and energy-adjusted relative risks suggested a direct relation between risk of lung cancer and intake of dietary fats (e.g., total fat, saturated fat) and frequency of meat consumption. After adjusting for confounders, dietary fats were no longer associated with risk, but the adverse effect of frequent consumption of meat persisted. Risk was elevated about 90 percent (95 percent confidence interval = 1.2-3.0) among women in the highest quintile of red meat intake compared with those in the lowest quintile. Risk estimates associated with red meat consumption, however, were dependent on interview status; the effect was restricted to cases whose dietary information was provided by proxy. In summary, after adjusting for potential confounders and removing data obtained from proxy respondents, dietary fats and consumption of red meat were not associated with lung cancer risk among women in Missouri.

Adult↗

A longitudinal assessment of the aquatic macroinvertebrate community in the channelized lower Missouri River.

We conducted an aquatic macroinvertebrate assessment in the channelized reach of the lower Missouri River, and used statistical analysis of individual metrics and multimetric scores to identify community response patterns and evaluate relative biological condition. We examined longitudinal site differences that are potentially associated with water quality related factors originating from the Kansas City metropolitan area, using data from coarse rock substrate in flowing water habitats (outside river bends), and depositional mud substrate in slack water habitats (dike fields). Three sites above river mile (RM) 369 in Kansas City (Nebraska City, RM = 560; St. Joseph, RM = 530; Parkville, RM = 377) and three below (Lexington, RM = 319; Glasgow, RM = 228; Hermann, RM = 94) were sampled with rock basket artificial substrates, a qualitative kicknet method, and the Petite Ponar. We also compared the performance of the methods used. A total of 132 aquatic macroinvertebrate taxa were collected from the lower Missouri River; one third of these taxa belonged to the sensitive EPOT insect orders (Ephemeroptera, Plecoptera, Odonata, and Trichoptera). Rock baskets had the highest mean efficiency (34.1%) of the methods, and the largest number of taxa was collected by Ponar (n = 69) and kicknet (n = 69) methods. Seven of the 15 metrics calculated from rock basket data, and five of the nine metrics calculated from Ponar data showed highly significant differences (ANOVA, P < 0.001) at one or more sites below Kansas City. We observed a substantial reduction in net-spinning Trichoptera in rock habitats below Kansas City (Lexington), an increase in relative dominance of Oligochaeta in depositional habitats at the next site downstream (Glasgow), and lower relative condition scores in rock habitat at Lexington and depositional habitat at Glasgow. Collectively, these data indicate that some urban-related impacts on the aquatic macroinvertebrate community are occurring. Our results suggest that the methods and assessment framework we used in this study could be successfully applied on a larger scale with concurrent water and sediment chemistry to validate metrics, establish impairment levels, and develop a specific macroinvertebrate community index for the lower Missouri River. We recommend accomplishing this with longitudinal multi-habitat sampling at a larger number of sites related to all potential sources of impairment, including major tributaries, urban areas, and point sources.

Animals↗

Missouri rural adolescent pregnancy project (MORAPP).

The purpose of this study was to investigate the pregnancy outcomes and services available to adolescent women in Missouri, comparing rural and urban residents. A secondary analysis of a large public use data set obtained from the Missouri Department of Health was done for the 5-year period 1992 to 1996. Data were collected by county, with each of the 114 counties of the state classified as rural or urban. The SAS program was used for analysis. Results demonstrated definite patterns of similarity and dissimilarity among the teen mothers based on residence, when age and race were controlled. There were over 54,000 births to adolescent mothers in the 5-year study period. Among the outcomes of pregnancy studied were: abortion rates, inadequate weight gain, intrauterine growth retardation, and low-birthweight (LBW) infants. Among the services available to the young mothers that were studied were fertility services, WIC (women, infants, and children supplemental nutrition) program, food stamps, and Medicaid coverage for pregnancy and infant care. The outcomes are probably generalizable to Midwestern, rural/urban states similar to Missouri.

Adolescent↗

TB-HIV Registry Matching in Missouri, 1987-1999.

Mycobacterium tuberculosis (MTB) is an important problem for human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients. This study investigated whether all cases of MTB reported to the HIV/AIDS Registry (HARS) in Missouri were also reported to the Tuberculosis Information Management System (TIMS) to determine the sensitivity of TIMS and the predictive value of HARS. We found 262 total MTB cases registered in HARS. Of these, 145 (55%) were included in the TIMS. Thirty-eight of the remaining 117 were caused by mycobacteria other than TB leaving 79 for investigation. Chart review of the 79 revealed 16 cases of MTB. Sensitivities and predictive values were calculated first including unknown/unreported group as being MTB-positive and the second including this group as being MTB-negative. Sensitivities for TIMS were 83 and 90%, respectively, and predictive values for HARS were 68 and 63%, respectively. The fact that there were at least 16 unreported cases of MTB has significant public health implications for TB control in Missouri. Public health nursing could work with HARS surveillance staff to help improve the accuracy of case finding and reporting. By whatever means necessary, communications between the TB and HIV programs within the Missouri Department of Health should be enhanced.

AIDS-Related Opportunistic Infections↗

Epidemiologic and diagnostic studies of patients with suspected early Lyme disease, Missouri, 1990-1993.

A retrospective case-control study investigated 45 Missouri outpatients with annular rashes meeting a surveillance case definition for erythema migrans and with onset in 1990-1991. Risk factors included being male, living near a body of water, and hunting. Twenty patients (44%) associated their rash with the bite of a tick; of these, 5 described an adult Amblyomma americanum. A typical rash was described as expanding over time and measuring 8 cm in diameter at 4 days after onset. Mild constitutional symptoms were common but fever was uncommon. Serologic tests failed to incriminate Borrelia burgdorferi or selected other arthropodborne pathogens. Skin specimens from suspected erythema migrans lesions of 23 Missouri patients sampled prospectively in 1991-1993 were culture-negative for B. burgdorferi. Thus, tick bite-associated annular rashes in Missouri remain idiopathic. Possible causes include infection with a novel A. americanum-transmitted pathogen and an atypical toxic or immunologic reaction to tick-associated proteins.

Adolescent↗

Seasonal activity and host associations of Ixodes scapularis (Acari: Ixodidae) in southeastern Missouri.

Based on tick collections recovered from wild vertebrates and by dragging, the seasonal occurrence of adult blacklegged ticks, Ixodes scapularis Say, extended from October through May in southeastern Missouri. Adult activity was bimodal with the higher peak occurring in November followed by a lower peak in February. The activity of immature I. scapularis had the general pattern of that found in the Northeast where Lyme disease is hyperendemic, with larval activity (July) peaking after that of nymphs (May and June). Vertebrates varied in their importance as hosts of I. scapularis. White-tailed deer, Odocoileus virginanus (Zimmerman), and coyotes, Canis latrans Say, were the primary hosts of adult I. scapularis. Broad-headed skinks, Eumeces laticeps (Schneider), and eastern fence lizards, Sceloporus undulatus (Latreille), were the primary hosts of nymphal I. scapularis. The broad-headed skink, 5-lined skink, Eumeces fasciatus (L.), and Carolina wren, Thryothorus ludovicianus (Latham), were the primary hosts of larval I. scapularis. Homeotherms were important hosts of immature I. scapularis, accounting for 30% of nymphs and 39% of larvae collected. The eastern cottontail rabbit, Sylvilagus floridanus (Allen), may play an important role in the epidemiology of Lyme disease in Missouri. Isolates of Borrelia burgdorferi Johnson, Schmid, Hyde, Steigerwalt & Brenner were made from ticks recovered from rabbits, making the cottontail rabbit a key species for further study of the epidemiology of Lyme borreliosis in Missouri.

Animals↗

Evaluation guidelines for adult and pediatric kidney transplant programs: the Missouri experience.

CONTEXT: Rigorous candidate evaluation is paramount for estimating risk and long-term success with transplantation. In addition, because of increasing waiting times, patients are seeking listing at multiple centers or transferring waiting time from one center to another. Variations in center evaluation criteria are becoming increasingly important to patients. OBJECTIVE: To describe the similarities and differences among the evaluation guidelines for adult and pediatric kidney transplant programs in Missouri. DESIGN: A descriptive design was used. SETTING AND PARTICIPANTS: Kidney transplant nurse coordinators from 7 adult and 4 pediatric kidney transplant programs from 10 centers in Missouri were invited to submit the kidney transplant candidate evaluation guidelines from their programs. RESULTS: Guidelines were submitted by nurse coordinators from all programs. Consults with the kidney transplant team members, including surgeon, nephrologist, social worker, and nurse coordinator, were included in all of the programs. For the adult programs, 67% (20/30) of the tests and laboratory values were agreed on by at least 70% of the program transplant team members. Similarly, for the pediatric programs, 62% (16/26) of the age-appropriate tests and laboratory values were agreed on by at least 75% of the program transplant team members. CONCLUSIONS: Within the Missouri programs, testing is consistent whether the center is large or small, adult or pediatric. Transplant teams should periodically review their kidney transplant recipient evaluation criteria for similarities to and differences from the current state-of-the-science and surrounding programs.

Adolescent↗

Theileriosis in a Missouri beef herd caused by Theileria buffeli: case report, herd investigation, ultrastructure, phylogenetic analysis, and experimental transmission.

A 6-year-old Simmental cow infected with Theileria buffeli had a clinical disease characterized by theilerial parasitemia, macrocytic normochromic anemia with acanthocytosis and spherocytosis, lymphoid hyperplasia (lymphocytosis, edematous lymphadenomegaly), dysproteinemia, evidence of liver disease, and a low serum antibody titer against T. buffeli. The cow was in a herd in which all cattle originated in Missouri; 22/75 (29%) of cattle had a theilerial parasitemia and 26/75 (35%) had titers to T. buffeli of > or =1:160. Classification of the Missouri bovine organism as T. buffeli was based on DNA sequencing and comparison to sequences for T. buffeli and Theileria sp. type A obtained from GenBank. Intraerythrocytic veils and piroplasms were seen during transmission electron microscopy. The organism was successfully transmitted to two splenectomized calves, which developed mild anemias while parasitemic. Blood from the second calf was used as the source of T. buffeli antigen for an indirect immunofluorescence antibody test. Theilerial isolates from a Missouri white-tailed deer were also sequenced and resembled Theileria sp. types F and G and were not consistent with the bovine organism.

Animals↗

Smoking and pregnancy outcome: trends among black teenage mothers in Missouri.

OBJECTIVES: The purpose of this study is to analyze the smoking changes that have occurred among pregnant Black teenagers in Missouri. The study also examines changes in Black teenage pregnancy outcomes in relation to smoking behavior changes. METHODS: This analysis used computerized data files from the 1978 to 1990 Missouri birth certificates to acquire information on smoking during pregnancy for 41,544 Black teenagers and 105,170 White teenagers. All Missouri births with smoking history were included in the study. RESULTS: During the study period, the rate for Blacks who smoked during pregnancy decreased from 37% in 1978 to less than 22% in 1990. A large part of this reduction is attributable to Black teenagers, whose smoking-during-pregnancy rate declined from 35.8% to 7.2%. Additionally, the Black teenage-specific low-birthweight rate decreased by 13.6% over the study period, possibly influenced by the decrease in smoking. CONCLUSIONS: The results indicate that a major norm has changed in smoking status among pregnant Black teenagers. Understanding the reasons behind this change could assist smoking cessation and other health promotion efforts.

Adolescent↗

Relative abundance of tree hole-breeding mosquitoes in Boone County, Missouri, USA, with emphasis on the vector potential of Aedes triseriatus for canine heartworm, Dirofilaria immitis (Spirurida: Filariidae).

Aedes (Protomacleaya) triseriatus currently shares its habitat in the USA with the introduced species Aedes (Finlaya) japonicus and Aedes (Stegomyia) albopictus. In the late 1980s, before the introduction of these 2 species, Ae. triseriatus was the dominant tree hole- and artificial container-breeding mosquito in central Missouri. Aedes triseriatus represented 89% of the mosquito immatures collected from water-filled tree holes and artificial containers at 3 forested field sites in central Missouri, from May to October, 1986 to 1988. Laboratory-reared female Ae. triseriatus were able to support larval development of Dirofilaria immitis (canine heartworm) to the infective 3rd larval stage. A blood meal from a microfilaremic Collie-mix dog was sufficient to infect adult female mosquitoes, indicating that Ae. triseriatus is a possible vector of canine heartworm in central Missouri. Confirmation of the vector status of this species depends on the yet-to-be observed transmission of D. immitis by Ae. triseriatus in the field, possibly by experimental infection of dogs by wild-caught mosquitoes. Defining the role of this species in epizootic outbreaks could contribute toward accurate risk assessment as the abundance of Ae. triseriatus increases and decreases in response to the success of Ae. albopictus, Ae. japonicus, or other introduced container-breeding mosquitoes.

Aedes↗

Environmental and policy factors associated with overweight among adults in Missouri.

PURPOSE: To measure the association between environmental and policy factors (i.e., community perceptions, community infrastructure, and worksite infrastructure) and being overweight. DESIGN: Cross-sectional data from the Missouri Cardiovascular Disease Survey, a one-time random-digit-dialed telephone interview of noninstitutionalized adults. SETTING: Missouri, 1999 to 2000. SUBJECTS: The response rate was 69.6%. A total of 2821 adults completed the interview. The sample was weighted to represent the population of Missouri: 52% female, 71% white, and 59% overweight. MEASURES: The survey comprised 92 closed-ended multiple-choice items. Overweight was defined as a body mass index greater than or equal to 25 kg/m2 on the basis of self-reported height and weight. RESULTS: After adjustment for demographic and behavioral factors, environmental variables associated with being overweight included negative (i.e., unsafe and unpleasant) community perceptions (adjusted odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.1, 2.3) and the absence of outdoor exercise facilities (OR = 1.2; CI = 1.0, 1.5). Worksite policy variables were not related to the outcome; however, negative community perceptions (OR = 2.8; CI = 1.5, 5.2) and the absence of sidewalks and shoulders (OR = 1.7; CI = 1.3, 2.4) were associated with overweight among employed persons. CONCLUSIONS: An ecological perspective, focusing on the physical and social environment, was adopted to address the subject of overweight and obesity. Results of this study show that negative perceptions of the physical environment and the absence of enabling infrastructure are modestly associated with overweight, in comparison with other known risk factors. Environmental and policy interventions that promote healthier lifestyles by encouraging physical activity and healthy eating may have an effect on reducing the prevalence of overweight and obesity.

Adolescent↗

An epizootic of hemorrhagic disease in white-tailed deer (Odocoileus virginianus) in Missouri: necropsy findings and population impact.

An epizootic occurred among white-tailed deer (Odocoileus virginianus) from July through October 1988 in Missouri (USA). From late July through September, nine necropsied deer had lesions of the peracute or acute forms of hemorrhagic disease (HD) or no apparent lesions, whereas two deer necropsied in October had lesions of the chronic form of HD. Epizootic hemorrhagic disease virus was isolated from two necropsied deer. Based on changes in population indices, there is evidence that deer populations declined in seven of Missouri's 57 deer management units from 1987 to 1990. Based on a deterministic model designed to simulate deer populations in management units, it appeared that summer and fall 1988 mortality ranging from 6% to 16% accounted for the population decreases in deer management units with population declines. Heavily hunted areas where high deer mortality was not reported in the summer and fall of 1988 did not have population declines. Based on these results, we believe that HD mortality was high and resulted in deer population declines in parts of Missouri when combined with hunting harvest.

Animals↗

Availability of eye care services in Missouri nursing homes.

PURPOSE: Residents of nursing homes do not have the same access to health care as do other elderly persons. Some sources have indicated that only 20% of nursing home residents in the United States ever receive eye care services in the nursing home. We sought to determine the availability of eye care services in Missouri nursing homes. METHOD: A survey was mailed to all licensed nursing homes in the State of Missouri (1,199). The survey inquired about the type of nursing facility, their location, and types of medical care and eye care provided at their institution. Information was also requested regarding the number of patients eligible for Medicare, Medicaid, and other third-party coverage. A 6-week period was allowed for responses. RESULTS: A response rate of 26.86% was obtained. Larger facilities were more likely to provide services than smaller facilities, and skilled nursing facilities were more likely to provide services than residential care facilities. Overall, 73% of the responding facilities provided some type of eye care services, as compared with 81% providing medical care. However, only 21% of nursing facilities have any type of regular schedule for provision of these services. Approximately 40% of the nursing homes without eye care services were interested in adding those services within a year, while half of those were not interested in adding them for their patients. CONCLUSIONS: Eye care services are available for many Missouri nursing home patients, but there is a lack of understanding as to how those services can be used. This can have considerable impact in meeting the health care needs of these patients, as well as enhancing the quality of life.

Aged↗

Prevalence of autism in Missouri: changing trends and the effect of a comprehensive state autism project.

To assess change in autism prevalence in Missouri from 1988 until 1995, computerized client registries from the Regional Diagnostic Centers were analyzed. In the five to nine year age group, the prevalence rose thirty fold from 0.15 to 4.8 per 10,000. The study period coincides with the establishment of the Missouri Autism Project suggesting that provision of services will increase the apparent prevalence figures and that autistic disorders were previously underdiagnosed in Missouri.

Adolescent↗

Increased cholesterol awareness in urban and rural areas--Missouri, 1988-1991.

Elevated serum cholesterol is a risk factor for coronary heart disease (CHD) (1,2). From 1983 through 1990, the percentage of persons who had their cholesterol measured--a first step in reducing risk for CHD from serum cholesterol-increased nationwide (3). Changes in patterns had not been monitored specifically in rural areas, where access to medical care and other socioeconomic barriers may hinder receipt and use of cholesterol screening (4,5). To monitor trends in cholesterol awareness and other risk factors for cardiovascular disease among persons who live in rural and urban settings in Missouri, Washington University and the Missouri Department of Health (MDH) analyzed 1988-1991 Behavioral Risk Factor Surveillance System (BRFSS) data for Missouri (6).

Adolescent↗

Arthritis in Missouri: disability, quality of life and treatment.

This study estimates Missouri's arthritis and activity limitation burden using the Behavioral Risk Factor Surveillance System data. In 2001, approximately one-third of Missouri adults reported physician-diagnosed arthritis and/or chronic joint symptoms, while over one-tenth reported an activity limitation from joint symptoms. These conditions are common among individuals with other chronic health problems and contribute to disability. The Missouri Arthritis and Osteoporosis Program provides self-management resources that can improve patient outcomes and quality of life.

Adult↗

Association of brain cancer with dental X-rays and occupation in Missouri.

This investigation of a brain cancer cluster in Missouri used two approaches to investigate associations with potential risk factors. In a case-control study in a rural town, we interviewed surrogates of cases and controls about potential risk factors. We found a statistically significant positive association of brain cancer with reported exposure to dental X-rays. Occupation was not associated with the cluster in the rural town. In a standardized proportional mortality study for the state of Missouri, we calculated the observed and expected proportion of brain cancers by occupation and industry in Missouri decedents. We found that motor vehicle manufacturers, beauty shop workers, managers and administrators, elementary school teachers, and hairdressers and cosmetologists had significantly elevated proportions of brain cancer. Brain tumors are inconsistently associated with occupation in the literature. Further study of brain cancer etiology with respect to dental X-ray exposures seems warranted.

Adult↗

Pathological gambling in Missouri.

Riverboat casinos were introduced in 1994, and there are now eleven gambling venues in Missouri, in addition to the lottery. Gambling is monitored by the Missouri Gaming Commission which was established to supervise gambling operations in the state, and minimize criminal involvement. The Commission also operates programs for problem gamblers that are described. Pathological gambling has become a major problem in Missouri and elsewhere, and its characteristics and clinical management are reviewed herein.

Gambling↗