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PubMed2004

Clinical results for patients with major depressive disorder in the Texas Medication Algorithm Project.

CONTEXT: The Texas Medication Algorithm Project is an evaluation of an algorithm-based disease management program for the treatment of the self-declared persistently and seriously mentally ill in the public mental health sector. OBJECTIVE: To present clinical outcomes for patients with major depressive disorder (MDD) during 12-month algorithm-guided treatment (ALGO) compared with treatment as usual (TAU). DESIGN: Effectiveness, intent-to-treat, prospective trial comparing patient outcomes in clinics offering ALGO with matched clinics offering TAU. SETTING: Four ALGO clinics, 6 TAU clinics, and 4 clinics that offer TAU to patients with MDD but provide ALGO for schizophrenia or bipolar disorder. Patients Male and female outpatients with a clinical diagnosis of MDD (psychotic or nonpsychotic) were divided into ALGO and TAU groups. The ALGO group included patients who required an antidepressant medication change or were starting antidepressant therapy. The TAU group initially met the same criteria, but because medication changes were made less frequently in the TAU group, patients were also recruited if their Brief Psychiatric Rating Scale total score was higher than the median for that clinic's routine quarterly evaluation of each patient. MAIN OUTCOME MEASURES: Primary outcomes included (1) symptoms measured by the 30-item Inventory of Depressive Symptomatology-Clinician-Rated scale (IDS-C(30)) and (2) function measured by the Mental Health Summary score of the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) obtained every 3 months. A secondary outcome was the 30-item Inventory of Depressive Symptomatology-Self-Report scale (IDS-SR(30)). RESULTS: All patients improved during the study (P<.001), but ALGO patients had significantly greater symptom reduction on both the IDS-C(30) and IDS-SR(30) compared with TAU. ALGO was also associated with significantly greater improvement in the SF-12 mental health score (P =.046) than TAU. CONCLUSION: The ALGO intervention package during 1 year was superior to TAU for patients with MDD based on clinician-rated and self-reported symptoms and overall mental functioning.

Adult↗
PubMed1996

Ethnicity and cure rates of Texas children with acute lymphoid leukemia.

BACKGROUND: Ethnic differences in the survival of children treated for acute lymphoid leukemia (ALL) have been described in several locations. Children of African, Polynesian, Native American, and Mexican ancestry had a less favorable outcome than children of European ancestry when treated in a similar manner by the same physicians and nurses. METHODS: We reviewed the medical records of the 94 European-American (E-A) and 84 Mexican-American (M-A) Texas children registered and treated in national collaborative ALL therapy trials at the M. D. Anderson Cancer Center in Houston between 1974 and 1985 and followed through June 1994. Information was collected regarding age, sex, presenting clinical features, risk for relapse grouping, protocol assignment, event free survival, and the financial status of their families. Cure was defined as initial continuous complete remission for more than seven years and cessation of therapy for more than four years. Presenting characteristics of E-A and M-A children were compared, and then related to cure rates by univariate and multivariate analyses. Event free survival rates of E-A and M-A children were determined together and by sex. RESULTS: Comparing presenting features, financial status as identified by pay code was significantly less for M-A children. Other features were not significantly different. By univariate analysis, an age of 2 to 6 years, female sex, initial white blood cell count below 10,000/microL, low risk grouping, registration on the most recent protocol, and full pay status were significantly associated with higher cure rates. By multivariate analysis, male gender, high risk group, and registration on earlier protocols were found to be significantly associated with a low cure rate. Event free survival and cure rate were lower for M-A children, but the differences were not statistically significant. CONCLUSIONS: Further study of larger numbers of patients, including contemporary immunophenotypic and genotypic characterization of ALL, is needed for better definition of possible ethnic differences. Ethnicity and financial status should be included in the analysis of clinical trials of ALL therapy.

Child↗
PubMed1998

Neuroblastoma screening in the United States: results of the Texas Outreach Program for neuroblastoma screening.

BACKGROUND: Mass screening of infants for neuroblastoma began in Japan after studies suggested that survival rates could be improved by early detection. This study was initiated in 1991 to test the methodology and feasibility of screening for neuroblastoma within the U. S. health care system. METHODS: Infants ages 5-10 months (mean age, 9 months, 25 days) who were born in Texas were screened for neuroblastoma. An enzyme-linked immunoadsorbent assay (ELISA) for homovanillic acid (HVA) and vanillylmandelic acid (VMA) used to quantify the HVA and VMA was performed on urine extracted from specimens dried on filter paper. Infants were recruited to participate in the study by several methods, and the effectiveness of each method was determined by calculating compliance rates. RESULTS: Between February 1991 and June 1994 a total of 14,046 infants were recruited to participate in neuroblastoma screening. Neuroblastoma was detected in 2 children for an incidence rate of 1 in 7023. A total of 291,158 screening kits were distributed to the parents of these infants, resulting in an overall compliance rate of only 4.8%. Compliance rates varied by method of distribution of the test kits: Houston Women, Infants, and Children (WIC) clinic (53%), volunteers (31%), Rio Grande Valley WIC clinics (14.5%), the patient's private physician (9.9%), and by mail (4.7%). CONCLUSIONS: Early detection of neuroblastoma in infants ages 5-10 months was achieved using ELISA. Compliance rates were poor, but clinics with a preventive health focus, such as the WIC clinics, achieved higher compliance rates than did private physicians.

Enzyme-Linked Immunosorbent Assay↗
PubMed1998

An updated mortality study of workers at a petroleum refinery in Beaumont, Texas.

The mortality experience of 7,119 workers who were employed at a Beaumont, Texas, refinery for at least 1 year between 1945 and 1987 was investigated. Mortality analyses based on standardized mortality ratios (SMRs) and 95% confidence intervals (95% CI) showed overall mortality was significantly lower than expected compared with the U.S. general population (SMR = 82, 95% CI = 79-86). Total cancer mortality was also lower than expected (SMR = 92, 95% CI = 84-100). Significant mortality deficits from several malignant and nonmalignant diseases were reported. A significant mortality increase in the broad category of lymphatic and hematopoietic cancers was found (SMR = 133, 95% CI = 103-170). This increase was attributed to a nonsignificant elevation in leukemia of all cell types combined (SMR = 139, 95% CI = 92-201) and a borderline significant increase in other lymphatic tissue cancer (SMR = 158, 95% CI = 101-235). The elevation in leukemia was confined to workers hired before 1950. Furthermore, the leukemia excess was shown to have peaked during the 1960s, with mortality no longer elevated post-1980. Analyses of cell type-specific leukemias showed a similar temporal pattern for acute myeloid leukemia (AML) which was not significantly elevated (SMR = 136, 95% CI = 59-268). Mortality from other leukemia cell types was similar to or lower than expected. Mortality from non-Hodgkin's lymphoma (NHL) (SMR = 140, 95% CI = 88-211) and multiple myeloma (MM) (SMR = 121, 95% CI = 55-230) were increased, but neither was statistically significant nor likely to be related to refinery employment. No death from asbestosis was reported, and mortality from mesothelioma and pulmonary fibrosis was lower than expected. Lung cancer mortality for the overall cohort was similar to expected. For the overall cohort, analyses by duration of employment and time since first employment showed no evidence of any trends for increasing cause-specific mortality. Separate analyses of male workers employed in operator jobs showed mortality patterns that were more favorable than those of the total cohort. Maintenance craftworkers showed statistically significant elevations in mortality for prostate cancer (SMR = 145, 95% CI = 107-194), leukemia (SMR = 179, 95% CI = 111-273), and other lymphatic tissue cancer (SMR = 233, 95% CI = 138-368). Detailed analyses indicated that, among maintenance craftworkers, mortality was elevated for AML, NHL, and MM, but none was significant. Furthermore, no upward trend by duration of maintenance jobs was observed. A small increase of lung cancer was observed among maintenance craftworkers (SMR = 120, 95% CI = 99-145), which was borderline significant. No relationship between lung cancer and duration of maintenance employment was found. In contrast, a deficit of pulmonary fibrosis was reported among maintenance craftworkers (SMR = 62, 95% CI = 17-159). These findings are discussed in conjunction with results from other refinery studies, and the limitations of the study are discussed.

Adult↗
PubMed1999

Linkage analysis of candidate obesity genes among the Mexican-American population of Starr County, Texas.

Recent advances in the molecular basis of body fat regulation have identified several genes in which genetic variation may influence obesity and related measures in human populations. Genes that have been shown to have a regulatory function in the control of body fat utilization, eating behavior, and/or metabolic rate in rodent models of obesity include leptin (LEP), leptin receptor (LEPR), neuropeptide Y (NPY), NPY Y1 receptor (NPYY1), glucagon-like peptide-1 (GLP-1), GLP-1 receptor (GLP1R), and uncoupling protein 1 (UCP1). We have typed microsatellite markers located within or near these seven candidate obesity genes in 302 non-diabetic individuals from 59 Mexican-American families from Starr County, Texas. Sib pair linkage analysis was used to examine linkage between these genes and obesity status (obese siblings only; n = 170 pairs) and several obesity-related quantitative variables (all siblings; n = 545 total sibling pairs). Significant linkage (P = 0.042) was found between obesity and NPY within the obese sibling pairs. No other candidate gene was linked to obesity status in this subsample. Consistent with the obese sib pair linkage results, NPY showed evidence of linkage to body weight (P = 0.020), abdominal circumference (P = 0.031), hip circumference (P = 0.012), diastolic blood pressure (P = 0.005), and a composite measure of body mass and size (P = 0.048) in the entire sibling sample. Other significant linkages observed were between LEP and waist/hip ratio (P = 0.010), total cholesterol (P = 0.030), and HDL cholesterol (P = 0.026) and between LEPR and fasting blood glucose (P = 0.018) and diastolic blood pressure (P = 0.003). These results support further investigation of NPY, LEP, and LEPR to identify genetic variation that may influence obesity status, glucose and lipid metabolism, and blood pressure in Mexican Americans.

Adult↗
PubMed1976

Excess and deficit lung cancer mortality in three ethnic groups in Texas.

Based on Texas vital statistics for 1969-71, patterns of lung cancer mortality in three ethnic groups are examined. Among males, the risk of lung cancer for Mexican Americans is considerably lower than for Blacks and Anglos for ages under 75 and slightly higher for older ages. Among females, Mexican American exhibit a distinct excess of lung cancer mortality for ages 70 and over and a deficit for younger ages. The excess among Mexican American females is confined mainly to the older foreign-born women and the excess is reduced for ages 45-60 and diminishes for younger immigrants. This suggests that the excess risk among Mexican Americans will completely disappear within a generation and a general deficit pattern will emerge for all ages. The implications of the diminishing excess and the emerging deficit lung cancer mortality among Mexican Americans clearly call for further study in exploring the effect of cultural change on mortality patterns, particularly for cancer.

Adult↗
PubMed1993

Impact of clinical trial protocols on patient care systems at the University of Texas M.D. Anderson Cancer Center.

Clinical trial protocols represent a significant component of the research program at the University of Texas M.D. Anderson Cancer Center. Currently, there are nearly 800 active protocols using more than 150 investigational drugs. Sponsors of these trials include the National Cancer Institute, numerous pharmaceutical companies, and a variety of other funding sources. Because of our large patient base, however, routine participation in cooperative groups is limited. The impact of clinical trial protocols on patient care systems is a growing concern that is addressed primarily by the Surveillance Committee at M.D. Anderson. Like many institutional review boards, this committee reviews all protocols and must grant approval before the activation of any clinical trial. The issues of medical ethics, including a risk-benefit assessment for research subjects, equitable patient selection, safeguards for economically disadvantaged populations, and the general requirements for informed consent, also fall under the purview of this board. For any comprehensive cancer center to succeed, it must have strong research programs that enhance treatment options for patients. The crisis in financing health care significantly threatens the viability of cancer research. Reimbursement for the related costs of individuals participating in clinical trials has become a battle ground for third-party payers. The resulting economic risk is shared by health care providers and patients. As a consequence, many cancer centers, including M.D. Anderson, have initiated an economic-impact analysis for protocols as a component of the review process. This analysis includes an estimation of the patient care costs compared to the funding allocated to support the research. Future research will include pharmacoeconomic analysis and other ways to relate the costs and outcomes of treatment protocols. In the interim, we must monitor reimbursement trends for patients enrolled in clinical trials closely and amend the informed consent process to include a discussion of potential economic risk or hardship to patients if insurance claims are denied. Cancer care providers, third-party payers, the federal government, and society at large must work together to address the funding of cancer research and patient care.

Cancer Care Facilities↗
PubMed1995

The Under Cover Skin Cancer Prevention Project. A community-based program in four Texas cities.

BACKGROUND: Although behavioral research has contributed much to our understanding of tobacco use and the development and evaluation of theory-based prevention strategies, the increasing incidence of nonmelanoma skin cancer continues to receive far less, but deserving, attention. METHODS: The Under Cover Skin Cancer Prevention Project represents a unique community awareness and education program that utilizes media partners in four Texas cities to disseminate ultraviolet (UV) radiation readings four times daily, along with education and behavioral change messages. Designed to change knowledge and attitudes about ultraviolet radiation exposure while promoting risk-reduction strategies, the program includes UV solar meters linked via telephone modem to provide continuous monitoring of UV exposure. RESULTS: Telephone survey results conducted during the summers of 1992 and 1993 (n = 1200 and 400, respectively) are part of a trend analysis study designed to access knowledge, attitude, and belief variables. Findings reveal that the general public, while knowledgeable of the sun's dangers, are less likely to practice prevention because of peer pressure and social norms favoring a tanned, "healthy" look. Trend data indicates that the media partner concept is an effective means for creating community awareness. CONCLUSIONS: Community-based programs utilizing media partners along with interventions that address issues of social norms and peer pressure appear to be effective strategies for increasing skin cancer prevention strategies among the general population. Long term, theory-based intervention strategies designed to test this media-based approach with a case-control, longitudinal design are needed.

Basal Cell Carcinoma↗
PubMed2003

Cohort mortality study of employees at the Celanese plant in Pampa, Texas.

BACKGROUND: The mortality experience of chemical workers from the Pampa, Texas Celanese Ltd. plant through 1991 has been previously reported. This study updates that effort and presents an additional seven years of data and follow-up that provided 268 additional cohort members and 71 new deaths. METHODS: Mortality was determined through December 31, 1998, the period for which the National Death Index could provide information on deaths. The mortality experience of Celanese Ltd. employees was compared to that of the general population of the United States. All cause and cause-specific standardized mortality ratios (SMRs) were calculated. RESULTS: For the entire cohort, several causes of death including all causes (SMR = 65.9; 95% confidence interval (CI) = 56.9-76.0), heart disease (SMR = 69.1; 95% CI = 53.6-87.8), and all malignant neoplasms (SMR = 74.2; 95% CI = 56.3-95.9) were significantly less than expected. SMRs were also calculated separately for white men, non-white men, and women. Unlike the initial study, the SMR for prostate cancer among white males was not significantly elevated (SMR=176.1; 95% CI = 76.0-347.0) and was much lower than the prior SMR of 330.4. This suggests that the initial findings, which were based on a small number of deaths, were likely due to chance. CONCLUSIONS: Overall, Celanese Ltd. employees from the Pampa plant have significantly lower than expected SMRs for several causes of death, and no causes of death that are significantly elevated.

Cause of Death↗
PubMed1984

Cancer mortality patterns by work category in three Texas oil refineries.

A previous proportionate mortality ratio analysis revealed elevated mortality from brain tumors, stomach cancer, leukemia, and other cancers among OCAW members employed in three Texas oil refineries. In order to evaluate these findings, complete work histories of cases and a matched set of controls who died from other causes of death were obtained from company personnel records. Work histories were summarized by classifying each job title and department entry into one of several broad work categories of refinery unit operations. A worker was considered "exposed" to a work category if he was known to have worked at least 1 day in the category 15 or more years prior to his death. Maximum likelihood estimates of the relative risk for brain tumor, stomach cancer, and leukemia were calculated by work category using a procedure for matched case-control data. No strong associations for brain tumor risk were seen with any work categories. A slight association for leukemia was seen among workers in the Treating category, which included unit operations that reduce the level of aromatic and sulfur constituents of petroleum products and combine them with additives to improve their quality. Stomach cancer risk was elevated among maintenance workers and workers exposed to lubricating oils and paraffin wax processing.

Brain Neoplasms↗
PubMed1989

Primary liver cancer death and occupation in Texas.

A death certificate case-control study of primary liver cancer and occupation was conducted to determine if the high risk of liver cancer in Mexican-Americans can be explained by farmworker exposures to pesticides. The association of liver cancer with the petroleum and chemical industry and with other potentially high-risk occupations was also examined. For the years 1969 to 1980, 1,742 deaths from primary liver cancer were identified for Texas males. Controls were randomly selected from other causes of deaths among males excluding all neoplasms, liver and gallbladder diseases, infectious hepatitis, and alcoholism, and were frequency matched to cases by age, race, ethnicity, and year of death. Risk for farmworkers based on age, race, and ethnicity-adjusted odds ratios (ORs) was not excessive (OR = 1.4, 95% confidence limits [C.L.] 0.8-2.2) but was larger than the risk for farmers (OR = 1.0, 95% C.L. 0.8-1.2). Excess risk in the petroleum and chemical manufacturing industries was confined to oil refinery workers (OR = 2.0, 95% C.L. 1.1-3.5). Other occupations with twofold risk or greater were plumbers and pipefitters (OR = 2.0, 95% C.L. 1.0-3.8), butchers and meat cutters (OR = 2.6, 95% C.L. 1.1-6.6), textile workers (OR = 3.1, 95% C.L. 1.2-7.8), cooks (OR = 2.2, 95% C.L. 1.1-4.5), and longshoremen (OR = 2.2, 95% C.L. 0.6-7.4).

Adult↗
PubMed2002

Genetic polymorphisms of methylenetetrahydrofolate reductase (MTHFR) and methionine synthase reductase (MTRR) in ethnic populations in Texas; a report of a novel MTHFR polymorphic site, G1793A.

The importance of hyperhomocysteinemia, birth defects, and vascular diseases has been the subject of intense investigations. The polymorphic MTHFR mutations (C677T and A1298C) cause mild hyperhomocysteinemia, especially in homozygotes for C677T, but also in compound heterozygotes for C677T/A1298C. The subject of this report is the frequency of the polymorphic mutations in the MTHFR gene C677T, C1298A, and newly discovered mutation G1793A, as well as the association with MTRR polymorphic site A66G in different ethnic groups. Four ethnic groups were studied: African-Americans, Caucasians, Hispanics, and Ashkenazi Jews. There are statistically significant differences in the frequency of these alleles in the different populations studied, which impacts compound heterozygosity for such alleles in these populations. DNA samples obtained from the blood of healthy individuals of African-Americans, Hispanics, and Caucasians from south Texas were analyzed and compared to those obtained from Ashkenazi Jewish individuals. The polymorphic site, the G1793A allele, is least frequent among Ashkenazi individuals, 1.3%, compared to 6.9% among Caucasians (P = 0.001), 5.8% among Hispanics (P = 0.012), and 3.1% among African-Americans. The MTRR polymorphic site shows the lowest allele frequency among Hispanics, 28.6%, compared to 34% among African-Americans, 43.1% among Ashkenazi Jews (P = 0.002), and 54.4% among Caucasians (P < 0.0001). Statistically significant differences in allele frequencies of C677T and C1298A polymorphisms were also observed in these populations. Compound heterozygosity for multiple polymorphic alleles may play a role in birth defects and vascular diseases.

Alleles↗
PubMed1983

Social class, admixture, and skin color variation in Mexican-Americans and Anglo-Americans living in San Antonio, Texas.

Social class may act in different ways as a barrier to gene flow in urban populations, depending on ethnicity. We test the hypothesis that biological variation is affected by social class subdivision using skin reflectance data collected for 393 Anglo-American and 930 Mexican-American adults in the major urban population of San Antonio, Texas. Two socioeconomic groups were sampled for the Anglo-American population: a middle-income transitional group and a high-income suburban group. In addition, we sampled a third socioeconomic group for Mexican-Americans: a low income barrio. Sex and age effects on skin color are minimal. Social class has no effect on skin color variation for Anglo-Americans, whereas there is a highly significant effect on social class subdivision for Mexican-Americans. Admixture estimates were derived from skin reflectance data and show that the proportion of native American ancestry decreases as social class increases.

Adult↗
PubMed1986

Individual admixture estimates: disease associations and individual risk of diabetes and gallbladder disease among Mexican-Americans in Starr County, Texas.

The ethnic and geographic distributions of several common chronic diseases show distinct patterns that are consistent with the distribution of genes and genetic admixture. For example, diabetes and gallbladder disease occur most frequently among Amerindians, while those genetically admixed with them (such as Mexican-Americans) have intermediate rates, and lowest rates are found among Whites and Blacks. Because there will be heterogeneity from individual to individual in ancestral affinity within an admixed population, a method is developed for estimating each person's admixture probability. Results confirm that there is substantial heterogeneity of individual admixture among Mexican-Americans in Starr County, Texas, with a mean value indicating that 65% of genes in this population are Caucasian derived and 35% Amerindian derived. The individual estimates are shown to be unrelated to the probability of being diabetic and only marginally related to gallbladder disease, with those having the most Amerindian affinity being at increased risk. These results are a consequence of the independent assortment of loci and indicate that unless the markers employed are related (including linkage) to the disease of interest, the method will have limited utility. Individual admixture estimates will be useful, however, for examining aspects of population structure and will find increased utility for predicting disease and examining disease associations as more and more of the genome is represented by markers, a very probable prospect with the abundance of DNA polymorphism being identified by restriction enzymes.

Adolescent↗
PubMed1987

The age-sex structure of the slave population in Harris County, Texas: 1850 and 1860.

The effect of the slave system on demography can be revealed by examining the age-sex structure of slave populations. The age-sex structure of slaves in Harris County, Texas is investigated using the 1850 and 1860 slave schedules. Median ages for black and mulatto slaves suggest that the population was young. Population pyramids exhibit a narrow base and top with a broad middle. The high proportion of slaves between 10 and 30 years of age and the increase in population size between 1850 and 1860 were mainly related to the importation of slaves and only partly due to natural increase. The data also show that black slaves were older on small plantations while mulattoes were older on larger farms. It is suggested that differential treatment in terms of purchase practices, assignment of tasks, food allocation, and/or differential susceptibility to infectious diseases may account for this pattern.

Black or African American↗
PubMed1989

Enlarged occlusal surfaces on first molars due to severe attrition and hypercementosis: examples from prehistoric coastal populations of Texas.

During an examination of prehistoric samples from the Texas coast, individuals consistently exhibited a suite of traits on the first molars that included severe wear, hypercementosis, and resorption of the buccal margin of the alveolus. The occlusal surface of the tooth was worn below the cervical margin, with the subsequent incorporation of the buccal surface of the buccal roots into the occlusal plane. This expanded occlusal surface, which extends the buccal surface beyond the normal edge of the tooth, is composed of a combination of original enamel, secondary dentin, and cementum. There is a marked rounding of the buccal aspect of the occlusal surface. These conditions were noted in both maxillary and mandibular first molars. The resorption of alveolar bone surrounding the buccal roots resembles resorption associated with periodontal infection and is thought to be the result of severe levels of stress being applied to this portion of the dentition.

Dental Occlusion↗
PubMed2004

The effect of fever, febrile illnesses, and heat exposures on the risk of neural tube defects in a Texas-Mexico border population.

BACKGROUND: Hyperthermia produces neural tube defects (NTDs) in a variety of animal species. Elevated maternal body temperatures may also place the developing human embryo at risk. We examined the relation between maternal hyperthermia and the development of NTDs in a high-risk Mexican-American population. METHODS: Case-women were Mexican-American women with NTD-affected pregnancies who resided and delivered in any of the 14 Texas counties bordering Mexico, during 1995-2000. Control-women were randomly selected from study area residents delivering normal live births, frequency-matched to cases by hospital and year. Information on maternal fevers, febrile illnesses, exposures to heat generated from external sources, and hyperthermia-inducing activities was gathered through in-person interviews, conducted about six weeks postpartum. RESULTS: The risk effect (OR) associated with maternal fever in the first trimester, compared to no fever, was 2.9 (95% CI, 1.5-5.7). Women taking fever-reducing medications showed a lower risk effect (OR, 2.4; 95% CI, 1.0-5.6) than those who did not (OR, 3.8; 95% CI, 1.4-10.9). First-trimester maternal exposures to heat devices such as hot tubs, saunas, or electric blankets were associated with an OR of 3.6 (95% CI, 1.1-15.9). Small insignificant effects were observed for activities such as cooking in a hot kitchen (OR, 1.6; 95% CI, 1.0-2.6) and working or exercising in the sun (OR, 1.4; 95% CI, 0.9-2.2). CONCLUSIONS: Maternal hyperthermia increases the risk for NTD-affected offspring. Women intending to become pregnant should avoid intense heat exposures, carefully monitor and manage their febrile illnesses, and routinely consume folic acid supplements.

Adult↗
PubMed1986

Familial aggregation of cancer in Laredo, Texas: a generally low-risk Mexican-American population.

Genealogies for the Mexican-American city of Laredo, Texas, have been assembled by computer from individual civil and church records of birth, marriage, and death. Documentation is available on vital events in the lives of over 300,000 individuals, about 80% of the city population from 1870-1981. These data were collected to determine the degree to which death from cancer is more clustered in families than would be expected by chance alone; methods specific to this data base have been developed to accomplish this task. A statistically significant excess of familial cancer was observed overall when all cancer sites were pooled, but no evidence was observed for excess familial risk at single sites except for breast cancer and perhaps for ovarian cancer. The excess of breast cancer risk is comparable to that observed in other populations. A few site-combinations manifest excess familial risk, most notably those involving and dominated by breast cancer and certain digestive system sites. We do not confirm the degree of familiarity observed elsewhere for cancers of the lung, colorectum, stomach, or other sites in this generally low-risk population. Even where we find evidence of excess risk, the degree of excess is small and the number of multiply affected families too small to test etiologic models by segregation analysis. The absence of excess familial risk does not appear to be due to inadequate numbers of cases, since breast cancer is familial with no more occurrences in Laredo than other sites. These results differ to some extent from those found in a similar study of Utah Mormons, but it is unclear whether this is because of differences in risk patterns or statistical properties of the analytic methods used in the two studies.

Adolescent↗