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PubMed1976

[A model for the valuation of mass attendance and attendance duration of patients with malignant neoplasms (author's transpl)].

By means of a combination of two methods known in demography - life table and estimates for intercensal years - probabilities of prevalence of cancer patients and duration of disease from onset to death are calculated. Starting-points are the incidence know by cancerregistration and death certificates. The results of the model are compared with the results of a special point prevalence counting. Both methods gave about the same results.

Adolescent↗
PubMed1998

[Genetic-demographic structure and prevalence of congenital malformations in rural regions of the Kursk district].

Investigation of the the genetics, demography, and epidemiology of congenital malformations (CMs) in Kursk oblast revealed statistically significant correlations between population parameters and the incidence of CM in the rural rations of the oblast. The general prevalence of CM and that of the separate CM forms ("guard" CM, multiple CM, hemangioma, congenital heart disease, congenital myelocele, talipes valgus, congenital femoral luxation, polydactyly, cryptorchism) increased with an increase in the average marital age of men and women of the reproductive part of the population and with an increase in the level of the populations homozygosity (an increase in the local consanguinity and ethnic marriage assortativeness, a decrease in the populations's migration activity, an increase in the proportion of genotypes homozygous for recessive genes, etc).

Congenital Abnormalities↗
PubMed1981

The intelligence of hydrocephalic children.

In a group of 78 children with hydrocephalus in the first months of life, the level and pattern of intelligence were considered in relation to various parameters and symptoms of their condition. These included demography (age, sex, handedness); early developmental status; symptoms (visual, motor, and seizure); formative pathology; type of hydrocephalus; site of CSF obstruction; extent and configuration of cortical thinning; and shunt treatment. The common outcome of early hydrocephalus is an uneven growth of intelligence during childhood, with nonverbal intelligence developing less well than verbal intelligence. The origin of this selective cognitive deficit is in neither the hydrocephalic condition itself nor its treatment, but rather in the developmental brain anomalies and symptoms to which the hydrocephalic child is prone: In children with aqueduct blocks and intraventricular hydrocephalus, a selectively thin vertex and occipital lobe; in any hydrocephalic child, ocular abnormalities, motor deficits, and seizures.

Age Factors↗
PubMed2001

The nature, incidence, and impact of eye injuries among US military personnel: implications for prevention.

OBJECTIVES: To assess incidence rates of eye injuries in the US Armed Forces and to identify demographic and occupational correlates of risk. DESIGN: Retrospective population-based study. SETTING: US military medical facilities worldwide. PARTICIPANTS: All individuals in the US Armed Forces during 1998. MAIN OUTCOME MEASURES: Incidence rates of hospitalizations and ambulatory visits for eye injuries. RESULTS: The incidence rate of ambulatory visits (983 per 100 000 person-years) for eye injuries was 58 times higher than the incidence rate of hospitalizations (17 per 100 000 person-years) for eye injuries. Orbital floor fractures, contusions, and open wounds to the ocular adnexa and orbit accounted for 85% of eye injuries resulting in hospitalization, while 80% of ambulatory visits were for superficial wounds and foreign bodies. Hospitalization rates varied widely across demographic subgroups. Men had twice the incidence rate as women, and the youngest age group (17-24 years) had 6 times the incidence rate of the oldest age group (35-65 years). Together, motor vehicle crashes and fights caused nearly half of the hospitalizations. Ambulatory rates varied significantly in relation to occupation but not to demography. Tradespeople (eg, metal body machinist, welder, and metalworker) had incidence rates 3 to 4 times higher than the overall population rate. CONCLUSIONS: Hospitalization and ambulatory data provide different views of the morbidity associated with eye injuries. General safety precautions and behavior modification, rather than eye-specific interventions, are indicated to prevent the most serious eye injuries. However, the consistent use of eye protection during known hazardous occupational activities could prevent much of the morbidity associated with the less serious, yet more common, eye injuries.

Accidents, Occupational↗
PubMed2005

Prevalence and burden of self-reported blindness, low vision, and visual impairment in the French community: a nationwide survey.

OBJECTIVE: To estimate the prevalence of self-reported visual impairment and its association with disabilities, handicaps, and socioeconomic consequences. METHODS: A national survey was conducted on a random stratified sample of 359 010 French citizens living in the community; 21 760 subjects were selected at random and 16 945 persons (78%) agreed to further questioning. Four thousand ninety-one randomly selected caregivers were interviewed. Four subgroups of subjects were defined (blind or light perception only, low vision or still have form perception, other visual problems, and no visual problems). These were compared after adjustment for age, comorbidity, and household size differences. RESULTS: The prevalence of blindness was 0.10% and of low vision, 1.94%. Subjects with blindness needed assistance with daily activities more often than subjects with no visual problems; they also needed more house modifications. Many subjects with blindness (46.8%) and subjects with low vision (29.0%) were registered for social allowances. Subjects with blindness had fewer paid activities (4.5%) than subjects with no visual problems (20.7%). Social allowances increased considerably (by 277) between those with low vision and those with blindness. Monthly household incomes were lower (P<.001) for subjects with low vision (1255) and blindness (1587) than for subjects with no visual problems (1851). MAIN OUTCOME MEASURES: Collected data included social demography, home description, household income, handicaps, disabilities, social allowances, and daily activities. CONCLUSION: The results demonstrate associations between self-reported visual impairment and daily living.

Activities of Daily Living↗
PubMed1997

Epidemiology of facial injury in blunt assault. Determinants of incidence and outcome in 802 patients.

BACKGROUND: Facial assault trauma has reached epidemic proportions. While the biomechanics of injury, methods of repair, and general demography of blunt facial trauma are well known, statistical associations between epidemiological factors, incidence, and outcome are poorly understood. OBJECTIVES: To provide a comprehensive epidemiological survey of this patient population. To assess factors determining outcome and pattern of injury. DESIGN: Retrospective review of 802 patients admitted with blunt assault facial trauma. Statistical analysis of associations between epidemiological factors, incidence, and outcome with chi 2 test, 2-tailed t test, and Fisher exact test. SETTING: Urban university and county hospital. RESULTS: Statistically significant associations are demonstrated between gender and the context of assault, incidence of armed assault, presence of fracture, and rate of intoxication at injury. Poor prognostic indicators for outcome include use of tobacco and presence of a mandible fracture. Open reduction and internal fixation were found to bear a higher complication rate only in mandible fractures. CONCLUSIONS: While choice of treatment carries a statistically significant association with outcome, social variables, including gender, tobacco use, intoxication, and low socioeconomic status, produce dramatic worsening of both injury incidence and outcome.

Adolescent↗
PubMed1989

The pediatric marketplace.

This study presents an overview of the demography of office-based pediatricians, trends in the patient population, and the growth of the pediatricians' market share of children seeking primary medical care. The following four factors bear directly on the present and future status of the office-based pediatric practice: (1) size of the office-based pediatrician population, (2) size of the pediatric patient population, (3) the frequency of patient visits, and (4) the pediatric market share. Results indicate that the pediatricians' market share of young children has continued to grow. However, the pediatricians' share of young children has not grown fast enough to offset an increase in the pediatrician population. Continued growth of the pediatric practice may depend on developing effective marketing strategies and providing more primary care to the adolescent population.

Adolescent↗
PubMed1980

Depression in an adolescent delinquent population.

One hundred and twenty adolescents aged 13, 14, and 15 were given a structured psychiatric interview within 48 hours of their admission to a correctional facility. The interview assessed demography, social and delinquent history, family history, and drug and alcohol use and related problems. The interview issued diagnoses based on the Research Diagnostic Criteria. The adolescents were followed up with self-rated and observer-rated instruments. Twenty-three percent of the population met criteria for a major affective disorder. Observer blind ratings significantly identified the depressed group at 15 days. Self-ratings of depression did not separate the two groups. No pattern of antisocial or "acting-out" behavior differentiated the depressed group, although the depressed group did relate more of their problems to drug and alcohol abuse. A depressed or alcoholic family member significantly predicted for depression. Some possible unique cognitive aspects of depression in younger adolescents are explored, and implications for further research with delinquents are discussed.

Adolescent↗
PubMed1982

Platelet monoamine oxidase activity in relatives of alcoholics. Preliminary study with matched control subjects.

Platelet monoamine oxidase (MAO) activity levels were determined before and 180 minutes after ingestion of ethyl alcohol in 30 healthy men aged 21 to 25 years. The subjects included 15 men with alcoholic first-degree relatives who were matched by demography, height-weight ratio, and drinking history with 15 control subjects who had no family history of alcoholism. There was a nonsignificant trend toward lower platelet MAO activities at baseline and after ethyl alcohol ingestion in the group with alcoholic relatives when compared with the control subjects who had no family history of alcoholism. With an arbitrary MAO cutoff of 5.24 nmole/mg of protein per hour, eight of the 15 subjects with alcoholic relatives and 12 of the 15 without alcoholic relatives were correctly identified. However, because of the number of false-positive and false-negative findings, the results have limited clinical usefulness.

Adolescent↗
PubMed1987

Assessing psychiatric disorders in children. Discrepancies between mothers' and children's reports.

Results were compared from independent interviews using the Schedule for Affective Disorders and Schizophrenia for School-aged Children-Epidemiologic Version and DSM-III with 220 subjects (ages 6 to 23 years) and their parent informants. In agreement with results from studies using a variety of structured diagnostic interviews or symptom scales, considerable discrepancies were found between parents' and children's reports on the degree and nature of the child's psychopathology. The children reported more illness about themselves than their parents reported about them. The parents' reports were primarily a subset of the children's reports. Various factors that might affect agreement, including demography, parental clinical status, severity of illness, and treatment, were also explored. The findings that parents under-report psychiatric disorders in their children are comparable with those reported in studies of adults when family informants are used to obtain diagnostic information. Until these parent-child discrepancies can be resolved by longitudinal, family, and other research, diagnostic assessment of children should include direct interviews with them. An independent assessment of the child's diagnosis based on information from multiple informants, including the child, may be the best estimate.

Adolescent↗
PubMed1987

Plasma cortisol levels following ethanol in sons of alcoholics and controls.

We used the pattern of change in plasma cortisol level following ethanol challenges to help characterize differences in response to alcohol in sons of alcoholics and controls. Thirty healthy, drinking young adult sons of alcoholics were matched with 30 sons of nonalcoholics on demography, drug use, and alcohol use histories. Each was tested on three occasions, when he received, in random order, placebo, 0.75 mL/kg of ethanol, and 1.1 mL/kg of ethanol. Subsequent blood samples for cortisol determinations were obtained every 30 minutes over the next four hours. The sons of alcoholics, at higher risk for the future development of alcoholism, demonstrated lower cortisol levels after drinking. The data are consistent with our prior measures of self-reported feelings of intoxication and family group differences in ethanol-induced decrements in performance.

Adult↗
PubMed1998

Effect of sample bias on paleodemographic fertility estimates.

Paleodemographers must work to understand how representative any archaeologically recovered skeletal series is and the potential effects of series bias on their demographic reconstructions. We examine two forms of bias: 1) infant underenumeration caused by differential preservation or incomplete archaeological recovery and 2) the underenumeration of individuals over age 45 related to methodological bias. We generated 60 simulated skeletal series of 250 individuals each based on the Brass ([1971] Biological Aspects of Demography (London: Taylor and Francis), pp. 69-110) logit models. In the first test, age bias was introduced deterministically for all individuals with age at death over 40 years using the Lovejoy et al. ([1985] Am. J. Phys. Anthropol. 68:1-14) bias estimates. In the second test, 50% of all individuals under 5 years old were removed from each simulated distribution. The simulated series were analyzed using the model life table fitting procedure developed by the authors (Milner et al. [1989] Am. J. Phys. Anthropol. 80:49-58; Paine [1989] Am. J. Phys. Anthropol. 79:51-62). Forms of adult age estimation bias described by Lovejoy and coworkers inflate estimates by 10-20% of the true crude birth rate (CBR) (the number of births per year per 1,000 population). Overestimation of fertility and birth rates increases both absolutely and as a percentage of the true rate as population growth increases. This bias is very consistent. Because Lovejoy and colleagues have estimated the methodological bias itself, its effects can be estimated. Infant underenumeration is a more serious obstacle. It is not presently possible to estimate infant underenumeration reliably without prior knowledge of fertility rates. This reduces fertility reconstructions based on infant-biased samples to minimum fertility estimates.

Adult↗
PubMed1999

Lemur traits and Madagascar ecology: coping with an island environment.

The last decade's lemur research includes successes in discovering new living and extinct species and learning about the distribution, biogeography, physiology, behavior, and ecology of previously little-studied species. In addition, in both the dry forest and rain forest, long-term studies of lemur demography, life history, and reproduction, have been completed in conjunction with data on tree productivity, phenology, and climate. Lemurs contrast with anthropoids in several behavioral features, including female dominance, targeted female-female aggression, lack of sexual dimorphism regardless of mating system, sperm competition coupled with male-male aggression, high infant mortality, cathemerality, and strict seasonal breeding. Hypotheses to explain these traits include the "energy conservation hypothesis" (ECH) suggesting that harsh and unpredictable climate factors on the island of Madagascar have affected the evolution of female dominance, and the "evolutionary disequilibrium hypotheses" (EVDH) suggesting that the recent megafauna extinctions have influenced lemurs to become diurnal. These hypotheses are compared and contrasted in light of recent empirical data on climate, subfossils, and lemur behavior. New data on life histories of the rain forest lemurs at Ranomafana National Park give further support to the ECH. Birth seasons are synchronized within each species, but there is a 6-month distribution of births among species. Gestation and lactation lengths vary among sympatric lemurs, but all lemur species in the rain forest wean in synchrony at the season most likely to have abundant resources. Across-species weaning synchrony seen in Ranomafana corroborates data from the dry forest that late lactation and weaning is the life history event that is the primary focus of the annual schedule. Lemur adaptations may assure maximum offspring survival in this environment with an unpredictable food supply and heavy predation. In conclusion, a more comprehensive energy frugality hypothesis (EFH) is proposed, which postulates that the majority of lemur traits are either adaptations to conserve energy (e.g., low basal metabolic rate (BMR), torpor, sperm competition, small group size, seasonal breeding) or to maximize use of scarce resources (e.g., cathemerality, territoriality, female dominance, fibrous diet, weaning synchrony). Among primates, the isolated adaptive radiation of lemurs on Madagascar may have been uniquely characterized by selection toward efficiency to cope with the harsh and unpredictable island environment.

Adaptation, Physiological↗
PubMed1999

Hyperostosis frontalis interna: an anthropological perspective.

Hyperostosis frontalis interna (HFI) is manifested by the accretion of bone on the inner table of the frontal bone. Despite the vast literature on HFI, ambiguity exists as to its etiology, osteogenesis, demography, and history. This stimulated the present broad-scale study of HFI which included the evaluation of 1,706 early 20th century skulls (1,007 males and 699 females) from the Hamann-Todd and Terry human osteological collections, as well as 2,019 pre-19th century East-Mediterranean, Amerindian, and Central European skulls. In addition, 72 cadavers were dissected for gross inspection and histology. Special attention was paid to the relationship of the brain and meninges to endocranial lesions. HFI is an independent condition, not a symptom of a more generalized syndrome as suggested in the past. It can appear in a variety of forms but each is the result of the same process and probably of the same etiology. Investigators' previous failure to recognize the mild stages of HFI (types A and B) as an early form of the general HFI process led to erroneous statistics and interpretations of observations. HFI should also be considered a phenomenon separate from HCI, hyperostosis cranialis diffusa (HCD), and other endostoses, even when it appears in association with them. To avoid ambiguity and facilitate the description of cranial hyperostoses, uniform nomenclature (HFI, HCD) has been recommended. HFI is rarely seen in historic populations, regardless of geographical origin. It is most commonly found among females and is believed to be associated with prolonged estrogen stimulation. While its magnitude of manifestation and frequency are much higher in females, HFI is not a purely female phenomenon. Males with hormonal disturbances such as atrophic testis were found to manifest HFI type D. HFI is associated with age insofar as it is much less frequent in females under 40 years of age. Although advanced cases of HFI (types C and D) have been observed in individuals as young as 40 years of age, it is more frequently found after age 60. The frequency of HFI type D will not increase from age 60. Type-predicted analysis by cohort reveals significant ethnic differences. Changes in African American (AA) females appear earlier in life and progress more rapidly than in European American (EA) females. Analysis of radiographs shows a discrepancy between the anatomic prevalence of HFI and its radiological recognition, which is very poor for mild cases. This apparently resulted in the misconceptions that HFI is entirely an old-age phenomenon, and that it is exclusively female. Histological analysis shows that the inner table along with the closely attached dural layer play a major role in the osteogenesis of HFI. Contrary to previous models, no evidence for diploe or ectocranial plate involvement was found. Cadaver study suggests that the predilection for the frontal area may be related to an altered blood supply and/or vascular stretching.

Adult↗
PubMed1997

Incidence of colorectal adenocarcinoma by anatomic subsite. An epidemiologic study of time trends and racial differences in the Detroit, Michigan area.

BACKGROUND: Colorectal adenocarcinoma may represent more than one disease process. Numerous epidemiologic studies suggest that rates of occurrence of colorectal adenocarcinoma at particular anatomic subsites (e.g., right colon, left colon, and rectum) may be associated with distinctive geographic, demographic, and risk factor profiles. This study explored time trends over a 22-year period of the incidence of adenocarcinoma of the colon and rectum at various subsites among patients of different race, gender, and stage of disease. METHODS: Data on the incidence of colorectal adenocarcinoma were obtained from a population-based cancer registry in the Detroit, Michigan area funded by the National Cancer Institute. Age-adjusted incidence rates were analyzed by year of diagnosis. Relative survival rates were also obtained for different race and gender categories, along with disease stage at diagnosis. RESULTS: A major rise was revealed in the incidence of adenocarcinoma in the right colon among African American men and women between the mid-1970s and the early 1980s. The rise was greatest among African American men and accounts for increases in late stage disease among them. Corresponding decreases in survival among African American men were noted. CONCLUSIONS: These findings indicated widely differing disease patterns based on anatomic subsite and patient demography and also indicated a need for targeted efforts at early detection of adenocarcinoma of the right colon among African Americans.

Adenocarcinoma↗
PubMed1997

The National Cancer Data Base report on patterns of childhood cancers in the United States.

BACKGROUND: Patterns of and progress against childhood cancer have been reported on multi-institution, regional, national, and international bases by several sources in the past. These sources have included clinical cooperative group trials and population-based registries. In general, the population-based surveys have excluded brain tumors of either benign or uncertain behavior. The authors of this article investigated the patterns of data reported for the period 1985-1993, motivated by their interest in assessing the potential of National Cancer Data Base (NCDB) data to 1) facilitate individual institution review and 2) cover institutions that are not members of the Pediatric Oncology Group or the Children's Cancer Group, which are both national clinical cooperative groups. METHODS: Six annual calls for data, starting with a call for 1985 and 1988 cases, were issued to approximately 2100 hospitals with cancer programs (1340 programs approved by the Commission on Cancer of the American College of Surgeons and 760 other programs). The baseline data items of the NCDB included patient demography, tumor characteristics, initial treatment, and follow-up. The data for each patient were coded in the traditional manner by trained cancer registrars before being transmitted to the NCDB in standard format. RESULTS: In the most recent year for which data were reported, the NCDB included 42% of all estimated U.S. childhood cancers. The cases were reported by institutions that were members of the Pediatric Oncology Group and the Children's Cancer Group as well as nonmember institutions. The distribution of diagnostic groups reported to the NCDB was generally similar to that reported to SEER, except for lymphomas and brain cancer (the NCDB series included benign as well as malignant brain tumors). The distribution of diagnostic groups reported to the NCDB did not change over the 9-year reporting period (1985-1993). With regard to ethnicity, the most varied distribution of diagnostic groups was found among African American patients. For many types of cancer, the survival of those patients reported to the NCDB was similar to that of patients included in the SEER population-based series. These cancers included Wilms' tumor (NCDB 89% vs. SEER 88%), non-Hodgkin's lymphoma (NCDB 74% vs. SEER 70%), soft tissue sarcomas (NCDB rhabdomyosarcomas 70% and sarcomas 79% vs. SEER soft tissue sarcomas 71%), and neuroblastoma (NCDB 58% vs. SEER 57%). CONCLUSIONS: The authors concluded that the number of brain tumors of benign and uncertain behavior being diagnosed were significant enough in number that they should be included in regional and national cancer registries that report data for clinical purposes. They further concluded that for reasons of data inclusion and institutional coverage, the NCDB will be an important data base for pediatric cancers that will warrant increased use by pediatric investigators.

Adolescent↗
PubMed1999

A longer breast carcinoma screening interval for women age older than 65 years?

BACKGROUND: The observed increase in sojourn time for preclinical breast carcinoma raises the question of whether women age >/= 65 years can be screened less frequently than younger women. METHODS: A cost-utility analysis using a computer model that simulates the demography, epidemiology, and natural history of breast carcinoma to estimate expected life-years gained, extra incidence, extra life-years with disease, and costs incurred by different breast carcinoma screening programs in the general population was conducted. RESULTS: The estimated ratio of favorable/unfavorable effects was lower for longer screening intervals compared with shorter screening intervals. The cost-effectiveness ratio was much less favorable in shorter screening intervals. CONCLUSIONS: The results of the current analysis showed that although a longer sojourn time for preclinical breast carcinoma should not necessarily be accompanied by a longer screening interval, a shorter screening interval was not very efficient.

Age Factors↗
PubMed1996

The effects of misclassification of the actual cause of death in competing risks analysis.

The problem of competing risks analysis arises often in public health, demography, actuarial science, industrial reliability applications, and experiments in medical therapeutics. In the classical competing risks scenario one models the risks with a vector (T = (T1, ..., Tk) of non-negative random variables that represents the potential times to death of k risks. One cannot see T directly but sees instead Y = min (T1, ..., Tk) and the actual cause of death. The major difficulty with this analysis is the requirement for the expert to specify the single cause of death that, in fact, may not be the actual cause. This paper addresses competing risks analysis for the situations where one observes Y and the set of several possible causes of death specified by the expert. Many times there are several causes that act together and realistically it is impossible for the expert to assign a death to a single cause. In particular, I provide a likelihood for parametric competing risks analysis when the actual cause of death is possibly misclassified. The data include time to death, Y, and a set of possible causes of death. If misclassification probabilities are unknown, I propose a Baysian analysis based on a prior distribution for the parameters of interest and for the misclassification probabilities.

Cause of Death↗