Abraham M. Lilienfeld

Photocoagulation Treatment of Proliferative Diabetic Retinopathy: The Second Report of Diabetic Retinopathy Study Findings

Data from the Diabetic Retinopathy Study (DRS) show that photocoagulad inhibited the progression of retinopathy. These beneficial effects were noted to some degree in all those stages of diabetic retinopathy which were included in the Study. Some deleterious effects of treatment were also found, including losses of visual acuity and constriction of peripheral visual field. The risk of these harmful effects was considered acceptable in eyes with retinopathy in the moderate or severe retinopathy in the moderate or severe proliferative stage when the risk of severe visual loss without treatment was great. In early proliferative or severe nonproliferative retinopathy, when the risk of severe visual loss without treatment was less, the risks of harmful treatment effects assumed greater importance. In these earlier stages, DRS findings have not led to a clear choice between prompt treatment and deferral of treatment unless and until progression to a more severe stage occurs.

Epidemiological Study of Sudden and Unexpected Deaths due to Arteriosclerotic Heart Disease

A study of sudden unexpected nontraumatic deaths was begun on June 1, 1964. A sample of all nontraumatic deaths in Baltimore residents between the ages of 20 and 64 from June 15, 1964, to June 14, 1965, was obtained. The deaths were then studied by reviewing all available medical information in order to determine: (1) whether the death was possibly sudden or not and (2) the accuracy of the diagnosis reported on the death certificate. The next of kin or other relative or friend of each deceased person who died suddenly was then interviewed.For comparison, information was obtained on (1) a probability sample of the Baltimore population, and (2) deaths due to arteriosclerotic heart disease (ASHD deaths) that were found to be “not-sudden.”There were 1,857 deaths in the original sample, of which 589 were sudden according to the definition of sudden death. After adjustment for sampling, it was estimated that 1,178 (32%) of the total 3,648 deaths in Baltimore were sudden. Arteriosclerotic heart disease (ASHD) accounted for 58% and the cardiovascular group together for 69% of the sudden deaths.Sixty per cent of all ASHD deaths were sudden. Of the 1,030 ASHD deaths in Baltimore City between the ages of 40 and 64, 20.6% occurred outside of a hospital and 46.2% represented deaths on arrival at a hospital. Only 18.9% of all ASHD deaths occurred after the first 24 hours of hospitalization.By use of data provided in several crosssectional and prospective studies, it was estimated that 22% of new coronary events were sudden deaths and that the case-fatality rate was 31%.In approximately half of the ASHD sudden deaths the deceased had a history of heart disease prior to death and in 24% the deceased had seen a physician within the week prior to death. Unfortunately we were not able to determine the reasons for these visits.In considering the implications of these findings with regard to the prevention of ASHD deaths, it would appear that prevention of only a comparatively small percentage (8.2%) of ASHD deaths is completely dependent on primary prevention. For the remaining ASHD deaths a combination of both primary and secondary prevention may be effective. Because of the rapidity of death and the high frequency of these deaths either occurring outside of a hospital or being called deaths on arrival, hospital treatment may well have little effect on reducing the ASHD mortality, while, on the other hand, the combination of better and earlier diagnosis and intensive treatment in a hospital could conceivably re- duce the mortality.

Trends in incidence rates of ulcerative colitis and Crohn's disease

Between 1960 and 1979, three studies were conducted in the Baltimore Standard Metropolitan Statistical Area to ascertain the incidence rates of first hospitalizations for ulcerative colitis and Crohns disease. The age-adjusted rates per 100,000 population for the 1977–1979 survey for ulcerative colitis in white and nonwhite males and females were 2.92, 1.79, 1.29, and 2.90, respectively; the Crohns disease rates were 3.39, 3.54, 1.29, and 4.08, respectively. In Baltimore the age-adjusted rate for Crohns disease has increased to exceed the ulcerative colitis rate for whites of both sexes and nonwhite females. The ulcerative colitis and Crohns disease rates for nonwhite males are similar. The rate for white males exceeds that for nonwhite males for both ulcerative colitis and Crohns disease, but the converse is true for females. Females have higher rates than males for Crohns disease in both color groups and for ulcerative colitis among nonwhites. White ulcerative colitis rates are higher for males than for females. From the first to the second surveys, the white male and female rates for ulcerative colitis converge with increasing male and decreasing female rates, but then both decline from the second to the third surveys. For Crohns disease, the age-adjusted rates increased for whites of both sexes and nonwhite females from the first to second surveys. The Crohns disease rates appeared to stabilize for whites of both sexes between the second and present surveys, but they increased for nonwhites of both sexes. Trends in age-adjusted rates for other areas are also discussed.

Some epidemiologic aspects of the high mortality rate in the young widowed group

Abstract The relationship between marital status and mortality appearing in statistical data published by the National Office of Vital Statistics on deaths and death rates in 1949–1951 by marital status, age, color, and sex was reviewed. The main feature was the lower death rate in the married group than in the single, widowed, or divorced, at every age. The outstanding excess risk of mortality among the young widowed was noted. This excess risk in the widowed under age 35, compared to the married, was greater than tenfold for at least one of the specific age-sex groups involved for several leading causes of death, including arteriosclerotic heart disease and vascular lesions of the central nervous system. Possible explanatory hypotheses were discussed. It seems unlikely that the several possible artificial factors mentioned, including the “selection” factor, could have accounted for more than a small part of the great excess risk noted in the young widowed for these several causes of death. Three biologic hypotheses were suggested in explanation of what appears to be a genuine association between young widowhood and subsequent mortality. These were called the 1. (1) “mutual selection of poor-risk mates,” 2. (2) “joint unfavorable environment,” and 3. (3) “effects of widowhood” hypotheses. Further studies, of both the retrospective and prospective types, were suggested to assess these hypotheses.

Incidence Rates of Ulcerative Colitis and Crohn's Disease in Fifteen Areas of the United States

A study was carried out during 1973 to determine the incidence of first hospitalizations for ulcerative colitis and Crohns disease in 15 areas of the United States, including communities of widely varied size, climatic, ethnic, racial, and socioeconomic characteristics. The following descriptions apply to incidence rates per 100,000 population for the aggregate of the 15 areas. Ulcerative colitis had a bimodal age distribution in white males (with peaks at ages 20-29 and 70-79 yr) and females (with peaks at ages 30-39 and 70-79 yr). Crohns disease had a bi- or trimodal age distribution in white males (with peaks at ages 20-29, 50-59, and 70-79 yr) and females (with peaks at ages 20-29, 50-59, and 70-79 yr). The age, sex, and geographic distributions that were observed in this study may have important etiologic implications.

Illness Experience and Life Stresses in Patients with Irritable Colon and with Ulcerative Colitis: An Epidemiologic Study of Ulcerative Colitis and Regional Enteritis in Baltimore, 1960–1964

Abstract An epidemiologic study in Baltimore from 1960–1964 identified hospitalized patients with inflammatory bowel disease and various control groups. Structured interviews were carried out with ...

The Inaccuracy in Using Interviews to Estimate Patient Reliability in Taking Medications at Home

AN IMPORTANT PART of the medical care of many chronically-ill patients is self-administration of oral medications at home over a long period of time. Many improvements in the care available for such patients rest in the development of new pharmacologic agents more effective and less toxic than their predecessors. As each new agent is developed, however, it must be submitted to clinical trials comparing it in effectiveness and toxicity with other drugs already in use. Such trials comparing several drugs presume that the patients assigned to receive the drugs being tested actually take their medications as prescribed. It is known, however, that patients vary

The association of maternal and fetal factors with the development of cerebral palsy and epilepsy

Abstract A study of the birth certificates of 561 cerebral palsied children born in Upper New York State between 1940 and 1947 showed that their mothers had significantly more complications of pregnancy and labor, prematurity, and previous infant loss than the population of births from which they were derived. The pattern of the association of these factors with cerebral palsy was similar to that found with regard to stillbirths and neonatal deaths. This led to postulating the existence of a continuum of reproductive casualty composed of a lethal component consisting of abortions, stillbirths, and neonatal deaths and a sublethal component consisting of cerebral palsy and perhaps other related conditions. Using this concept of a continuum as a working hypothesis, similar studies have been carried out in Baltimore with regard to epilepsy, mental deficiency, and behavior disorders of childhood. The results of the study of epileptic children are presented in detail while the results of the other studies are briefly summarized. The prenatal and paranatal records of mothers of 564 epileptic children born in Baltimore between 1935 and 1952 showed significantly more complications of pregnancy and delivery, prematurity and abnormal neonatal conditions than a similar number of matched controls. In addition, more mothers of the epileptic children had a history of previous reproductive casualties than the mothers of the controls. The fact that the pattern of association of these maternal and fetal factors with epilepsy, mental deficiency, and behavior disorders of childhood was similar to that found with regard to cerebral palsy indicates that these conditions should be included in the postulated continuum . The importance of the concept of the continuum as providing a conceptual framework for obstetrical research and practice is discussed.

Studies in the epidemiology and preventability of rheumatic fever. II. Socio-economic factors and the incidence of acute attacks.

Abstract Incidence rates of hospitalized rheumatic fever from 1960 to 1964 have been calculated for socio-economic fifths of the Baltimore white and non-white populations. The incidence rates for non-whites are consistently higher than those for whites in each socio-economic fifth. With improving socio-economic status the incidence rate of rheumatic fever declines in the white population but in the non-white population there is no clear pattern of declining incidence. A comparison of white and non-white socio-economic fifths, in terms of housing characteristics, indicates that extent of crowding is the variable which relates most closely to incidence of rheumatic fever. When degree of crowding is held constant, incidence rates among non-whites are no higher than those calculated for whites. The data suggest that the higher incidence of rheumatic fever among non-whites is not a result of any particular susceptibility of non-whites to rheumatic fever, but relates to the crowded conditions in which most of this ethnic group live in Baltimore. The findings in this study suggest that socio-economic factors should be an important consideration in programs designed to prevent and control rheumatic fever.

Dietary and purgation factors in the epidemiology of gastric cancer

A study was made of 188 men and 88 women with gastric cancer plus controls of 800 men and 1400 women with non‐neoplastic, nondigestive disease seen at Roswell Park Memorial Institute between 1957 and 1965. Sex and age‐specific comparisons of cases and controls showed few positive results for men and almost none for women regarding ingestion of a large number of specific foods and beverages, including alcohol. Higher proportions of men with gastric cancer ate cabbage and potatoes than controls though the latter result was not significant. Eating infrequently also more often characterized patients with cancer; this result may parallel those of Segi and Wynder regarding “irregular” eating. The current finding of a higher risk for use of purgatives was similar to the one reported earlier by Boyd and Doll. Many sources of possible error in these results may inhere in the interview method used. Nevertheless, a number of considerations with regard to the interview approach suggest the need for similar research in the future to investigate the relationships found.