Dean S. Bross

Relevance of correlates of infant deaths for significant morbidity at 1 year of age

This paper examines the issue of whether or not factors identified as risks for death in the first year of life also serve as risks for morbidity in surviving infants through data collected on 390,425 live births, 5,084 infant deaths, and 4,327 surviving 1-year-old children among singleton births in eight geographically defined regions in the United States. Factors which presented risks for neonatal death, such as advanced maternal age and maternal history of prior fetal loss, proved to present risks for congenital anomalies/severe developmental delay, whereas factors heavily influenced by environmental conditions, such as young maternal age and lower maternal educational attainment, were associated with higher postneonatal mortality rates and other significant illness, among both low-birth-weight and normal-birth-weight infants. The association of delivery by cesarean section with death and morbidity was also explored.

Risk factors in interstitial pneumonitis following allogenic bone marrow transplantation

Total body irradiation is part of the preparatory regimen for allogeneic bone marrow transplantation because of its cytotoxic and immunosuppressive properties. A major toxicity of bone marrow transplantation has been interstitial pneumonitis, which may be, in part, related to the lung irradiation. One hundred and sixty-one consecutive patients receiving allogeneic bone marrow transplantation for leukemia and aplastic anemia at Johns Hopkins Hospital (1968-1979) were retrospectively studied. The present study demonstrated that lung shielding to 600 rad maximum in single dose total body irradiation, fractionation of total body irradiation in comparison to single dose total body irradiation, and absence of graft versus host disease in the leukemia patients, each reduced the risk of interstitial pneumonitis. Total body irradiation significantly reduced the leukemia recurrence rate and/or the failure of remission induction.

Mortality and morbidity in infants with intrauterine growth retardation

This report is based on an analysis of the experience with all births in several urban and rural areas of the United States. All infants whose birth weight was in the lowest quartile for their week of gestation were designated as small for gestational age regardless of their birth weight or length of gestation; other infants were considered appropriate for gestation age. We interpret the data to indicate that appropriate-for-gestational age and small-for-gestational age infants, all of low birth weight, differ in the nature of their risk for adverse outcome as determined by an assessment at one year of age, although both are at approximately equal risk of adverse outcome overall. In each weight group, the total proportion of infants who either died before one year of age or were handicapped at one year of age was similar for small-for-gestational age and appropriate-for-gestational age infants, but appropriate-for-gestational age infants were at greater risk of neonatal death and small-for-gestational age infants were at greater risk of problems manifested during the first year of life or at one year of age. As the findings are based on data obtained from entire populations (rather than from infants born in particular hospitals), they are likely to be generalizable.

Epidemiology of cancer of the vulva. A case—control study

Few epidemiologic studies have been undertaken to investigate the etiology of cancer of the vulva. To identify risk factors associated with this cancer, a case—control study was conducted in 149 patients with histologically proven vulvar carcinoma and the same number of control patients matched for age, race, marital status, and hospital from five U.S. metropolitan areas. As previously suspected, we found prior histories of leukoplakia of the vulva, inflammation of the vulva or vagina, and urogenital cancer to be significantly associated with vulvar cancer. In addition, we found moderately high odds ratios associated with occupational histories of private household maids and servants, and work in laundry, cleaning, and other garment services. A slightly increased odds ratio was associated with coffee consumption and a dose—response effect was demonstrated. The findings suggest that environmental exposures may play a role in vulvar carcinogenesis.

Cigarette smoking and nasopharyngeal carcinoma

A case‐control study was undertaken to investigate possible etiologic factors in nasopharyngeal cancer, a rare tumor in the United States. Data from 39 nasopharyngeal cancer cases and the same number of matched controls showed significantly more cases born in Asia than controls, supporting the notion that exposure in early life has a prolonged carcinogenic effect. Cases also smoked significantly more cigarettes than controls, indicating a need for investigating the role of cigarette smoking and other exposures in the etiology of nasopharyngeal cancer in western countries.

A parametric method for comparing cumulative pregnancy curves following infertility therapy

When evaluating the results of infertility therapy, it is often of interest to know whether differences exist between a new form of therapy and the established one, between medical and surgical therapy, or between patient groups that differ in severity of disease, age, parity, and so on. In this paper, a likelihood-ratio test is developed to evaluate differences between cumulative pregnancy curves of different patient groups. The test takes into account variation in patient follow-up and can be applied to any type of infertility therapy. It is illustrated by consideration of a group of patients who underwent artificial insemination by donor (AID) and determination of whether pregnancy outcome differed according to parity. It was found that the cure rate for both nulliparous and parous patients was virtually 100% and that the monthly probability of pregnancy was not significantly different between the two groups.

Assessing the efficacy of The American Fertility Society's classification of endometriosis: application of a dose-response methodology.

In order to promote uniform reporting of endometriosis. The Americal Fertility Society (AFS) recently proposed a classification in which severity was categorized on the basis of both location and extent of disease. The results of this study indicate that the AFS scale poorly specifies the relation between severity of disease and pregnancy outcome after therapy, because of the arbitrary point scores assigned to each classification category, and the arbitrary cutoff points chosen to divide patients into severity groupings. A nonparametric monotonic estimator, which generates a dose-response relationship between AFS score (dose) and pregnancy following treatment (response) is shown to improve the discriminatory power of the AFS scale; however, in order to obtain the full benefit of the detail provided by the AFS classification, it is recommended that the current arbitrary individual-category weights be replaced by empirically derived weights.

Local control and reduced complications in split course irradiation of prostatic cancer

Abstract Split course prostatic irradiation is a treatment technique where 4000–4500 rod whole pelvis irradiation is followed by two weeks of rest and an additional 2000–2500 rod by reduced field technique to a total dose of 6000–6500 rod. Eighty-four patients were studied and the results indicated a local regional control rate of 97.6% with an overall 3 year survival without evidence of disease of 96.6% for Stages A and B and 60% for Stage c. Significant complications occurred in 1.2 % of the patients. None of the patients needed surgical correction of a complication other than a perineal abscess. The risk/benefit ratio for pelvic and prostatic irradiation favors split course prostatic irradiation in that it demonstrates a low complication rate, high local regional control, and comparable disease-free survival to continuous irradiation.

Anthropometric predictors of low birth weight outcome in teenage pregnancy

The highest relative risks of low birth weight are found among births to teenage mothers. An analysis of anthropometrics (weight, mid-arm circumference, and triceps skinfold) among black teenagers attending an adolescent prenatal program was studied. The sample consisted of 100 girls under 17 years. Data were collected from 19 to 35 weeks gestation. Adolescent mothers who delivered low birth weight (LBW) infants demonstrated different patterns of anthropometric changes than teen mothers who delivered normal birth weight (NBW) infants. Mean mid-arm circumference increases in the LBW group (0.05 mm/wk) were significantly less than mean increases in the NBW group (0.80 mm/wk) (p less than 0.05). Arm fat area estimates of the LBW mothers demonstrated weekly depletion (-24.9 mm2/wk), which was significantly less than those of the NBW group, who accumulated fat (+15.3 mm2/wk) (p less than .05). Changes in maternal nutritional status may in part mediate the birthweight outcome in adolescent pregnancy. Anthropometrics may be useful in predicting those teens at highest risk of bearing LBW infants.

Convenient numerical procedures for estimating cumulative pregnancy curves

OBJECTIVE To develop a simple estimation procedure that will always converge on a solution for a two-parameter model of cumulative pregnancy curves. DESIGN Utilize raw data from a previous study in which estimation of the two-parameter model did not converge on a solution, and re-estimate the model with the new estimation method. PATIENTS, SETTING, TREATMENT: Infertile women with endometriosis treated as outpatients with laser laparoscopy. MAIN OUTCOME MEASURES Pregnancy and ability of the new computer program to converge on a solution. RESULTS The new estimation procedure converged on a solution. Over all stages of endometriosis, the cure rate from laser laparoscopy was 56%, and the monthly probability of pregnancy among those cured was 9.7%. CONCLUSIONS The new estimation procedure, written for a personal computer, is easy to use and will virtually always converge on a solution for the two-parameter model of cumulative pregnancy after infertility treatment.