Donna Brogan

The NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study: background and methodology.

OBJECTIVE A collaborative study was conducted to develop methods for surveys of mental disorder and service utilization in unscreened population-based samples of children and adolescents. METHOD Probability household samples of youths 9 through 17 years of age were selected at four sites and interviews were conducted with a total of 1,285 pairs of youths and their adult caretakers in their homes. Lay interviewers administered a computer-assisted version of the NIMH Diagnostic Interview Schedule for Children Version 2.3 and structured interviews to assess demographic variables, functional impairment, risk factors, service utilization, and barriers to service utilization. RESULTS More than 7,500 households were enumerated at four sites, with enumeration response rates above 99%. Across sites, 84% of eligible youth-caretaker pairs were interviewed for about 2 hours each. Ninety-five percent of both youths and caretakers found the interview to be acceptable enough to recommend to a friend. CONCLUSIONS These findings indicate that large-scale epidemiological surveys of mental disorders and mental health service use involving lengthy interviews in the homes of unscreened population-based samples of youths and their adult caretakers are acceptable to the community and can achieve good response rates. The other reports in this Special Section address the reliability and validity of the various survey instruments and other key findings.

Atherosclerotic risk factor reduction in peripheral arterial disease: Results of a national physician survey

OBJECTIVE: Individuals with peripheral arterial disease (PAD) have a 3- to 6-fold increased risk of coronary heart disease and stroke compared to those without PAD. We documented physician-reported practice behavior, knowledge, and attitudes regarding atherosclerotic risk factor reduction in patients with PAD.DESIGN: National physician survey.PATIENTS/PARTICIPANTS: General internists (N=406), family practitioners (N=435), cardiologists (N=473), and vascular surgeons (N=264) randomly identified using the American Medical Association’s physician database.MEASUREMENTS AND MAIN RESULTS: Physicians were randomized to 1 of 3 questionnaires describing a) a 55- to 65-year-old patient with PAD; b) a 55- to 65-year-old patient with coronary artery disease (CAD), or c) a 55- to 65-year-old patient without clinically evident atherosclerosis (no disease). A mailed questionnaire was used to compare physician behavior, knowledge, and attitude regarding risk factor reduction for each patient. Rates of prescribed antiplatelet therapy were significantly lower for the patient with PAD than for the patient with CAD. Average low-density lipoprotein levels at which physicians “almost always” initiated lipid-lowering drugs were 121.6±23.5 mg/dL, 136.3±28.9 mg/dL, and 149.7±24.4 mg/dL for the CAD, PAD, and no-disease patients, respectively (P<.001). Physicians stated that antiplatelet therapy (P<.001) and cholesterol-lowering therapy (P<.001) were extremely important significantly more often for the CAD than for the PAD patient. Perceived importance of risk factor interventions was highly correlated with practice behavior. Compared to other specialties, cardiologists had lowest thresholds, whereas vascular surgeons had the highest thresholds for initiating cholesterol-lowering interventions for the patient with PAD. Cardiologists were significantly more likely to report “almost always” prescribing antiplatelet therapy for the patient with PAD than were all other physicians.CONCLUSIONS: Deficiencies in physician knowledge and attitudes contribute to lower rates of atherosclerotic risk factor reduction for patients with PAD. Reversing these deficiencies may reduce the high rates of cardiovascular morbidity and mortality associated with PAD.

End-stage renal disease treatment modality and patients' quality of life. Longitudinal assessment.

Quality of life assessments were obtained at two 18-month follow-up intervals from 97 end-stage renal disease patients. Data were compared for three stable treatment groups (transplant, home hemodialysis, in-center hemodialysis) and for two transfer treatment groups (hemodialysis to transplant, hemodialysis to continuous ambulatory peritoneal dialysis). Home hemodialysis patients demonstrated the highest quality of life and lowest hospitalization rates over time. Transplant patients had higher employment and perceived health status but not necessarily higher subjective quality of life as compared to in-center hemodialysis patients, and transplant patients experienced more hospitalization. At follow-up, hemodialysis patients who obtained transplants assessed their quality of life as higher than did hemodialysis patients who went on continuous ambulatory peritoneal dialysis.

Alcohol consumption and breast cancer risk among women under age 45 years

In a population‐based case‐control study of women younger than 45 years of age, we obtained a detailed lifetime history of alcohol use to evaluate the effects of drinking during different periods of life in relation to breast cancer risk. This analysis focused on interviews obtained from 1,645 cases and 1,497 controls. Breast cancer risk was not influenced by drinking during the teenage years or early adulthood. Contemporary drinking (that is, average intake during the recent 5‐year interval) was directly associated with risk, but the adverse effect of recent drinking was restricted to women who consumed ≥14 drinks per week [relative risk (RR) = 1.7; 95% confidence interval (CI) = 1.2–2.5]. The effect of alcohol was most pronounced among women with advanced disease. Compared with nondrinkers, the risk estimate associated with recent consumption of ≥14 drinks per week was 2.4 (95% CI = 1.6–3.8) for women with regional/distant disease. Our data add support to the accumulating evidence that alcohol consumption is associated with increased risk of breast cancer and further indicate that alcohol acts at a late stage in breast carcinogenesis.

Increasing the accuracy of the Expanded Programme on Immunization's cluster survey design.

The Expanded Programme on Immunization (EPI) of the World Health Organization developed a cluster survey design for the rapid assessment of childrens vaccination coverage in developing countries. Because of its simplicity and familiarity, the EPI methodology has been used for additional purposes, including the detection of relatively small changes in vaccination coverage levels that are already high and the estimation of other population parameters when moderate accuracy is required. This article suggests techniques for improving the accuracy of the EPI cluster survey method, including (a) segmenting sample clusters, if necessary, so that reasonably sized areas can be counted, mapped, and listed; (b) selecting an equal probability sample of housing units within a cluster; (c) selecting a fixed number of housing units per sample cluster; and (d) performing weighted analyses. These procedures will produce accurate estimators and corresponding standard errors in EPI cluster surveys.

Stage of breast cancer in relation to body mass index and bra cup size.

Most studies on women with breast cancer indicate that obesity is positively associated with late‐stage disease. Some results have shown a similar relationship between breast size and stage. A recent study found that the association between body mass index (BMI) and stage was limited to cancers that were self‐detected, suggesting that the BMI‐stage relation may be due to delayed symptom recognition. We examined the relationships between stage and both BMI and breast (bra cup) size, stratified by method of detection, using data from a population‐based case‐control study of 1,361 women (ages 20–44 years) diagnosed with breast cancer during 1990–1992. Height and weight measurements and information on bra cup size, method of cancer detection and other factors predictive of stage at diagnosis were collected during in‐person interviews. A case‐case comparison was conducted using logistic regression to estimate odds of regional or distant stage rather than local stage in relation to BMI and bra size. Odds of late‐stage disease were increased with higher BMI [adjusted odds ratio (OR) for highest to lowest tertile = 1.46, 95% confidence interval (CI) 1.10–1.93] and larger bra cup size (OR for cup D vs. cup A = 1.61, 95% CI 1.04–2.48). These relationships were not modified by the method of detection. Differences in etiologic effects, rather than differences in detection methods, may explain the relations observed between stage and both BMI and breast size. Int. J. Cancer 82:23–27, 1999.

Employment Status and Ability to Work among Working-Age Chronic Dialysis Patients

283 patients, age 18-59 years on chronic dialysis were interviewed about their current work status and their ability to work if currently not employed. Only 11% of the total sample was currently employed. However, one third of the nonemployed patients said they were able to work, and most of these patients had made an effort to be employed. Age, race, educational level, health status, and physical ability to perform job tasks, recent work experience, and interest in working were related to the reported ability to work. Patients who said they were able to work were also likely to be rated able to work by the medical director of their dialysis facility. The data indicate the importance of helping work-interested patients maintain their jobs when they start chronic dialysis treatment.

Cigarette smoking and breast cancer risk among young women (United States)

Objectives: To evaluate whether heavy cigarette smoking as a teenager or long-term smoking increases breast cancer risk or, alternatively, whether smoking acts as an anti-estrogen and reduces risk.Methods: Data from a multi-center, population-based, case-control study among women under age 55 were analyzed.Results: Among women under age 45, there was a modest inverse relation with current (OR=0.82, 95% CI=0.67, 1.01) but not past (OR=0.99, 95% CI=0.81, 1.21) smoking. Odds ratios were decreased for current smokers who began at an early age (0.59 for≤15, 95% CI=0.41, 0.85) or continued for long periods of time (0.70 for >21 years, 95% CI=0.52, 0.94). In subgroup analyses, reduced odds ratios were observed among current smokers who were ever users of oral contraceptives (0.79, 95% CI=0.63, 0.98), were in the lowest quartile of adult body size (0.53, 95% CI=0.34, 0.81), or never or infrequently drank alcohol (0.68, 95% CI=0.47, 0.98). Among women ages 45-54, there was little evidence for an association with smoking.Conclusions: These results suggest that breast cancer risk among women under age 45 may be reduced among current smokers who began smoking at an early age, or long-term smokers, but require confirmation from other studies.

Assisted survival, aging, and rehabilitation needs: Comparison of older dialysis patients and age-matched peers

In Western societies a growing number of older persons have their lives extended by medical or surgical intervention. Older persons who suffer kidney failure and are maintained by chronic dialysis therapy are a good example. We compared 349 persons aged 60 years or older, who were on chronic dialysis, with 354 persons similar in age, race, gender, and geographic residence who were not undergoing dialysis. Recent health problems and demographic characteristics were included as control variables in all analyses. Older persons on dialysis reported more functional disability (as measured by ADL-mobility difficulty), less frequent walking for exercise, decreased ability to do the things they would like to do, and lower levels of perceived mastery over their lives. They were also more likely to report a need for health-related aids or services. The residual impairments of disabled elderly persons challenge rehabilitation professionals to address quality of life issues.

Menstrual risk factors and early-onset breast cancer.

AbstractObjectives: Epidemiologic studies provide evidence for increased breast cancer risk among women with prolonged exposure to endogenous estrogens and progesterone. Menstrual cycle characteristics, such as early menarche, rapid initiation of regular ovulatory cycles, short cycle length, and more days of flow, all potentially contribute to higher cumulative ovarian hormone exposure. Methods: We assessed the associations between these characteristics and breast cancer risk in a population-based, case–control study of 1505 controls and 1647 newly diagnosed cases, all younger than 45 years of age. Results: Compared to women with menarche at ≥15 years, we observed some increase in risk for women with younger ages at menarche, although those with very early ages were not at particularly high risk [odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.1–1.9 for menarche at age 12 and OR = 1.2, 95% CI = 0.9–1.7 for menarche at age ≤10]. Women who reported having regular menstrual cycles within 2 years of menarche were at increased breast cancer risk (OR = 1.7, 95% CI = 1.2–2.3), compared to those never having regular cycles. Stratification by current body mass index revealed slightly stronger associations with menstrual characteristics among thinner women ( < 22.0 kg/m2) compared to heavier women ( > 28.8 kg/m2). Conclusions: These findings suggest that future studies should focus on clarifying how the interrelated effects of body size and menstrual factors, such as age at menarche and cycle regularity, contribute to breast cancer etiology.