Donovan J. Thompson

Association of exogenous estrogen and endometrial carcinoma.

To determine the association between the incidence of endometrial cancer and the use of estrogen in menopausal and post-menopausal women, we retrospectively compared 317 patients with adenocarcinoma of the endometrium with an equal number of matched controls having other gynecologic neoplasms; 152 patients used estrogen, as compared to 54 of 317 controls. Thus, the risk of endometrial cancer was 4.5 times greater among women exposed to estrogen therapy. When estrogen use was adjusted for concomitant variables such as obesity, hypertension, diabetes, parity, referral pattern, age at diagnosis, year of diagnosis and other gynecologic neoplasms, the magnitude of the increased relative risk was associated with several of these variables, and was highest in patients without obesity and hypertension. Exogenous estrogen therapy is associated with an increased risk of endometrial carcinoma, but this increased relative risk is less apparent in patients with physiologic characteristics previously associated with an increased risk.

Nontreatment of fever in extended-care facilities.

In a study of decisions not to treat febrile patients, we reviewed the medical records of 1256 people admitted to nine extended-care facilities in Seattle during 1973. Fever, defined as two temperatures of 38.33 degrees C to 38.83 degrees C (101 to 101.9 degrees F), within 24 hours or one temperature greater than or equal to 38.88 degrees C (102 degrees F), developed in 190 patients before two years of stay. Active treatment, defined as antibiotics or hospitalization (or both), was ordered for fever in 109 patients, of whom 10 (9 per cent) died. Active treatment was not ordered for 81 patients, of whom 48 (59 per cent) died. The pre-decision factors that showed a significant relation (P less than 0.05) to such nontreatment were: diagnosis, mental status, mobility, pain, narcotics prescribed, size of the facility, relation of the physician to the patient and medical-record statements documenting the patients deterioration or plans for nontreatment in general. This pattern of nontreatment suggests that physicians and nurses did not intend to treat these patients actively and that high mortality was expected.

Prevalence of Prior Hysterectomy in the Seattle- Tacoma Area

Hysterectomy is the most common major surgical procedure performed in the United States. The frequency of hysterectomy among women in the general population is of interest because it affects the population at risk for uterine diseases and because the procedure itself carries significant personal and socioeconomic consequences. We studied factors related to the occurrence of hysterectomy by interviewing a representative sample of women ages 35-74 (n= 1087) in two urban Washington counties during 1976-1977.One-third of the women studied had had a hysterectomy. Later birth cohorts were at higher risk. The ageadjusted prevalence of prior hysterectomy was negatively associated with education and age at first childbirth; it was positively associated with parity, history of irregular menses, and history of a variety of other health conditions. Contrary to expectation, income was negatively associated with hysterectomy rates in one county and showed no association in the other. Part of the income effect was due to confounding by age at first childbirth, which was a surprisingly strong predictive factor. WE CONCLUDE THAT: 1) despite economic predictions based on the discretionary nature of the procedure, hysterectomies are not necessarily more common among high-income women; 2) age at first childbirth may be a more important risk factor for uterine disease than previously thought; and 3) estimates of hysterectomy frequency based on clinic populations may be misleading. (Am J Public Health 70:40-47, 1980.)

Factors Related to ST-Segment Depression after Exercise in Middle-Aged Chinese Men

Ninety-four or 7% of 1,346 healthy middle-aged Chinese men who underwent a graded treadmill test of maximal exercise showed post-exercise ST-segment depression. Stepwise linear discriminant function analysis showed that the major factors associated with this response were systolic blood pressures at maximal exercise, age, and certain resting ECG abnormalities, and to a lesser extent, systolic and diastolic pressure at rest, resting heart rate, and cigarette smoking. Hypertensive subjects showed at least a fourfold increase of post-exercise ST depression as compared with age-matched normotensive controls. Since coronary atherosclerosis is rare among Chinese, the study is of particular interest in demonstrating some factors related to ST depression after maximal exercise, particularly the effect of higher systemic pressure, in a group of middle-aged Chinese men.

Nontreatment and Aggressive Narcotic Therapy Among Hospitalized Pancreatic Cancer Patients

OBJECTIVES: Strong feelings about patient autonomy as expressed in living wills, polls, and legislative referenda have been challenging the medical establishment to increase nontreatment, defined as foregoing a life‐prolonging treatment, and even to provide treatments having life‐shortening potential to selected patients. Because there are little data about the actual practice of these procedures, including aggressive narcotic therapy as defined herein, we studied the terminal management of 417 pancreatic cancer patients.