Kirsten H. Alcser

Age-specific distribution of serum prostate-specific antigen in a community-based study of African-American men

OBJECTIVES Previous studies have observed higher age-specific serum prostate-specific antigen (PSA) values in African-American (AA) men without prostate cancer compared to white men, leading some to recommend race-specific PSA reference ranges for the early detection of prostate cancer. The primary objective of the Flint Mens Health Study was to determine age-specific PSA reference values in a community-based sample of AA men, aged 40 to 79 years. METHODS A probability sample of 943 AA men was selected from households in Genesee County, Michigan. Men without a prior history of prostate cancer/surgery were invited to participate in a prostate cancer screening protocol, consisting of measurement of serum total PSA, free/total PSA ratio, and digital rectal examination. Sextant biopsies were recommended, based on total PSA greater than 4.0 ng/mL and/or an abnormal digital rectal examination. RESULTS From the sample of 943 men, 732 were eligible, 432 had blood drawn for PSA testing, and 374 completed all phases of the clinical examination. The 95th percentile PSA values were estimated to range from 2.36 ng/mL for men in the fifth decade to 5.59 ng/mL for men in the eighth decade. The 95th percentile values for age-specific PSA were comparable to those observed in a similar study of white men in Olmsted County, Minnesota. The median and 5th percentile values for free/total PSA did not vary significantly across age. CONCLUSIONS The minor differences in PSA reference ranges between AA and white men may not be of sufficient magnitude to recommend the use of race-specific PSA reference ranges for screening.

Job strain and blood pressure in African Americans: The pitt county study

OBJECTIVES This report examined whether job strain (or its components, decision latitude and job demands) was associated with elevated blood pressure levels in a community-based sample of 726 African-American adults. METHODS Blood-pressure, anthropometric, behavioral, demographic, and psychosocial data were collected for the current cross-sectional analyses during home interviews conducted for the second wave (1993) of the Pitt County Study (North Carolina), a prospective cohort study of hypertension among African Americans. RESULTS Job strain was not associated with blood pressure among men or women in this study. However, men in the 80th percentile of decision latitude had more than a 50% decrease in the prevalence of hypertension compared with men in the 20th percentile (odds ratio = .46, 95% confidence interval = .22, .96). CONCLUSIONS These results indicate that decision latitude may be important for hypertension risk among African-American men. More research is needed on African Americans to determine why job strain and its two component variables differ in their associations with blood pressure for men and women.

Potential selection bias in a community-based study of PSA levels in African-American men.

The first phase of the Flint Mens Health Study (FMHS) in Michigan was a community-based epidemiologic study of prostate cancer and benign prostatic hyperplasia (BPH) in African-Americans aged 40 to 79 years. An objective of the FMHS was to determine age-specified prostate specific antigen (PSA) reference ranges in a random population sample of African-American men without clinically evident prostate cancer. The FMHS study protocol included an initial in-home epidemiologic interview followed by PSA testing and a urologic examination of eligible subjects. Since the participation rate in the PSA phase of the study was under 60%, it was important to determine whether selectivity in participation biased the FMHS results for age-specific PSA distributions. Logistic regression analyses were used to investigate selectivity in the sample of subjects who participated in the PSA testing and urologic examination. Younger men, with current urologic symptoms, and with a family history of prostate cancer were more likely to participate in the PSA testing and urologic examination. Linear regression analysis indicated that greater participation by African-American men without clinically evident prostate cancer but with obstructive or irritative lower urinary tract symptoms or a family history of prostate cancer did not bias the estimated age-specific reference ranges for total PSA concentrations and free-to-total PSA ratios.

Views of United States Physicians and Members of the American Medical Association House of Delegates on Physician-assisted Suicide.

OBJECTIVE: To ascertain the views of physicians and physician leaders toward the legalization of physician-assisted suicide.DESIGN: Confidential mail questionnaire.PARTICIPANTS: A nationwide random sample of physicians of all ages and specialties, and all members of the American Medical Association (AMA) House of Delegates as of April 1996.MEASUREMENTS: Demographic and practice characteristics and attitude toward legalization of physician-assisted suicide.MAIN RESULTS: Usable questionnaires were returned by 658 of 930 eligible physicians in the nationwide random sample (71%) and 315 of 390 eligible physicians in the House of Delegates (81%). In the nationwide random sample, 44.5% favored legalization (16.4% definitely and 28.1% probably), 33.9% opposed legalization (20.4% definitely and 13.5% probably), and 22% were unsure. Opposition to legalization was strongly associated with self-defined politically conservative beliefs, religious affiliation, and the importance of religion to the respondent (P<.001). Among members of the AMA House of Delegates, 23.5% favored legalization (7.3% definitely and 16.2% probably), 61.6% opposed legalization (43.5% definitely and 18.1% probably), and 15% were unsure; their views differed significantly from those of the nationwide random sample (P<.001). Given the choice, a majority of both groups would prefer no law at all, with physician-assisted suicide being neither legal nor illegal.CONCLUSIONS: Members of the AMA House of Delegates strongly oppose physician-assisted suicide, but rank-and-file physicians show no consensus either for or against its legalization. Although the debate is sometimes adversarial, most physicians in the United States are uncertain or endorse moderate views on assisted suicide.

Evaluation of in-plant ergonomics training

Plant personnel involved in a joint labor-management Ergonomics Pilot Project attended an introductory ergonomics course. The training was developed to provide trainees with the ergonomic knowledge necessary to perform their functions as part of the Ergonomic Pilot Project. A Train-the-Trainer program for Introductory Ergonomics was developed and implemented to provide Pilot Project plants with in-plant Introductory Ergonomics trainers. Trainee course satisfaction, ergonomic knowledge, and performance did not differ significantly for those trained by in-plant trainers compared to those trained by University instructors. This suggests that the Train-the-Trainer approach is a viable way of meeting the increasing demand for ergonomics training in industry.

The design of a population-based case-control study of systemic sclerosis (Scleroderma): Commentary on the University of Michigan study

‘Department of Epidemiology, School of Public Health, 2Department of Biostatistics, School of Public Health, ‘Division of Rheumatology, Department of Internal Medicine, School of Medicine, 4Division of Rheumatology, Department of Internal Medicine, Wayne State University School of Medicine and %n-vey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48109, U.S.A.

Pregnancy recruitment for population research: the National Children's Study vanguard experience in Wayne County, Michigan.

BACKGROUND To obtain a probability sample of pregnancies, the National Childrens Study conducted door-to-door recruitment in randomly selected neighbourhoods in randomly selected counties in 2009-10. In 2011, an experiment was conducted in 10 US counties, in which the two-stage geographic sample was maintained, but participants were recruited in prenatal care provider offices. We describe our experience recruiting pregnant women this way in Wayne County, Michigan, a county where geographically eligible women attended 147 prenatal care settings, and comprised just 2% of total county pregnancies. METHODS After screening for address eligibility in prenatal care offices, we used a three-part recruitment process: (1) providers obtained permission for us to contact eligible patients, (2) clinical research staff described the study to women in clinical settings, and (3) survey research staff visited the home to consent and interview eligible women. RESULTS We screened 34,065 addresses in 67 provider settings to find 215 eligible women. Providers obtained permission for research contact from 81.4% of eligible women, of whom 92.5% agreed to a home visit. All home-visited women consented, giving a net enrolment of 75%. From birth certificates, we estimate that 30% of eligible county pregnancies were enrolled, reaching 40-50% in the final recruitment months. CONCLUSIONS We recruited a high fraction of pregnancies identified in a broad cross-section of provider offices. Nonetheless, because of time and resource constraints, we could enrol only a fraction of geographically eligible pregnancies. Our experience suggests that the probability sampling of pregnancies for research could be more efficiently achieved through sampling of providers rather than households.

Menstrual cycle effects on the dexamethasone suppression test in major depression

Patients with major depressive disorder (MDD) fiequently exhibit dysregulation of the hypothalamo-pituitary-adrenal (HPA) axis reflected in elevated basal cortisol levels as well as resistance to feedback inhibition, which is typically manifested by resistance to suppression by dexamethasone (Carroll et al 1981; Stokes and Sikes 1988). Alterations in and interactions between the HPA and hypothalamo-pituitary-gonadal (HPG) axes in MDD have also been documented (Rubin and Poland 1984; McEwen 1987). Systematic fluctuations of gonadal steroid levels through the menstrual cycle have been well described (Yen 1980), with maximal estrogen activity in the periovulatory phase and maximal progesterone activity in the early to mid-luteal phase. In view of the interactions between the HPG and HPA axes, the relationship between premenstrual syndrome and mood disorders (Endicott et al 1985; Rubinow et al 1985; Mortola et al 1989; Graze et al 1990), and the systematic menstrual oscillations in gonadal steroid activity, it would be important to evaluate possible menstrual effects on HPA function. Early studies in this regard have failed to find differences in cortisol secretory parameters between the follicular and luteal phase (Haskett et al 1984;