Lisa H. Gren

The incidence of fibromyalgia and its associated comorbidities: a population-based retrospective cohort study based on International Classification of Diseases, 9th Revision codes.

Background:The epidemiology of fibromyalgia is poorly defined. The incidence of fibromyalgia has not been determined using a large population base. Previous studies based on prevalence data demonstrated that females are 7 times more likely to have fibromyalgia than males and that the peak age for females is during the childbearing years. Objective:We have calculated the incidence rate of fibromyalgia in a large, stable population and determined the strength of association between fibromyalgia and 7 comorbid conditions. Methods:We conducted a retrospective cohort study of a large, stable health insurance claims database (62,000 nationwide enrollees per year). Claims from 1997 to 2002 were examined using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to identify fibromyalgia cases (ICD code 729.1) and 7 predetermined comorbid conditions. Results:A total of 2595 incident cases of fibromyalgia were identified between 1997 and 2002. Age-adjusted incidence rates were 6.88 cases per 1000 person-years for males and 11.28 cases per 1000 person-years for females. Females were 1.64 times (95% confidence interval = 1.59–1.69) more likely than males to have fibromyalgia. Patients with fibromyalgia were 2.14 to 7.05 times more likely to have one or more of the following comorbid conditions: depression, anxiety, headache, irritable bowel syndrome, chronic fatigue syndrome, systemic lupus erythematosus, and rheumatoid arthritis. Conclusion:Females are more likely to be diagnosed with fibromyalgia than males, although to a substantially smaller degree than previously reported, and there are strong associations for comorbid conditions that are commonly thought to be associated with fibromyalgia.

Cellulitis incidence in a defined population.

A population-based insurance claims database was used to examine cellulitis incidence, anatomical sites of infection, complicating diagnoses, source of health service, and recurrence rates. Insurance claim files were searched for cellulitis ICD-9-CM codes 681.0-682.9. Complications of cellulitis including erysipelas, lymphadenitis, lymphangitis, and necrotizing fasciitis were also identified by ICD-9-CM codes. We found a cellulitis incidence rate of 24.6/1000 person-years, with a higher incidence among males and individuals aged 45-64 years. The most common site of infection was the lower extremity (39.9%). The majority of patients were seen in an outpatient setting (73.8%), and most (82.0%) had only one episode of cellulitis during the 5-year period studied. There was a very low incidence of cellulitis complications, including necrotizing fasciitis. Cellulitis is fairly common, usually treated in outpatient settings, and is infrequently complicated by erysipelas, lymphadenitis, lymphangitis, or necrotizing fasciitis.

Relationships between body mass indices and surgical replacements of knee and hip joints

BACKGROUND Osteoarthritis is both the most common form of arthritis and the most common reason for joint replacement surgery. Obese persons are believed to be more likely to develop generalized osteoarthritis that leads not only to knee but also to hip joint replacement surgeries. We hypothesized that obesity is also a risk for partial joint replacements and surgical revisions. METHODS A frequency-matched case-control study was conducted in Utah. Between 1992 and 2000, 840 hip and 911 knee joint replacement surgery patients, aged 55 to 74 years, were included in this study. Cases were randomly matched to 5578 controls, defined as Utah residents enrolled in a cancer screening trial. Odds ratios (ORs) were calculated using ICD-9 (International Classification of Diseases, 9th revision) procedural codes and body mass index (BMI) groups. RESULTS There was a strong association between increasing BMI and both total hip and knee replacement procedures. In males, the highest OR was for those weighing 37.50 to 39.99 kg/m(2) (total hip: OR=9.37, 95% confidence interval [CI] 2.64-33.31; total knee: OR=16.40; 95% CI 5, 19-51.86). In females, the highest OR was for those weighing > or =40 kg/m(2) (total hip: OR=4.47; 95% CI, 2.13-9.37; total knee: OR=19.05; 95% CI, 9.79-37.08). There were slight gender-specific differences in risk found for partial hip replacement procedures. Unexpectedly, no statistically significant association was found between obesity and the risk for hip or knee revision procedures. CONCLUSIONS While there is an association between obesity and hip and knee joint replacement surgeries, obesity does not appear to confer an independent risk for hip or knee revision procedures.

Associations between body-mass index and surgery for rotator cuff tendinitis.

BACKGROUND Rotator cuff tendinopathy is a common entity. We hypothesized that obesity, because of biomechanical and systemic risk factors, increases the risks of rotator cuff tendinitis, tears, and related surgical procedures. METHODS A frequency-matched case-control study was conducted. Three hundred and eleven patients who were fifty-three to seventy-seven years old and who underwent rotator cuff repair, arthroscopy, and/or other repair of the shoulder in a large hospital from 1992 to 2000 were included in the study. These surgical procedures were used as proxies for the risk of rotator cuff tendinitis. These patients were age and frequency-matched to 933 controls, who were randomly drawn from a pool of 10,943 potential controls consisting of Utah state residents who were enrolled in a large cancer-screening trial. Age-adjusted odds ratios were calculated with use of the International Classification of Diseases, Ninth Revision procedural codes and body-mass-index groups. The data were stratified according to gender and age. Multiple linear regression analyses also were performed. RESULTS There was an association between increasing body-mass index and shoulder repair surgery. The highest odds ratios for both men (odds ratio = 3.13; 95% confidence interval = 1.29 to 7.61) and women (odds ratio = 3.51; 95% confidence interval = 1.80 to 6.85) were for individuals with a body-mass index of > or =35.0 kg/m(2). Tests for trend also were highly significant for both men (p = 0.002) and women (p < or = 0.001). Multiple linear regression analysis also indicated a significant association between increasing body-mass index and shoulder surgery (beta = 1.57; 95% confidence interval = 0.97 to 2.17; p < or = 0.001). CONCLUSIONS There is an association between obesity and shoulder repair surgery in men and women who are fifty-three to seventy-seven years of age. The results of the present study suggest that increasing body-mass index is a risk factor for rotator cuff tendinitis and related conditions.

Recruitment strategies in the prostate, lung, colorectal and ovarian (PLCO) cancer screening trial: The first six years

The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial has a total enrollment goal of almost 150,000 participants. These participants are being recruited at ten screening centers across the United States. All screening centers tested recruitment methodologies during a 1-year pilot phase. The main phase of recruitment was planned to take place over a 3-year period. The majority of participants are being recruited during the main phase of the study. Each of the screening centers tailors recruitment to its individual catchment area. Recruitment strategies in the PLCO trial are described. As the trial began, several protocol changes were made to help to increase enrollment. The National Cancer Institute (NCI) initiated recruitment efforts at the national level. The individual screening centers describe some of the specific recruitment experiences encountered. As the study progressed, the NCI implemented special initiatives to increase the enrollment of minority participants.

Tobacco, alcohol, body mass index, physical activity, and the risk of head and neck cancer in the prostate, lung, colorectal, and ovarian (PLCO) cohort

Estimation of attributable fractions for tobacco and alcohol, and investigation of the association between body mass index (BMI) and head and neck cancer risk have largely been in case‐control studies. These aspects and physical activity need to be assessed as possible head and neck cancer risk/protective factors in a cohort study.

Cold hands, warm heart

The saying “cold hands, warm heart” probably has a basis in temperature differences between men and women. In medicine, infrared tympanic thermometers (ITT) are widely used to quickly and reliably determine core temperature by measuring the infrared radiation given off by the tympanic membrane. This technology can also be applied to measure the temperature on any body surface and has been successfully used to measure the temperature of the cornea. We used this instrument to investigate the role of sex in determining core and hand temperatures. We studied 219 people whose ages ranged from under 1 year to 84 years (78 male, 141 female). Each completed a questionnaire, reporting date of birth, sex, height, weight, menstrual status, and stage of menstrual cycle. The ITT used was a First Temp Genius (Sherwood-Davis & Geck, St Louis, Missouri, USA). Measurements were taken on the fingernails of the left and right middle fingers, and on the left and right tympanic membranes. The ITT produced reproducible measurements. We obtained 20 repeat measures on 20 people. The average standard deviation in core temperature and hand temperature for these measurements was 0·23oF. A literature search found studies which concluded that ITTs do not measure core temperatures, as well as studies concluding that they did. Women had a mean core temperature of 97·8 (SD 0·8)oF, whereas the mean core temperature for men was 97·4 (0·8)oF. The mean hand temperature for women was 87·2 (6·7)oF, compared with 90·0 (5·5)oF for men. Menstrual status affected women’s body temperatures. Postmenstrual women older than 50 years had significantly lower hand and core temperatures than premenstrual women below the age of 13 (OR 0·4 for both core and hand). Women in the first 14 days of their cycle were more likely to have lower core temperatures (OR=6·6) than women in the last 14 days. Body-mass index (BMI) was also related to core temperature, but only in men. Men with higher BMI had lower core temperatures (OR 0·4). BMI had little effect on hand temperature. We also investigated the relation between core and hand temperature. We found that women with lower core temperatures were more likely to have lower hand temperatures (OR 3·4). We did not find this relation among men. We found that women are more likely to have cold hands than men. This difference seems to be independent of age, BMI, and core temperature. However, women’s core temperatures were on average 0·4oF (about 0·2°C) higher than men’s, Thus, the adage “cold hands, warm heart” is based on real differences in temperature.

Coffee, tea, caffeine intake, and the risk of cancer in the PLCO cohort.

Background:The association between coffee intake, tea intake and cancer has been extensively studied, but associations are not established for many cancers. Previous studies are not consistent on whether caffeine may be the source of possible associations between coffee and cancer risk.Methods:In the Prostate, Lung, Colorectal, and Ovarian cancer screening trial, of the 97 334 eligible individuals, 10 399 developed cancer. Cancers included were 145 head and neck, 99 oesophageal, 136 stomach, 1137 lung, 1703 breast, 257 endometrial, 162 ovarian, 3037 prostate, 318 kidney, 398 bladder, 103 gliomas, and 106 thyroid.Results:Mean coffee intake was higher in lower education groups, among current smokers, among heavier and longer duration smokers, and among heavier alcohol drinkers. Coffee intake was not associated with the risk of all cancers combined (RR=1.00, 95% confidence interval (CI)=0.96–1.05), whereas tea drinking was associated with a decreased risk of cancer overall (RR=0.95, 95% CI=0.94–0.96 for 1+ cups per day vs <1 cup per day). For endometrial cancer, a decreased risk was observed for coffee intake (RR=0.69, 95% CI=0,52–0.91 for ⩾2 cups per day). Caffeine intake was not associated with cancer risk in a dose–response manner.Conclusions:We observed a decreased risk of endometrial cancer for coffee intake, and a decreased risk of cancer overall with tea intake.

Recruitment methods employed in the prostate, lung, colorectal, and ovarian cancer screening trial

Background The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) is a US National Cancer Institute (NCI)-funded randomized controlled trial designed to evaluate whether certain screening tests reduce mortality from prostate, lung, colorectal, and ovarian cancer. To obtain adequate statistical power, it was necessary to enroll over 150,000 healthy volunteers. Recruitment began in 1993 and ended in 2001. Purpose Our goal is to evaluate the success of recruitment methods employed by the 10 PLCO screening centers. We also provide estimates of recruitment yield and cost for our most successful strategy, direct mail. Methods Each screening center selected its own methods of recruitment. Methods changed throughout the recruitment period as needed. For this manuscript, representatives from each screening center provided information on methods utilized and their success. Results In the United States between 1993 and 2001, ten screening centers enrolled 154,934 study participants. Based on participant self-report, an estimated 95% of individuals were recruited by direct mail. Overall, enrollment yield for direct mail was 1.0%. Individual center enrollment yield ranged from 0.7% to 3.8%. Cost per enrolled participant was

Organizational Culture Associated With Provider Satisfaction

9.64—35.38 for direct mail, excluding personnel costs. Limitations Numeric data on recruitment processes were not kept consistently at individual screening centers. Numeric data in this manuscript are based on the experiences of 5 of the 10 centers. Conclusions Direct mail, using rosters of names and addresses from profit and not-for-profit (including government) organizations, was the most successful and most often used recruitment method. Other recruitment strategies, such as community outreach and use of mass media, can be an important adjunct to direct mail in recruiting minority populations. Clinical Trials 2009; 6: 52—59. http://ctj.sagepub.com