Michael A. Stoto

EFFECTS OF MAMMOGRAPHY SCREENING UNDER DIFFERENT SCREENING SCHEDULES: MODEL ESTIMATES OF POTENTIAL BENEFITS AND HARMS

To inform the USPSTF recommendations about breast cancer screening, Mandelblatt and colleagues developed 6 models of breast cancer incidence and mortality in the United States and estimated benefit...

Entrepreneurs in Academe: An Exploration of Behaviors among Life Scientists.

A study explored entrepreneurship in theresearch university. The data were collected in 2 surveys conducted in 1985 -one of a sample of life scientists located in major research universities andthe other of key administrators in the same universities. Five types ofacademic entrepreneurship were identified: 1. engaging in externally fundedresearch, 2. earning supplemental income, 3. gaining industry support foruniversity research, 4. obtaining patents or generating trade secrets, and 5.forming or holding equity in private companies based on a faculty members ownresearch. Individual attitudes and characteristics were the most importantpredictors of large-scale science and supplemental income, while local groupnorms played a more important role in predicting active involvement incommercialization. (Publisher abstract)

The Accuracy of Population Projections

A review of past population projection errors is presented as a means for constructing confidence intervals for future projections. The author first defines a statistic to measure projection errors independent of the size of population and the length of the projection period. A sample of U.S. and U.N. projections is used to show that the distributions of components of the error statistic are relatively stable. This information is then used to construct confidence intervals for the U.S. population up to the year 2000.

Prevalence of Symptoms of Bladder Pain Syndrome/Interstitial Cystitis Among Adult Females in the United States

PURPOSE Bladder pain syndrome/interstitial cystitis is a poorly understood condition that can cause serious disability. We provide the first population based symptom prevalence estimate to our knowledge among United States adult females. MATERIALS AND METHODS We developed and validated 2 case definitions to identify bladder pain syndrome/interstitial cystitis symptoms. Beginning in August 2007 we telephoned United States households, seeking adult women with bladder symptoms or a bladder pain syndrome/interstitial cystitis diagnosis. Second stage screening identified those subjects who met case definition criteria. Each completed a 60-minute interview on the severity and impact of bladder symptoms, health care seeking and demographics. Data collection ended in April 2009. Using population and nonresponse weights we calculated prevalence estimates based on definitions spanning a range of sensitivity and specificity. We used United States Census counts to estimate the number of affected women in 2006. The random sample included 146,231 households, of which 131,691 included an adult female. Of these households 32,474 reported an adult female with bladder symptoms or diagnosis, of which 12,752 completed the questionnaire. RESULTS Based on the high sensitivity definition 6.53% (95% CI 6.28, 6.79) of women met symptom criteria. Based on the high specificity definition 2.70% (95% CI 2.53, 2.86) of women met the criteria. These percentages translated into 3.3 to 7.9 million United States women 18 years old or older with bladder pain syndrome/interstitial cystitis symptoms. Symptom severity and impact were comparable to those of adult women with established diagnoses. However, only 9.7% of the women reported being assigned a bladder pain syndrome/interstitial cystitis diagnosis. CONCLUSIONS Bladder pain syndrome/interstitial cystitis symptoms are widespread among United States women and associated with considerable disability. These results suggest bladder pain syndrome/interstitial cystitis may be underdiagnosed.

A reducible four-parameter system of model life tables

Abstract In this paper a four-parameter extension of Brasss relational system of model life tables is suggested that (1) matches a wide range of empirical age patterns of mortality, (2) is easy to apply, especially to partial life tables, and (3) contains demographically meaningful parameters. A test of the model on a set of 62 empirical life tables indicates that four parameters are necessary and sufficient for fitting a wide range of mortality patterns. A further test on an historical series of Swedish life tables reveals a consistent pattern of mortality change. Examination of the parameters for a set of geographicallyrelated life tables suggests a way to define families of life tables. Identification of such temporal and spatial relationships allows the model to be reduced to a form with twoor three-parameters for application to incomplete or inaccurate data.

HIV and the blood supply: an analysis of crisis decisionmaking.

During the early years of the AIDS epidemic, thousands of Americans became infected with HIV through the nations blood supply. Because little reliable information existed at the time AIDS first began showing up in hemophiliacs and in others who had received transfusions, experts disagreed about whether blood and blood products could transmit the disease. During this period of great uncertainty, decisionmaking regarding the blood supply became increasingly difficult and fraught with risk. This volume provides a balanced inquiry into the blood safety controversy, which involves private sexual practices, personal tragedy for the victims of HIV/AIDS, and public confidence in Americas blood services system. The book focuses on critical decisions as information about the danger to the blood supply emerged. The committee draws conclusions about what was done--and recommends what should be done to produce better outcomes in the face of future threats to blood safety. The committee frames its analysis around four critical area * Product treatment--Could effective methods for inactivating HIV in blood have been introduced sooner? * Donor screening and referral--including a review of screening to exlude high-risk individuals. * Regulations and recall of contaminated blood--analyzing decisions by federal agencies and the private sector. * Risk communication--examining whether infections could have been averted by better communication of the risks.

A Review of Instruments Assessing Public Health Preparedness

Objectives. The purpose of this study was to review instruments that assess the level of preparedness of state and local public health departments to respond to health threats such as bioterrorism. Methods. The authors examined 27 published population-based instruments for planning or evaluating preparedness that were mostly unavailable in the peer-reviewed literature. Using the Essential Public Health Services framework, the instruments were evaluated for (1) clarity of measurement parameters, (2) balance between structural and process measures, (3) evidence of effectiveness, and (4) specification of an accountable entity. Results. There was a great deal of overlap but little consistency in what constitutes “preparedness” or how it should be measured. Most instruments relied excessively on subjective or structural measures, lacked scientific evidence for measures assessed, and failed to clearly define what entity was accountable for accomplishing the task or function. Conclusion. Strategies for improvement include measure standardization, better interagency communication, and investment in public health practice research to develop the underlying evidence base required for developing quality measures and assessments.

Race-Specific Impact of Natural History, Mammography Screening, and Adjuvant Treatment on Breast Cancer Mortality Rates in the United States

Background: U.S. Black women have higher breast cancer mortality rates than White women despite lower incidence. The aim of this study is to investigate how much of the mortality disparity can be attributed to racial differences in natural history, uptake of mammography screening, and use of adjuvant therapy. Methods: Two simulation models use common national race, and age-specific data for incidence, screening and treatment dissemination, stage distributions, survival, and competing mortality from 1975 to 2010. Treatment effectiveness and mammography sensitivity are assumed to be the same for both races. We sequentially substituted Black parameters into the White model to identify parameters that drive the higher mortality for Black women in the current time period. Results: Both models accurately reproduced observed breast cancer incidence, stage and tumor size distributions, and breast cancer mortality for White women. The higher mortality for Black women could be attributed to differences in natural history parameters (26–44%), use of adjuvant therapy (11–19%), and uptake of mammography screening (7–8%), leaving 38% to 46% unexplained. Conclusion: Black women appear to have benefited less from cancer control advances than White women, with a greater race-related gap in the use of adjuvant therapy than screening. However, a greater portion of the disparity in mortality appears to be due to differences in natural history and undetermined factors. Impact: Breast cancer mortality may be reduced substantially by ensuring that Black women receive equal adjuvant treatment and screening as White women. More research on racial variation in breast cancer biology and treatment utilization is needed. Cancer Epidemiol Biomarkers Prev; 20(1); 112–22. ©2011 AACR.

Development, validation and testing of an epidemiological case definition of interstitial cystitis/painful bladder syndrome.

PURPOSE No standard case definition exists for interstitial cystitis/painful bladder syndrome for patient screening or epidemiological studies. As part of the RAND Interstitial Cystitis Epidemiology study, we developed a case definition for interstitial cystitis/painful bladder syndrome with known sensitivity and specificity. We compared this definition with others used in interstitial cystitis/painful bladder syndrome epidemiological studies. MATERIALS AND METHODS We reviewed the literature and performed a structured, expert panel process to arrive at an interstitial cystitis/painful bladder syndrome case definition. We developed a questionnaire to assess interstitial cystitis/painful bladder syndrome symptoms using this case definition and others used in the literature. We administered the questionnaire to 599 women with interstitial cystitis/painful bladder syndrome, overactive bladder, endometriosis or vulvodynia. The sensitivity and specificity of each definition was calculated using physician assigned diagnoses as the reference standard. RESULTS No single epidemiological definition had high sensitivity and high specificity. Thus, 2 definitions were developed. One had high sensitivity (81%) and low specificity (54%), and the other had the converse (48% sensitivity and 83% specificity). These values were comparable or superior to those of other epidemiological definitions used in interstitial cystitis/painful bladder syndrome prevalence studies. CONCLUSIONS No single case definition of interstitial cystitis/painful bladder syndrome provides high sensitivity and high specificity to identify the condition. For prevalence studies of interstitial cystitis/painful bladder syndrome the best approach may be to use 2 definitions that would yield a prevalence range. The RAND Interstitial Cystitis Epidemiology interstitial cystitis/painful bladder syndrome case definitions, developed through structured consensus and validation, can be used for this purpose.

The use of the Heimlich maneuver in near drowning: Institute of Medicine report

The application of the Heimlich maneuver as the initial and perhaps only step for opening the airway in all near-drowning victims has been proposed by Henry Heimlich and Edward Patrick, contrary to current resuscitation guidelines for the treatment of near-drowning victims established by the Emergency Cardiac Care (ECC) Committee of the American Heart Association. Although the Heimlich maneuver is useful for the removal of aspirated solid foreign bodies, there is no evidence that death from drowning is frequently caused by aspiration of a solid foreign body that is not effectively treated by the current ECC recommendations. Furthermore, the evidence is insufficient to support the proposition that the Heimlich maneuver is useful for the removal of aspirated liquid. Moreover, because there is no evidence to support Heimlichs hypothesis that substantial amounts of water are aspirated by near-drowning victims or that such aspirated liquid causes brain damage and death, the available evidence does not support routine use of the Heimlich maneuver in the care of near-drowning victims. The routine use of the Heimlich maneuver for treatment of near drowning raises several concerns: (a) the amount of time it would take to repeat this maneuver and how long this would delay the initiation of artificial ventilation; (b) possible complications of the Heimlich maneuver, especially if the near drowning is associated with a cervical fracture; and (c) the prospect of teaching rescue workers a different protocol than that which is taught at present for resuscitating victims of cardiopulmonary arrest from all causes other than near drowning.(ABSTRACT TRUNCATED AT 250 WORDS)