Raymond Y. Demers

Effect of age and race on the survival of men with prostate cancer in the Metropolitan Detroit tricounty area, 1973 to 1987

OBJECTIVES Reports have demonstrated that African Americans diagnosed with prostate cancer have a poor survival compared with whites. We examined the impact of age, race, and stage of disease on survival for men diagnosed with prostate cancer. METHODS A retrospective analysis was made of men diagnosed with prostate cancer utilizing the Surveillance, Epidemiology, and End Results Program (SEER) database. A total of 12,907 men (9339 white, 3568 black) diagnosed from January 1, 1973 through December 31, 1987 were included in the study. For each stage of disease, survival experience was examined using Kaplan-Meier and life table methods, followed by analysis using Coxs proportional hazard model. RESULTS African-American men have a poorer survival than whites for all stages of prostate cancer when the cancer is diagnosed at younger ages. These differences in survival were not demonstrated for men diagnosed with prostate cancer after age 70. CONCLUSIONS Age and race should be taken into account when assessing the survival of patients with prostate cancer.

Serum cholesterol and colorectal polyps

Colorectal cancer and hypocholesterolemia have recently been associated, and colorectal polyps have a known relationship with colorectal cancer. In order to establish further evidence regarding the nature of the serum cholesterol-colorectal cancer relationship, this study investigated the hypothesis that men with colorectal polyps would have lower serum cholesterol levels than men without polyps. Of the 1380 men screened by sigmoidoscopy for colorectal polyps, 246 had at least one polyp. The men with polyps were older than those without, and also had higher cholesterol levels, but after controlling for age, there were no serum cholesterol differences. These data suggest that low serum cholesterol is not etiologically linked to cancer. Analyses of potentially confounding variables showed smoking to be strongly related to the presence of polyps.

Compliance with colorectal cancer screening in a high-risk occupational group.

A Detroit-area union offers an early detection colorectal cancer screening program consistent with that recommended by the American Cancer Society. Analyses compared men who have complied with the American Cancer Society recommendations with men who have not so complied. Older men, nonsmokers, and woodworkers were most likely to participate in all screening examinations. Primary reasons for nonparticipation were the belief that the examination was unnecessary, anxiety/affective concerns; and time/motivation problems. Particularly important to the success of such programs is a sensitive health education component to address personal concerns related to the procedure, and also the dissemination of information about the efficacy of the examination for early detection of colorectal cancer.

Environmental medicine content in medical school curricula

BACKGROUND: The Institute of Medicine has recommended basic clinical competence in environmental medicine (EM) for all physicians. However, the amount and content of instruction in EM currently offered in U.S. medical schools is unknown. METHOD: This cross-sectional study was based on responses to a questionnaire regarding the EM curriculum content of U.S. medical schools, mailed in June 1994 with the Association of American Medical Colleges curriculum survey. RESULTS: Of the 126 schools, 119 (94%) responded. Of these, 29 (24%) reported no required EM content in the curriculum. Schools with EM content averaged seven hours of instruction. Eighty-one schools (68%) had faculty with environmental and occupational medicine expertise, primarily within the departments of medicine, preventive medicine, and family medicine. CONCLUSION: There is a need for increased instruction in EM in medical school curricula for students to acquire the knowledge and skills to prevent, diagnose, and treat health problems with an environmental exposure component. For those schools without EM content in the curriculum, the necessary expertise to develop EM curriculum may be available in current faculty.

Relative sensitivity of the fecal occult blood test and flexible sigmoidoscopy in detecting polyps.

A group of 1,002 male pattern and model makers, an occupational group at high risk for colorectal cancers, was screened for the presence of polyps and malignancies of the lower gastrointestinal tract. Flexible sigmoidoscopy and serial fecal occult blood testing were both performed on 988 of the participants, and 165 were found to have at least one colorectal polyp. Only 3% of all men with visualized polyps showed Hemoccult-positive stools. Only 2 (4%) of the 51 men with histologically proven adenomatous polyps were Hemoccult positive. Adenomatous polyps of 1 cm or greater in diameter are malignant 8% of the time. This study concludes that the fecal occult blood test sensitivity in detecting colorectal polyps is unacceptably low. It should be supplemented by more rigorous procedures, especially in populations at high risk for colorectal cancer.

Neurobehavioral and health‐related deficits in solvent‐exposed painters

The health status of 133 solvent-exposed painters was evaluated using the Neurobehavioral Evaluation System (NES) and blood test results from a physical exam. The comparison group consisted of 51 sheetmetal workers, minimally exposed to solvents. Degree of solvent exposure was calculated using three different indices derived from questionnaire responses. Multivariate analyses, adjusted for age, alcohol consumption, and smoking, indicated that painters performed less well on the symbol digit learning and vocabulary tasks. Evidence was also found for a dose-effect relationship, particularly when several features of the work environment were considered in estimating exposure. Degree of solvent exposure predicted levels of serum lead, BUN, and SGOT. These findings indicate that questionnaire-based measures of solvent exposure can be useful predictors of neurobehavioral and health-related deficits. Verbal ability, often used by researchers as a measure of premorbid functioning, may be adversely affected by solvent exposure.

Prevalence of colorectal polyps among Michigan pattern and model makers.

A group of 902 pattern and model makers were screened for colorectal cancer and polyps using a 60-cm flexible sigmoidoscope. Three recent mortality studies have found a significant excess of colorectal malignant neoplasms in this occupational group. Four adenocarcinomas, two carcinoids, and two cancers in situ were found. In addition, 150 (17%) of the individuals were found to have polyps. Among white males 40 to 70 years of age, the prevalence rate was found to be 23%. The prevalence of colorectal polyps among the pattern and model makers was compared with that of four previously studied asymptomatic populations who were also examined using a 60-cm flexible sigmoidoscope. Polyp rates were found to be significantly greater among pattern and model makers than among three of the four comparison populations. The odds ratios between these three populations and the study population ranged from 1.9 to 2.7 and closely approximate the ratios found in previous studies evaluating colon cancer in this occupational group.

Glycosylated Hemoglobin Levels and Self-Reported Stress in Adults with Diabetes

This study examined the relationship between glycosylated hemoglobin and self-reported stress in a sample of adult Type II diabetics. The study sample was drawn from participants in a randomized clinical trial of the comparative effectiveness of two oral antihyperglycemic drugs in the treatment of non-insulin-dependent diabetes. The 19 study participants were asked to complete a brief questionnaire on recent stress. Stress scores were then compared with levels of glycosylated hemoglobin. Correlations between glycosylated hemoglobin and stress scores were highly significant, a finding of particular clinical relevance in view of the relatively small number of participants. These findings suggest that sustained stress may contribute to poor glucose control in diabetics. Individuals interested in stress-related research may find glycosylated hemoglobin a useful marker of physiological stress.

A Practical Guide for Estimating Dietary Fat and Fiber Using Limited Food Frequency Data

There are occasions when health promotion programs must be developed based on limited food intake data that are insufficient for estimating dietary fat and fiber intake. Health educators, however, often have sufficient knowledge to evaluate available food intake data as part of a nutrition education needs assessment. A methodology for estimating daily intake of dietary fat and fiber based on limited food frequency data is presented. This procedure involves identifying the medianportion of food items from National Food Consumption Survey data; determining the insoluble fiber and fat content of the food items; multiplying the fiber and fat content of the median portion by the daily consumption rate; summing all items and calculating mean and standard deviationsfor the entire sample. This method can provide baseline estimates of dietary patterns to health promotion policymakers interested in using existingfood intake information.

Termination of health benefits for Pittston mine workers: Impact on the health and security of miners and their families

Mine workers represented by the United Mine Workers of America (UMWA) have had comprehensive medical care coverage since 1950. On February 1, 1988, UMWA employees of the Pittston Coal Group had their health care benefits abruptly terminated. Renewal of these benefits became a major reason for the subsequent UMWA strike against Pittston.In December, 1989, physician interviewers were organized to document the human experience of this termination of health care benefits. This report summarizes these interviews, and concludes that the UMWA experience in the Pittston coal fields is one example of the barriers to health care experienced by an increasing proportion of the United States population.