ABSTRACT
Analyses of tumor size and breast cancer stage were used to determine whether biased detection of breast cancer could have materially influenced estimates of risk associated with use of oral contraceptives. In a population-based case-control study conducted from 1980-1982, surveillance for breast cancer by breast exams, but not mammography, was found to be strongly linked to use of oral contraceptives. Tumors were slightly smaller and less likely to be late-stage (TNM stage III or IV) in patients who had used oral contraceptives. The net effect of any diagnostic bias on advancing the date of cancer diagnosis, whether from breast exams or other sources, was estimated to be less than 8 weeks. This corresponds to spuriously increasing the risk of early-occurring breast cancer in oral contraceptive users by at most 2.4% (relative risk = 1.024).
Subject(s)
Breast Neoplasms/diagnosis , Contraceptives, Oral/adverse effects , Adult , Age Factors , Bias , Breast/pathology , Breast Neoplasms/chemically induced , Breast Neoplasms/pathology , Case-Control Studies , Female , Humans , Mammography , Menopause , Middle Aged , Risk Factors , Self-Examination , Time FactorsABSTRACT
Data on 109,312 singleton births at U.S. Army hospitals over 3 years were examined to determine differences in perinatal risk factors between infants with a diagnosis of sepsis confirmed by blood culture and those whose cultures remained negative. The incidence of confirmed sepsis (1.1/1000 live births) and the importance of perinatal complications and prematurity were consistent with other reported findings. No reliable indicators of bacteremia that could be used in conjunction with other clinical data were found. These findings support continued empiric therapy in infants at risk until infection can be verified by culture.
Subject(s)
Escherichia coli Infections/epidemiology , Sepsis/epidemiology , Streptococcal Infections/epidemiology , Hospitals, Military , Humans , Infant, Newborn , Retrospective Studies , United StatesABSTRACT
The consequences of a factory closure on future employment, disability and death were investigated in a 10-year prospective follow-up study in a general practice setting. The study population consisted of 85 persons who lost their jobs when a brisling sardine factory close to Bergen in Norway was shut down in 1975. The employees of a nearby "sister factory" within the same company were chosen as a control population, consisting of 87 persons. After the factory closure, the annual employment rate of the study group showed a steady rise to a maximum level of 44% within 6 years, but even after 10 years never matched the employment rate of the controls. The cumulative rates of disability pension, granted for medical conditions only, was more than three times higher in the study group than among controls from the second through the fourth year of follow-up. This excess of disabilities then stayed relatively constant at approximately 17 per 100 persons from 5 to 10 years after the shut-down. Given present days' unemployment, the results of this investigation point to the importance of acknowledging a long-term effect of job-loss on health and social readjustment.
