Fetal imaging prompts maternal diagnosis: autosomal dominant polycystic kidney disease.

Autosomal dominant polycystic kidney disease (ADPKD) is a common inherited disorder. Ultrasound (US) findings can include enlarged echogenic kidneys in utero and cysts in multiple organs in adults. Though a highly penetrant disease, due to varied clinical expression and the typical late onset of symptoms, reproductive-aged women may not know their carrier status. We present two cases in which fetal US findings suggested ADPKD and additional evaluation identified likely maternal ADPKD as well.

Utilization of available prenatal screening and diagnosis: effects of the California screen program.

OBJECTIVE: In 2009, the California Genetic Disease Branch introduced an aneuploidy screening program allowing Medi-Cal (state insured) patients access to state-sponsored first-trimester screening. The objective of this study was to assess the effect of greater access to prenatal screening on available resources at a single center. STUDY DESIGN: Data of prenatal screening and diagnostic procedures performed 4 months before the introduction of the program were compared with those of 12 months following the introduction. RESULT: Between December 2008 and March 2010, 7689 women underwent first trimester screening, 1286 underwent amniocentesis and 398 underwent chorionic villus sampling. When a comparison was made between the 4 months before and the 12 months after the program's introduction, a greater number of nuchal translucency (NT) examinations was seen to have been performed (384 per month vs 513 per month, P=0.001). Prenatal diagnostic procedures did not increase, but a greater proportion was performed for positive screen results. CONCLUSION: Introduction of the California screening program was associated with increased NT procedures and fewer invasive procedures for advanced maternal age.

Pinworm control and risk factors of pinworm infection among primary-school children in Taiwan.

Longitudinal pinworm (Enterobius vermicularis) infection rates were estimated at a mass screening for first-grade children during 1991-1996; children were provided medication at the screening. This campaign was able to decrease the infection rates for the 1991 cohort from 16.3% to 0.6%. A case-control study was further conducted for the investigation of risk factors among fourth-graders. Cases comprised 429 children with at least one infection between September 1996 to June 1999, and controls were 280 randomly selected uninfected classmates. Parents were asked to complete a questionnaire survey to report students' personnel hygiene habits. The case-control study revealed that significant factors associated with the infection included playing on the floor (odds ratio [OR], 2.5), nail biting (OR, 2.1), failure to wash hands before meals (OR, 1.7) and living in nonapartment dwellings (OR, 1.6). Girls were at a higher, but not significant, risk (OR, 1.4), than boys. In conclusion, inadequate personal hygiene increases the risk for pinworm infection. The mass screening-medication campaign can be adapted to countries with a similar parasitic problem.

Risk factors for prostate carcinoma in Taiwan: a case-control study in a Chinese population.

BACKGROUND: Although prostate carcinoma remains a rare disease among Chinese men, its incidence is on the rise. The authors conducted a hospital-based case-control study to identify risk factors for prostate carcinoma in northern Taiwan. METHODS: Patients at a selected veterans hospital or 2 military hospitals who were newly diagnosed with prostate carcinoma between August 1995 and July 1996 were included as cases (n = 90). Controls (n = 180) were comprised noncancer patients who were treated in emergency rooms and departments other than those of urology and cardiology at the same hospitals; controls were matched to cases by age (+/-5 years) and admission date (+/-4 months). Subjects were interviewed in person to elicit information regarding sociodemographic characteristics, life-style, diet, height, and weight. RESULTS: Cases and controls were similar in terms of age and the majority of sociodemographic characteristics. However, cases tended to have received more education and were less likely to have blue-collar jobs than controls. The consumption of pork was moderately higher for cases than for controls, although this difference was not statistically significant. Cases were more likely than controls to engage in exercise (odds ratio [OR] = 2.16; 95% confidence interval [CI] = 1.18-3.96) and to have a body mass index > or = 24.75 kg/m2 at ages 40-45 years (OR = 2.00; 95%CI = 1.05-3.82). In addition, cases were less likely to cook vegetables with pork lard (OR = 0.47; 95%CI = 0.24-0.91). CONCLUSIONS: The higher frequency of exercise and lower use of pork lard for cooking among cases reported in the current study suggest that cases tended to have relatively affluent life-styles compared with controls. Because less affluent families are likely to consume more vegetables than meat, these preliminary findings indicate that vegetable intake appears to have a protective effect.

Cancer rate differentials between blacks and whites in three metropolitan areas: a 10-year comparison.

This article compares cancer rate differentials for 1989-1993 and 1979-1981 between black and whites in Los Angeles, Nashville, and Atlanta, In Los Angeles and Atlanta, the black/white relative risk of lung cancer incidence has increased. While the relative risk for prostate cancer has decreased, blacks still show an excess incidence. White women still show a higher incidence of breast cancer, but the risk is closer to one. In all three cities, the excesses of black male lung cancer and female breast cancer mortalities have increased. The excess of black prostate cancer mortality increased in Atlanta and Nashville but decreased in Los Angeles. The excess of black cervical cancer mortality fell in Los Angeles and Atlanta but rose in Nashville. These results indicate a continuing need to develop and implement culturally sensitive interventions targeted at the black population.

Racial and urban/rural differences in cervical carcinoma in Georgia Medicaid recipients.

BACKGROUND: The authors conducted a study of racial and geographic differences in the occurrence of cervical carcinoma in a population of uniformly low economic status: Georgia Medicaid recipients. METHODS: Medicaid reimbursement claims data for 1992 were used to calculate counts, rates, and black-to-white risk ratios for newly and previously diagnosed cases of cervical carcinoma in metropolitan Atlanta and in the remainder of the state. RESULTS: Among 615,787 female Georgia Medicaid recipients in 1992, 2050 women (333 per 100,000) had a diagnosis of carcinoma of the cervix. Of 111,208 women who had received Medicaid assistance continuously from 1988 to 1992 (5-year eligibles), a new claim for cervical carcinoma was submitted for 110 (99 per 100,000). In both analyses, rates were higher in metropolitan Atlanta than in the remainder of the state. Black women had significantly higher claims rates than white women only in metropolitan Atlanta; risk ratios were 3.7 (95% confidence interval [CI], 1.3-10.8) for new claims among 5-year eligibles, and 3.5 (95% CI, 3.0-4.1) for prevalence. There was no racial disparity in cervical carcinoma rates in rural areas. CONCLUSIONS: The current study data suggest a high risk of cervical carcinoma among metropolitan Atlanta Medicaid recipients, particularly blacks. Data from rural Georgia (but not Atlanta) support the hypothesis that racial differences in cervical carcinoma rates would largely disappear in a population of uniform economic status.

Knowledge, beliefs, attitudes, and cancer screening among inner-city African-American women.

Three hundred twenty-one inner-city African-American women were interviewed to determine their knowledge, attitudes, and beliefs regarding cancer and cancer screening, and their cancer screening histories. The women were recruited from a variety of sources in Atlanta and were interviewed in their homes by trained lay health workers. Half of the subjects had an annual household income of < $15,000. About half had received a Pap smear and clinical breast examination within the year preceding the interviews. For women > 35 years old, 35% had received a mammogram within the recommended interval. Younger women and women with higher incomes were more likely than older women and those with lower incomes to have received a Pap test and clinical breast examination within the preceding year, but income was not significantly associated with mammography histories. In general, women who were more knowledgeable about cancer and its prevention were more likely to have been appropriately screened. However, various attitudes and beliefs regarding cancer generally were not associated with screening histories. We conclude that cancer screening programs for inner-city minority women should focus on improving knowledge levels among older women rather than attempting to alter attitudes and beliefs.

Effect of a cancer screening intervention conducted by lay health workers among inner-city women.

INTRODUCTION: We conducted a randomized controlled trial to determine if an in-home educational intervention conducted by lay health workers (LHWs) could increase adherence among low-income, inner-city, African-American women to breast and cervical cancer screening schedules. METHODS: We recruited 321 African-American women from diverse inner-city sources. After baseline interviews, they were randomly assigned to either the intervention (n = 163) or the control (n = 158) group. Those in the intervention group were visited in their homes up to three times by LHWs who provided a culturally sensitive educational program that emphasized the need for screening. RESULTS: Ninety-three (93) women in the intervention group and 102 in the control group completed the postintervention interview. For Pap smears, the increase in screening was similar in both groups. For clinical breast exams (CBEs), however, there was a modest increase in the intervention group. The improvement was greatest for mammography, for which there was a 10% to 12% increase. Among women who were not on recommended schedules at baseline, the improvement was substantial and greater in the intervention group. CONCLUSIONS: LHWs' intervention appeared to improve the rate at which inner-city women obtained CBEs and mammograms, but had no effect on Pap smears. A high attrition rate weakened our ability to make conclusive statements about the exact impact of the intervention.

Is there a difference in hypertensive claim rates among Medicaid recipients?

The purpose of this study was to determine whether there are racial differences in the rates of prevalence and new claims to Medicaid for hypertension treatment in a population of uniformly low economic status--i.e., Georgia Medicaid recipients. Age-specific and age-adjusted prevalence rates of hypertension in 1991 and the first 1991 claim rates by race and gender were calculated. Gender-specific black-to-white risk ratios, using the Mantel-Haenszel pooled point estimate (RMH) and the corresponding test-based 95 percent confidence interval (CI) were also calculated. African-American females were more likely than African-American males, or whites of either sex to have hypertension diagnoses. For newly claimed cases, the gender-specific black-to-white risk ratios were significant in malignant hypertension for both females (RMH = 1.9, 95 percent CI 1.4-2.5) and males (RMH = 2.0, 95 percent CI 1.2-3.7) and in unspecified hypertension for females (RMH = 1.5, 95 percent CI 1.4-1.6), but were less significant in unspecified hypertension for males, and in benign hypertension for both sexes. Using Medicaid data may have caused underestimation of the prevalence and incidence of hypertension among Medicaid recipients; however, significant racial differences in the "occurrence" of hypertension still existed among them. Factors other than the household income status may be responsible for much of the excess risk of hypertension in the black Medicaid population.

Maternal factors, birthweight, and racial differences in infant mortality: a Georgia population-based study.

Black infant mortality rates (IMRs) are approximately twice those of whites in Georgia and nationwide. This study evaluates maternal factors, particularly marital status, that influence racial differences in infant mortality. Population-based data on 565,730 live births and 7269 infant deaths in Georgia from 1980 to 1985 were examined. The IMR ratio for unmarried compared to married mothers was calculated and adjusted singly for maternal education, age and race, and infant birthweight. In addition, racial differences in IMR were estimated using stratified analysis on the basis of four factors: infant birthweight, maternal age, marital status, and education. When only normal birthweight infants were considered, the IMR, adjusted for maternal education level, was highest for infants born to unmarried black teens (9.5/1000 live births), followed by that for infants born to married black teens (9.1), unmarried black adults (7.5), married black adults (4.8), married white teens (4.4), married white adults (3.4), unmarried white adults (2.4), and unmarried white teens (1.3). When only low birthweight infants were considered, the highest IMR per 1000 was found in infants born to married black adults (119), followed by unmarried black adults (103), married black teens (99.9), unmarried black teens (92.5), married white adults (92.1), married white teens (79.0), unmarried white adults (38.0), and unmarried white teens (26.3). These differences led to a black-to-white IMR risk ratio from 1.3 for low birthweight infants born to unmarried teen or adult mothers to 3.7 for normal birthweight infants born to unmarried teen mothers.(ABSTRACT TRUNCATED AT 250 WORDS)

Interactive effect of race and marital status in low birthweight.

Although unmarried mothers are at risk of delivering low-birthweight (LBW) infants, the meaning and significance of this variable need to be explored in depth. With data on 216,285 infants born to white and black mothers aged 10 to 49 years in Atlanta, Georgia, between 1980 and 1987, we examined the association of LBW and marital status and the effect of race on the association. Education and age were controlled in the analysis in an attempt to isolate the effect of race on the marital status and birthweight association. The crude LBW rate among infants born to unmarried mothers was about twice the rate among infants born to married mothers (132.8 vs 63.9 per 1000 live births). Adjustment singly for maternal race, age, and education gave risk ratios (unmarried vs married) of 1.50, 2.03, and 1.78, respectively. Simultaneous control for all factors led to a hierarchy of education-adjusted risk: unmarried black adult mothers had the highest risk of delivering an LBW infant (2.49), followed by married black adults (1.93), unmarried black teenagers (1.90), married black teenagers (1.67), unmarried white adults (1.65), unmarried white teenagers (1.35), married white teenagers (1.08), and married white adults (1.0; reference group, with an LBW rate of 51.2/1000 live births). Thus, these data demonstrate both a consistently higher risk for black women and an interactive effect of age on the association of marital status and LBW: unmarried status appears to increase the risk of LBW much more among adult women than among younger women. This finding has implications for research and prevention of LBW.

Preterm delivery and low birth weight among first-born infants of black and white college graduates.

Reproductive outcomes were investigated in black and white female college graduates, presumed to be of similar socioeconomic status and similar risk profile with respect to environmental factors. Data were gathered by mail survey from graduates (1973-1985) of four Atlanta, Georgia, colleges between February and June 1988. Of 6,867 alumnae to whom questionnaires were mailed, 3,084 responded. A follow-up study of black nonrespondents yielded responses from 14% (335) of those who did not respond to the mail survey. For all graduates with a first live born at the time of survey (n = 1,089), the rates of preterm delivery, low birth weight, and infant mortality were 80.8, 82.6, and 14.6 per thousand births (primigravida), respectively. Compared with white graduates, black graduates had 1.67 times the risk of preterm delivery and 2.48 times the risk of low birth weight. Measures of social and economic status differed significantly by race. However, adjustment for these variables did not reduce the estimated risk for black graduates compared with whites. Analysis of the nonresponder survey suggested that respondent data alone overestimates the incidence of adverse outcomes in blacks; using nonresponder data, relative risks of 1.28 (preterm delivery) and 1.75 (low birth weight) were calculated as lower limits of the increased risk for blacks.

Cancer screening intervention among black women in inner-city Atlanta--design of a study.

This experimental study attempts to determine if an in-home educational intervention conducted by lay health workers (LHWs) can increase adherence among low-income, inner-city black women to schedules for screening for breast cancer and cervical cancer, as well as increase the women's knowledge and change their attitudes regarding these cancers. This paper is a description of the purposes, hypotheses, design, subject recruitment, intervention, and evaluation of the study conducted by Morehouse School of Medicine. Subjects were recruited from a variety of sources, including patients seen in a community health center, women referred by the National Black Women's Health Project (NBWHP), residents of public and senior citizen housing projects, and persons identified in various community settings. Fewer than half of those asked to participate agreed to do so. The 321 women who were recruited were demographically diverse. Overall, about half of these volunteer subjects self-reported at least one Papanicolaou (Pap) smear and one breast examination within a year before enrollment in the study. There was little variation by source of recruitment in compliance with screening recommendations, except that referrals from NBWHP were more likely (P less than 0.01) to have had a Pap test and breast self-examination, while residents of public housing projects were somewhat less likely to have done so. About 35 percent of participants ages 35 and older had a mammogram within an appropriate interval. Participants were randomly assigned to intervention and control groups. Women in the intervention group were visited in their homes by LHWs on three occasions; the LHWs provided education on cancer and reproductive health. The groups were comparable in their baseline sociodemographic status and previous screening history.

Racial differences in mortality from cardiovascular disease in Atlanta, 1979-1985.

Mortality from cardiovascular disease (CVD) for the period 1979 to 1985 in the Atlanta metropolitan population was reviewed for racial differences. About 28% of the population was black in 1980. Of 22,585 deaths from hypertension, stroke, ischemic heart disease, and atherosclerosis, 78.7% occurred among whites and 21.3% among blacks. Overall, ischemic heart disease accounted for 47.7% of these four types of CVD deaths for both races and sexes. Age-specific and age-adjusted rates were compared. Among these four causes of death, blacks have the greatest excess of deaths from hypertension over whites for both males and females; the excesses were more than 200% when the rates were age-adjusted. The excess risk of death from hypertension occurred for all ages in blacks, with an excess of about 10 times in 30- to 49-year-olds. An excess risk from stroke also occurred in blacks below the age of 75; the risk reversed afterward. The age-specific mortality rates revealed an excess from ischemic heart disease only between the ages of 30 and 59 years and from atherosclerosis between 40 and 59 years of age for black men. This age-related crossover in females did not occur until the age of 75 years for deaths attributed to these causes. These data suggest that blacks were at highest risk for all four causes at younger age groups.

Does increased detection account for the rising incidence of breast cancer?

BACKGROUND: The incidence of breast cancer has been increasing over time in the United States. METHODS: To determine the role of screening in this increase, trends in the incidence of in situ and invasive carcinoma of the breast were evaluated using records of the metropolitan Atlanta SEER program between 1979 and 1986. From a sample of records, evidence of symptoms and mammographic screening prior to diagnosis was recorded. RESULTS: The average annual age-adjusted incidence of invasive disease rose 29 percent among Whites and 41 percent among Blacks. Incidence increased in all age groups. A trend towards earlier detection of invasive disease was found. Asymptomatic tumors accounted for only 40 percent of the increased incidence among whites and 25 percent of the increased incidence among blacks, with mammography as the principal contributing procedure. CONCLUSIONS: These data suggest that increased detection accounts for some but not all of the rising incidence of breast cancer in the United States.