White Female Patients Research Articles

OCCUPATIONAL RISKS OF BLADDER CANCER AMONG WHITE WOMEN IN THE UNITED STATES

The relation between occupation and bladder cancer in women was examined based on data collected during the National Bladder Cancer Study, a population-based, case-control study conducted in 10 areas of the United States. Occupational hazards among women have received little attention in previous bladder cancer studies, in part because most studies have included too few females to accurately estimate risks. In this large case-control study, 652 white female bladder cancer patients and 1,266 white female controls were interviewed to obtain lifetime occupational histories. Patterns of bladder cancer risk by occupation in women tended to be similar to those previously observed among men. Increased risk was apparent for women ever employed in metal working and fabrication occupations (relative risk (RR) = 1.5; 95% confidence interval (CI) 0.9-2.6). Within this summary occupation category, punch and stamping press operatives had a significant trend in risk with increasing duration of employment (p = 0.012); the RR for women employed 5 years or more was 5.6 (95% CI 1.4-26.4). The authors also observed an increased risk for women employed as chemical processing workers (RR = 2.1; 95% CI 0.9-5.1 = with a significant, contrast, a decreased risk was apparent for female textile workers (RR = 0.6; 95% CI 0.3-1.1) with a significant, negative trend in risk with increasing duration of employment (p = 0.031); the relative risk for textile workers employed 10 years or more was 0.4. The authors estimate that 11% of bladder cancer diagnosed among white women in the United States is attributable to occupational exposures; this percentage is considerably lower than the 21-25% previously reported for white men in this study.

A mathematical model for the survival of skin melanoma patients

The mathematical model assumes that following treatment there are two groups of patients, with (P) proportion in the “cured” group and (1-P) proportion in the “non-cured” group. Each group has a constant force of survival for each time interval, and that proportion is S 1 for the “cured” group and S 2 for the “non-cured” group. The group with the greater survival rate is considered the “cured” group. The survival experience for skin melanoma patients will be described by a theoretical distribution (Mathematical reviews 89d:92054 April 1989). Acturarial life tables for white male and female skin melanoma patients, provided by NCI, were analyzed for cases diagnosed from 1950 to 1973. The data shows the average survival time and the proportion of “cured” decreases from local, to regional and to distant stages which does reflect the extent of the disease.

Risk factors for ocular sarcoidosis.

We reviewed 121 consecutive patients with biopsy-proven sarcoidosis who visited the sarcoidosis clinic of the University Hospital in Amsterdam, to determine the risk factors for the development of ocular manifestations. Of 121 patients 52 (43%) were black. Ocular disease developed in 50 (41%) patients and was more common in female and in black patients. uveitis was the most frequent manifestation of ocular sarcoidosis (29 out of 50 or 58%). There were no differences in the extra-ocular manifestations of the sarcoidosis between patients with and without ocular disease or between uveitis and non-uveitis patients. This study covered a mixed racial population and shows that different types of uveitis are seen in white and black patients. Anterior uveitis was more frequent in black patients (P less than .001), whereas posterior uveitis was more common in white patients (P less than .01). Chronic posterior uveitis with complications occurred most frequently in white female patients with late onset of the systemic disease. Uveitis was an early feature of sarcoidosis (25 out of 29 or 86%); moreover in 9 out of 29 (31%) cases, uveitis preceded the non-ocular detectable signs of sarcoidosis by more than one year. This emphasizes the importance of periodic re-evaluation of uveitis patients for sarcoidosis.

Body size, reproductive factors, and breast cancer survival

Mortality rates among 838 white female breast cancer patients were examined for relationships to personal characteristics assessed at time of diagnosis. These included weight and body mass index, oral contraceptive use, and prior menstrual and reproductive events. Multivariate analyses were used to determine the importance of these characteristics in predicting death rates specific for age and extent of disease at time of diagnosis. Weight was associated with poor prognosis among premenopausal patients, but not among postmenopausal patients. Premenopausal women weighing more than 140 lbs at diagnosis had death rates 1.7 times those of lighter women ( P = 0.04). This effect was not explained by differences in the distribution of disease stage between the two groups. Body mass index was positively associated with mortality in both premenopausal and postmenopausal patients. In the entire group, the death rate ratio was 1.4 ( P = 0.02) for obese (body mass index >30.4 × 10 −3 lbs/in. 2) vs lean women. Among premenopausal patients, parous women had higher mortality rates than nulliparous women (death rate ratio = 2.0, P = 0.06). Although the data were sparse, death rates were higher for women having a full-term pregnancy within 2 years of diagnosis than for premenopausal women with earlier pregnancies. Oral contraceptive use, age at menarche, age at first full term birth, and age at menopause were unrelated to mortality.

Urinary Lithiasis in the Black Population: An Epidemiological Study and Review of the Literature

A retrospective review of 199 black patients with urinary calculi and review of the census figures of the index hospitals revealed that white patients had urinary calculi 3 to 4 times as often as black subjects. The black male-to-female ratio was 1 to 1.55 compared to a ratio for white patients of 2.3 to 1. Calculi in black male subjects occur at a younger age than in black or white female or white male patients. The most common organisms cultured in black patients with stones were Escherichia coli and Proteus mirabilis. In contrast to the white population the most common type of stone formed in black patients was struvite/carbonate apatite. Stones of this type accounted for a third of all stones in male and 44 per cent in female subjects. We conclude that nephrolithiasis is an uncommon but not rare disease in the American black population.

Subclinical Hyperthyroidism and reduced bone density as a possible result of prolonged suppression of the pituitary-thyroid axis with L-Thyroxine

Spontaneous hyperthyroidism and that due to excessive administration of thyroid hormone result in osteopenia. Bone density was measured in 28 white premenopausal female patients who were taking commonly prescribed suppressive doses of l-thyroxine (mean dose 0.171 ± 0.035 mg) for five or more years. The thyroxine level was 13.5 ± 2.6 μg/dl (normal 8.0 ± 2.4 μg/dl), the free thyroxine index was 4.4 ± 1.0 (normal 2.4 ± 0.8), and the triiodothyronine value was 154 ± 26 ng/dl (normal 132 ± 32 ng/dl). Basal thyrotropin was undectable (less than 0.08 μIU/ml) in 23 patients, and thyrotropin measured 20 minutes after thyrotropin-releasing hormone administration was not demonstrable in 13 patients and subnormal in 10 patients. Women who had taken l-thyroxine for 10 or more years (n = 12, age 37 ± 4 years) had a 9 percent reduction in bone density (0.667 ± 0.044 g/cm 2, p <0.01) compared with normal premenopausal age-matched control subjects (n = 56, age 35 ± 6 years, bone density 0.733 ± 0.055 g/cm 2). It is concluded that prolonged suppressive L-thyroxine treatment may result in mild subclinical hyperthyroidism with adverse effects on bone. Patients requiring suppression of the pituitary-thyroid axis should be given the smallest dose of l-thyroxine necessary to achieve a satisfactory clinical response.

Epidemiology of Childhood Poisonings Leading to Hospitalization in the United States, 1979–1983

Since 1979 unintentional childhood poisonings have accounted for about 75 deaths annually in the United States, and for each death thousands of ingestions are reported to poison control centers. Little is known about childhood ingestions that lead to hospitalization. To address this issue, we analyzed National Hospital Discharge Survey data from the National Center for Health Statistics for 1979-1983. For these years, an estimated 108,280 children from birth to 9 years of age were hospitalized because of unintentional poisonings. Overall, the annual rate for hospitalization because of childhood poisoning was 65.1 per 100,000 children aged 0-9 years. Hospitalization rates for poisoning were highest for children aged 1 and 2 years (216.2 and 184.3 per 100,000, respectively) and lowest for those aged 5-9 years (11.3 per 100,000). Rates for children less than 1 year old and for those 3-4 years old were moderate. Children of other races had higher hospitalization rates for poisoning than did white children (124.2 per 100,000 compared with 51.9 per 100,000). White male patients were hospitalized more frequently than white female patients, but this sex difference did not occur in children of other races. Rates were consistently highest for children in the Northeast and South and lowest for children in the West. From 1979 to 1983, the length of a hospital stay for childhood poisoning declined by 26 percent. Our results provide new information on childhood poisonings requiring hospitalization.

Pigmentary demarcation lines: A population survey

An examination of 380 patients was accomplished in order to determine the frequency of occurrence of pigmentary demarcation lines in an unselected population. Both white and black patients were included in the study, and there was an equal sex distribution. Separation of data by age groups enabled us to determine that the age of onset is in early childhood in the majority of cases. Seventy-nine percent of black female adults have at least one type of pigmentary demarcation line, with types A and B being present in over 50% of the cases. Seventy-five percent of black male patients had at least one pigmentary demarcation line, with type C being most prevalent. Fifteen percent of white female patients had one pigmentary demarcation line. Finally, it was determined that seven of fifty black women (14%) had the new appearance of type B lines with pregnancy.

Community Hospital-based Stroke Programs: North Carolina, Oregon, and New York. II: Description of study population.

The three Community Hospital-based Stroke Programs collected data on 4132 stroke patients admitted to acute care hospitals during 1979 and 1980. White female stroke patients were older than the white male, nonwhite female and nonwhite male stroke patients. Nearly one-fourth (23%) of stroke patients were employed at the time of the event. Most (77%) of the patients were hospitalized for first stroke episodes. Eighty-three percent of the patients had at least one of the four major risk factors for stroke, namely, hypertension, diabetes, transient ischemic attacks and cardiac disease. Half (49%) of the patients were alert at the time of admission. The three diagnostic categories included infarction (60%), stroke not otherwise specified (30%) and hemorrhage (10%). Fourteen days was the median length of hospitalization; 50% of the stroke patients were discharged to a home setting, 31% were institutionalized and 19% died while in the hospital. The mean Barthel Index score for 2400 patients at the time of discharge was 61.8 (normal is 100). Of those patients who were working at the time of the stroke, 22% returned to work. In comparison to the patients in the National Survey of Stroke, patients in this Study were less severe at the time of admission (49% of patients in the National Survey of Stroke were stuporous or comatose compared to 21% of the patients in the current Study). The inhospital fatality was 30.7% in the National Survey of Stroke, and 19.7% in the current Study.

The Melkersson-Rosenthal Syndrome

The Melkersson-Rosenthal syndrome consists of recurrent swelling of the lip or face, intermittent facial palsy, and fissured tongue. Lengthy intervals may occur between those various manifestations. Four white female patients with this disorder are described. First identified in Europe, the condition is now increasingly recognized in this country. The cause is unknown. The pathology, clinical features, and management of this unusual disorder are discussed.

The role of stress, social support and age in survival from breast cancer

This study focused on the relationship of objective and subjective stresses to survival from breast cancer. The potential mediating roles of social support and age were also considered. This prospective study involved 208 white female breast cancer patients diagnosed between 1958 and 1960. At the time of diagnosis, subjects were interviewed regarding objective and subjective stress and social support present in the 5-year period preceding their diagnosis. Twenty years later, survival was calculated. The relationships between stress and survival were examined for three age groups: 15–45, 46–60, and 61 and older. Objective stress was related to survival for the oldest group while subjective stress was related to survival for the youngest group. Neither stress was related to survival for women aged 46–60. Social involvement was independently related to survival although it was not a mediator in the stress-survival relationship. Using the entire sample, stage of cancer at diagnosis was the best predictor of survival. However, when women aged 46–60 were eliminated from the analysis, stress and social involvement accounted for twice as much variance in survival as stage.

Thyroid autoimmunity in insulin-dependent diabetes mellitus: The case for routine screening

Of 771 young diabetic patients, thyroid microsomal autoantibodies occurred in 136 (17.6%) at a female/male ratio of nearly 2:1 and with a predominance of white patients (20.1%) over black patients (5.5%) (P less than 0.001). Thus, one in every four white female patients with insulin-dependent diabetes mellitus had TMA. Thyroglobulin autoantibodies were no more common in patients with IDDM than among controls. Of the 117 patients (out of the 136) with serologic evidence of chronic thyroiditis who could be studied, eight (7%) had hyperthyroidism and 45 (38%) were hypothyroid. Hyperthyroidism usually preceded or coincided with the appearance of IDDM, whereas hypothyroidism occurred with or following the onset of IDDM. Hypothyroidism appeared irreversible in most patients, but in three, periods of hypothyroidism were followed by euthyroidism, presumably explained by a compensatory hyperplasia of the thyroid gland. In the 136 patients with TMA, gastric and adrenocortical autoantibodies also occurred at relatively high frequencies (16.8% and 5.1%, respectively). On the basis of these studies, we urge that all patients with IDDM be screened for TMA and that those with positive results undergo annual thyroid function tests as well as determinations of gastric parietal and adrenocortical autoantibodies.

Racial Differences in Normal Values of Proptosis

Measurement of proptosis was made with a Luedde exophthalmometer by one experimenter in 402 black and 325 white adults without endocrine disease or obvious orbital pathologic conditions. Black subjects had significantly higher values of proptosis than white subjects. It is suggested that the following "upper limits of normal" be used when clinically estimating proptosis: 19 and 21 mm for white female and male patients, respectively; and 23 and 24 mm for black female and male patients, respectively.

Racial differences in normal values of proptosis.

Measurement of proptosis was made with a Luedde exophthalmometer by one experimenter in 402 black and 325 white adults without endocrine disease or obvious orbital pathologic conditions. Black subjects had significantly higher values of proptosis than white subjects. It is suggested that the following "upper limits of normal" be used when clinically estimating proptosis: 19 and 21 mm for white female and male patients, respectively; and 23 and 24 mm for black female and male patients, respectively.

Impact of Long-Term Filter Cigarette Usage on Lung and Larynx Cancer Risk: A Case-Control Study2

A case-control study was conducted among 1.034 white male and female hospital patients with histologically proved lung cancer (Kreyberg type l) or larynx cancer. After adjustment for duration of the smoking habit, inhalation, and butt length, relative risks of developing lung or larynx cancer were consistently lower among long-term smokers of filter cigarettes than among smokers of nonfilter cigarettes, irrespective of quantity smoked. Relative risks in all groups declined with increased years of smoking cessation. The observed risk reduction among current smokers of filter cigarettes was consistent with that expected, considering that these persons had smoked the older high-tar nonfilter cigarettes for a large proportion of their lives.

Immunoglobulin levels in psychiatric patients

In a study of 19 schizophrenic patients, 7 nonschizophrenic patients, and 31 controls, the authors found significantly higher mean serum levels of 1) immunoglobulin A in schizophrenic women then in control women and in schizophrenic blacks than in either schizophrenic whites or black controls. 2) immunoglobulin D in schizophrenic blacks than in schizophrenic whites, 3) immunoglobulin M in controls than in nonschizophrenic patients, and 4) immunoglobulin G (IgG) in schizophrenics whose urine was positive for phenothiazines than in schizophrenics whose urine was negative for phenothiazines. High serum levels of IgG were associated with no or mild hallucinations and low levels with moderate or severe hallucinations. Black female patients had significantly more severe hallucinaions than white female patients. The authors discuss the possible implications of these findings.

Black—white differences in serum creatine phosphokinase (CPK) activity

The mean serum creatine phosphokinase activities of hospitalized black male and female, and white male and female psychiatric patients were established. The effects of both race and sex on mean serum creatine phosphokinase activities were both highly significant. Black males had significantly higher mean serum creatine phosphokinase activity than white males, black females and white females. White males and black females had significantly higher mean serum creatine phosphokinase levels than white females but were not significantly different from each other. Age, height and weight did not contribute to the difference between races. There was a trend for mean serum creatine phosphokinase activity to be greater for dark skinned black males than light skinned black males but this trend was not present in black females. The standard deviation of each subject's mean serum creatine phosphokinase activity was highly correlated with the mean. The levels of serum creatine phosphokinase activity found in these subjects were significantly greater than those previously observed with the method of Rosalki (J. Lab. Clin. Med., 69 (1967) 696).

Validity of beta IQ's for white female patients in a state psychiatric hospital.

Validity of beta IQ's for white female patients in a state psychiatric hospital.

Biliary Tract Disease In Navajo Indians

To the Editor:— In the article, Biliary Tract Disease Among the Navajos, by Brown and Christensen ( 202 :1050, 1967), there were two unverified conclusions. The average age of the male patients in the study was 56.8 and that of female patients 39.9 years. Colcock and Perey ( Surg Gyn Obstet 117 :529, 1963) stated that the average age of white male and female patients with biliary tract disease in their study was 53.7 and 53.4 years, respectively. The female-to-male ratio of patients with biliary tract disease in the Navajo group was about four to one, while that in the white population from various sources is about two to one ( Surg Gyn Obstet 85 :776, 1947; Surg Gyn Obstet 101 :161, 1955). From this information was concluded the following: (1) biliary tract disease occurs at a younger age in the general Navajo population as compared to the white population, and (2) the

8. North America

Differences in symptomatology have been noted between American Negroes and American Whites, and DE HOYOS attempts to show why fewer symptoms are recorded for Negro patients than for white patients. The next article deals with a similar problem but in a different manner. PIEDMONT reports a systematic comparison of schizophrenic symptomatology and family dynamics in two contrasting cultural groups: the Polish and the Germans of Buffalo, N.Y. The author attributes differences in symptomatology to cultural differences. Cultural differences are also invoked by SIMON to explain why involutional psychotic reactions are more frequently diagnosed in white male and female patients than in negro female patients, and very rarely in negro male patients. BOYER'S article on the folk psychiatry of the Apaches in Mescalero Indian Reservation presents interesting comparisons between Apache shamanism and Western psychiatry.