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oai:open-archive.highwire.org:amjepid:140/7/5852015-05-11HighWireOUPamjepid:140:7
Parity, Contraception, Infertility, and the Risk of Epithelial Ovarian Cancer
Risch, Harvey A.
Marrett, Loraine D.
Howe, Geoffrey R.
ORIGINAL CONTRIBUTIONS
A case-control study of reproductive factors and cancer of the ovary was conducted during 1989-1992 in metropolitan Toronto and nearby areas of Southern Ontario, Canada. In total, 450 women aged 35–79 years with histologically verified new primary epithelial ovarian cancers were interviewed concerning their reproductive histories. Over the same time period, 564 randomly selected population controls, frequency-matched to the cases according to three 15-year age groups, were also interviewed. Continuous unconditional logistic regression methods were used for analysis. It was found that childbearing and use of oral contraceptives were associ ated with significant decreasing trends in risk of ovarian cancer; the respective odds ratios were 0.78 for each full-term pregnancy (p < 10−8) and 0.92 for each year of use (p < 10−6). Hysterectomy was also associated with reduced risk, even after more than 20 years. Among parous women, infertility did not appear to affect risk; for nulliparous women, some evidence of increased risk was present, although fertility problems were reported by only a small fraction of nulliparae. It is suggested that the relatively lower parity of cases as compared with controls may be due to voluntary choices for having fewer children.
Oxford University Press
1994-10-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/140/7/585
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Copyright (C) 1994, Oxford University Press
oai:open-archive.highwire.org:amjepid:140/7/5982015-05-11HighWireOUPamjepid:140:7
DNA Repair and Susceptibility to Basal Cell Carcinoma: A Case-Control Study
Wei, Qingyi
Matanoski, Genevieve M.
Farmer, Evan R.
Hedayati, Mohammad A.
Grossman, Lawrence
ORIGINAL CONTRIBUTIONS
This study investigated the role of DNA repair in susceptibility to sunlight-induced basal cell carcinoma using a host cell reactivation assay in peripheral lymphocytes. The study included Maryland basal cell carcinoma patients and cancer-free derma tologic controls who had had noncancerous skin disorders diagnosed between 1987 and 1990. Logistic regression models were used to assess the independent effect of the selected variables stratified by DNA repair level, with adjustment for age and family history. Skin type, lifetime number of severe sunburns, and actinic elastosis were also selected as risk factors for basal cell carcinoma. Cryopreserved lymphocytes from 88 cases and 135 controls were used for the DNA repair assay. When data were stratified by DNA repair level and adjusted for age and family history of skin cancer, significantly increased odds ratios associated with lighter skin (odds ratio (OR) = 3.2, 95% confidence interval (Cl) 1.5–7.3), six or more severe sunburns in a lifetime (OR = 4.2, 95% Cl 1.6–10.7), and moderate or severe actinic elastosis (OR = 4.4, 95% Cl 1.5–12.8) were observed in persons with low DNA repair but not in those with high DNA repair. These findings suggest that impaired DNA repair may be a susceptibility factor for sunlight-induced skin cancer in the general public, as it is in patients with xeroderma pigmentosum.
Oxford University Press
1994-10-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/140/7/598
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Copyright (C) 1994, Oxford University Press
oai:open-archive.highwire.org:amjepid:140/7/6082015-05-11HighWireOUPamjepid:140:7
Physical Activity and Stroke Risk: The Framingham Study
Kiely, Dan K.
Wolf, Philip A.
Cupples, L. Adrienne
Beiser, Alexa S.
Kannel, William B.
ORIGINAL CONTRIBUTIONS
The authors prospectively examined the influence of increased levels of physical activity on risk of stroke in members of the Framingham Study cohort. Two separate analyses were performed, one during midlife in 1,897 men (mean age = 49.7 years) and 2,299 women (mean age = 49.9 years) and another when the cohort was older (1,361 men (mean age = 63.0) and 1,862 women (mean age = 63.7)). A structured questionnaire administered at two separate examinations was used to estimate the amount of metabolic work done during a typical 24-hour period. Physical activity was categorized into tertiles, and medium and high levels of physical activity were compared with a low level of physical activity, which was used as the referent group. Coxproportional hazards, life table, and time-dependent covariate analyses were used to examine the relation between level of physical activity and stroke risk over a follow-up period of up to 32 years. In men, adjusted analyses revealed that increased levels of physical activity were protective. The strongest effect was obtained from an analysis involving older cohort members in the medium tertile (risk ratio = 0.41, 95% confidence interval 0.24–0.69). High levels of physical activity did not confer an additional benefit over medium levels. Adjusted analyses showed no significant protective effect in women. These results indicate that medium and high levels of physical activity among men are protective against stroke relative to low levels.
Oxford University Press
1994-10-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/140/7/608
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Copyright (C) 1994, Oxford University Press
oai:open-archive.highwire.org:amjepid:140/7/6212015-05-11HighWireOUPamjepid:140:7
"Thucydides Syndrome" Reconsidered: New Thoughts on the "Plague of Athens"
Morens, David M.
Littman, Robert J.
ORIGINAL CONTRIBUTIONS
A recently published theory (<it>N Engl J Med</it> 1985;313:1027–30) argues that the famous Athenian epidemic of 430 B.C. was caused by a combination of influenza and toxin-producing staphylococci (the “Thucydides syndrome”). Although it is accepted by some medical authorities, and ostensibly supported by identification of modern cases, the theory's plausibility has not been carefully examined. The authors used an epidemiologic approach supplemented by historical and clinical observations to ex amine the likelihood that a “Thucydides syndrome” could have caused the Athenian epidemic. Arguing against the influenza theory are epidemiologic and clinical features of the disease, mathematical models of the spread of influenza, and empirical obser vations of epidemic influenza in premodern populations of known size and crowding. The authors conclude that neither influenza nor a “Thucydides syndrome” could have produced the Athenian epidemic. Epidemiologic features suggest either a zoonotic or vectorborne disease, a disease associated with an environmental source, or a respi ratory infection with unusual alternative mechanisms of spread.
Oxford University Press
1994-10-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/140/7/621
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Copyright (C) 1994, Oxford University Press
oai:open-archive.highwire.org:amjepid:140/7/6292015-05-11HighWireOUPamjepid:140:7
Invited Commentary: "Thucydides Syndrome" Reconsidered
Langmuir, Alex D.
ORIGINAL CONTRIBUTIONS
Oxford University Press
1994-10-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/140/7/629
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Copyright (C) 1994, Oxford University Press
oai:open-archive.highwire.org:amjepid:140/7/6312015-05-11HighWireOUPamjepid:140:7
Morens and Littman Reply to Langmuir
Morens, David M.
Littman, Robert J.
ORIGINAL CONTRIBUTIONS
After submitting our paper on the “Plague of Athens” (1), we learned with sorrow of Alex Langmuir's death. Although our paper contradicts his “diagnosis” of the Athenian epidemic, it was inspired by several rousing and friendly exchanges with Alex, whose gracious recommendation in favor of publication (2) was not swayed by his strong disagreement with our conclusion. An experientialist at heart (3), Alex would have agreed with Emerson's belief that “the laws of disease… are as beautiful as the laws of health. [We] readily [accept] the testimony of negative facts, as every shadow points to the sun” (4, p. 127). Alex also understood that part of the value of studying the Athenian epidemic lies in the fact that its cause will never be known with certainty. This encourages students of epidemiology, at all levels of experience, to shape ideas and strategies without fear of being proven wrong. In doing so, we may come to learn about the discovery <it>process</it> itself. Alex, who wrote that “the process of discovery stands at the very beginning of science” (3), taught and influenced three generations of American epidemiologists in the same spirit. We can think of no better way to thank a man we so admired than to remember Alex Langmuir as a friend of learning.
Oxford University Press
1994-10-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/140/7/631
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Copyright (C) 1994, Oxford University Press
oai:open-archive.highwire.org:amjepid:140/7/6322015-05-11HighWireOUPamjepid:140:7
Shingles, Allergies, Family Medical History, Oral Contraceptives, and Other Potential Risk Factors for Systemic Lupus Erythematosus
Strom, Brian L.
Reidenberg, Marcus M.
West, Suzanne
Snyder, Ellen Sim
Freundlich, Bruce
Stolley, Paul D.
ORIGINAL CONTRIBUTIONS
The authors undertook a case-control study to explore the many factors that have been postulated to be related to the etiology of systemic lupus erythematosus. A total of 195 cases of systemic lupus diagnosed in the Philadelphia, Pennsylvania, metro politan area between 1985 and 1987 were compared with 143 controls, friends of the cases matched to them according to age (±5 years) and sex. Through personal interviews and chart reviews, data were collected on demographic factors, personal and familial medical history, reproductive history, medication history, and environ mental exposures. Associations were found between systemic lupus erythematosus and having a family history of autoimmune disease (age-, sex-, and race-adjusted odds ratio (OR) = 2.3, 95% confidence interval (Cl) 1.2–4.6), a history of shingles (adjusted OR = 6.4, 95% Cl 1.4–28.0), a history of hives (adjusted OR = 1.8, 95% Cl 1.1–3.0), and a history of medication allergies (adjusted OR = 2.6, 95% Cl 1.5–4.5). No association was present between systemic lupus erythematosus and either any use or recent use of oral contraceptives (e.g., OR = 0.6(95% Cl 0.2–1.4) for use in the 3 years prior to diagnosis), family history of multiple other diseases, or a history of numerous other infections or various other types of allergies. Thus, these data indicate that systemic lupus erythematosus is associated with a family history of autoimmune diseases, a history of shingles, and a history of allergies. In contrast, if the develop ment of systemic lupus is affected by use of oral contraceptives, this effect must be extremely modest. These findings may help clarify the possible pathogenesis of systemic lupus erythematosus, and they provide clues as to when the presence of systemic lupus should be suspected.
Oxford University Press
1994-10-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/140/7/632
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Copyright (C) 1994, Oxford University Press
oai:open-archive.highwire.org:amjepid:140/7/6432015-05-11HighWireOUPamjepid:140:7
Comparison of Control Subjects Recruited by Random Digit Dialing and Area Survey
Lete, Chitra
Holly, Elizabeth A.
Roseman, Diane S.
Thomas, David B.
ORIGINAL CONTRIBUTIONS
Although random digit dialing (RDD) is an accepted and commonly used method of sampling populations for controls in case-control studies, there have been surprisingly few attempts to compare the accuracy of RDD with that of the best traditional alternative, i.e., household area surveys. The aim of the present study was to compare a variety of characteristics of control subjects selected by ROD and area survey methods. All data were gathered through in-person interviews of both types of control subjects. The area survey identified a population-based sample of 20- to 79-year-old residents of two Washington State counties in 1978 and 1979. Control groups for three case-control studies of bladder cancer, gynecologic cancers, and multiple myeloma were drawn from this area sample, for a total of 240 control subjects. Controls aged 21-64 years from the same counties were identified for the National Bladder Cancer Study using ROD telephone sampling during the same time period. There were 134 respondents in the ADD control group. Overall, the two control groups selected by these two different methods yielded similar estimated frequencies of various population characteristics. The small differences observed in some age/sex subgroups and the statistical significance of the overall measure of association for occupational exposure to organic substances may be attributed to multiple compar isons.
Oxford University Press
1994-10-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/140/7/643
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Copyright (C) 1994, Oxford University Press
oai:open-archive.highwire.org:amjepid:140/7/6492015-05-11HighWireOUPamjepid:140:7
Calendar Effects in the Analysis of Seasonal Data
Walter, S. D.
ORIGINAL CONTRIBUTIONS
A variety of statistical methods exist for analyzing seasonal patterns in epidemiologic data. As a simplification in the calculations, these methods often do not explicitly take into account certain calendar effects, such as the variation in month length, the irregular number of weekend days in each month, and the occurrence of holidays. This paper evaluates the bias caused by failing to recognize these effects. It is found that with the sample sizes commonly encountered in this type of analysis of epidemiologic data, calendar effects have a high probability of producing a spuriously significant seasonal effect, the amplitude of which may be of the same order of magnitude as the true un derlying seasonal trend. Therefore, it is recommended that calendar effects be routinely taken into account, and some methods for doing so are proposed.
Oxford University Press
1994-10-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/140/7/649
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Copyright (C) 1994, Oxford University Press
oai:open-archive.highwire.org:amjepid:140/7/6582015-05-11HighWireOUPamjepid:140:7
RE: "REPRODUCTIVE FACTORS AND BREAST CANCER"
Maguire, Andrew
Porta, Miquel
Piñol, Josep Lluís
Kalache, Alex
LETTERS TO THE EDITOR
Oxford University Press
1994-10-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/140/7/658
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Copyright (C) 1994, Oxford University Press
oai:open-archive.highwire.org:amjepid:140/7/6592015-05-11HighWireOUPamjepid:140:7
THE AUTHORS REPLY
Kelsey, Jennifer L.
Gammon, Marilie D.
John, Esther M.
LETTERS TO THE EDITOR
Oxford University Press
1994-10-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/140/7/659
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Copyright (C) 1994, Oxford University Press
oai:open-archive.highwire.org:amjepid:140/7/661-a2015-05-11HighWireOUPamjepid:140:7
THE AUTHORS REPLY
Goldhaber, Marilyn K.
Armstrong, Mary Anne
Friedman, Gary D.
Golditch, Ira
Sheehe, Paul R.
Petitti, Diana B.
LETTERS TO THE EDITOR
Oxford University Press
1994-10-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/140/7/661-a
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Copyright (C) 1994, Oxford University Press
oai:open-archive.highwire.org:amjepid:140/7/6612015-05-11HighWireOUPamjepid:140:7
RE: "LONG-TERM RISK OF HYSTERECTOMY AMONG 80,007 STERILIZED AND COMPARISON WOMEN AT KAISER PERMANENTE, 1971-1987"
Santow, Gigi
Bracher, Michael
LETTERS TO THE EDITOR
Oxford University Press
1994-10-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/140/7/661
en
Copyright (C) 1994, Oxford University Press
oai:open-archive.highwire.org:amjepid:140/7/6632015-05-11HighWireOUPamjepid:140:7
RE: "ASSOCIATION OF DELAYED CONCEPTION WITH CAFFEINE CONSUMPTION"
Caan, Bette
Coates, Ashley
LETTERS TO THE EDITOR
Oxford University Press
1994-10-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/140/7/663
en
Copyright (C) 1994, Oxford University Press
oai:open-archive.highwire.org:amjepid:140/7/6642015-05-11HighWireOUPamjepid:140:7
THE AUTHORS REPLY
Hatch, Elizabcth E.
Bracken, Michael B.
LETTERS TO THE EDITOR
Oxford University Press
1994-10-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/140/7/664
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Copyright (C) 1994, Oxford University Press
oai:open-archive.highwire.org:amjepid:140/7/6652015-05-11HighWireOUPamjepid:140:7
RE: "INCONSISTENT ASSOCIATIONS OF CAFFEINE-CONTAINING BEVERAGES WITH BLOOD PRESSURE AND WITH LIPOPROTEINS: THE CARDIA STUDY"
Sharp, Dan S.
Benowitz, Neal L.
LETTERS TO THE EDITOR
Oxford University Press
1994-10-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/140/7/665
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Copyright (C) 1994, Oxford University Press
oai:open-archive.highwire.org:amjepid:140/7/6662015-05-11HighWireOUPamjepid:140:7
THE AUTHORS REPLY
Lewis, Cora E.
Funkhouser, Ellen
Hilner, Joan E.
Bragg, Charlotte
Raczynski, James M.
Caan, Bette
Armstrong, Mary Anne
Friedman, Gary D.
Dyer, Alan
Savage, Peter J.
LETTERS TO THE EDITOR
Oxford University Press
1994-10-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/140/7/666
en
Copyright (C) 1994, Oxford University Press
oai:open-archive.highwire.org:amjepid:140/7/6672015-05-11HighWireOUPamjepid:140:7
RE: "AGE AND SEASON OF BIRTH IN SUDDEN INFANT DEATH SYNDROME IN NORTH CAROLINA, 1982-1987: NO INTERACTION"
Leiss, Jack K.
Tyson, Dianne
Butts, John D.
Suchindran, C. M.
LETTERS TO THE EDITOR
Oxford University Press
1994-10-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/140/7/667
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Copyright (C) 1994, Oxford University Press
oai:open-archive.highwire.org:amjepid:140/7/6682015-05-11HighWireOUPamjepid:140:7
ERRATUM
ERRATUM
In their recent commentary, “Attributable Risk: Advantages of a Broad Definition of Exposure” (<it>Am J Epidemiol</it> 1994;140:303–9), Drs. Sholom Wacholder, Jacques Benichou, Ellen Heineman, and colleagues illustrated their discussion with data from an unpublished manuscript submitted for publication. That paper, a case-control study by R. Spirtas, E. F. Heineman, L. Bernstein, et al., “Malignant Mesothelioma: Attrib utable Risk of Asbestos Exposure,” has now been accepted by <it>Occupational and Environmental Medicine</it> and is scheduled for publication in the November 1994 issue of that journal.
Oxford University Press
1994-10-01 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/140/7/668
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Copyright (C) 1994, Oxford University Press