Descriptive epidemiology of cancer in three regions of Kazakhstan

The current study investigated data quality and estimated cancer incidence and mortality rates using data provided by Pavlodar, Semipalatinsk and Ust-Kamenogorsk Regional Cancer Registries of Kazakhstan during the period of 1996–1998. Assessment of data quality was performed using standard quality indicators including internal database checks, proportion of cases verified from death certificates only, mortality:incidence ratio, data patterns, proportion of cases with unknown primary site, proportion of cases with unknown age. Crude and age-adjusted incidence and mortality rates and 95% confidence intervals were calculated, by gender, for all cancers combined and for 28 specific cancer sites for each year of the study period. The five most frequent cancers were identified and described for every population. The results of the study provide the first simultaneous assessment of data quality and standardized incidence and mortality rates for Kazakh cancer registries. ^

Is low parental education associated with congenital heart defects?

Objective. The purpose of this study was to determine if there are associations between low parental education and congenital heart defects. ^ Methods. This was a cross-sectional study of 281,262 live born singletons, 1765 of whom were identified by the Texas Birth Defects Monitoring Division (TBDMD) as having heart defects without known chromosomal anomalies. Data on the specific diagnoses of these infants were linked to their corresponding birth certificates. Only infants born between January 1, 1995 and December 31, 1997, whose mothers resided in the Texas public health regions under surveillance by the TBDMD were included in the study. The number of years of schooling of the most educated parent was used to calculate crude, stratified and adjusted odds ratios. ^ Results. An increase in the likelihood of having an infant with any type of congenital heart defect was found among parents with less than 16 years of education, compared to those with 16 or more years of schooling. The association became more marked with increasing paternal age, and was found among whites and Hispanics but not among blacks. Statistically significant associations with low parental education were found for ventricular septal defects, transposition of the great vessels and miscellaneous heart and vessel defects. Among whites, there was an inverse association between parental education and likelihood of having an infant with a severe ASD. This association was not found among non-whites. The suggestion of an association between low parental education and tetralogy of Fallot, was also found, but was not statistically significant. Parents with ≥16 years of education had a greater likelihood of having an infant with severe endocardial cushion lesions or total anomalous pulmonary return than less well educated parents. ^ Conclusion. This study suggests that parental education is associated with certain types of heart defects, especially among whites and Hispanics. ^

Parental demographic risk factors and occupational exposure to ionizing radiation for achondroplasia, thanatophoric and autosomal deletions in Texas, 1996--2002

Little is known about the etiology of Achondroplasia (AC), Thanatophoric Dwarfism (TD), and autosomal deletions (CD). These syndromes are due to fully penetrate genetic mutations, yet arise de novo, instead of being inherited. We examined the association between parental demographic characteristics and parental occupations with exposure to ionizing radiation and these birth defects. ^ We conducted a cross-sectional study and two case-control studies using a large database that was created by linking records from Texas Birth Defects Registry, Texas birth certificates and Texas fetal death certificates from 1996 to 2002. The first case-control study was matched on paternal age and examined 73 cases of AC and 43 cases of TD. The second case-control study was unmatched and examined 343 cases of autosomal deletion syndromes. ^ We used a job exposure matrix (JEM) to measure exposures to ionizing radiation in the workplace. This gives an estimate of the intensity and probability of exposure to ionizing radiation for each occupation and industry. ^ The prevalence rate of Achondroplasia, Thanatophoric Dwarfism and autosomal deletions was 0.36 per 10,000, 0.21 per 10,000, and 1.68 per 10,000 births respectively in Texas 1996–2002. ^ Older fathers had a strong increase in the risk of having offspring with AC or TD and a modest increase in the risk of CD. Fathers who were Black or Hispanic were less likely to have infants with AC or TD compared to Whites (adjusted POR=0.61; 95% CI 0.30, 1.26 and 0.44; 95% CI 0.27, 0.88, respectively). Black fathers and Hispanic mothers were also less likely to have infants with CD (adjusted POR=0.54; 95% CI 0.22, 1.35 and 0.62; 95% CI 0.39, 0.97). ^ After adjusting for other parental demographic factors, there was no significant relation between fathers exposure to ionizing radiation in the work place and AC or TD (adjusted OR=0.48; 95% CI 0.19, 1.25) and no significant relation between parental exposure to ionizing radiation in the work place and CD (adjusted OR=1.16; 95% CI 0.73, 1.85). ^ This is the first study to find an association between father's age and TD and CD and paternal race and AC or CD. Parental exposure to radiation for therapeutic or diagnostic indications was not measured, thus it can not be excluded as a cause of these birth defects. ^

Differences in small-for-gestational-age and preterm birth among Asian subgroups in relation to nativity status

This retrospective cohort study examined the association between nativity status and very preterm birth, preterm birth, and small-for-gestational-age (SGA) among Asian subgroups using Texas birth certificate data with no personal identifiers. A total of 877,322 birth certificates of Asian and US-born white women with a singleton birth in Texas from 2001-2004 were analyzed. Birth certificate records of US-born white, Chinese, Japanese, Korean, Vietnamese, Filipino, and Asian Indian women with a singleton birth were included in the analysis. Logistic regressions models were used to explore and understand the differences of the effect of nativity status on birth outcomes in Asian subgroups with US-born whites as the reference group. Most of the Asian subgroups had a lower risk of preterm births compared with US born whites, with reductions in risk ranging from 19% to 49% and the lowest risk of preterm birth observed among foreign-born Chinese mothers. Only Filipino mothers had a higher risk of preterm birth compared to US-born whites. Overall, foreign-born Asians had lower risks for very preterm birth and preterm birth than US-born Asians and US-born whites. US-born Asians were at higher risk for preterm birth than US-born whites. For SGA, all Asian subgroups and Asian subgroups by nativity status were at higher risk of SGA than US-born whites. Asian Indians and Japanese were at highest risk for SGA infants with 2.5 to 3 times the risk of SGA present in US-born whites. Foreign-born Asian women were at higher risk for SGA than their US-born counterparts. This study showed that health disparities among Asian subgroups are hidden by classifying Asians into a single group. By examining Asian subgroups separately and looking at nativity status, the differences in risk of SGA and preterm birth can be revealed so prevention efforts can focus on high risk groups. ^

The association between maternal use of selective serotonin reuptake inhibitors during pregnancy and adverse pregnancy outcomes

Maternal use of SSRIs for depression and anxiety during pregnancy has increased over the last decade. Recent studies have questioned the safety of these antidepressants when used in during pregnancy. The aim of this project is to assess the associations between maternal SSRI use and GH, SGA, and preterm birth using data from a U.S. population-based study with self-reported exposure information. ^ The study population is comprised of mothers of control infants from the NBDPS, an ongoing, multi-state, population-based case-control study. Mothers were asked about any use of medications during pregnancy, including the dates they started and stopped taking each medication. Maternal GH was self-reported, while gestational age and birth weight were calculated from information on birth certificates or medical records. ^ Our study found that women exposed to SSRIs in the first trimester and beyond had a higher odds of GH compared to unexposed women (aOR=1.96, 95% CI=1.02-3.74). Women who used SSRIs only in the first trimester had no increased odds of GH (aOR=0.77, 95% CI=0.24-2.50). Women who used SSRIs throughout their entire pregnancy had a two-fold increase in the odds of delivering an SGA infant compared to unexposed women (aOR=2.16, 95% CI=1.01-4.62), while women who reported SSRI use only in the first trimester had a decreased odds of delivering an SGA infant (aOR=0.56, 95% CI=0.14-2.34). Finally, both women who used SSRIs in the first trimester only (aOR=1.58, 95% CI=0.71-3.51) and women who used SSRIs in the first trimester and beyond (aOR=1.49, 95% CI=0.76-2.90) had an increased odds of delivering preterm compared to unexposed women. ^ Results from our study suggest that women who use SSRIs in the first trimester and beyond have an increased and significant odds of GH and SGA. An increase in the odds of preterm birth was also observed among women exposed in this period and is consistent with the results of previous studies which had much larger sample sizes. Women who use SSRIs only in the first trimester appear to have no increased odds of GH or SGA, but may have an increased odds of preterm birth. These findings are consistent with previous studies and highlight how exposure to SSRIs at different points in gestation may result in different risks for these outcomes. ^

Association between cardiorespiratory fitness and Alzheimer's mortality: A prospective cohort study

Context. Alzheimer’s disease is a major source of morbidity and mortality in aging societies. Preventive measures, such as increasing cardiorespiratory fitness, to reduce the risk of Alzheimer’s disease mortality have not been sufficiently examined.^ Objective. To examine the association between levels of cardiorespiratory fitness and Alzheimer’s disease mortality.^ Design, Setting, and Patients. A prospective cohort study of 53,911 men and 18,876 women (mean age, 51.4 [SD, 10.0] years; range 20-88) enrolled in the Cooper Center Longitudinal Study who completed a baseline health examination during 1970-2006. The primary exposure, cardiorespiratory fitness, was assessed via a maximal exercise test. Fitness was categorized according to age- and sex-specific tertiles based on the participants’ distribution of maximal treadmill exercise test duration, in metabolic equivalent tasks (METs). The main outcome measure was Alzheimer’s disease mortality, defined as the underlying or contributing cause of death using the National Death Index and death certificates through December 31, 2006.^ Results. There were 175 Alzheimer’s disease deaths during a mean follow up of 37 years and 1,309,170 person-years of exposure. Women in the high fitness category had a 70% reduction in risk of Alzheimer’s mortality compared to women in the low fitness category (HR=0.3; 95% CI, 0.1-0.8; P=.02), while adjusting for potential confounders. Similarly, women in the moderate fitness category had a 70% reduction in risk for AD mortality compared to women in the low fit category (HR=0.3; 95% CI, 0.1-0.7; P=.005). Among men, the relationship between fitness level and AD mortality risk was examined but none were of statistical significance. The adjusted comparison of men in the high fitness category to low fit men yielded an HR of 0.9 (95% CI, 0.6-1.5; P=.79), while moderately fit men compared to low fit men yielded an HR of 1.3 (95% CI, 0.9-1.9; P=.21).^ Conclusions. Higher levels of cardiorespiratory fitness were associated with decreased risk of AD mortality, in women. No statistically significant association was found among men. Physical fitness may be an important protective factor against Alzheimer’s disease death in women, further supporting its clinical and public health values.^

Incidence of fatal gunshot injuries occurring to Galveston County residents between 1979--1981

Fatal gunshot injury deaths and their characteristics were ascertained for the population of Galveston County, Texas, for 1979-81. A total of 147 gunshot deaths occurring to residents of Galveston County were enumerated from death certificates, police and hospital records. Residents accounted for 96.1% of all gunshot deaths occurring in the county. The overall firearms death rate was 25 per 100,000 population. This ranked gunshot mortality as the third leading cause of injury death and the sixth leading cause of death from all causes. Gunshot deaths accounted for 10% of all years of life lost due to premature mortality.^ Firearms accounted for 73% of all homicide deaths. The median age of gunshot homicide victims was 27 years. Gunshot homicide mortality was highest among black males with a rate of 61 per 100,000. Rates of 23 per 100,000 and 12 per 100,000 were observed for Hispanic males and black females respectively. Gunshot homicide cases were characterized by use of "low quality" handguns (76.1%), circumstances involving a "relationship breakup" (38.1%), and alcohol consumption (79.6%). The place of occurrence of gunshot homicide was a residence in over half of all cases. The occupation most frequently associated was fishing and farming. Homicide was the primary motivation for 84% of the cases.^ The descriptive epidemiology of gunshot suicide differed from that of gunshot homicide. Firearms accounted for 64% of all suicide deaths. The median age of gunshot suicide victims was 41 years. Gunshot suicide mortality was highest among white males with a rate of 24 per 100,000. Rates of 14 per 100,000 and 9 per 100,000 were observed for black males and Hispanic females respectively. Gunshot suicide cases were characterized by use of "low quality" handguns (69.4%), circumstances involving a "relationship breakup" (39.1%) and alcohol consumption (63%). The place of occurrence was a residence in 80% of the cases. The occupation most frequently associated was police or security guard.^ Strategies for primary prevention are recommended. The research strategy, based on Haddon's model, is suggested for further investigations. ^

Assessment of cancer incidence in Titus County, Texas, 1977--1984

The purpose of this study was to determine the incidence of cancer in Titus County, Texas, through the identification of all cases of cancer that occurred in residents of the county during the period from 1977 to 1984. Data gathered from Texas Cancer Registry, hospital records, and death certificates were analyzed with regard to anatomic site, race, sex, age, city of residence, and place of birth. Adjustment of incidence rates by sex and race allowed comparisons with U.S. rates provided by the Surveillance, Epidemiology, and End Results Program (SEER).^ Seven hundred sixty-six (766) cancer cases were identified for the eight year period during 171,536 person-years of observation. In whites, statistically significant standardized incidence ratios (SIR) were found for leukemia (males SIR = 2.70 and females SIR = 2.26), melanoma (males SIR = 1.90 and females SIR = 2.25), lung (males SIR = 1.45) and for multiple myeloma (both sexes combined SIR = 1.86). In blacks, significant excess numbers of cases were found for Hodgkin's disease (males SIR = 8.33 and females SIR = 13.3) and for esophagus and bone considering both sexes together (SIR = 2.68 and 12.54, respectively). Rates for blacks were based on a small population and therefore unstable. A statistically significant excess number of cases for all sites combined was found in Mount Pleasant residents (age-adjusted incidence rate = 563.6 per 100,000 per year).^ A review of possible environmental risk factors in the area: hazardous waste disposal site, lignite deposits, and petrochemical and poultry industries are presented. A need for further epidemiological and environmental studies to identify etiological factors that could be responsible for the excess number of leukemia cases are recommended. For melanoma, a public health educational program to teach the population methods of protection from sun exposure is also suggested. ^

The use of the computerized and revised vital record in conducting etiologic studies on neural tube defects

The purpose of this study was to evaluate the adequacy of computerized vital records in Texas for conducting etiologic studies on neural tube defects (NTDs), using the revised and expanded National Centers for Health Statistics vital record forms introduced in Texas in 1989.^ Cases of NTDs (anencephaly and spina bifida) among Harris County (Houston) residents were identified from the computerized birth and death records for 1989-1991. The validity of the system was then measured against cases ascertained independently through medical records and death certificates. The computerized system performed poorly in its identification of NTDs, particularly for anencephaly, where the false positive rate was 80% with little or no improvement over the 3-year period. For both NTDs the sensitivity and predictive value positive of the tapes were somewhat higher for Hispanic than non-Hispanic mothers.^ Case control studies were conducted utilizing the tape set and the independently verified data set, using controls selected from the live birth tapes. Findings varied widely between the data sets. For example, the anencephaly odds ratio for Hispanic mothers (vs. non-Hispanic) was 1.91 (CI = 1.38-2.65) for the tape file, but 3.18 (CI = 1.81-5.58) for verified records. The odds ratio for diabetes was elevated for the tape set (OR = 3.33, CI = 1.67-6.66) but not for verified cases (OR = 1.09, CI = 0.24-4.96), among whom few mothers were diabetic. It was concluded that computerized tapes should not be solely relied on for NTD studies.^ Using the verified cases, Hispanic mother was associated with spina bifida, and Hispanic mother, teen mother, and previous pregnancy terminations were associated with anencephaly. Mother's birthplace, education, parity, and diabetes were not significant for either NTD.^ Stratified analyses revealed several notable examples of statistical interaction. For anencephaly, strong interaction was observed between Hispanic origin and trimester of first prenatal care.^ The prevalence was 3.8 per 10,000 live births for anencephaly and 2.0 for spina bifida (5.8 per 10,000 births for the combined categories). ^

THE RELATIONSHIP BETWEEN SERUM CHOLESTEROL AND CANCER INCIDENCE IN THE POPULATION OF THE HYPERTENSION DETECTION AND FOLLOW-UP PROGRAM

The relationship between serum cholesterol and cancer incidence was investigated in the population of the Hypertension Detection and Follow-up Program (HDFP). The HDFP was a multi-center trial designed to test the effectiveness of a stepped program of medication in reducing mortality associated with hypertension. Over 10,000 participants, ages 30-69, were followed with clinic and home visits for a minimum of five years. Cancer incidence was ascertained from existing study documents, which included hospitalization records, autopsy reports and death certificates. During the five years of follow-up, 286 new cancer cases were documented. The distribution of sites and total number of cases were similar to those predicted using rates from the Third National Cancer Survey. A non-fasting baseline serum cholesterol level was available for most participants. Age, sex, and race specific five-year cancer incidence rates were computed for each cholesterol quartile. Rates were also computed by smoking status, education status, and percent ideal weight quartiles. In addition, these and other factors were investigated with the use of the multiple logistic model.^ For all cancers combined, a significant inverse relationship existed between baseline serum cholesterol levels and cancer incidence. Previously documented associations between smoking, education and cancer were also demonstrated but did not account for the relationship between serum cholesterol and cancer. The relationship was more evident in males than females but this was felt to represent the different distribution of occurrence of specific cancer sites in the two sexes. The inverse relationship existed for all specific sites investigated (except breast) although a level of statistical significance was reached only for prostate carcinoma. Analyses after exclusion of cases diagnosed during the first two years of follow-up still yielded an inverse relationship. Life table analysis indicated that competing risks during the period of follow-up did not account for the existence of an inverse relationship. It is concluded that a weak inverse relationship does exist between serum cholesterol for many but not all cancer sites. This relationship is not due to confounding by other known cancer risk factors, competing risks or persons entering the study with undiagnosed cancer. Not enough information is available at the present time to determine whether this relationship is causal and further research is suggested. ^

OUT-OF-HOSPITAL CHILDBEARING CENTERS IN THE UNITED STATES: A DESCRIPTIVE STUDY OF THE DEMOGRAPHIC AND MEDICAL-OBSTETRIC CHARACTERISTICS OF WOMEN BEGINNING LABOR THEREIN 1972-1979

There is currently much interest in the appropriate use of obstetrical technology, cost containment and meeting consumers' needs for safe and satisfying maternity care. At the same time, there has been an increase in professionally unattended home births. In response, a new type of service, the out-of-hospital childbearing center (CBC) has been developed which is administratively and structurally separate from the hospital. In the CBC, maternity care is provided by certified nurse-midwives to carefully screened low risk childbearing families in conjunction with physician and hospital back-up.^ It was the purpose of this study to accomplish the following objectives: (1) To describe in a historical prospective study the demographic and medical-obstetric characteristics of patients laboring in eleven selected out-of-hospital childbearing centers in the United States from May 1, 1972, to December 15, 1979. Labor is defined as the onset of regular contractions as determined by the patient. (2) To describe any differences between those patients who require transfer to a back-up hospital and those who do not. (3) To describe administrative and service characteristics of eleven selected out-of-hospital childbearing centers in the United States. (4) To compare the demographic and medical-obstetric characteristics of women laboring in eleven selected out-of-hospital childbearing centers with a national sample of women of similar obstetric risk who according to birth certificates delivered legitimate infants in a hospital setting in the United States in 1972.^ Research concerning CBCs and supportive to the development of CBCs including studies which identified factors associated with fetal and perinatal morbidity and mortality, obstetrical risk screening, and the progress of technological development in obstetrics were reviewed. Information concerning the organization and delivery of care at each selected CBC was also collected and analyzed.^ A stratified, systematic sample of 1938 low risk women who began labor in a selected CBC were included in the study. These women were not unlike those described previously in small single center studies reported in the literature. The mean age was 25 years. Sixty-three per cent were white, 34 per cent Hispanic, 88 per cent married, 45 per cent had completed at least two years of college, nearly one-third were professionals and over a third were housewives. . . . (Author's abstract exceeds stipulated maximum length. Discontinued here with permission of school.) UMI ^

Las redes étnicas en la emigración : los gallegos en Buenos Aires

En este trabajo analizaremos los lazos sociales mantenidos y generados por los inmigrantes gallegos en el Buenos Aires tardo colonial, con otros familiares y paisanos instalados en la capital virreinal o en la tierra natal. Tomaremos en consideración los aportes del Análisis de Redes a los estudios migratorios y a partir de ello identificaremos las redes étnicas y los mecanismos sociales que las activaron. Nos basaremos en un conjunto variado de fuentes (las actas matrimoniales, las sucesiones testamentarias, los padrones de habitantes y expedientes varios localizados en el Archivo General de la Nación Argentina) que nos permitirán examinar las diferentes vías (el ejercicio comercial, los matrimonios, el temprano asociacionismo, las disposiciones testamentarias, entre otras) a través de las cuales los inmigrantes establecieron los contactos sociales en cuestión. De este modo, constataremos el componente afectivo e identificatorio que pudo orientar los lazos étnicos y su importante funcionalidad instrumental, en un contexto donde el inmigrante necesitaba garantizar su integración en la sociedad de acogida. El estudio también pondrá de manifiesto que, sin llegar a constituirse en un “grupo cerrado", los oriundos de Galicia reforzaron sus vínculos entre sí, cuando fue posible.

Los títulos coloniales y la propiedad plena en la región pampeana cordobesa a fines del siglo XIX

El objetivo del artículo es analizar la apropiación de la tierra a través de la legalización de títulos precarios ocurrida en la segunda mitad del siglo XIX en la región pampeana argentina. Para ello, se recurrió a un recorte temporal y espacial y aun abordaje cualitativo de documentación judicial, notarial y catastral, relacionada con los inmuebles afectados por mercedes o denuncias coloniales, correspondientes al departamento Rio Cuarto.
Una de las principales conclusiones alcanzadas es que por medio de la legitimación de derechos precarios se constituyó un grupo de grandes propietarios de reciente vinculación con la tierra

Los títulos coloniales y la propiedad plena en la región pampeana cordobesa a fines del siglo XIX

El objetivo del artículo es analizar la apropiación de la tierra a través de la legalización de títulos precarios ocurrida en la segunda mitad del siglo XIX en la región pampeana argentina. Para ello, se recurrió a un recorte temporal y espacial y aun abordaje cualitativo de documentación judicial, notarial y catastral, relacionada con los inmuebles afectados por mercedes o denuncias coloniales, correspondientes al departamento Rio Cuarto.
Una de las principales conclusiones alcanzadas es que por medio de la legitimación de derechos precarios se constituyó un grupo de grandes propietarios de reciente vinculación con la tierra

Los títulos coloniales y la propiedad plena en la región pampeana cordobesa a fines del siglo XIX

El objetivo del artículo es analizar la apropiación de la tierra a través de la legalización de títulos precarios ocurrida en la segunda mitad del siglo XIX en la región pampeana argentina. Para ello, se recurrió a un recorte temporal y espacial y aun abordaje cualitativo de documentación judicial, notarial y catastral, relacionada con los inmuebles afectados por mercedes o denuncias coloniales, correspondientes al departamento Rio Cuarto.
Una de las principales conclusiones alcanzadas es que por medio de la legitimación de derechos precarios se constituyó un grupo de grandes propietarios de reciente vinculación con la tierra