Medicine and Health Sciences Commons^™

Variability Of Target Volume Delineation In Cervical Esophageal Cancer, Patricia Tai, Jake Van Dyk, Edward Yu, Jerry Battista, Larry Stitt, Terry Coad

Edward Yu

PURPOSE: Three-dimensional (3D) conformal radiation therapy (CRT) assumes and requires the precise delineation of the target volume. To assess the consistency of target volume delineation by radiation oncologists, who treat esophageal cancers, we have performed a transCanada survey. MATERIALS AND METHODS: One of three case presentations, including CT scan images, of different stages of cervical esophageal cancer was randomly chosen and sent by mail. Respondents were asked to fill in questionnaires regarding treatment techniques and to outline boost target volumes for the primary tumor on CT scans, using ICRU-50 definitions. RESULTS: Of 58 radiation oncologists who agreed to participate, 48 …

A Longitudinal Study Of Hospitalization Rates For Patients With Chronic Disease: Results From The Medical Outcomes Study., Eugene C. Nelson, Colleen A. Mchorney, Willard G. Manning, W H. Rogers

Dartmouth Scholarship

To prospectively compare inpatient and outpatient utilization rates between prepaid (PPD) and fee-for-service (FFS) insurance coverage for patients with chronic disease. Data from the Medical Outcomes Study, a longitudinal observational study of chronic disease patients conducted in Boston, Chicago, and Los Angeles.A four-year prospective study of resource utilization among 1,681 patients under treatment for hypertension, diabetes, myocardial infarction, or congestive heart failure in the practices of 367 clinicians.

Does Delay In Breast Irradiation Following Conservative Breast Surgery In Node-Negative Breast Cancer Patients Have An Impact On Risk Of Recurrence?, Olga Vujovic, Francisco Perera, A. Dar, Larry Stitt, Edward Yu, Sachi Voruganti, Pauline Truong

Edward Yu

PURPOSE: This retrospective review was conducted to determine if delay in the start of radiotherapy after definitive breast surgery had any detrimental effect on local recurrence or disease-free survival in node-negative breast cancer patients. METHODS AND MATERIALS: A total of 568 patients with T1-T2, N0 breast cancer were treated with breast-conserving surgery and breast irradiation, without adjuvant systemic therapy between January 1, 1985 and December 31, 1992, at the London Regional Cancer Centre. Adjuvant breast irradiation consisted either of 50 Gy in 25 fractions or 40 Gy in 15 or 16 fractions, followed by a boost of 10 Gy or …

Secular Trends In The Incidence Of Anorexia Nervosa: Integrative Review Of Population-Based Studies, Kevin M. Gorey

Social Work Publications

OBJECTIVE AND METHOD: Aggregating across retrospective cohort samples, this integrative review synthesizes the findings of 12 cumulative incidence studies (45 hypotheses) on anorexia nervosa secular trends.

RESULTS: (1) The female/male anorexia incidence rate ratio was estimated to be 8.20, 18.46 versus 2.25 cases per 100,000 per year, p < .05; (2) female teenagers experienced anorexia at a rate fivefold greater than other women, 50.82 versus 10.37 incident cases per 100,000 per year, p < .001; (3) no secular trend or change in the incidence of anorexia was observed among teenagers, while a near threefold increase was observed over the past 40 years among women in their 20s and 30s, 6.28 (1950-1964) versus 17.70 (1980-1992) cases per 100,000 per year, p < .05; and (4) the two cohort characteristics of age, and the age by year interaction accounted for nearly two thirds of the variability among anorexia incidence estimates, R2 = .614, F(2,27) = 21.49, p < .001. After the two factors of age and the Age x Year interaction were accounted for, none of the other study characteristics, including study year(s), were found to be significantly associated with anorexia incidence, that is, a main effect of time was not observed.

DISCUSSION: The integrative evidence across the population-based epidemiologic studies covering 40 years in this field suggests strongly that, overall, the incidence of anorexia nervosa, particularly among those very young women at greatest risk of experiencing it, has not increased significantly. However, the risk does seem to have increased significantly among women in …

Effectiveness Of Case Management With Severely And Persistently Mentally Ill People, Kevin M. Gorey

Social Work Publications

This meta-analytic review synthesizes the findings of 24 published studies dealing with the effectiveness of case management with the severely and persistently mentally ill. Summative findings were: (1) Overall, case management interventions are effective--75% of the clients who participate in them do better than the average client who does not; (2) The estimated preventive fraction (e.g., prevention of re-hospitalization) among clients who experience relatively intense case management service (case loads of 15 or less, 89%) is nearly 30% greater than that estimated among similar clients receiving less intensive service; and (3) Various case management practice models did not differ significantly …

Gorey, K. Association Between Socioeconomic Status And Cancer Incidence In Toronto, Ontario: Possible Confounding Of Cancer Mortality By Incidence And Survival, Kevin M. Gorey

Social Work Publications

OBJECTIVE: To observe the association between socioeconomic status (SES) and cancer incidence in a cohort of Canadians.

DESIGN: Cases of primary malignant cancer (83,666) that arose in metropolitan Toronto, Ont., from 1986 to 1993 were ascertained by the Ontario Cancer Registry and linked by residence at the time of diagnosis to a census-based measure of SES. Socioeconomic quintile areas were then compared by cancer incidence.

RESULTS: Significant associations between SES and cancer incidence in the hypothesized direction--greater incidence in low-income areas--were observed for 15 of 23 cancer sites.

CONCLUSIONS: These findings, together with the recently observed consistent pattern of significant …

Secular Trends In The United States Black/White Hypertension Prevalence Ratio: Potential Impact Of Diminishing Response Rates, Kevin M. Gorey

Social Work Publications

In this integrative review, the authors analyzed 25 studies on hypertension prevalence among black and white adults (1960-1991). The authors made the following inferences: 1) both female (2.59 vs. 1.77) and male (2.20 vs. 1.38) black/white hypertension prevalence ratios have diminished by approximately a third over the past three decades; 2) response rates were significantly lower among the more recent surveys (i.e., 1976 or later, mean 69.2 percent (standard deviation (SD) 6.9) vs. 1960 to 1975, mean 86.1 percent (SD 9.1)); and 3) these two trends are directly associated--response rates may account for a third (women, R2 = 0.362) to …

The Beneficial Effects Of Volunteering For Older Volunteers And The People They Serve: A Meta-Analysis, Kevin M. Gorey

Social Work Publications

The current political-economic climate, which is generally supportive of both private and public sector down-sizing, increasingly demands that human service workers assess, engage, and creatively use consumer strengths and resources. This meta-analysis of thirty-seven independent studies provided the means of inferring not only that elder volunteers' sense of well-being seemed to be significantly bolstered through volunteering, but also that such relatively healthy older people represent a significant adjunct resource for meeting some of the service needs of more vulnerable elders, as well as those of other similarly vulnerable groups such as disabled children. Averaging across studies, 85 percent of the …

Surveillance For Waterborne-Disease Outbreaks -- United States, 1995-1996, Deborah A. Levy, Michelle S. Bens, Gunther F. Craun, Rebecca L. Calderon, Barbara L. Herwaldt

Journal Articles: Epidemiology

PROBLEM/CONDITION: Since 1971, CDC and the U.S. Environmental Protection Agency have maintained a collaborative surveillance system for collecting and periodically reporting data that relate to occurrences and causes of waterborne-disease outbreaks (WBDOs).

REPORTING PERIOD COVERED: This summary includes data for January 1995 through December 1996 and previously unreported outbreaks in 1994.

DESCRIPTION OF THE SYSTEM: The surveillance system includes data about outbreaks associated with drinking water and recreational water. State, territorial, and local public health departments are primarily responsible for detecting and investigating WBDOs and for voluntarily reporting them to CDC on a standard form.

RESULTS: For the period 1995-1996, …

Superior Vena Cava Obstruction In Small-Cell Lung Cancer, Roscoe Chan, A. Dar, Edward Yu, Larry Stitt, Francis Whiston, Pauline Truong, Mark Vincent, Walter Kocha

Edward Yu

PURPOSE: To identify prognostic or treatment factors influencing the response of superior vena cava obstruction (SVCO), time to SVCO recurrence, and overall survival of SCLC patients with SVCO at presentation; and to assess the role of retreatment in patients with SVCO at recurrent or persistent disease. METHODS AND MATERIALS: Between January 1983 and November 1993, 76 consecutive patients who had small-cell lung cancer (SCLC) with SVCO were treated in our institution. Analysis was done according to the disease status at diagnosis of SVCO. The first analysis concerned a group of 50 patients who had SVCO at initial presentation. The second …

The Prevalence Of Child Sexual Abuse: Integrative Review Adjustment For Potential Response And Measurement Biases, Kevin M. Gorey

Social Work Publications

This integrative review synthesizes the finding of 16 cross-sectional surveys (25 hypotheses) on the prevalence of child abuse among nonclinical, North American samples. It is essentially a research literature on sexual abuse; only one of the studies assessed physical abuse, and there has not yet been a single study of prevalent child emotional abuse nor neglect. The following summative inferences were made: (1) response rates diminished significantly over time, M = 68% prior to 1985 and M = 49% for more recent surveys, p < .05; (2) unadjusted estimates of the prevalent experience among women and men of childhood sexual abuse was 22.3% and 8.5%, respectively; (3) study response rates and child abuse operational definitions together accounted for half of the observed variability in their abuse prevalence estimates, R2 = .500, p < .05; (4) female and male child sexual abuse prevalence estimates adjusted for response rates (60% or more) were respectively, 16.8% and 7.9%, and adjusted for operational definitions (excluding the broadest, noncontact category) they were 14.5% and 7.2%; (5) after adjustment for response rates and definitions, the prevalence of child sexual abuse was not found to vary significantly over the three decades reviewed. Given the large human costs, both personal and social, of child abuse, and the identified gap in the requisite knowledge needed to steer effective preventive and treatment interventions, it is time to invest in a large, methodologically rigorous, population-based study of child abuse which, if it does nothing else, spares no expense in ensuring very high participation.

An International Comparison Of Cancer Survival: Toronto, Ontario, And Detroit, Michigan, Metropolitan Areas, Kevin M. Gorey

Social Work Publications

OBJECTIVES: This study examined whether socioeconomic status has a differential effect on the survival of adults diagnosed with cancer in Canada and the United States.

METHODS: The Ontario Cancer Registry and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program provided a total of 58,202 and 76,055 population-based primary malignant cancer cases for Toronto, Ontario, and Detroit, Mich, respectively. Socioeconomic data for each person's residence at time of diagnosis were taken from population censuses.

RESULTS: In the US cohort, there was a significant association between socioeconomic status and survival for 12 of the 15 most common cancer sites; …

The Association Of Near Poverty Status With Cancer Incidence Among Black And White Adults, Kevin M. Gorey

Social Work Publications

This cumulative incidence study was accomplished among adults in Upstate New York metropolitan areas (Buffalo, Rochester, Syracuse and Albany--1979-1986). It used a new ecological socioeconomic status measure--near poverty status (i.e., below 200% of the federally established poverty criterion, including the poor and near poor)--and observed its association with site-specific cancer incidence (lung, stomach, cervix uteri, prostate, colon, rectum and breast). Findings were: 1) near poverty status is directly associated with each cancer site's incidence and the strength of the associations are similar among blacks and whites for each one and 2) the prevalence of exposure, of living in high near …

Cancer Differentials Among Us Blacks And Whites: Quantitative Estimates Of Socioeconomic-Related Risks, Kevin M. Gorey

Social Work Publications

This article analyzes 10 studies that assessed the association of socioeconomic status (SES) with cancer occurrence among blacks and whites in the United States. The following summative inferences were made: the associations of SES with cancer are similar among blacks and whites; cancers of organ sites with the most intimate environmental interfaces have the strongest SES-cancer associations (stomach, lung, cervix, and rectum); the prevalence of exposure to low socioeconomic-related risks such as poverty are approximately fourfold greater among blacks; the all-site population attributable risk percent due to low socioeconomic exposure among blacks is estimated to be four times that of …

Effects Of Surgery On The Mental Status Of Older Persons. A Meta-Analytic Review, Arthur G. Cryns, Kevin M. Gorey, Marion Z. Goldstein

Social Work Publications

The data bases of 18 empirical studies were combined into one comprehensive data set and subjected to meta-analysis. The following trends were observed: (1) surgery has a significantly decompensating impact on the mental status of older persons, and the average effect size observed is modest (r = .37); (2) for all mental status measures included in the review (cognition, delirium and affect), effect size appears to be significantly moderated by patient age; (3) patient sex may be predictive of the kind of mental impairment that is most likely to occur within an older surgery population, with women manifesting a greater …