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Objective. To explore how underlying disability affects treatments and outcomes of disabled women with breast cancer. Data Sources. Surveillance, Epidemiology, and End Results program data, linked with Medicare files and Social Security Administration disability group. Study Design. Ninety thousand two hundred and forty-three incident cases of early-stage breast cancer under age 65; adjusted relative risks and hazards ratios examined treatments and survival, respectively, for women in four disability groups compared with nondisabled women. Principal Findings. Demographic characteristics, treatments, and survival varied among four disability groups. Compared with nondisabled women, those with mental disorders and neurological conditions had significantly lower adjusted rates of breast conserving surgery and radiation therapy. Survival outcomes also varied by disability type. Conclusions. Compared with nondisabled women, certain subgroups of women with disabilities are especially likely to experience disparities in care for breast cancer. Key Words. Breast cancer, disability, disparities, Government officials, including the U.S. Surgeon General, and patient advocates have called for including persons with disabilities in treatment disparity studies (U.S. Department of Health and Human Services 2000, 2005). [...]

Objective. To examine stage at diagnosis and survival for disabled Medicare beneficiaries diagnosed with cancer under age 65 and compare their experiences with those of other persons diagnosed under age 65. Data Sources. Surveillance, Epidemiology, and End Results (SEER) Program data and SEER-Medicare linked data for 1988-1999. SEER-11 Program includes 11 population-based tumor registries collecting information on all incident cancers in catchment areas. Tumor registry and Medicare data are linked for persons enrolled in Medicare. Study Design. 307,595 incident cases of non-small cell lung (51,963), colorectal (52,092), breast (142,281), and prostate (61,259) cancer diagnosed in persons under age 65 from 1988 to 1999. Persons who qualified for Social Security Disability Insurance and had Medicare (SSDI/Medicare) were identified from Medicare enrollment files. Ordinal polychotomous logistic regression and Cox proportional hazards regression were used to estimate adjusted associations between disability status and later-stage diagnoses and mortality (all-cause and cancer-specific). Principal Findings. Persons with SSDI/Medicare had lower rates of Stages III/IV diagnoses than others for lung (63.3 versus 69.5 percent) and prostate (25.5 versus 30.8 percent) cancers, but not for breast or colorectal cancers. After adjustment, they remained less likely to be diagnosed at later stages for lung and prostate cancers. Nevertheless, persons with SSDI/Medicare experienced higher all-cause mortality for each cancer. Cancer-specific mortality was higher among persons with SSDI/Medicare for breast and colorectal cancer patients. Conclusions. Disabled Medicare beneficiaries are diagnosed with cancer at similar or earlier stages than others. However, they experience higher rates of cancer-related mortality when diagnosed at the same stage of breast and colorectal cancer. Key Words. Disability, disparities, stage of cancer, cancer survival, SSDI, SEER-Medicare, Populations with attributes marking social disadvantage in the United States--such as persons living in poverty and racial and ethnic minorities--often experience worse outcomes than others when diagnosed with cancer. They [...]

Background: Breast-conserving surgery combined with axillary lymph node dissection and radiotherapy or mastectomy are definitive treatments for women with early-stage breast cancer. Little is known about breast cancer treatment for women with disabilities. Objective: To compare initial treatment for early-stage breast cancer between women with and without disabilities and to examine the association of treatment differences and survival. Design: Retrospective cohort study. Setting: 11 Surveillance, Epidemiology, and End Results (SEER) Program tumor registries. Participants: 100 311 women who received a diagnosis of stage I to IIIA breast cancer at 21 to 64 years of age from 1988 to 1999. Women who qualified for Social Security Disability Insurance (SSDI) and Medicare at breast cancer diagnosis were considered disabled. Measurements: Receipt of breast-conserving surgery versus mastectomy. For women who had breast-conserving surgery (n = 49 166), the authors examined receipt of radiotherapy and axillary lymph node dissection. Survival was measured from diagnosis until death or until 31 December 2001. Results: Women with SSDI and Medicare coverage had lower rates of breast-conserving surgery than other women (43.2% vs. 49.2%; adjusted relative risk, 0.80 [95% CI, 0.76 to 0.84]). Among women who had breast-conserving surgery, women with SSDI and Medicare coverage were less likely than other women to receive radiotherapy (adjusted relative risk, 0.83 [CI, 0.77 to 0.90]) and axillary lymph node dissection (adjusted relative risk, 0.81 [CI, 0.74 to 0.90]). Women with SSDI and Medicare coverage had lower survival rates than those of other women in all-cause mortality (adjusted hazard ratio, 2.02 [CI, 1.88 to 2.16]) and breast cancer-specific mortality (adjusted hazard ratio, 1.31 [CI, 1.18 to 1.45]). Results were similar after adjustment for treatment differences. Limitations: Findings are limited to women who qualified for SSDI and Medicare. No data on adjuvant chemotherapy and hormonal therapy were available, and details about the underlying disability were lacking. Conclusions: Women with disabilities had higher breast cancer mortality rates and were less likely to undergo standard therapy after breast-conserving surgery than other women. Differences in treatment did not explain the differences in breast cancer mortality rates.

Background: Heatstroke is the third leading cause of death in athletics, and an important cause of morbidity and mortality in exercising athletes. There is no current method, however, for identifying [...]

Background: The success with which primary care physicians are able to meet American Diabetes Association (ADA) clinical goals is unknown. Methods: Charts of 218 randomly sampled type 2 diabetic patients [...]

KEY POINTS FOR CLINICIANS * A greater supply of primary care physicians is associated with a lower incidence of colorectal cancer and a lower colorectal cancer mortality rate. * More [...]

Background. Little is known about the screening behavior of older minority women, especially Hispanic women. Data from Los Angeles were compared to national data to examine any similarities and unique problems. Methods. In 1990, 726 women from Los Angeles older than 65 years of age were surveyed by telephone after being identified through a probability sample or through Medicare listings. Mammography experience and knowledge and attitudes about screening were collected. Differences in mammography experience by racial/ethnic group were computed using the chi-square test. Results. Hispanic women were not underscreened significantly compared with older white and black women. Approximately three quarters of Hispanics had had a mammogram in the previous 2 years, compared with 84% of blacks and 82% of whites. Income and education levels were more explanatory of underscreening than was race. For example, 50% of whites with incomes of less than $15,000 had been screened in the previous 2 years, compared with 71% of those with higher incomes. Hispanics, however, reported significantly more concerns about screening and getting breast cancer than did whites or blacks despite the Hispanics' lower incidence and mortality rates. Hispanics also reported more health insurance inadequacies and a poorer quality of life that may interfere with maintenance of screening behaviors. Conclusions. To maintain equal screening across racial/ethnic groups, national programs should focus on strategies that help Hispanics acculturate to achieve equal educational and other benefits. To decrease screening inequities within races and help realize the National Cancer Institute's Year 2000 goals, income and educational differences will need to be less pronounced. Cancer 1994; 74:2028-33.

Background. Although there have been clear secular trends of increased use of some breast cancer screening modalities, such as mammography, it is less certain that similar trends have occurred among high risk women. Methods. Population-based surveys were conducted in three socioeconomically diverse Los Angeles communities in 1988 and 1990. Trends in breast cancer screening behavior and key determinants of screening were compared separately for women with a family history of breast cancer, a personal history of benign breast disease, and for women without these risks. Results: In two independent samples drawn in 1988 and 1990, women at a higher risk of breast cancer (positive family history) showed smaller increases in the prevalence of self-reported breast cancer screening than a comparison group of women without a family history of breast cancer or a history of benign breast disease. This was especially true for family-history-positive minority Women and women aged 65 years and older, for whom screening actually decreased. In 1990, mammograms for the prior year were reported by only 39% of women with a positive family history, 54% of women with benign breast disease, and 35% of women without these risks. Trends in physicians' office visit discussions of breast cancer screening paralleled trends observed in screening behavior. Conclusions. Although breast cancer screening increased substantially among lower risk women, rates were unchanged for women at increased risk because of a family history of breast cancer. By identifying and counseling higher risk women, physicians can play an important role in promoting appropriate screening to this group. Cancer 1994; 74:625-31.

Background. Americans visit their primary care physicians several times a year. These visits provide physicians with many opportunities to reduce cancer risk in their patients by recommending periodic cancer screening. There is evidence of noncompliance among primary care physicians and their patients with regard to periodic cancer screening. Barriers to screening may be perceived by physicians and patients. Results. The authors found that when physicians recommended cancer screening tests, the compliance among patients was relatively high. Conclusion. Primary care physicians can take the opportunity to recommend cancer screening tests during routine patient visits, and this strategy may well increase cancer screening rates in the population. Cancer 1993; 71:839-43.

Background. The American Cancer Society has sponsored community-based, low-cost, Breast Cancer Detection Awareness Projects throughout the United States. The authors hypothesized that these projects tend to exclude minorities and women of lower socioeconomic status--groups with a higher incidence of late-stage disease. Methods. A cross-sectional survey was performed of participants in the 1990 Breast Screening Project in Tampa, Florida. The demographic profile of participants was compared with that predicted by 1990 census data. Results. There were 13,920 women who called phone banks for additional information. Of these, 13,215 were deemed eligible and 6640 completed mammographic screening. Forty percent of participants were having mammography for the first time. Comparisons with census data indicated that elderly people, members of minority groups, and women of lower educational levels were underrepresented. Conclusions. The results of this study support the concept that 'reverse targeting' occurs with these breast cancer screening projects, and recommendations for recruiting underrepresented groups are given. Cancer 1992; 70:1152-1158.

Background. Unavoidable exposure to disease and to patients susceptible and vulnerable to disease warrants that students entering medical school be immunized against many of the illnesses for which vaccines are available. The validity of immunization records presented at the time of registration, however, is largely dependent on the provision of accurate and reliable documentation by the student. Methods. We evaluated for authenticity the immunization and tuberculin testing records of 85 students entering medical school in 1990. Five levels of valid documentation were defined, and the information on each record was reviewed accordingly. Results. Only 43% of the records were original documents or laboratory reports of antibody titers, and 7.5% were not date-specific. We found that 8% to 20% of the forms were missing physician and/or student signatures, and 12% to 19% of the forms did not have health care provider addresses. Conclusions. Even though medical student preventive health programs may have strict requirements, there may be substantial deficiencies in the quality of the documentation provided by the students. Such deficiencies undermine the purpose of these programs., Students in the health care professions are susceptible to acquiring and transmitting communicable diseases; therefore, the trend among medical schools is toward requiring health status certification before matriculation. Various organizations [...]

ABSTRACT Background Comorbidity may be associated with later detection of cancer. Methods. Incident cases of colorectal, breast, and prostate cancer and melanoma were determined from the 1994 Florida state tumor [...]

Objective: To examine the frequency with which sun protection is used by parents for their children. Design and Selling: Descriptive survey conducted at a university medical clinic in Florida. Participants: Parents of children aged 1 to 16 years were approached in the waiting area, and 77 of 100 were successfully interviewed. Main Outcome Measures: Parents' self-reported use of sun protection measures for their children and their attitudes and beliefs about sun protection. Results: Fewer than half of respondents (43%) reported regularly using sun protection for their child. Regular use of sun protection was reported more frequently by female caretakers and those with more favorable attitudes regarding sun protection use. Sunscreen was the most frequently used measure, and preventing sunburn was the primary reason for using sun protection. Respondents held several unfavorable sun protection attitudes, including the belief that sun exposure was healthy, that children looked better with a tan, and that it was okay to stay out in the sun longer if the child wore sunscreen. Conclusions: Regular use of sun protection for children is infrequent and consists primarily of applying sunscreen rather than methods that reduce sun exposure. Parents primarily use sunscreen to prevent sunburn and may increase their children's overall sun exposure as a result. Arch Pediatr Adolesc Med. 2001;155:891-896

BACKGROUND * Despite widespread use, the accuracy of community-based automated blood pressure machines has been questioned. We sought to determine if these machines are as accurate and reliable as those [...]

BACKGROUND. Policymakers question whether there is a relationship between the number and distribution of physicians and the outcomes for important health conditions. We hypothesized that increasing primary care physician supply [...]

Background: The presence and type of health insurance may be an important determinant of cancer stage at diagnosis. To determine whether previously observed racial differences in stage of cancer at diagnosis may be explained partly by differences in insurance coverage, we studied all patients with incident cases of melanoma or colorectal, breast, or prostate cancer in Florida in 1994 for whom the stage at diagnosis and insurance status were known. Methods: The effects of insurance and race on the odds of a late stage (regional or distant) diagnosis were examined by adjusting for an individual's age, sex, marital status, education, income, and comorbidity. All P values are two-sided. Results: Data from 28237 patients were analyzed. Persons who were uninsured were more likely diagnosed at a late stage (colorectal cancer odds ratio [OR] = 1.67, P = .004; melanoma OR = 2.59, P = .004; breast cancer OR = 1.43, P = .001; prostate cancer OR = 1.47, P = .02) than were persons with commercial indemnity insurance. Patients insured by Medicaid were more likely diagnosed at a late stage of breast cancer (OR = 1.87, P [is less than] .001) and melanoma (OR = 4.69, P [is less than] .001). Non-Hispanic African-American patients were more likely diagnosed with late stage breast and prostate cancers than were non-Hispanic whites. Hispanic patients were more likely to be diagnosed with late stage breast cancer but less likely to be diagnosed with late stage prostate cancer. Conclusions: Persons lacking health insurance and persons insured by Medicaid are more likely diagnosed with late stage cancer at diverse sites, and efforts to improve access to cancer-screening services are warranted for these groups. Racial differences in stage at diagnosis are not explained by insurance coverage or socioeconomic status. [J Natl Cancer Inst 1999;91:1409-15]

The nonsteroidal anti-inflammatory drug diflunisal is used to treat rheumatism and to relieve pain. This drug is derived from aspirin and causes a skin outbreak in 3 to 5 percent of treated patients. Diflunisal was also reported to cause Stevens-Johnson syndrome, also referred to as erythema multiforme, a spotty outbreak of dark red, solid, circular skin lesions, and areas of swelling; urticaria, or itching hives; and exfoliative dermatitis, characterized by skin inflammation, redness, and flaky shedding. A case is described of a 30-year-old woman who developed a fixed drug eruption after treatment with diflunisal. The patient developed six reddish oval patches on her legs, right hip, and abdomen after taking diflunisal for a headache the previous day. After this patient discontinued use of diflunisal, her lesions resolved. She reported the development of similar lesions in the same areas after using diflunisal previously. In fixed drug reactions, the outbreak recurs at the same site as the initial eruption after resumption of drug therapy. The condition is treated by discontinuing the drug. When the lesions resolve, the affected skin become hyperpigmented, or discolored, due to deterioration of the outer skin layer and release of pigments. In this case, the lesions healed without hyperpigmentation. This is the first reported case of fixed drug eruption caused by diflunisal. (Consumer Summary produced by Reliance Medical Information, Inc.)