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A case-control study was conducted among 205 women in Michigan and Ohio who were diagnosed with undifferentiated connective tissue disease (UCTD) to investigate the significance of self-reported past exposures to implanted silicone-containing or non-silicone-containing medical devices. The 205 UCTD cases were compared with 2,095 controls who were sampled by random digit dialing. When silicone-containing devices, including shunts and catheters, were analyzed collectively, a significant association was observed (odds ratio (OR) = 2.81, 95% confidence interval (CI): 1.34, 5.89). The odds ratio for exposure to breast implants was increased, but not significantly (OR = 2.22, 95% CI: 0.65, 7.57). Among the non-silicone-containing devices, artificial joints (OR = 5.01, 95% CI: 1.60, 15.71) and orthopedic metallic fixation devices (OR = 1.95, 95% CI: 1.05, 3.60) were associated with UCTD. The estimations of risk associated with implanted medical devices in UCTD cases were explored in a comparison with 660 scleroderma patients who were ascertained concurrently in Michigan and Ohio. In general, the associations that were observed with non-silicone-containing devices, and more specifically with the fixation devices, persisted in the comparison of UCTD cases with scleroderma patients. The studies conducted among populations in Michigan and Ohio are intended to stimulate new hypotheses, innovative approaches, and the fostering of understanding of the environmental determinants of autoimmune disease.

The first phase of the Flint Men's Health Study (FMHS) in Michigan was a community-based epidemiologic study of prostate cancer and benign prostatic hyperplasia (BPH) in African-Americans aged 40 to 79 years. An objective of the FMHS was to determine age-specified prostate specific antigen (PSA) reference ranges in a random population sample of African-American men without clinically evident prostate cancer. The FMHS study protocol included an initial in-home epidemiologic interview followed by PSA testing and a urologic examination of eligible subjects. Since the participation rate in the PSA phase of the study was under 60%, it was important to determine whether selectivity in participation biased the FMHS results for age-specific PSA distributions. Logistic regression analyses were used to investigate selectivity in the sample of subjects who participated in the PSA testing and urologic examination. Younger men, with current urologic symptoms, and with a family history of prostate cancer were more likely to participate in the PSA testing and urologic examination. Linear regression analysis indicated that greater participation by African-American men without clinically evident prostate cancer but with obstructive or irritative lower urinary tract symptoms or a family history of prostate cancer did not bias the estimated age-specific reference ranges for total PSA concentrations and free-to-total PSA ratios.

Objective: To investigate the relationship between exposure to silicone (including breast implants) and silica and the development of scleroderma (systemic sclerosis, SSc) among women., Methods: A population based case-control study was conducted among women in Michigan. 274 confirmed cases of SSc diagnosed between 1985 and 1991 were identified by contacting rheumatologists, hospitals, and a scleroderma support group. These cases and 1184 controls were interviewed by telephone to ascertain past exposures to silicone or silica., Results: Silicone in the form of breast implants was not associated with significantly increased risk of SSc (adjusted odds ratio, 1.30; 95% confidence interval, 0.27 to 6.23). Among 20 other potential silicone exposure surveyed, self-reported exposure to silicone based glues, sealants, and caulks, manufacture or repair of windows or windshields, repairing or frequently using photocopy machines, consumption of simethicone-containing antacids, and implanted medication delivery pumps were significantly associated with SSc. However, blinded assessment of all job and hobby descriptions in terms of their potential for silicone exposure failed to support the first 3 associations, antacid consumption may have been confounded by esophageal dysmotility before the diagnosis of SSc, and other silicone containing device categories (pacemakers, central nervous system shunts, other shunts and catheters) were not significantly associated with SSc. Surgically implanted metallic fixation devices were associated with significantly reduced risk for SSc. No association was detected between SSc and silica dust exposure., Conclusion: Consistent with other studies, we found no increased risk of SSc among women with silicone breast implants, equivocal evidence of risk from other silicone exposures, and no evidence of risk from silica exposure.

A survey was conducted to determine community health concerns, interests, and perceived health needs. The survey data were used in the selection of health promotion interventions. An index of Concern/Information Need/Participation Willingness (CIP) was developed as a model for planning, implementing, marketing, and evaluating programs.