Screening for colorectal neoplasms with new fecal occult blood tests: update on performance characteristics.

Background: One type of fecal occult blood test (FOBT), the unrehydrated guaiac fecal occult blood test (GT), is recommended by the United States Preventive Services Task Force and the Institute of Medicine for use in screening programs, but it has relatively low sensitivity as a single test for detecting advanced colonic neoplasms (cancer and adenomatous polyps > or = 1 cm in diameter). Thus, improving the sensitivity of FOBT should make colon cancer screening programs that use these tests more effective.

Methods: We assessed prospectively the performance characteristics of two newer FOBTs in 5841 subjects at average risk for colorectal cancer in a large group-model managed care organization.

Health problems and hospitalizations among Asian-American ethnic groups.

Objectives: To study health status and hospitalization risk among Asian Americans.

Design: Cross-sectional analyses and cohort study.

Setting: Comprehensive prepaid health care program in Northern California.

Marijuana use and injury events resulting in hospitalization.

Purpose: Information on the potential relation between marijuana use and the incidence of hospitalized injury is extremely limited. The purpose of this effort was to investigate the potential for this association.

Methods: A retrospective study was conducted in a large prepaid Northern California health care program cohort (n = 64,657) that completed baseline questionnaires about health behaviors, including marijuana use, and health status between 1979 and 1985.

Risk of subsequent cancer following invasive or in situ squamous cell skin cancer.

Purpose: Determine the risk of subsequent cancer following squamous cell skin cancer.

Methods: Using computerized surgical pathology records and membership data from a health maintenance organization, we retrospectively identified 822 individuals with primary squamous cell skin cancer (SCSC) and 3662 comparison subjects matched for age, sex, race, residence area, and length of membership. Patients were included in the study if they had no prior history of cancer, and received at least one multiphasic health checkup and questionnaire (MHC).

Cohort study of thyroid cancer in a San Francisco Bay area population.

Using data from a large health plan, we performed a cohort study of thyroid cancer among 204,964 persons (aged 10--89 at baseline in 1964--1973, 54% female) followed for a median of 20 years. There were 196 incident thyroid cancers (73 in men, 123 in women). Risk was independently and positively related to female gender [relative risk (RR) = 1.

Association of basal cell skin cancers with other cancers (United States).

Background: Persons with basal cell skin cancer (BCSC) have shown increased risk of developing cancer at several other sites.

Methods: We identified 3164 persons with BCSC and 15,730 comparison subjects matched for age, sex, race, residence area and length of membership in a health maintenance organization.

Results: In retrospective follow-up for up to 24 years (mean 11.

Evaluating hypertension control in a managed care setting.

Background: We conducted a retrospective cohort study on a random sample of adult patients with hypertension in a large health maintenance organization to assess the feasibility of documenting blood pressure (BP) control and to compare different measures for defining BP control.

Methods: Three criteria for BP control were assessed: systolic BP less than 140 mm Hg; diastolic BP less than 90 mm Hg; and combined BP control, with systolic BP less than 140 mm Hg and diastolic BP less than 90 mm Hg. Four methods of assessing hypertension control by the above criteria were examined: proportion of patients with BP under control at 75% and 50% or more of their office visits; the mean of all pressures during the study period; and the BP from the last visit during the study period.

Differences in calcium metabolism between black and white men and women.

To determine whether environmental factors influence racial differences in calcium metabolism, the authors evaluated the influence of three factors (season, length of sunlight exposure, and diet) on calciotropic hormones, renal calcium excretion, and markers of bone turnover in an ambulatory population aged 25-36 years. Included were 109 black men, 114 white men, 95 black women, and 84 white women. Compared with white subjects, black subjects of both genders showed lower levels of serum 25-hydroxyvitamin D (25-OHD) and higher levels of serum 1,25-dihydroxyvitamin D [1,25(OH)(2)D].

Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease, and cancer in men.

Background: The sale of cigars in the United States has been increasing for the past six years. Cigar smoking is a known risk factor for certain cancers and for chronic obstructive pulmonary disease (COPD). However, unlike the relation between cigarette smoking and cardiovascular disease, the association between cigar smoking and cardiovascular disease has not been clearly established.

Marijuana use and medically attended injury events.

Study Objective: This study evaluated the relation between self-reported marijuana use and 3-year incidence of injury.

Methods: We conducted a retrospective cohort study of adult Kaiser Permanente Medical Care Program members who underwent multiphasic health examinations between 1979 and 1986 (n=4,462). Injury-related outpatient visits, hospitalizations, and fatalities within 3 years of examination were determined.

Marijuana use and cancer incidence (California, United States).

The purpose of this retrospective cohort study was to examine the relationship of marijuana use to cancer incidence. The study population consisted of 64,855 examinees in the Kaiser Permanente multiphasic health checkup in San Francisco and Oakland (California, United States), between 1979-85, aged 15 to 49 years, who completed self-administered questionnaires about smoking habits, including marijuana use. Follow-up for cancer incidence was conducted through 1993 (mean length 8.

Marijuana use and mortality.

Objectives: The purpose of this study was to examine the relationship of marijuana use to mortality.

Methods: The study population comprised 65171 Kaiser Permanente Medical Care Program enrollees, aged 15 through 49 years, who completed questionnaires about smoking habits, including marijuana use, between 1979 and 1985. Mortality follow-up was conducted through 1991.

Racial differences in bone density between young adult black and white subjects persist after adjustment for anthropometric, lifestyle, and biochemical differences.

This study tested whether racial differences in bone density can be explained by differences in bone metabolism and lifestyle. A cohort of 402 black and white men and women, ages 25-36 yr, was studied at the Kaiser Permanente Medical Care Program in Northern California, a prepaid health plan. Body composition (fat, lean, and bone mineral density) was measured using a Hologic-2000 dual-energy x-ray densitometer.

A comparison of fecal occult-blood tests for colorectal-cancer screening.

Background: Hemoccult II, a widely used guaiac test for fecal occult blood, has a low sensitivity for detecting colorectal neoplasms in asymptomatic patients at average risk. In such patients, the performance characteristics of screening tests developed to improve on Hemoccult II are not known.

Methods: A set of three fecal occult-blood tests--Hemoccult II; Hemoccult II Sensa, a more sensitive guaiac test; and HemeSelect, an immunochemical test for human hemoglobin--was mailed to all patients 50 years of age or older who were scheduled for personal health appraisals at the Kaiser Permanente Medical Center in Oakland, California.

Cardiovascular risk factors among Asian Americans.

MANY ASIANS HAVE RECENTLY IMMIGRATED to the United States, but there have been few studies of cardiovascular risk factors in these groups. Researchers analyzed data from 13,031 people who described themselves as Chinese, Filipino, Japanese, and other Asians, and used regression analyses controlled for age, alcohol use, education, and marital status. Adjusted mean body mass index and smoking prevalence were lowest in Chinese men and women.

Mentholated cigarette use and lung cancer.

Background: Menthol combustion produces carcinogenic compounds such as benzo[a]pyrenes. Mentholated cigarettes are much more commonly smoked by black individuals than by white individuals. The incidence of lung cancer is much higher (60%) in black men than in white men, but it differs little by race in women.

The effect of retirement on mental health and health behaviors: the Kaiser Permanente Retirement Study.

To assess the short-term effect of retirement on mental health and health behaviors of members of a health maintenance organization aged 60-66, questionnaires were completed in 1985 and 1987 by employed members planning to retire during the study period and those not planning to retire. Mental health and health behaviors of members who actually retired (n = 320) were compared with those members who did not retire (n = 275). Using logistic regression controlling for age, gender, marital status, and education, we found that retired members were more likely to have lower stress levels and to engage in regular exercise more often as compared to those who did not retire during the study period.

The risk of hospitalization for ischemic heart disease among Asian Americans in northern California.

To supplement sparse data about ischemic heart disease in Asian Americans, hospitalization risk was prospectively examined in a group of Asian Americans living in Northern California. Analyses used Cox models with ischemic heart disease risk traits as covariables. With Whites as the referent category, relative risks by ethnic group were as follows: Chinese, 0.

Iron stores are not associated with acute myocardial infarction.

Background: This study evaluated the relation between body iron stores and coronary artery disease. It has been suggested that total body iron stores are an independent risk factor for acute myocardial infarction (AMI).

Methods And Results: Our study population consisted of 46,932 members of a prepaid health plan who were > or = 30 years old and who received a standard health check between 1969 and 1971.

Health care use by frequent marijuana smokers who do not smoke tobacco.

Even though marijuana smoke contains carcinogens and more tar than tobacco smoke and marijuana intoxication has been implicated as a risk factor for injuries, relatively little epidemiologic evidence has identified marijuana use as a risk factor for ill health. This study is the first to examine the health effects of smoking marijuana by comparing the medical experience of "daily" marijuana smokers who never smoked tobacco (n = 452) with a demographically similar group of nonsmokers of either substance (n = 450). Marijuana smoking status was determined during multiphasic health checkups at Kaiser Permanente medical centers between July 1979 and December 1985.

A prospective study of cigarette tar yield and lung cancer.

We examined the relationship of cigarette tar yield and other cigarette-usage characteristics in current smokers to the incidence of lung cancer in a study population of 79,946 Kaiser Permanente Medical Care Program members, aged 30-89 years, who completed a detailed, self-administered, smoking-habit questionnaire during the years 1979 through 1985. Mean length of follow-up was 5.6 years.

Home blood pressure monitoring. Effect on use of medical services and medical care costs.

The objective of this study was to determine whether a hypertension management program in which patients monitor their own blood pressure (BP) at home can reduce costs without compromising BP control. The prospective, randomized, controlled 1-year clinical trial was conducted at four medical centers of the Kaiser Permanente Medical Care Program in the San Francisco Bay Area. Of 467 patients with uncomplicated hypertension who were referred by their physicians, 37 declined to participate in the study; 215 were randomly assigned to a Usual Care (UC) group and 215 to a Home BP group.