Relationship between breast cancer risk factors and mammographic breast density in the Fernald Community Cohort.

Background: We investigated associations of known breast cancer risk factors with breast density, a well-established and very strong predictor of breast cancer risk.

Methods: This nested case-control study included breast cancer-free women, 265 with high and 860 with low breast density. Women were required to be 40-80 years old and should have a body mass index (BMI) <35 at the time of the index mammogram.

From 51% to 100%: mandatory seasonal influenza vaccination.

We believe we are the first union hospital to succeed in mandating the seasonal influenza vaccine for employees and physicians. We relate the process that we used to achieve this success. Our main purpose is to share our success with other colleagues in the health care industry who are facing similar opposition to mandatory vaccination.

Medical monitoring: a beneficial remedy for residents living near an environmental hazard site.

Objective: People living close to an environmental hazard site may suffer health harms from real or perceived contaminant exposures. In class-action litigation, medical monitoring is a potential remedy that has been allowed in some jurisdictions but not others. From 1952 to 1989, a US Department of Energy uranium metal plant near Fernald, Ohio, released ionizing radiation and uranium particulates into the surrounding community.

Health effects in community residents near a uranium plant at Fernald, Ohio, USA.

Objectives: Health outcomes in persons who lived in the area surrounding a U.S. Department of Energy (DOE) uranium processing plant near Fernald, Ohio were evaluated using data of Fernald Medical Monitoring Program (FMMP) participants.

Rewarding teaching faculty with a reimbursement plan.

Objective: To develop a system for measuring the teaching effort of medical school faculty and to implement a payment system that is based on it.

Design: An interventional study with outcomes measured before and after the intervention.

Setting: A department of internal medicine with a university hospital and an affiliated Veterans Administration hospital.

Intercorrelations and sources of variability in three mutagenicity assays: a population-based study.

The purpose of this study was to evaluate the intercorrelation between three genetic assays in 112 subjects. The group was pooled from two originally separate but homogeneous subgroups of 56 persons each. Procedures included assays for hprt mutant frequencies, micronuclei in human lymphocytes, and mutations at the glycophorin A (gpa) loci.

Do persons living near a uranium processing site have evidence of increased somatic cell gene mutations? A first study.

The objective of this study was to examine if individuals living near a uranium processing site have greater mutagenic damage, as measured by three mutagenicity assays, compared with subjects unexposed to any nuclear facilities. The design was a cross-sectional exploratory analysis of 112 subjects; 56 volunteer residents were from within a 5-mile radius of the Fernald Uranium Processing site and 56 'control' subjects were from a geographically separate area unexposed to any known uranium emissions. The groups were constrained to be similar in age and sex composition.

How an academic health center and a community health center found common ground.

Despite their divergent missions, academic health centers (AHCs) and community health centers (CHCs) are natural partners. This is becoming more obvious as national attention is focused on greatly increasing the number of primary care providers. AHCs are responding to this pressure and now need more sites to train primary care physicians, and CHCs need more primary care physicians (the AHCs' graduates) as staff.

Lack of effect of drinking water chlorine on lipid and thyroid metabolism in healthy humans.

Animal studies and a single human epidemiological study have suggested that chlorine in drinking water may raise the level of blood cholesterol. The purpose of this study was to determine whether a 4-week exposure to drinking water chlorine (1.5 L per day) at a concentration of 20 ppm (ppm = mg/L) under controlled conditions would alter circulating parameters of lipid metabolism in healthy humans.

Effects of drinking water monochloramine on lipid and thyroid metabolism in healthy men.

The purpose of this study was to determine whether a 4-week consumption of 1.5L per day of drinking water containing monochloramine at a concentration of 2 ppm (ppm = mg/L) or 15 ppm under controlled conditions would alter parameters of lipid or thyroid metabolism in healthy men. Forty-eight men completed an 8-week protocol during which diet (600 mg cholesterol per day, 40% calories as fat) and other factors known to affect lipid metabolism were controlled.

Lack of effect of drinking water barium on cardiovascular risk factors.

Higher cardiovascular mortality has been associated in a single epidemiological study with higher levels of barium in drinking water. The purpose of this study was to determine whether drinking water barium at levels found in some U.S.

Addressing unanswered questions about population cholesterol screenings: the Model Systems for Blood Cholesterol Screening Program.

Elevated blood cholesterol is one of the three major modifiable risk factors for heart disease. Almost 60% of adults in the United States have an elevated blood cholesterol level, yet most adults are unaware of their level. The National Heart, Lung and Blood Institute (NHLBI) and other organizations have now recommended that all adults be tested to assess their blood cholesterol level.

Comparisons of referral criteria for public screening of blood cholesterol levels.

Total and high-density lipoprotein (HDL) cholesterol levels of 2,387 adults were screened at a worksite and a bloodbank. Hypothetical referral decisions were made according to three sets of guidelines: the 1984 National Institutes of Health Consensus Conference guidelines (NIHCC), a single referral cutpoint of 5.2 millimoles per liter (mmol per L), and the current National Cholesterol Education Program (NCEP) guidelines for screening in physicians' office.

Screening, diagnosis, and treatment of hypercholesterolemia.

All adults should be screened for high blood cholesterol. Those found to be high should undergo a diagnostic process to confirm and classify their disorder. Diet is recommended for all and drug therapy should be considered for those who do not meet treatment goals on diet.

Should physicians perform their own quality assurance audits?

Quality assurance is required of all hospital outpatient clinics although there is little evidence documenting its value. The purposes of this study were to assess the impact of quality assurance audits on physicians' ordering behavior and to learn whether doctors who actually performed audits behaved differently from physicians who passively received audit results. Baseline influenza vaccination and screening mammography ordering rates were established for the authors' residents' clinic in 1985.

An ambulatory medical education program for internal medicine residents.

Teaching the fundamentals of ambulatory medicine has many well known difficulties. An education program with specific topics covered and modeled after continuing medical education programs for practicing physicians was instituted for residents in a university hospital clinic and was evaluated. The program was effective in improving the residents' knowledge, in enhancing their attitudes toward the clinic, and in improving their performance of influenza vaccinations.

Effects of chlorinated drinking water on human lipid metabolism.

Atherosclerosis with its complications is the most important health problem affecting American adults. The levels of serum cholesterol, of high and low density lipoproteins, and of apolipoproteins A1, A2, and B are major risk factors for the development of atherosclerotic lesions. Animal studies suggest that chlorinated drinking water may elevate the serum cholesterol.