A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study.

Study Design: A randomized clinical trial.

Objectives: To compare the effectiveness of medical and chiropractic care for low back pain patients in managed care; to assess the effectiveness of physical therapy among medical patients; and to assess the effectiveness of physical modalities among chiropractic patients.

Summary Of Background Data: Despite the burden that low back pain places on patients, providers, and society, the relative effectiveness of common treatment strategies offered in managed care is unknown.

Baylisascaris procyonis: an emerging helminthic zoonosis.

Baylisascaris procyonis, a roundworm infection of raccoons, is emerging as an important helminthic zoonosis, principally affecting young children. Raccoons have increasingly become peridomestic animals living in close proximity to human residences. When B.

Negotiating cross-cultural issues at the end of life: "You got to go where he lives".

Culture fundamentally shapes how individuals make meaning out of illness, suffering, and dying. With increasing diversity in the United States, encounters between patients and physicians of different backgrounds are becoming more common. Thus the risk for cross-cultural misunderstandings surrounding care at the end of life is also increasing.

The role of epidemiology in challenging the HIV/AIDS pandemic.

The HIV/AIDS pandemic has challenged the resourcefulness of epidemiology and epidemiologists. In response to the challenge, epidemiologists have used existing epidemiologic strategies, expanded existing strategies, and developed new strategies to answer key questions about the transmission of HIV, the natural history of HIV at the molecular, host, and community levels, for evaluation of treatment effectiveness and intervention strategies, and to inform public health policy. In responding to the challenge of the pandemic, epidemiologists have also increasingly collaborated with scientists from other disciplines, particularly immunology, virology, and the behavioral sciences.

Confounding in health research.

Consideration of confounding is fundamental to the design, analysis, and interpretation of studies intended to estimate causal effects. Unfortunately, the word confounding has been used synonymously with several other terms, and it has been used to refer to at least four distinct concepts. This paper provides an overview of confounding and related concepts based on a counterfactual model of causation.

Supplemental health insurance for Medicare beneficiaries.

Because Medicare leaves beneficiaries at risk for significant health care costs, most need to obtain some form of supplemental coverage to protect themselves against the financial burden of illnesses. Close to nine out of ten Medicare beneficiaries age 65 or older now have some health coverage that provides additional benefits beyond standard Medicare Part A and Part B. The most common types of supplementation are insurance coverage offered by former employers, policies that individual beneficiaries purchase, benefits offered by Medicare managed care plans and assistance provided through the Medicaid program.

Arsenic methylation capacity and skin cancer.

Chronic ingestion of arsenic from drinking water is associated with the occurrence of skin cancer. To clarify the role of arsenic methylation capacity in the development of arsenic-associated skin lesions, an epidemiological case-control study was conducted in the southwestern region of Taiwan, in which 26 skin disorder patients were matched with control subjects. The objective of this study was to determine whether arsenic methylation capacity of patients with skin disorders differed from that of matched controls.

Environmental tobacco smoking, mutagen sensitivity, and head and neck squamous cell carcinoma.

Although active tobacco smoking has been considered a major risk factor for head and neck cancer, few studies have evaluated environmental tobacco smoke (ETS) and its interaction with mutagen sensitivity on the risk of head and neck cancer. We investigated the relationship between ETS and head and neck cancer in a case-control study of 173 previously untreated cases with pathologically confirmed diagnoses of squamous cell carcinoma of the head and neck and 176 cancer-free controls at Memorial Sloan-Kettering Cancer Center between 1992 and 1994. A structured questionnaire was used to collect ETS exposure and other covariates including a history of active tobacco smoking and alcohol use.

Chewing tobacco, alcohol, and the risk of erythroplakia.

Although chewing tobacco, smoking, and alcohol drinking have been suggested as risk factors for oral cancer, no study has examined the relationship between those factors and the risk of erythroplakia, an uncommon but severe oral premalignant lesion. In this study, we have analyzed the effects of chewing tobacco, smoking, alcohol drinking, body mass index, and vegetable, fruit, and vitamin/iron intake on the risk of erythroplakia and explored potential interactions between those factors in an Indian population. A case-control study including 100 erythroplakia cases and 47,773 controls was conducted, as part of an on-going randomized oral cancer screening trial in Kerala, India.

Demographic predictors of cancer screening among Filipino and Korean immigrants in the United States.

Background: Little is known about cancer-screening practices of various Asian subgroups, and even less is known about factors that may predict screening in these populations.

Design: Two independent surveys were conducted with 218 Filipino and 229 Korean female immigrants, aged 50 years and older, residing in Los Angeles.

Results: In these convenience samples, 48% of Filipino and 41% of Korean women reported receipt of a Pap smear within the past 2 years; 41% of Filipino and 25% of Korean women reported receipt of a mammogram and a clinical breast exam within the past 2 years; and 25% of Filipino and 38% of Korean women reported colorectal cancer screening (blood stool test within the past 12 months or sigmoidoscopy/colonoscopy within the past 5 years).

GSTT1 and GSTM1 null genotypes and the risk of gastric cancer: a case-control study in a Chinese population.

Glutathione S-transferase (GST) enzymes are involved in detoxification of many potentially carcinogenic compounds. The homozygous deletions or null genotypes of GSTT1 (theta class) and GSTM1 (mu class) genes may be associated with an increased risk of cancer. Few studies have evaluated the relationship between GSTT1, GSTM1 and the risk of gastric cancer, as well as the potential interactions between these genetic markers and other risk factors of gastric cancer in the Chinese population.

Marijuana use and increased risk of squamous cell carcinoma of the head and neck.

Marijuana is the most commonly used illegal drug in the United States. In some subcultures, it is widely perceived to be harmless. Although the carcinogenic properties of marijuana smoke are similar to those of tobacco, no epidemiological studies of the relationship between marijuana use and head and neck cancer have been published.

Tailored risk notification for women with a family history of breast cancer.

Background: Evidence indicates that although first-degree relatives of breast cancer cases are at increased risk of developing the disease themselves, they may be underutilizing screening mammography. Therefore, interventions to increase the use of mammography in this group are urgently needed.

Methods: A randomized two-group design was used to evaluate an intervention to increase mammography use among women (N = 901) with at least one first-degree relative with breast cancer.

Condom use in young blacks and Hispanics in public STD clinics.

Background And Objectives: Young blacks and Hispanics are an emerging risk group for contracting HIV. The goal of this study was to assess the most salient correlates of condom use for young Hispanics and blacks in Los Angeles county sexually transmitted diseases (STD) clinics as a first step toward designing a short clinic-based intervention.

Study Design: Face-to-face interviews were conducted with 376 patients younger than the age of 27 years at six STD clinics operated by the Los Angeles County Department of Health Services.

Epidemiologic features of facial injuries among motorcyclists.

Study Objective: To describe the extent, nature, and severity of facial injuries among motorcyclists injured in a crash requiring hospital treatment.

Methods: The study population consisted of 5,790 motorcycle riders who sustained a nonfatal crash injury during 1991, 1992, or 1993 in 10 California counties. The injured riders were identified in 28 hospitals during 1991 and 1992 and in 18 of these 28 hospitals in 1993.

A study of sexual behavior among rural residents of China.

Objective: Although the recent spread of HIV/AIDS and other sexually transmitted diseases (STDs) in China has been associated with sexual activities, little information has been available about sexual behavior in rural areas with high HIV prevalence. Studies identifying high-risk sexual behaviors are needed to formulate effective prevention programs.

Methods: A cross-sectional study design was used to measure sexual activities using a two-stage cluster sampling method.

CD8+ T-lymphocyte activation in HIV-1 disease reflects an aspect of pathogenesis distinct from viral burden and immunodeficiency.

The CD8+ T-cell response is central to control and eventual elimination of persistent viral infections. Although it might be expected that CD8+ T-cell activation would be associated with a better clinical outcome during viral infections, in long-term HIV-1 infection, high levels of CD8+ T-cell activation are instead associated with faster disease progression. In this study, cell surface expression of CD38, a flow cytometric marker of T-cell activation of CD8+ T cells, had predictive value for HIV-1 disease progression that was in part independent of the predictive value of plasma viral burden and CD4+ T-cell number.

The persistence of race and ethnicity in the use of long-term care.

We examine the use of nursing homes, formal personal care, informal Activities of Daily Living (ADL) assistance, and no care to identify racial differences in their use. Using the 1987 National Medical Expenditure Survey of both nursing homes and the community, multinominal logistic regressions controlled for predisposing, enabling, and need variables as well as other types of service use. Additional state-level variables make few changes in race/ethnicity parameters, indicating that race/ethnicity are not simply proxies for state-level variables.

Hierarchical modeling of gene-environment interactions: estimating NAT2 genotype-specific dietary effects on adenomatous polyps.

Data sparseness currently limits gene-environment interaction estimation. To improve effect estimates of gene-environment interactions, we give an overview of one approach, hierarchical modeling, and propose a two-stage hierarchical model. The first stage is a logistic model for the joint effects of the genetic and environmental factors.

Risk factors for intravenous drug use and sharing equipment among young male drug users in Longchuan County, south-west China.

Objectives: To identify the risk factors for intravenous drug use and sharing of equipment in Longchuan County in south-west China.

Methods: Demographic information and sexual and drug-use-related behavior between 1 January 1991 and 1 August 1994 were collected retrospectively from a cohort of young male drug users aged 18-29 years in 82 villages.

Results: A total of 433 drug users were identified.

AIDS-related attitudes and risk behaviors: a survey of a random sample of California heterosexuals.

Background: This paper describes the results of an AIDS knowledge, attitudes, and behaviors survey of a random sample of heterosexual California adults.

Methods: The study was conducted from August 1990 until February 1991 and consisted of telephone interviews conducted in English and Spanish, with a household probability sample of 3,545 California adults, undersampling those age 44 and older.

Results: Approximately one-third of the sample believed that HIV/AIDS is contracted by donating blood, and 20% believed the infection could result from insect bites.

Lifetime alcohol consumption and breast cancer risk among postmenopausal women in Los Angeles.

Although most data support an overall relation of alcohol consumption with risk of breast cancer, the timing of alcohol consumption as it relates to risk of breast cancer is still debatable. The authors examined this issue in a case-control study conducted among non-Hispanic white and Hispanic women in Los Angeles. Cases aged 55-64 years at diagnosis in 1987-1989 were enrolled through the Cancer Surveillance Program of Los Angeles County (a Surveillance, Epidemiology, and End Results Program registry).

Risk of breast cancer in relation to lifetime alcohol consumption.

Background: Although an association between alcohol consumption and risk of breast cancer has been observed in many studies, questions of major importance remain, including the nature of the dose-response relationship and the effects of drinking at various periods in life.

Purpose: Our goal was to address the issues listed above with a large case-control study.

Methods: We conducted a population-based case-control study in Maine, Massachusetts (excluding the four counties that include metropolitan Boston), New Hampshire, and Wisconsin.