Journal of the National Cancer Institute
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J. Natl. Cancer Inst. · Dec 1999
Environmental tobacco smoke, genetic susceptibility, and risk of lung cancer in never-smoking women.
Exposure to environmental tobacco smoke (ETS) is considered to be a major lung cancer risk factor for never smokers. We investigated the hypothesis that never-smoking women who are exposed to ETS and develop lung cancer are a genetically susceptible population. ⋯ A common genetic polymorphism divides the population of never smokers into two groups of approximately equal size, one (homozygous carriers of the GSTM1 null allele) that has a statistically significant greater risk of lung cancer from ETS than the other (heterozygous or homozygous carriers of the wild-type GSTM1 allele).
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J. Natl. Cancer Inst. · Nov 1999
Population-based study of relationships between hospital volume of prostatectomies, patient outcomes, and length of hospital stay.
Despite the large number of prostatectomies performed annually, few data exist regarding relationships between the volume of prostatectomies handled by a hospital, the length of a patient's stay in the hospital, and patient outcomes. We examined the effect of hospital prostatectomy volume and changes in the hospital volume on patient outcomes and the length of a patient's stay. ⋯ Cross-sectional analyses revealed that, compared with high-volume hospitals, low-volume, medium-low-volume, and medium-high-volume hospitals had higher relative risks of readmission by 30% (95% confidence interval [CI] = 21%-39%), 16% (95% CI = 7%-25%), and 8% (95% CI = -1% to 17%), respectively; higher relative risks of serious complications by 43% (95% CI = 37%-48%), 25% (95% CI = 19%-31%), and 9% (95% CI = 3%-15%), respectively; and higher relative risks of mortality by 51% (95% CI = 25%-77%), 43% (95% CI = 17%-69%), and 42% (95% CI = 16%-68%), respectively. The mean length of a patient's stay in a low-volume hospital was 9% longer than that in a high-volume hospital (8.51 days [95% CI = 8.47-8.56] versus 7.81 days [95% CI = 7.77-7.85]; P for trend across all volume categories =.0001). Within-hospital longitudinal analyses revealed that hospitals with a relative increase in prostatectomy volume had a 57% greater reduction in the length of a patient's stay compared with those with a relative decrease in volume (P =.005). Changes in prostatectomy volume did not affect the frequency of complications, mortality, and readmission. These findings suggest that an increase in a given hospital's prostatectomy volume may facilitate a decrease in the length of a patient's stay without an adverse impact on patient outcomes.
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The health care system provides an important opportunity for addressing tobacco use among youths, but there is little information about how frequently physicians discuss smoking with their adolescent patients. We analyzed data from the National Ambulatory Medical Care Surveys to assess the prevalence and the predictors of physicians' identification of smoking status and counseling about smoking at office visits by adolescents. ⋯ We found that physicians frequently identified adolescents' smoking status but rarely counseled them about smoking. Physicians' practices did not improve in the first half of the 1990s, despite a clear consensus about the importance of this activity and the publication of physician guidelines targeting this population. Physicians treating adolescents are missing opportunities to discourage tobacco use among teens.