Bladder cancer risk associated with family history of cancer.

Twin studies suggest a familial aggregation of bladder cancer, but elements of this increased familial risk of bladder cancer are not well understood. To characterize familial risk of bladder cancer, we examined the relationship between family history of bladder and other types of cancer among first-degree relatives and risk of bladder cancer in 1193 bladder cancer cases and 1418 controls in a large population-based case-control study. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between family history of bladder cancer (defined as at least one first-degree family member with bladder cancer or a cancer of any other site). We also evaluated cancer aggregation of specific sites in family members. Participants with a first-degree relative with bladder cancer had nearly double the risk of bladder cancer (OR = 1.8, 95% CI 1.2-2.9) as those without a family history of bladder cancer. Risk was increased for having a sibling with bladder cancer (OR = 2.6, 95% CI 1.3-5.3) compared to no siblings with cancer. Bladder cancer risk was elevated when participants reported a first-degree relative with a history of female genital cancer (OR = 1.5, 95% CI 1.1-2.1), melanoma (OR = 1.9, 95% CI 1.02-3.6), and tobacco-associated cancer (OR = 1.3, 95% CI 1.06-1.6). These findings add to evidence of a familial predisposition to bladder cancer. Clarification of the aggregation of bladder cancer in families and with other cancer sites will be of interest as many loci and common polymorphisms related to bladder cancer have yet to be identified in large genomic studies.

Findings of a Statewide Environmental Lead Inspection Program Targeting Homes of Children With Blood Lead Levels as Low as 5 µg/dL.

CONTEXT: There are limited data on the nature of environmental lead hazards identified during residential inspections for child blood lead levels (BLLs) of less than 10 µg/dL. We compare inspection findings for child BLLs of 5 to 9 µg/dL versus 10 µg/dL or more. DESIGN: We reviewed inspection reports in Maine from September 2016 to March 2018. We used continuity-adjusted or Fisher's exact test for categorical variables and Wilcoxon rank-sum tests for continuous variables to compare differences in child, family, household, and lead hazard characteristics between BLL categories (5-9 µg/dL vs ≥10 µg/dL). We used Spearman correlation coefficients to assess relationships between home surface lead dust measurements and BLLs. RESULTS: Of 351 residential inspections, 272 (77%) were for children with BLLs of 5 to 9 µg/dL. Children with BLLs of 5 to 9 µg/dL as compared with children with BLLs of 10 µg/dL or more were less likely to chew window sills and door frames (8% vs 21%; P = .01), but otherwise were similar with respect to other established risk factors for lead poisoning. Children with BLLs of 5 to 9 µg/dL tended to have fewer paint hazards inside their homes (64% vs 78%; P = .03), and they were more likely to have dust-only hazards (8% vs 3%) or no identified lead paint hazards (23% vs 15%), though these differences were not statistically significant. For children with BLLs of 5 to 9 µg/dL, BLL was weakly correlated with average window sill dust level (Spearman r = 0.16; P = .01) and average floor dust level (r = 0.13; P = .03), but these correlations were not observed for children with BLLs of 10 µg/dL and higher. CONCLUSIONS: We have found that inspections of homes of children with BLLs of 5 to 9 µg/dL are nearly as likely to identify lead hazards that require abatement as inspections of homes of children with BLLs of 10 µg/dL.

New options for child health surveillance by state health departments.

Until recently there were no child health surveillance instruments available to state health departments for children 1-14 years old. In recent years, several states have developed new surveillance instruments. This article includes information about examples of four types of child health surveys: (1) Behavioral Risk Factor Surveillance System (BRFSS) follow-back survey [phone-based in Colorado]; (2) Pregnancy Risk Assessment Monitoring System (PRAMS) re-interviews [PRAMS-based in Rhode Island]; (3) elementary school child health survey combined with dental screening and physical measurements of height and weight [school-based in Maine]; and (4) freestanding elementary school survey [school-based in Oregon]. The PRAMS-based survey was moderate in expense but addressed only issues related to 2 year olds. The phone-based survey was the most expensive but addressed issues of children 1-14 years old. The school-based surveys were moderate in expense, logistically complex, and were least likely to provide robust generalizable data.

Emergency medical services data for cardiovascular disease surveillance, program planning, and evaluation in Maine.

Rapid access to medical treatment is a key determinant of outcomes for cardiovascular events. Emergency medical services (EMS) play an important role in delivering early treatment for acute cardiovascular events. Attention has increased on the potential for EMS data to contribute to our understanding of prehospital treatment. Maine recently began to explore the possible role of EMS data in cardiovascular disease surveillance and cardiovascular health program planning and evaluation. We describe the Maine EMS data system, discuss findings on ease of data use and data quality, provide a sample of findings, and share how we plan to use EMS data for program planning and evaluation of community-level interventions and to partner with EMS provider organizations to improve treatment. Our objective is to increase understanding of the promise and limitations of using EMS data for cardiovascular disease surveillance and program planning and evaluation.

Using state lead poisoning surveillance system data to assess false positive results of capillary testing.

OBJECTIVE: The purpose of this study was to determine the false positive percentage of capillary blood lead screening in a statewide surveillance system and to explore potential predictors of false positive results. METHODS: Data were all blood lead tests of 0-5 year old children in Maine during 2002-2003. We determined the proportion of children with elevated (>/=10 microg/dL) capillary test results who received a venous confirmatory test, and calculated the percentage of false positive tests, defined as a capillary test of >/=10 microg/dL with a confirmatory venous test of <10 microg/dL. Multivariable binomial regression was used to determine whether capillary blood lead level and length of time between capillary and venous tests predicted false positive results, after controlling for potential confounders. We also examined the positive bias of the capillary test among both false positive and true positive results. RESULTS: Seventy-three percent of elevated capillary screening tests (2.2 percent of all capillary screening tests) were false positives. False positive results were less likely for capillary levels of 15-19 microg/dL (RR=0.78; 95% CI 0.5-0.92) and 20 microg/dL or above (RR=0.83; 95% CI 0.71-0.96) compared to 10-14 microg/dL. The percentage of false positives did not vary by interval between screening and confirmatory tests. The capillary test exhibited a positive bias compared to the venous test, even among true positive results. CONCLUSIONS: False positive results may have been caused by sample contamination, rather than laboratory error or true variation in blood lead level between screening and confirmatory tests. Capillary screening could be improved by training in proper sample collection methods.