The changing survival of patients with mycosis fungoides: a population-based assessment of trends in the United States.

BACKGROUND: The authors sought to evaluate trends in survival among a population-based group of patients with mycosis fungoides, in response to informal evidence of improved prognosis and concerns about the influence of detection bias on incidence data. METHODS: Data used in this study were drawn from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute, which includes 9 population-based cancer registries. Together, these registries cover approximately 10% of the U.S. population and have tracked the survival of all mycosis fungoides patients who were registered during the years 1973-1992. Data included follow-up through 1994. RESULTS: There was a total of over 10,000 person-years of follow-up for the 1633 patients studied. Relative survival changed little after 11 years, at which point it was 66%. Advanced age and black race were associated with poorer survival. The prognoses of Asian and Hispanic patients were slightly but not significantly worse than those of whites, and there were no significant geographic differences related to prognosis. The survival of married women was superior to that of other gender and marital-status groups. Prognosis did improve substantially over the 20-year period of study. CONCLUSIONS: Mycosis fungoides is usually not a fatal disease, although the mortality risk is substantial. The authors quantified various prognostic factors and documented an improved prognosis over the 20-year period of study. The data from this study raise concern about possible detection bias in incidence data. These data are also consistent with the concept that beyond 11 years after diagnosis, this disorder has relatively little impact on the risk of death.

Validation of cause-of-death certification for outpatient cancers: the contrasting cases of melanoma and mycosis fungoides.

The reported incidence of cancers typically diagnosed in the outpatient setting may underestimate their true frequency, but the validity of mortality estimates from many of these causes has not been studied in detail. The authors sought to evaluate the validity of mortality estimation from death certificates for two such cancers, melanoma and mycosis fungoides (a cutaneous lymphoma), using routinely collected cancer registry data for 1973-1994 from the Surveillance, Epidemiology, and End Results program. Their method estimates that 93% of the deaths attributable to melanoma were certified as due to melanoma but that only 60% of the deaths attributable to mycosis fungoides were so certified. Evaluation of the accuracy of cause-of-death certification in this manner is helpful in the interpretation of mortality statistics.

Education and risk factors for coronary heart disease: results from a New England community.

This article investigates the association of education with the estimated coronary heart disease (CHD) risk and the prevalence of CHD risk factors for men and women in a New England community over a period of 10 years. Educational differentials in knowledge of cardiovascular disease prevention, body mass index (BMI), total and high-density lipoprotein (HDL) cholesterol, cigarette smoking, and hypertension were examined for 3,765 respondents 25-64 years of age from five surveys of the Pawtucket Heart Health Program. We found a clear negative association between education and composite CHD risk. A stable separation in risk level was maintained across time between the least educated (< 12 years of education) and the other two educational groups (12, > or = 13 years of education) in both men and women. Educational differentials were observed in BMI and total and HDL cholesterol of the women 25-44 years of age. For men and women 25-44 years of age, smoking was negatively associated with education. Hypertension differed by education level among the women 45-64 years of age. These findings are highly comparable with the national data from aggregate vital statistics and the results of the National Health and Nutrition Examination Survey (NHANES) cohort follow-up.

The dynamics of contraceptive adoption in Bohol, Philippines: 1976-1978.

PIP: A researcher analyzed 1976 and 1978 data on 414 rural women who had never used a family planning method to prevent pregnancy and lived in the predominantly Catholic island province of Bohol in the Philippines to look at the influence certain aspects of the family planning program, begun in 1976, as predictors of changes in contraceptive behavior. 34.5% accepted contraception between 1976-1978. The researchers learned that couple traits (e.g., age, income, education, and religiosity) had only an indirect effect on change in contraceptive behavior. A desire to stop, limit, or space births (motivation) was a strong predictor of family planning method acceptance (p.001). Further couples who clinic providers contacted the most often or who had received more family planning services (services) were much more likely to use contraceptives (p.001). Indeed a significant relationship existed between motivation and services (p.001). Moreover couples who were truly motivated to use family planning methods did not let distance to family planning services prevent them from seeking these services (p.001). On the other hand, couples who confronted personal obstacles to family planning including social, psychological, and other subjective costs (cost index) tended not to accept family planning methods (p.001). A negative association existed between services and location of households vis a vis the intervention program (p.001) which indicated that the program did have an effect in the area of the province where it was located. In conclusion, the strongest predictors of change in contraceptive behavior included motivation, services, and cost index. Services and cost index indicated the great importance of interpersonal and/or client staff contact, especially since they were more important in influencing behavior change than distance and family planning site.^ieng

[Horton's disease and rhizomelic pseudopolyarthritis. Developmental data apropos of 95 cases]. / Maladie de Horton et pseudopolyarthrite rhizomélique. Données évolutives à propos de 95 cas.

The many common factors linking rhizomelic pseudopolyarthritis and Horton's disease prompt to compare their respective evolutions and the long-term results of their treatments. The comparative study of 28 patients with temporal Horton's arteritis, proven histologically, and 28 rhizomelic pseudopolyarthritis without arteritis on biopsy, in a total population of 95 patients, confirms the similarity of their clinical and biological signs and show a closely related evolution in the three groups. The evolution leads to a cure approximately 16.4 +/- 14 months in 41 p. cent of the cases. 34 p. cent of the patients are at an advanced stage with a mean follow-up of 37 months and relapses during the weaning period were frequent. 25 p. cent of the patients died. Most deaths occur in the first month of the disease, and occur readily in patients who have received a short treatment with steroids discontinued because of a iatrogenic accident. Cerebral vascular accidents and coronary accidents, arterial hypertension and iatrogenic gastro-intestinal ulcerations are the most frequent complications.