Donna Brogan’s research while affiliated with Emory University and other places

Patient-reported physical and mental health status, along with disease-specific concerns ("quality of life") reported by patients, provide information about experience on dialysis that can help to improve patient care. Among prevalent hemodialysis (HD) patients, blacks have been shown to report higher health status and quality of life scores than whites, but whether similar race differences characterize incident patients who start regular dialysis is not known. Health status and quality of life, measured by the Kidney Disease Quality of Life-Short Form, reported by black men, black women, white men, and white women who initiated HD and peritoneal dialysis (PD) in the Dialysis Morbidity and Mortality Study (DMMS) Wave 2 were examined. After adjustment for patients' sociodemographic and clinical characteristics, the only race differences observed were that among HD patients, black women scored highest on the burden of kidney disease measure (lower perceived burden), and among PD patients, black men had the lowest satisfaction with care scores. It is possible that differences between blacks' and whites' reported health status and quality of life become more evident as patients' dialysis vintage increases, a hypothesis that requires following a well-characterized incident cohort over time. These findings add to existing evidence that minority patients on dialysis report less satisfaction with their care than do white patients, an important area for continued study.

To examine the relation between breast cancer risk and job history among women 20-44 years of age who participated in a multi-center, population-based, case-control study. Participants consisted of women newly diagnosed with breast cancer (1642) and controls identified by random-digit dialing (1494). Details about the three longest jobs were collected and coded by an industrial hygienist. Odds ratios and 95% confidence intervals were calculated and adjusted for age, study site, and other breast cancer risk factors. Several occupational and industrial categories were found to influence breast cancer risk. Stratification of the study population by parity revealed differences in breast cancer risk between the two groups for several occupational categories, including teachers, librarians or counselors (increased risk only among parous women) and natural scientists and mathematicians (decreased risk only among nulliparous women). This is among the first population-based case-control studies to examine occupational history and breast cancer risk in young women, with the ability to consider a wide array of potential confounders, including reproductive characteristics. This study provides further evidence of an increased breast cancer risk for several occupations and industries. Other findings were not as strongly supported by previous investigations.

This study evaluates the prevalence of selected life events around the time of pregnancy, examining changes in the prevalence of these events, and identifying maternal characteristics associated with these events. We used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to examine 18 stressful life events among women who recently gave birth and to identify maternal characteristics associated with these events. PRAMS is a mail sample survey with telephone follow-up for non-respondents. Sixty-four percent of women experienced at least one event. The prevalence of specific events ranged from 0.4 to 30%. Women who experienced events differed from those who did not. Most notably, women of low socioeconomic status (SES) were much more likely to experience stressful life events. These events were also associated with other demographic and behavioral characteristics after controlling for SES. These results have implications for interpreting studies of stressful life events. The strong associations with SES highlight the importance of controlling for SES in studies of life events and health, and of considering differences in SES when interpreting these studies.

This study investigated whether the opportunity to obtain Continuing Medical Education (CME) credit together with a five-dollar bill increased response rates and questionnaire completion rates in a physician survey involving mailed questionnaires. One thousand, three hundred and fourteen cardiologists, family practitioners, general internists (non-surgeons) and 264 vascular surgeons randomly identified from the American Medical Association database participated. After two, of up to four, questionnaire mailings, the opportunity to obtain CME credit and a five-dollar bill were included with questionnaire mailings. Among non-surgeons, 26.5% responded to pre-incentive mailings and 30.2% of those initially unresponsive replied after the interventions. Among surgeons, 39% responded to pre-incentive mailings and 32.7% of those initially unresponsive replied after the interventions. In conclusion, the opportunity to receive CME credit combined with a small monetary incentive is an effective motivation for physicians participating in a study involving mailed questionnaires.

OBJECTIVE: Individuals with peripheral arterial disease (PAD) have a 3- to 6-fold increased risk of coronary heart disease and stroke compared to those without PAD. We documented physician-reported practice behavior, knowledge, and attitudes regarding atherosclerotic risk factor reduction in patients with PAD. DESIGN: National physician survey. PATIENTS/PARTICIPANTS: General internists (N = 406), family practitioners (N = 435), cardiologists (N = 473), and vascular surgeons (N = 264) randomly identified using the American Medical Association's physician database. MEASUREMENTS AND MAIN RESULTS: Physicians were randomized to 1 of 3 questionnaires describing a) a 55- to 65-year-old patient with PAD; b) a 55- to 65-year-old patient with coronary artery disease (CAD), or c) a 55- to 65-year-old patient without clinically evident atherosclerosis (no disease). A mailed questionnaire was used to compare physician behavior, knowledge, and attitude regarding risk factor reduction for each patient. Rates of prescribed antiplatelet therapy were significantly lower for the patient with PAD than for the patient with CAD. Average low-density lipoprotein levels at which physicians "almost always" initiated lipid-lowering drugs were 121.6 +/- 23.5 mg/dL, 136.3 +/- 28.9 mg/dL, and 149.7 +/- 24.4 mg/dL for the CAD, PAD, and no-disease patients, respectively (PCONCLUSIONS: Deficiencies in physician knowledge and attitudes contribute to lower rates of atherosclerotic risk factor reduction for patients with PAD. Reversing these deficiencies may reduce the high rates of cardiovascular morbidity and mortality associated with PAD.

To determine whether lesbian and heterosexual female physicians differ on health, professional, and demographic characteristics. The Women Physicians' Health Study (WPHS), a mailed questionnaire sample survey, was completed by 4501 women physicians (59% response rate), of whom 115 were identified as lesbians and 4177 were identified as heterosexuals. Lesbian and heterosexual were defined by response to items about self-identification and sexual behavior. Dependent variables are self-reported health status and behavior and professional characteristics. Lesbians weighed more and were more likely to report histories of depression or sexual abuse, family histories of alcoholism, and orientation-related workplace harassment (all p = .01). On the other hand, they were more likely to comply with mammogram screening (p < .01). Many health status and behavior differences found in other studies of lesbian and heterosexual women were less pronounced here. This may be because the population of female physicians is more homogeneous, but perhaps also because the size of our lesbian sample was limited (n = 115). However, even with the buffer of high socioeconomic status and medical education, lesbian physicians seem to have a somewhat higher cumulative risk of disease compared to their heterosexual female colleagues.

To gain insight into whether breast cancer tumors jointly classified by estrogen receptor (ER) and progesterone receptor (PR) status represent diseases with differing etiologies, data from a population-based case-control study of US women 20-44 years of age were analyzed. Cases included 1,556 women diagnosed between 1990 and 1992. Age- and geographic-frequency-matched controls included 1,397 women identified by random digit dialing. Heterogeneity between ER+PR+ and ER-PR- tumors was most pronounced in relation to age, race, and recreational exercise at 12-13 years of age. Multivariate-adjusted odds ratios for ER+PR+ tumors were 0.64 (95% confidence interval (CI): 0.47, 0.89) for 30-34 versus 40-44 years of age, 0.89 (95% CI: 0.63, 1.25) for Black versus White race, and 0.84 (95% CI: 0.68, 1.03) for exercise at 12-13 years of age above versus at or below the median. Corresponding odds ratios for ER-PR- tumors were 1.24 (95% CI: 0.86, 1.77), 1.51 (95% CI: 1.07, 2.14), and 1.15 (95% CI: 0.90, 1.48). Risk of ER-PR- cancer in relation to menstrual and reproductive (parity and lactation) characteristics, alcohol consumption, and family history of breast cancer was similar to that observed for ER+PR+ tumors. These findings only modestly support the hypothesis that hormonally related risk factors have differing relations with ER+PR+ versus ER-PR- tumors among younger women.

Biologic evidence suggests that the hormones activated by stress affect gestational length, but the results of epidemiologic investigations are inconsistent. The authors of this paper know of no threshold models that have been studied; these models assume that stress does not affect preterm delivery until a certain amount of stress has been experienced but that each unit of stress above the threshold adds to the risk of preterm delivery. By using standard logistic regression, the authors compared threshold and nonthreshold models of the relation between number of stressful life events and preterm delivery in 11 US states. They used data on 1990-1995 births from the Pregnancy Risk Assessment Monitoring System. The risk of preterm delivery among multiparas who gave birth in 1990-1993 increased 7% for each event over five they experienced, but no relation was found for 1994-1995 births. Among primiparas who gave birth in 1994-1995, the risk increased 5% for each event over two, but no relation was found for 1990-1993 births. These results suggest that a threshold model may fit the relation between stress and preterm delivery better than one with no threshold. However, the inconsistent results are difficult to reconcile with a biologic threshold in the relation between stress and preterm delivery.

Few studies have examined methods by which breast cancers are detected, and only one study has been published on predictors of those methods. This study examined patterns and predictors of breast cancer detection methods during 1990-1992 among women age 20-44. In-person interview and medical record data were obtained during a population-based case-control study of 1619 women newly diagnosed with breast cancer in three areas of the United States (US). Seventy-one percent of the cancers were identified by self-detection, 9% by routine clinical breast exam (CBE), and 20% by routine mammography. Cancers detected by mammography and CBE, but not those detected by breast self-exam, were much more likely to be early-stage. Detection by mammography increased with age, and a history of mammography use was associated with detection by mammography or CBE. Several commonly studied predictors of screening utilization in the US population were associated with CBE detection, but were less clearly related to or unrelated to mammography detection. Findings suggest that, during the 1990s in the US, most breast cancers among women under age 45, including those age 40-44, were self-detected. Few factors other than age and prior screening are verified predictors of method of breast cancer detection.