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A case‐control study was undertaken to investigate possible etiologic factors in nasopharyngeal cancer, a rare tumor in the United States. Data from 39 nasopharyngeal cancer cases and the same number of matched controls showed significantly more cases born in Asia than controls, supporting the notion that exposure in early life has a prolonged carcinogenic effect. Cases also smoked significantly more cigarettes than controls, indicating a need for investigating the role of cigarette smoking and other exposures in the etiology of nasopharyngeal cancer in western countries.

OBJECTIVE -To evaluate performance of process and outcome measures in the care of patients with diabetes seen in Department of Veterans Affairs (VA) facilities.RESEARCH DESIGN AND METHODS -Retrospective audits of records and databases were conducted on randomly selected patients with diabetes over 5 years (1995 [baseline] and 1997-2000) in 22 VA networks. Performance on diabetes-specific and preventive processes was measured.RESULTS -Nationally, significant improvements over time were observed for all measures (P Ͻ 0.001). For example, the percentage of patients receiving a dilated retinal examination rose from 44% in 1995 to 67% in 2000. The percentage of patients who received a urinary protein test rose from 23% in 1997 to 54% in 2000. Those who received influenza vaccination rose from 34% in 1995 to 78% in 2000. However, there was significant regional variation among all measures.CONCLUSIONS -Adherence to diabetes-specific and preventive care measures in the VA improved from 1997 to 2000 compared with a 1995 baseline. The improvement occurred in a setting of the provision of guidelines, the contractual setting of specific targets, and the timely feedback of results to medical center and network directors. Future studies are needed to determine whether adherence to these measures will decrease the rates of complications in VA patients with diabetes. Diabetes Care 27 (Suppl. 2):B90 -B94, 2004

This study of 220 wives of participants from four of the 22 clinics in the Multiple Risk Factor Intervention Trial (MRFIT) addresses the question of whether spouses of men exposed to a continuous coronary heart disease (CHD) risk-factor intervention program (SI group) make changes in their own risk status compared to wives of men who did not receive the intervention program (UC group). Total serum cholesterol and low-density lipoprotein (LDL) cholesterol were significantly lower for the SI wives. These differences were found for both hypertensive and normotensive wives, although the magnitudes were much greater for the hypertensive wives. There were also significant differences between the two groups of wives in the food-record rating and in dietary-knowledge scores, indicating that the probable mechanism for the beneficial effect of the intervention with respect to cholesterol levels was the change in the family diet. Although not statistically significant, differences indicating a lower risk for SI wives were found for diastolic blood pressure. There was also a greater mean reduction in cigarettes per day for SI wives who smoked.

Few epidemiologic studies have been undertaken to investigate the etiology of cancer of the vulva. To identify risk factors associated with this cancer, a case—control study was conducted in 149 patients with histologically proven vulvar carcinoma and the same number of control patients matched for age, race, marital status, and hospital from five U.S. metropolitan areas. As previously suspected, we found prior histories of leukoplakia of the vulva, inflammation of the vulva or vagina, and urogenital cancer to be significantly associated with vulvar cancer. In addition, we found moderately high odds ratios associated with occupational histories of private household maids and servants, and work in laundry, cleaning, and other garment services. A slightly increased odds ratio was associated with coffee consumption and a dose—response effect was demonstrated. The findings suggest that environmental exposures may play a role in vulvar carcinogenesis.

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