Jacobs MA, Hotaling JM, Mueller BA, Koyle M, Rivara F, Voelzke BB.  Conservative management vs early surgery for high grade pediatric renal trauma-do nephrectomy rates differ?  J Urol 2012 [In press]

Guidelines for management of pediatric high grade renal injuries are currently based on limited pediatric data and algorithms from adults, for whom initial nonoperative management is associated with decreased nephrectomy risk. Using a national database, we compared nephrectomy rates between children with high grade renal injury managed conservatively and those undergoing early surgical intervention. All children with high grade renal  injuries were identified in the National Trauma Data BankŪ. High grade renal injuries were defined as American Association for the Surgery of Trauma grade IV  or V renal injuries. After excluding fatalities within 24 hours of hospitalization, 419 pediatric patients comprised our study cohort. A total of 81 patients underwent early (within 24 hours of hospitalization) surgical intervention, while 338 were initially treated conservatively. Using stratified analysis with adjustment for relevant covariates, we compared nephrectomy rates between these groups. Nephrectomy was performed less often in patients treated conservatively (RR 0.24, 95% CI 0.16 to 0.36, adjusted for age, renal injury grade and injury mechanism). The decreased risk of nephrectomy was more marked among children with grade IV vs grade V renal injuries (adjusted RR 0.16,  95% CI 0.08 to 0.23). Multiple procedures were more common in patients initially  observed. Of pediatric patients with grade IV and V renal injuries 11% still underwent nephrectomy. Conservative management of high grade renal injuries is common in children. Although mechanism of injury and renal injury grade impact initial clinical management decisions, the risk of nephrectomy was consistently decreased in children with high grade renal trauma managed conservatively regardless of injury characteristics.

Searles Nielsen S, Mueller BA, Preston-Martin S, Farin FM, Holly EA, McKean-Cowdin R. Childhood brain tumors and maternal cured meat consumption in pregnancy: Differential effect by glutathione S-transferases. Cancer Epidemiol Biomarkers Prev 2011; 20:2413-2419.

Some epidemiologic studies suggest that maternal consumption of cured meat during pregnancy may increase risk of brain tumors in offspring. We explored whether this possible association was modified by fetal genetic polymorphisms in  genes coding for glutathione S-transferases (GSTs) that may inactivate nitroso compounds. We assessed six GST variants: GSTM1 null, GSTT1 null, GSTP1I105V (rs1695), GSTP1A114V (rs1138272), GSTM3*B (3 bp deletion), and GSTM3A-63C (rs1332018) within a population-based case-control study with data on  maternal prenatal cured meat consumption (202 cases and 286 controls born in California or Washington, 1978-1990). Risk of childhood brain tumor increased with increasing cured meat intake by the mother during pregnancy among  children without GSTT1 (odds ratio [OR]=1.29, 95% confidence interval [CI] 1.07-1.57 for each increase in the frequency of consumption per week) or with potentially reduced GSTM3 (any -63C allele, OR=1.14, 95% CI 1.03-1.26), whereas no increased risk was observed among those with GSTT1 or presumably normal GSTM3  levels (interaction p=0.01 for each). Fetal ability to deactivate nitrosoureas may modify the association between childhood brain tumors and maternal prenatal consumption of cured meats.Impact: These results support the hypothesis that maternal avoidance during pregnancy of sources of some nitroso compounds or their precursors may reduce risk of brain tumors in some children.

Johnson KJ, Carozza SE, Chow EJ, Fox EE, Horel S, McLaughlin CC, Mueller BA, Puumala SE, Reynolds P, Von Behren J, Spector LG.  Birth characteristics and childhood carcinomas.  Br J Cancer 2011; 105:1396-1401.

Carcinomas in children are rare and have not been well studied. We conducted a population-based case-control study and examined associations between birth characteristics and childhood carcinomas diagnosed from 28 days to 14 years during 1980-2004 using pooled data from five states (NY, WA, MN, TX, and CA) that linked their birth and cancer registries. The pooled data set contained 57 966 controls and 475 carcinoma cases, including 159 thyroid and 126 malignant melanoma cases. We used unconditional logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs). White compared with 'other' race was positively associated with melanoma (OR=3.22, 95%  CI 1.33-8.33). Older maternal age increased the risk for melanoma (OR(per 5-year  age increase)=1.20, 95% CI 1.00-1.44), whereas paternal age increased the risk for any carcinoma (OR=1.10(per 5-year age increase), 95% CI 1.01-1.20) and thyroid carcinoma (OR(per 5-year age increase)=1.16, 95% CI 1.01-1.33). Gestational age <37 vs 37-42 weeks increased the risk for thyroid carcinoma (OR=1.87, 95% CI 1.07-3.27). Plurality, birth weight, and birth order were not significantly associated with childhood carcinomas. This exploratory study indicates that some birth characteristics including older parental age and low gestational age may be related to childhood carcinoma aetiology.

Deroo LA, Cummings P, Mueller BA.  Smoking before the first pregnancy and the risk of breast cancer: A meta-analysis.  Am J Epidemiol 2011; 17:390-402.

The authors conducted a meta-analysis of the association between smoking before a first pregnancy, when undifferentiated breast tissue may be vulnerable to tobacco carcinogens, and the risk of breast cancer. A search of the published literature  through August 2010 identified 23 papers reporting on associations between smoking before a first pregnancy and breast cancer. Odds ratios or hazard ratios  and 95% confidence intervals, adjusted for known or suspected breast cancer risk  factors, were abstracted from each study. Data were pooled using both fixed- and  random-effects models. The fixed-effect summary risk ratio for breast cancer among the women who smoked before their first pregnancy versus women who had never smoked was 1.10 (95% confidence interval: 1.07, 1.14); the random-effects estimate was similar. The separate fixed-effect risk ratios for smoking only before the first pregnancy (5 studies) or only after the first pregnancy (16 studies) were both 1.07, providing no evidence that breast tissue is more susceptible to malignant transformation from smoking before the first pregnancy.  While these small summary risk ratios may represent causal effects, residual confounding could readily produce estimates of this size in the absence of any causal effect.

Cummings P, Mueller BA, Quan L.  Association between wearing a personal floatation device and death by drowning among recreational boaters: a matched cohort analysis of United States Coast Guard data.  Inj Prev 2011; 17:156-159.

The objective of this study was to estimate the association between wearing a personal floatation device (PFD) and death by drowning among recreational boaters.  This was a matched cohort study analysis of Coast Guard data.  Subjects were recreational boaters during 2000-2006.  The main outcome measures were risk ratio (RR) for drowning death comparing boaters wearing a PFD with boaters not wearing a PFD.  Approximately 4915 boater records from 1809 vessels may have been eligible for our study, but because of missing records and other problems, the analysis was restricted to 1597 boaters in 625 vessels with 878 drowning deaths.  The adjusted RR was 0.51 (95% CI 0.35 to 0.74).  If the estimated association is causal, wearing a PFD may potentially prevent one in two drowning  deaths among recreational boaters. However, this estimate may be biased because many vessels had to be excluded from the analysis.

Chow EJ, Mueller BA, Baker KS, Cushing-Haugen KL, Flowers ME, Martin PJ, Friedman DL, Lee SJ.  Cardiovascular hospitalizations and mortality among recipients of hematopoietic stem cell transplantation.  Ann Intern Med 2011;155:21-32.

Hematopoietic stem cell transplantation (HSCT) is increasingly used to treat multiple malignant and nonmalignant conditions. The risk for cardiovascular disease after the procedure has not been well-described. The objective of the study was to compare rates and hazards of cardiovascular-related hospitalization and death among persons who were still alive at least 2 years after HSCT with those in a population-based sample using a retrospective cohort study.  1491 patients who had survived 2 years or longer after HSCT received between 1985-2006 were compared to frequency-matched persons who were randomly selected from drivers' license files in the state of Washington. Measurements: Cardiovascular hospitalizations and death were determined from statewide hospital discharge records and death registries in Washington. Compared with the general population, transplant recipients  experienced increased cardiovascular death (adjusted incidence rate difference, 3.6 per 1000 person-years [95% CI, 1.7 to 5.5]). Recipients also had an increased cumulative incidence of ischemic heart disease, cardiomyopathy or heart failure,  stroke, vascular diseases, and rhythm disorders and an increased incidence of related conditions that predispose toward more serious cardiovascular disease (hypertension, renal disease, dyslipidemia, and diabetes). No consistent differences in hazards were observed after total-body irradiation or receipt of an allogeneic versus an autologous graft, aside from an increased rate of hypertension among recipients of allogeneic grafts. Disease relapse after transplantation was associated with an increased hazard of cardiovascular death (hazard ratio, 2.3 [CI, 1.1 to 4.8]). All patients received HSCT at a single institution, and no information was available on pretransplantation treatment and lifestyle factors that may influence risk for cardiovascular disease. Increased rates of cardiovascular disease should be taken into account when caring for patients who have received HSCT. Future efforts should be directed toward improved screening and controlling of factors that predispose toward cardiovascular disease.

Sidman EA, Grossman DC, Mueller BA.  Comprehensive smoke alarm coverage in lower economic status homes: Alarm presence, functionality, and placement.  J Community Health 2011; 36:525-533.

The objectives of this study are to estimate smoke alarm coverage and adherence with national guidelines in low- to mid-value owner-occupied residences, and to identify resident demographic, behavioral, and building characteristics and other fire and burn safety practices associated with smoke alarm utilization. Baseline  visits were conducted with 779 households in King County, Washington, for a randomized trial of smoke alarm functionality. Presence, functionality, features, and location of pre-existing smoke alarms were ascertained by staff observation and testing. Household and building descriptors were collected using questionnaires. Households were classified by presence of smoke alarms, functional alarms, and functional and properly mounted alarms placed in hallways  and on each floor but not in recommended avoidance locations. Smoke alarms were present in 89%, and functional units in 78%, of households. Only 6-38% met all assessed functionality and placement recommendations. Homes frequently lacked alarms in any bedrooms or on each floor. Building age, but not renovation status, was associated with all dimensions of smoke alarm coverage; post-1980 constructions were 1.7 times more likely to comply with placement recommendations than were pre-1941 homes (95% CI: 1.1-2.6). Respondent education and race/ethnicity, children <5 years, residency duration, number of floors, wood stoves and fireplaces, number of smoke alarms, recency of smoke alarm testing, carbon monoxide monitors, and fire ladders displayed varying relationships with alarm presence, functionality, and placement. Strategies for maintaining smoke alarms in functional condition and improving compliance with placement recommendations are necessary to achieve universal coverage, and will benefit the majority of households.

DeRoo LA, Cummings P, Daling JR, Mueller BA.  Smoking during first pregnancy and breast cancer: a case-control study using Washington State registry data.  Ann Epidemiol 2011; 21(1):53-55.

The purpose of this study was to examine whether smoking during first pregnancy, a time of potential vulnerability to tobacco mutagens, is associated with breast cancer. We conducted a nested case-control study within a cohort of Washington State residents with first deliveries during 1984-1999, identified in birth and fetal death records. Linkage to population-based cancer registry data identified  1,099 women in the cohort aged 65 years and younger diagnosed with breast cancer  in 1985-2000. Controls (N=10,922) were matched by year and age of first delivery, race/ethnicity, and birth outcome. Maternal smoking and other variables characterizing the pregnancy were obtained from birth and fetal death records. Conditional logistic regression was used to analyze the data. The adjusted risk ratio for breast cancer was 0.8, 95% confidence interval 0.7-0.9, among women who smoked during their pregnancy compared with similar women who did not smoke. When the sample was restricted to known state residents at the time of the matched case's diagnosis, there was no association (risk ratio 1.0; 0.8-1.1). Our results do not suggest that cigarette smoking during first pregnancy increases the risk of breast cancer.