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3 - Epidemiology and etiology
- from Part I - History and general issues
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- By Logan G. Spector, Assistant Professor, Division of Pediatric Epidemiology & Clinical Research, Julie A. Ross, Professor, Division of Pediatric Epidemiology & Clinical Research, Leslie L. Robison, Professor, Division of Pediatric Epidemiology & Clinical Research, Smita Bhatia, Director Epidemiology and Outcomes Research, Division of Pediatrics, City of Hope National Medical Center, Duarte, CA, USA
- Edited by Ching-Hon Pui
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- Book:
- Childhood Leukemias
- Published online:
- 01 July 2010
- Print publication:
- 02 February 2006, pp 48-66
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- Chapter
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Summary
Introduction
The acute leukemias of childhood are a heterogeneous group of diseases. In reviewing the descriptive and analytic epidemiology of these malignancies, we have emphasized specific subgroups, as defined by morphology [the French-American-British (FAB) classification], cytogenetic features, or molecular markers. There is evidence that specific subtypes of leukemia may have distinct etiologies, and that molecular abnormalities associated with particular subtypes may be linked with specific causal mechanisms. Moreover, the mutations produced at the successive stages of leukemogenesis, from initiation through induction to promotion, may all involve separate etiologic processes.
It is also important to note that changes over time in diagnostic practice and precision may account in part for some reported epidemiologic trends. Moreover, changes in terminology and classification schemes for leukemia make it difficult to perform direct comparisons among studies, especially if risk factors differ for different subgroups. However, in assessing risk factors, studies of the childhood leukemias present several methodologic advantages. The interval between exposure to putative risk factors and the onset of leukemia may be shorter, recall of exposures is likely to be better, and intervening factors may be fewer than those associated with adult leukemias. These characteristics of childhood leukemia may facilitate identification of the most likely risk factors for each leukemia subtype. Furthermore, they lend themselves to an approach that includes both population studies and molecular epidemiologic techniques, permitting the design of research to assess genetic-environmental causal interactions.
Depression in Later-Life Puerto Rican Primary Care Patients: The Role of Illness, Stress, Social Integration, and Religiosity
- Julie Robison, Leslie Curry, Cynthia Gruman, Theresa Covington, Sonia Gaztambide, Karen Blank
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- Journal:
- International Psychogeriatrics / Volume 15 / Issue 3 / September 2003
- Published online by Cambridge University Press:
- 10 January 2005, pp. 239-251
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- Article
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Background: Older Puerto Ricans belong to two rapidly growing demographic groups known to have high rates of depression: the aging and Hispanic populations. Studies of depression in Puerto Ricans have primarily focused on the impact of demographic factors and health. This study expands previous research, examining the relationships between depression and social stressors, social support, and religiosity, for Puerto Rican primary care patients aged 50 and older. Patients: Participants included 303 Puerto Ricans from six primary care clinics in a northeastern city. Methods: Patients completed in-person interview in Spanish. The Composite International Diagnostic Interview indicated depressive disorders meeting DSM-IV criteria. Bivariate and multivariate relationships between depression and demographics, health, social stress and support, and religiosity were explored. Results: One fifth of participants met DSM-IV criteria for major depression or dysthymia. Participants with the lowest income, more recent migration, and poor subjective health were significantly more likely to be depressed. In addition, rates of depression increased steeply for patients caring for grandchildren and those with personal or family legal problems. Seeing few relatives each month and needing more instrumental, emotional, or financial support were also related to higher rates of depression. Unexpectedly, low objective illness severity correlated with increased depression, whereas religiosity and religious participation had no relationship to depression. Conclusions: The findings presented here indicate the potential for social stressors and inadequate supports to substantially increase the risk of depression in older Puerto Ricans in primary care settings. Further studies should explore incorporating these social risk factors into improved prevention, clinical detection, and culturally sensitive treatment of older depressed Puerto Ricans.