Search

Study Question: Does maternal age at a daughter's birth predict her subsequent probability of lifelong childlessness?Summary Answer: In this study population, women born to older mothers were more likely to be childless.What Is Known Already: Although maternal age at childbearing is increasing in many countries, there is limited evidence on whether being born to older parents may influence offspring fertility.Study Design Size and Duration: This analysis included 43 135 women from the US-based Sister Study, a cohort study of 50 884 sisters of women with breast cancer recruited between 2003 and 2009.Participants/materials, Setting, Methods: Participants had no breast cancer at baseline. Women were included in the analytic sample if they were born between 1930 and 1964 and were at least 44 years old at enrolment. Median age when reproductive history was last ascertained was 63.8 years. We estimated relative risks (RR) and 95% CI of lifelong childlessness as a function of maternal age at birth, using multivariable log-binomial models, including total number of siblings, birth order, socioeconomic indicators of the family of origin, race and birth cohort. We examined the association in different subgroups and in a sibling-matched analysis including 802 sister pairs discordant for childlessness.Main Results and Role Of Chance: Compared with women born to 20-24-year-old mothers, those born to mothers aged 25-29, 30-34 and ≥35 years were more likely to be childless [RR (95% CI): 1.21 (1.14-1.29), 1.30 (1.22-1.39) and 1.40 (1.31-1.50), respectively]. The association was consistent in strata defined by birth cohort, number of siblings, birth order, and participant's educational level, as well as within sister pairs. Overall, we found weak evidence for an independent contribution of paternal age at birth to the daughter's probability of childlessness.Limitations Reasons For Caution: All participants had at least one sister, and all information was self-reported. We had no knowledge of whether childlessness was intentional and found only a modest association between maternal age at birth and self-reported indicators of infertility. Still, the association with childlessness was highly consistent.Wider Implications Of the Finding: Given the widespread tendency to delay childbearing, evaluating the influence of maternal age at birth on offspring fertility is a public health priority.Study Funding/competing Interests: This research was supported in part by the Intramural Research Programme of the NIH, National Institute of Environmental Health Sciences (Z01-ES044005). The authors report no conflict of interest. [ABSTRACT FROM AUTHOR]

Background: Thrombolysis can significantly reduce the burden of stroke but the time window for safe and effective treatment is short. In patients travelling to hospital via ambulance, the sending of a 'prealert' message can significantly improve the timeliness of treatment.Objective: Examine the prevalence of hospital prealerting, the extent to which prealert protocols are followed and what factors influence emergency medical services (EMS) staff's decision to send a prealert.Methods: Cohort study of patients admitted to two acute stroke units in West Midlands (UK) hospitals using linked data from hospital and EMS records. A logistic regression model examined the association between prealert eligibility and whether a prealert message was sent. In semistructured interviews, EMS staff were asked about their experiences of patients with suspected stroke.Results: Of the 539 patients eligible for this study, 271 (51%) were recruited. Of these, only 79 (29%) were eligible for prealerting according to criteria set out in local protocols but 143 (53%) were prealerted. Increasing number of Face, Arm, Speech Test symptoms (1 symptom, OR 6.14, 95% CI 2.06 to 18.30, p=0.001; 2 symptoms, OR 31.36, 95% CI 9.91 to 99.24, p<0.001; 3 symptoms, OR 75.84, 95% CI 24.68 to 233.03, p<0.001) and EMS contact within 5 h of symptom onset (OR 2.99, 95% CI 1.37 to 6.50 p=0.006) were key predictors of prealerting but eligibility for prealert as a whole was not (OR 1.92, 95% CI 0.85 to 4.34 p=0.12). In qualitative interviews, EMS staff displayed varying understanding of prealert protocols and described frustration when their interpretation of the prealert criteria was not shared by ED staff.Conclusions: Up to half of the patients presenting with suspected stroke in this study were prealerted by EMS staff, regardless of eligibility, resulting in disagreements with ED staff during handover. Aligning the expectations of EMS and ED staff, perhaps through simplified prealert protocols, could be considered to facilitate more appropriate use of hospital prealerting in acute stroke. [ABSTRACT FROM AUTHOR]

Prospective cohorts have played a major role in understanding the contribution of diet, physical activity, medical conditions, and genes to the development of many diseases, but have not been widely used for occupational exposures. Studies in agriculture are an exception. We draw upon our experience using this design to study agricultural workers to identify conditions that might foster use of prospective cohorts to study other occupational settings. Prospective cohort studies are perceived by many as the strongest epidemiologic design. It allows updating of information on exposure and other factors, collection of biologic samples before disease diagnosis for biomarker studies, assessment of effect modification by genes, lifestyle, and other occupational exposures, and evaluation of a wide range of health outcomes. Increased use of prospective cohorts would be beneficial in identifying hazardous exposures in the workplace. Occupational epidemiologists should seek opportunities to initiate prospective cohorts to investigate high priority, occupational exposures. Am. J. Ind. Med. 58:113-122, 2015. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background:Local inflammation after tubal ligation may affect ovarian function and breast cancer risk.Methods:We analysed tubal ligation, menopausal characteristics, and breast cancer risk in the Sister Study cohort (N=50 884 women).Results:Tubal ligation was associated with hot flashes (hazard ratio (HR) 1.09; 95% confidence interval (CI): 1.06-1.12) but not menopausal age (HR 0.99; 95% CI: 0.96-1.02). Tubal ligation did not have an impact on breast cancer overall (HR 0.95; 95% CI: 0.85-1.06), but had a suggested inverse relation with oestrogen receptor+/progesterone receptor+ invasive tumours (HR 0.84; 95% CI: 0.70-1.01), possibly because of subsequent hysterectomy/bilateral oophorectomy.Conclusion:Tubal ligation does not influence overall breast cancer risk. [ABSTRACT FROM AUTHOR]

Objectives To examine the association of employment and work schedule with shorter DNA telomeres, a marker of cellular ageing and disease risk factor, and consider whether differences were related to health, behaviours and sociodemographic factors, or varied by stress levels or menopausal status. Methods This cross-sectional analysis of 608 women aged 35-74 in the Sister Study examined determinants of relative telomere length (rTL) measured by quantitative PCR in leucocyte DNA. Age-adjusted regression models estimated base pair (bp) rTL differences for current and lifetime schedule characteristics (ie, part-time, full-time or overtime hours; multiple jobs; irregular hours; shiftwork; work at night). Covariates included race, smoking, perceived stress, sleep, physical activity, health and menopausal status, education, marital status, live births, children under 18, measured body mass index and urinary stress hormones. Results Compared with non-employed women with moderate or substantial past work histories (n=190), those currently working full-time (n=247; median 40 h/week) had a shorter rTL, an age-adjusted difference of -329 bp (95% CI -110 to -548). Longer-duration full-time work was also associated with shorter rTL (age-adjusted difference of -472 bp, 95% CI -786 to -158 for 20+ vs 1-5 years). Findings were not explained by health and demographic covariates. However, rTL differences for working at least full-time were greater in women with higher stress and epinephrine levels. Conclusions Current and long-term full-time work were associated with shorter rTL, with differences of similar magnitude to smoking and history of heart disease or diabetes. Longitudinal data with specific stress measures are needed to further evaluate the impact of work schedule on rTL. [ABSTRACT FROM AUTHOR]

Exposure to high levels of many pesticides has both acute and long-term neurologic consequences, but little is known about the neurotoxicity of chronic exposure to moderate pesticide levels. We analysed cross-sectional data from 18 782 Caucasian, male, licensed pesticide applicators, enrolled in the Agricultural Health Study from 1993 to 1997. Applicators provided information on lifetime pesticide use, and 23 neurologic symptoms typically associated with pesticide intoxication. Increased risk of experiencing ≥10 symptoms during the year before enrollment was associated with cumulative pesticide use, personally mixing or applying pesticides, pesticide-related medical care, diagnosed pesticide poisoning, and events involving high personal pesticide exposure. Greatest risk was associated with use of organophosphate and organochlorine insecticides. Results were similar after stratification by pesticide use during the year before enrollment, or exclusion of applicators with a history of pesticide poisoning, or high-exposure events. Use of pesticide application methods likely to involve high personal exposure was associated with greater risk. Groups of symptoms reflecting several neurologic domains, including affect, cognition, autonomic and motor function, and vision, were also associated with pesticide exposure. These results suggest that neurologic symptoms are associated with cumulative exposure to moderate levels of organophosphate and organochlorine insecticides, regardless of recent exposure or history of poisoning. [ABSTRACT FROM AUTHOR]

Background: Several studies have reported associations between solvent exposure and reduced female fertility, but the evidence is inconclusive for male fertility. Objectives: To investigate the impact of solvent exposure on subfertility among families of male licensed pesticide applicators in the Agricultural Health Study cohort. Methods: The couples enrolled between 1993 and 1997. Cross-sectional questionnaire information on work tasks was used to assess exposure to solvents. The data were limited to couples (wife aged less than 40 years) with an attempt at pregnancy in the last four years (n=2112). Results: Twenty eight per cent of the couples were defined as subfertile (not conceiving a pregnancy after at least 12 months of unprotected intercourse, regardless of whether or not a pregnancy ultimately occurred). Adjusted subfertility odds ratios (OR) for exposure to solvents were calculated with logistic regression. Female (OR 1.42, 95% Cl 1.15 to 1.75) and male exposure to solvents (OR 1.21(95% Cl 0.93 to 1.57) for monthly exposure and 1.40 (95% Cl 0.97 to 2.03) for daily or weekly exposure) were associated with subfertility. In farming, spouses may share or exchange jobs. To account for potential dual exposure, variables for parental exposure (either parent exposed or both parents exposed) were also defined. Both were strongly associated with subfertility (OR 1.62 (95% Cl 1.20 to 2.17) and OR 2.10 (95% Cl 1.22 to 3.60), respectively). Conclusions: Solvents may impair fertility of either gender, though the evidence for female effects is stronger than for male effects. [ABSTRACT FROM AUTHOR]

Menstrual cycle characteristics may have implications for women’s fecundability and risk of hormonally related diseases. Certain pesticides disrupt the estrous cycle in animals. The authors investigated the cross-sectional association between pesticide use and menstrual function among 3,103 women living on farms in Iowa and North Carolina. Women were aged 21–40 years, premenopausal, not pregnant or breastfeeding, and not taking oral contraceptives. At study enrollment (1993–1997), women completed two self-administered questionnaires on pesticide use and reproductive health. Exposures of interest were lifetime use of any pesticide and hormonally active pesticides. Menstrual cycle characteristics of interest included cycle length, missed periods, and intermenstrual bleeding. The authors used generalized estimating equations to assess the association between pesticide use and menstrual cycle characteristics, controlling for age, body mass index, and current smoking status. Women who used pesticides experienced longer menstrual cycles and increased odds of missed periods (odds ratio = 1.5, 95% confidence interval: 1.2, 1.9) compared with women who never used pesticides. Women who used probable hormonally active pesticides had a 60–100% increased odds of experiencing long cycles, missed periods, and intermenstrual bleeding compared with women who had never used pesticides. Associations remained after control for occupational physical activity. [ABSTRACT FROM AUTHOR]

Objective: As part of a larger epidemiologic study of risk factors for attention-deficit hyperactivity disorder (ADHD), this pilot study combined parent and teacher information to estimate ADHD prevalence among elementary school children in a North Carolina county. The methods developed for this study and the pitfalls we encountered illustrate the challenges involved in conducting population-based studies of ADHD.Methods: We employed 2-stage screening using DSM-IV criteria. Teachers completed behaviour-rating scales for all children. We then administered a structured telephone interview to parents of potential cases. We screened 362 of 424 (85%) children in grades 1 to 5 in 4 schools.Results: According to parent reports, 43 children (12%) had previously been diagnosed with ADHD by a health professional. Thirty-four children (9%) were taking ADHD medication. Forty-six children (12.7%) met study case criteria for ADHD, based on combined teacher and parent reports. Of the 46 cases, 18 (39%) had not been previously identified. Eight previously diagnosed children, however, did not meet case criteria. After we adjusted for nonresponse, the estimated prevalence was 16% (95%CI, 12% to 20%).Conclusions: These data suggest that the DSM-IV prevalence of ADHD has been substantially underestimated, although the true prevalence in this population may be less than the 16% estimated here. Population-based studies of ADHD are feasible and may provide important information about practice and treatment patterns in community settings, as well as a broader understanding of the etiology and life course of this common disorder. [ABSTRACT FROM AUTHOR]

We evaluated predictive value of left ventricular ejection fraction at rest (REF) and its increment with exercise (ΔEF) on autologous and allogeneic stem cell transplantation mortality. In a 7 year period, a total of 163 patients evaluated for stem cell transplantation were studied. All were followed for at least 3 months after the transplant. REF was discriminatory for peritransplant mortality only in younger (<43 years) patients (n = 66), particularly those who underwent autologous transplantation (n = 30). Resting ejection fraction was not a discriminator for early death in any other subgroup. Cardiac reserve (ΔEF) was significantly lower in patients (n = 35), who died early. The finding was most prominent in younger patients who underwent autologous transplantation (n = 26). Combination of decreased REF and low ΔEF (n = 18) was associated with high peritransplant mortality (56%), after both autologous and allogeneic transplantation. A low REF with an appropriate ΔEF (n = 43) was associated with a 19% peritransplant mortality and no deaths in the autologous group. These observations indicate that resting ejection fraction is of only limited value for pretransplant evaluation. However, measurement of cardiac reserve during exercise can provide important prognostic information before stem cell transplantation. [ABSTRACT FROM AUTHOR]

Exposure to radon has been identified as a risk factor for lung cancer in uranium miners, but evidence of adverse health effects due to indoor radon exposure is inconsistent. Ecological studies have suggested a correlation between indoor radon levels and leukaemia incidence. We evaluated the risk associated with indoor residential radon exposure within a larger interview-based case-control study of risk factors for childhood acute myeloid leukaemia (AML). A total of 173 cases and 254 controls met the eligibility criteria, and information was collected through telephone interviews with parents and analysis of alpha-track radon detectors placed in the home for a period of 1 year. No association was observed between radon exposure and risk of AML, with adjusted odds ratios of 1.2 (95% confidence interval (CI) 0.7-1.8) for 37-100 Bq m(-3) and 1.1 (95% CI 0.6-2.0) for > 100 Bq m(-3) compared with < 37 Bq m(-3). Although there was an inverse association between radon level and AML risk among children < 2 years at diagnosis, among children > or = 2 years, AML risk was increased among those with higher radon exposure. The observed association after age 2 is most likely due to chance. Overall, there was no association between residential radon and risk of childhood AML. [ABSTRACT FROM AUTHOR]

Background: Cigarette smoking may be a risk factor for leukemia. No detailed biological mechanism has been proposed, but a causal link is made plausible by evidence of systemic effects of cigarette smoke and the presence in cigarette smoke of chemicals that have been associated with leukemia risk.Purpose: Our purpose was to investigate the leukemia risk associated with cigarette smoking in a multicenter case-control study of acute leukemias in adults.Methods: Adults aged 18-79 with newly diagnosed leukemia were contacted to participate in this epidemiologic study when they entered a clinical trial to be treated under protocols sponsored by Cancer and Leukemia Group B. Smoking histories for 610 patients with acute leukemia and 618 population control subjects were obtained by telephone interviews. We examined bone marrow samples and classified patients by morphology of leukocyte precursor cells according to the French-American-British (FAB) classification system and, for 378 patients, by the presence or absence of specific clonal chromosome abnormalities. We calculated odds ratios (ORs) for risk of leukemia associated with smoking cigarettes. ORs were adjusted for age, race, and sex.Results: Smoking was associated with only a modest increase in risk for leukemia overall (adjusted OR = 1.13; 95% confidence interval [CI] = 0.89-1.44). However, among participants aged 60 and older, smoking was associated with a twofold increase in risk for acute myeloid leukemia (AML) (OR = 1.96; 95% CI = 1.17-3.28) and a threefold increase in risk for acute lymphocytic leukemia (ALL) (OR = 3.40; 95% CI = 0.97-11.9). Among older persons, risks increased with amount and duration of smoking. Smoking was associated with increased risk for AML classified as FAB type M2 at all ages, with ORs of 1.70 (95% CI = 1.00-2.90) for those younger than 60 and 3.50 (95% CI = 1.53-8.03) for those aged 60 and older. Smoking was also associated with ALL type L2 at all ages, with ORs of 1.72 (95% CI = 0.90-3.27) for those younger than 60 and 5.34 (95% CI = 1.03-27.6) for those who were older. Smoking was more common among patients with specific chromosome abnormalities in AML [-7 or 7q-, -Y, +13] and in ALL [t(9;22)(q34;q11)].Conclusions: Cigarette smoking is associated with increased risk for leukemia and may lead to leukemias of specific morphologic and chromosomal types. The association varies with age.Implication: Examining discrete subtypes of disease may permit more accurate assessment of risk. As standardized morphologic classification and cytogenetic and molecular evaluation of leukemia patients becomes more common, epidemiologic studies that take advantage of these advances will begin to contribute to the identification of additional risk factors and mechanisms in acute leukemia. [ABSTRACT FROM AUTHOR]

An attempt was made to identify all patients diagnosed as having deep vein thrombosis (DVT) in a large teaching hospital during one year. A review of the radiology records showed that 124 (81%) of the 154 venograms performed were for suspected DVT, and that the diagnosis was confirmed in 57 (46%). During the same period, the Hospital Activity Analysis (HAA) records revealed 174 episodes classified as 'phlebitis or thrombophlebitis' in 162 patients. Only 37 of these episodes (21%) had been confirmed by X-ray venography and at least 29 patients were incorrectly classified by HAA. 'Medical' patients accounted for 54% of the episodes of DVT, yet in only 25% of these was the diagnosis confirmed by venography, while 'surgical' DVTs were less frequent but were more often confirmed by venography. [ABSTRACT FROM AUTHOR]

A new physical sign is described in the feet of a group of diabetic patients with ulcerating neuropathic problems, in which major venous distension of the veins on the dorsum of the foot and lower calf is seen. Elevation of the leg is required to an average height of 32.3 cm to cause collapse of these distended veins. It is suggested that this clinical sign indicates the presence of arteriovenous shunting in such neuropathic legs, and as such is a simple and useful measure of this abnormality. [ABSTRACT FROM AUTHOR]

The authors examined the association between age at menarche, menstrual cycle characteristics between ages 28 and 32 years, and peri- and postmenopausal fracture risk in a cohort of 874 women who prospectively recorded menstrual cycle data for at least 5 years from their early 20s through their menopause. Fracture history was obtained with a self-administered questionnaire. The mean age of respondents at the time the questionnaire was completed was 73 years. Wrist fracture (n = 62) risk increased with increasing age at menarche (odds ratio 3.3, 95% confidence interval 1.7–6.2) for menarche age ≥14 years compared with 12–13 years) and increasing mean cycle length at age 28–32 (odds ratio 2.2, 95% confidence interval 1.0–4.9) for >30.5 days compared with 26.6–30.5 days). Similar results were seen in analyses of the combined wrist, hip, or vertebral fracture group (n = 92). These prospectively recorded menstrual diary data indicate that age at menarche and menstrual cycle patterns may have a long-term association with fracture risk, with effects lasting into the postmenopausal years. Am J Epidemiol 1997; 145: 804–9. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the risk for chronic renal disease associated with regular use of nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs).Design: Multicenter case-control study.Patients: Patients were 554 North Carolina residents (age range, 30 to 79 years) hospitalized between 1980 and 1982 with a discharge diagnosis indicating newly diagnosed chronic renal dysfunction and a serum creatinine level consistently at or above 130 mumol/L (1.5 mg/dL). Controls were 516 persons chosen randomly by telephone screening (if younger than 65 years of age) and from listings of Medicare recipients (if 65 years of age or older), frequency-matched to patients by age, race, sex, and proximity to study hospitals.Measurements: Data on use of prescription NSAIDs and other analgesics before 1980, other risk factors, and potential confounders were obtained by telephone interviews. Patients were classified by frequency and duration of use; daily users were those who took an NSAID for at least 360 consecutive days.Main Results: A twofold risk for chronic renal disease was associated with previous daily use of NSAIDs (adjusted odds ratio, 2.1; 95% Cl, 1.1 to 4.1). Increased risk was predominantly limited to men older than 65 years, for whom the odds ratio for daily use was 10.0 (Cl, 1.2 to 82.7) after adjusting for use of other analgesics. In other age-sex groups, the risk associated with NSAID use tended to be increased among those with heart disease or other factors that might indicate compromised renal circulation. These findings did not result from confounding by known renal disease risk factors and were not readily explained by potential biases.Conclusions: Regular use of NSAIDs may increase the risk for chronic kidney disease in some high-risk groups. With the recent over-the-counter availability and increasing popularity of NSAIDs, the possibility of an increased risk for chronic renal disease associated with their use may warrant further scrutiny. [ABSTRACT FROM AUTHOR]

Despite the considerable efforts and funds devoted to cancer research over several decades, cancer still remains a mainly lethal disease. Cancer incidence and mortality have not declined at the same rate as other major causes of death, indicating that primary prevention remains a most valuable approach to decrease mortality. There is general agreement that environmental exposures are variously involved in the causation of the majority of cancer cases and that at least half of all cancers could be avoided by applying existing etiologic knowledge. There is disagreement, however, regarding the proportion of cancer risks attributable to specific etiological factors, including diet, occupation and pollution. Estimates of attributable risks are largely based today on unverified assumptions and the calculation of attributable risks involves taking very unequal evidence of various types of factors and treating them equally. Effective primary prevention resulting in a reduction of cancer risk can be obtained by: (i) a reduction in the number of carcinogens to which humans are exposed; or (ii) a reduction of the exposure levels to carcinogens. Exposure levels that could be seen as sufficiently low when based on single agents, may actually not be safe in the context of the many other concomitant carcinogenic and mutagenic exposures. The list of human carcinogens and of their target organs might be quite different if: (i) epidemiological data were available for a larger proportion of human exposures for which there is experimental evidence of carcinogenicity; (ii) more attention was paid to epidemiological evidence that is suggestive of an exposure-cancer association, but is less than sufficient, particularly in identifying target organs; and (iii) experimental evidence of carcinogenicity, supported by mechanistic considerations, were more fully accepted as predictions of human risk. [ABSTRACT FROM PUBLISHER]

Proceeding from a least-action principle, a generalization of the random-phase approximation is developed which is suited to the description of elementary excitations in such strongly-interacting Fermi systems as nuclei, nuclear matter, neutron-star matter and liquidHe. The equations of the theory involve matrix elements of the Hamiltonian and identity operators in a nonorthogonal basis of states incorporating short-range correlations. Linear response of the dynamically correlated system to a weak external perturbation is investigated within the same framework. [ABSTRACT FROM AUTHOR]

We examined ovarian cancer risk in relation to use of phenolphthalein-containing laxatives in 410 epithelial ovarian cancer cases and 713 controls. Compared to women who never used a laxative, ever use of a phenolphthalein-containing laxative was not associated with an increased risk of ovarian cancer (odds ratio, OR, 1.1, 95% confidence interval, CI, 0.9-1.4). Risk was slightly, but not significantly, higher with more frequent use (OR 1.2 for 75 or more days of use). When women who used non-phenolphthalein containing laxatives was used as the reference group, the associations were slightly, but not significantly larger (OR 1.4 for any use of phenolphthalein-containing laxatives and OR 1.5 for 75 or more days of use). [ABSTRACT FROM AUTHOR]

To investigate the present status of pulmonary embolism as a cause of death in a general hospital patient population, a 5-year retrospective study of all autopsy reports and associated hospital records was undertaken. Pulmonary embolism was thought to be the cause of death in 239 of 2388 autopsies performed (10%): 15% of these patients were aged less than 60 years and 68% did not have cancer. Of these patients, 83% had deep-vein thrombosis (DVT) in the legs at autopsy, of whom only 19% had symptoms of DVT before death. Only 3% of patients who had DVT at autopsy had undergone an investigation for such before death. Twenty-four per cent of patients who died from pulmonary embolism had undergone surgery a mean of 6.9 days before. Screening tests for DVT should be applied widely in the hospital population. [ABSTRACT FROM AUTHOR]

To investigate the present status of pulmonary embolism as a cause of death in a general hospital patient population, a 5-year retrospective study of all autopsy reports and associated hospital records was undertaken. Pulmonary embolism was thought to be the cause of death in 239 of 2388 autopsies performed (10%): 15% of these patients were aged less than 60 years and 68% did not have cancer. Of these patients, 83% had deep-vein thrombosis (DVT) in the legs at autopsy, of whom only 19% had symptoms of DVT before death. Only 3% of patients who had DVT at autopsy had undergone an investigation for such before death. Twenty-four per cent of patients who died from pulmonary embolism had undergone surgery a mean of 6.9 days before. Screening tests for DVT should be applied widely in the hospital population. [ABSTRACT FROM AUTHOR]

Conclusion Both primary and secondary endpoints show that daily doses of ASI prior to workout significantly increased pre-workout energy levels, increased muscle pump immediately following a workout, and decreased biomarkers of muscle damage immediately after a workout and during recovery. The purpose of this study was to examine the benefits of inositol-stabilized arginine silicate (ASI; Nitrosigine SP ® sp ) as a workout ingredient in healthy adults. Subjects had baseline measurements drawn at the hour 0 visit, took the study product, and completed an intense leg extension exercise protocol to induce muscle soreness. [Extracted from the article]

A letter to the editor is presented in response to the article "Post-intravitreal anti-VEGF endophthalmitis in the United Kingdom: incidence, features, risk factors, and outcomes," by D. A. M. Lyall and colleagues in the 2012 issue.

Editorial. Comments on the study findings regarding the effect of null genotype on an individual's susceptibility to environmental tobacco smoke (ETS). Percentage of the United States' population that carry null genotype for glutathione S-transferase; Limitations on the use of case-control study; Estimate ratio of two genotype-specific environmental tobacco smoke.

Three hundred and fifty non-insulin-dependent diabetic patients were screened for hypercholesterolaemia in an integrated diabetes lipid clinic. Forty six of the 70 patients with serum cholesterol concentrations over 7.0mmol/l were reviewed for further beta lipoprotein and endocrine assessment. After confirmatory testing or dietary therapy, only 22 of the original screened population had serum cholesterol concentrations over 7.0mmol/l. Of these, eight had both historical and biochemical evidence of poor diabetes control, two patients had significant clinical depression, two were hypothyroid, and ultimately 10 patients were started on lipid-lowering therapy. Nine patients continued follow-up for one year. Total costs of screening and follow-up were £2,740, representing a non-drug cost of £7.80 per patient screened or £468 per patient treated. These costs are also extrapolated in a sensitivity analysis for different cholesterol treatment cutoff levels. The study emphasises the need for proper assessment of diabetic patients prior to commencing lipid-lowering therapy, not only as good clinical practice but also in view of resources involved. [ABSTRACT FROM AUTHOR]

Objectives: Rhinitis is common, but the risk factors are not well described. To investigate the association between current rhinitis and pesticide use, we used data from 2245 Iowa commercial pesticide applicators in the Agricultural Health Study. Methods: Using logistic regression models adjusted for age, education and growing up on a farm, we evaluated the association between current rhinitis and 34 pesticides used in the past year. Results: 74% of commercial pesticide applicators reported at least one episode of rhinitis in the past year (current rhinitis). Five pesticides used in the past year were significantly positively associated with current rhinitis: the herbicides 2,4-D, glyphosate and petroleum oil, the insecticide diazinon and the fungicide benomyl. The association for 2,4-D and glyphosate was limited to individuals who used both in the past year (OR 1.42, 95% CI 1.14 to 1.77). Both petroleum oil and diazinon showed consistent evidence of an association with rhinitis, based on both current use and exposure-response models. We saw no evidence of confounding by common agricultural rhinitis triggers such as handling grain or hay. Conclusions: Exposure to pesticides may increase the risk of rhinitis. [ABSTRACT FROM AUTHOR]

Presents an abstract of the article " Mortality Among Farmers and Spouses in the Agricultural Health Study," published in the 2002 issue of the journal "Annals of Epidemiology."

Background: Exposure to animals, their feeds, and by-products contribute to respiratory symptoms among farmers.Aims: To investigate the role of animal exposures and wheeze, and to assess whether their impact differs among susceptible subgroups, including atopics, asthmatics, and smokers.Methods: Using the Agricultural Health Study, a cohort of pesticide applicators in Iowa and North Carolina enrolled in 1994-97, wheeze associated with animal production was evaluated and interactions among susceptible subgroups assessed. Logistic regression models were used to examine risk factors for wheeze in the past year among 20 468 farmers.Results: Individuals raising animals requiring direct contact had the highest odds ratios (OR) for wheeze (OR(dairy) = 1.26; OR(eggs) = 1.70). A significant dose response was observed for both the number of poultry and the number of livestock on the farm. Farmers who performed veterinary procedures on a daily basis had an OR of 1.51. The odds of wheeze associated with poultry production was greater among atopic than non-atopic individuals. Milking cows daily increased the odds of wheeze in all individuals, with the largest association observed among atopic asthmatic individuals. The impact of dairy, poultry, and egg production varied among smoking groups. Past smokers had the highest odds ratios, followed by never smokers, and then current smokers. The OR(eggs) was 2.88 among past smokers but only 1.46 for never smokers. The OR(eggs) for current smokers of 0.80 might reflect self selection of exposure among smokers.Conclusions: Results are consistent with animal production and respiratory symptoms, and suggest that subgroups may respond differently to exposure. [ABSTRACT FROM AUTHOR]