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Smoking has been identified as a risk factor for esophageal cancer; however, there is evidence that magnitudes and patterns of association differ by histologic type. The authors aimed to measure and compare the independent effects of various dimensions of smoking (duration, intensity, total dose, and time since quitting) on risks of esophageal adenocarcinoma (EAC), gastroesophageal junction adenocarcinoma (GEJAC), and esophageal squamous cell carcinoma (ESCC). They used data from a population-based Australian case-control study (2002–2005) comprising 367 EAC cases, 426 GEJAC cases, and 309 ESCC cases and 1,580 controls. Multivariate logistic and generalized additive logistic regression (for nonlinear dose effects) were used. Ever smokers had significantly higher risks of EAC (odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.3, 2.3), GEJAC (OR = 2.4, 95% CI: 1.8, 3.2), and ESCC (OR = 2.8, 95% CI: 2.0, 4.0) than did never smokers; however, there were significant differences in magnitude and patterns of association between subtypes. When multiple dimensions of smoking were assessed concurrently, duration was significantly associated with all three subtypes but intensity was associated only with GEJAC and ESCC, and the associations were nonlinear. For all types of esophageal cancer, time since quitting was independently associated with approximately 15–19% risk reductions per decade. [ABSTRACT FROM AUTHOR]

Background People with intellectual disability constitute ~ 2% of the population. They die prematurely, and often have a number of unrecognized or poorly managed medical conditions as well as inadequate health promotion and disease prevention. Methods A cluster randomized controlled trial with matched pairs was carried out. The participants were adults with intellectual disability (n = 453 in 34 clusters). The intervention was a health assessment programme to enhance interactions between the adult with intellectual disability, their carer and their general practitioner (GP). It prompted the systematic gathering of a health history and, subsequently, access to a GP for a guided health review and development of a health action plan. It also provided information about the health of adults with intellectual disability. Follow-up was for 1 year post intervention, with outcomes extracted from GPs’ clinical records. Results Increased health promotion, disease prevention and case-finding activity was found in the intervention group. Compared with the control group there was a 6.6-fold increase in detection of vision impairment (95% confidence interval 1.9–40); a 30-fold increase in hearing testing (4.0–230); an increase in immunization updates [tetanus/diphtheria a 9-fold increase (4.2–19)], and improvements in womens health screening [Papanicolau smears were eight times more common (1.8–35)]. The intervention increased detection of new disease by 1.6 times (0.9–2.8). Conclusions The Comprehensive Health Assessment Program (CHAP) produced a substantial increase in GPs’ attention to the health needs of adults with intellectual disability with concomitantly more disease detection. The presumption that these will yield longer-term health benefits, while suggestive, remains unexamined. [ABSTRACT FROM AUTHOR]