Search

In a randomized clinical trial to assess the effectiveness of different strategies for treating low-back pain in a managed-care setting, 681 adult patients presenting with low-back pain were randomized to four treatment groups: medical care with and without physical therapy; and chiropractic care with and without physical modalities. Follow-up information was obtained by questionnaires at two and six weeks, six, 12 and 18 months and by a telephone interview at four weeks. One outcome measurement at each follow-up is the patient’s self-report on the perception of low-back pain improvement from the previous survey, recorded as ‘A lot better,’ ‘A little better,’ ‘About the same’ and ‘Worse.’ Since the patient’s perception of improvement may be influenced by past experience, the outcome is analysed using a transition (first-order Markov) model. Although one could collapse categories to the point that logistic regression analysis with repeated measurements could be used, here we allow for multiple categories by relating transition probabilities to covariates and previous outcomes through a polytomous logistic regression model with Markov structure. This approach allows us to assess not only the effects of treatment assignment and baseline characteristics but also the effects of past outcomes in analysing longitudinal categorical data.

The objectives of the study are to test the hypotheses that psychological distress affects subsequent low-back pain, and pain affects subsequent distress. Six hundred eighty-one participants in a randomized clinical trial of low-back pain treatments were followed for 18 months with assessments for pain, disability, and psychological distress at 6 weeks and 6, 12, and 18 months. Multivariable logistic regression modeling with generalized estimating equations was used to estimate effects. Current pain and disability increased the odds of subsequent psychological distress [pain: adjusted odds ratio (OR) = 1.36, 95% confidence interval (CI) = 1.07, 1.72; disability: adjusted OR = 1.23, 95% CI = 0.98, 1.55], and current distress increased the odds of subsequent pain and disability (pain: adjusted OR = 1.51, 95% CI = 1.24, 1.86; disability: adjusted OR = 1.49; 95% CI = 1.20, 1.85). Cross-sectional associations were much stronger than the longitudinal associations, suggesting bias in the former due to selection factors and/or temporal ambiguity. The longitudinal findings suggest that pain/disability and psychological distress may be causes and consequences of each other, although the associations are small.

Both paraffin-embedded tissue specimens and buccal cells are excellent resources for large-scale molecular epidemiological studies. In order to identify the optimal method for DNA extraction, we compared three methods: (1) modified phenol–chloroform protocol; (2) simple boiling method; and (3) DNA Extraction Mini Kit. For paraffin-embedded tissue specimens, amplification of the β-globin gene sequence was successful in 30 of 34 (88.2%) by the simple boiling method, 29 of 34 (85.3%) samples using DNA extracted by the phenol–chloroform method, and 18 of 34 (52.9%) by the DNA Mini Kit. For buccal cells, amplification of the β-globin gene sequence was successful in 16 of 17 (94.1%) DNA samples extracted by the phenol–chloroform method, 2 of 16 (12.5%) by the simple boiling method, and 12 of 16 (75%) by the DNA Mini Kit. Both the simple boiling method and the phenol–chloroform method are better methods for DNA isolation from paraffin-embedded tissue specimens, and the phenol–chloroform method is the best method for DNA extraction from buccal cells.

Background context: Although many researchers and practitioners believe that patients' positive expectations of their treatment favorably influence clinical outcomes, there is little scientific evidence to support this belief. Purpose: To describe the level of patients' initial confidence in the success of their assigned treatment, by treatment group and other factors; and to estimate the effects of treatment confidence on subsequent changes in low-back pain and related disability. Study design and patient sample: Randomized clinical trial involving 681 patients treated for low-back pain in a managed-care facility in Southern California. Outcome measures: Treatment confidence; and changes in three clinical measures of low-back pain: average pain, most severe pain and back-pain–related disability. Methods: Patients were randomly assigned to one of four treatment groups: medical care with and without physical therapy, and chiropractic care with and without physical modalities. Information was collected by questionnaires at baseline, 2 weeks, 6 weeks and 6 months. Treatment confidence was measured just after randomization on a scale of 0 to10. Results: Treatment confidence was lowest, on average, for patients assigned to medical care only and highest for patients assigned to medical care plus physical therapy. Other predictors of high treatment confidence were having acute pain and being older, female and nonwhite. Although treatment confidence was only weakly associated with subsequent changes in low-back pain or disability in the total sample, high treatment confidence was associated with greater improvement among patients assigned to medical care plus physical therapy. Conclusions: Initial confidence in treatment for low-back pain varies by type of care and other factors. Higher confidence may have some beneficial effect on the course of low-back pain in certain patients, but this effect may depend on the type of interaction between client and provider.

Objectives. This study examined the difference in satisfaction between patients assigned to chiropractic vs medical care for treatment of low back pain in a managed care organization. Methods. Satisfaction scores (on a 10–50 scale) after 4 weeks of follow-up were compared among 672 patients randomized to receive medical or chiropractic care. Results. The mean satisfaction score for chiropractic patients was greater than the score for medical patients (crude difference = 5.5; 95% confidence interval = 4.5, 6.5). Self-care advice and explanation of treatment predicted satisfaction and reduced the estimated difference between chiropractic and medical patients’ satisfaction. Conclusions. Communication of advice and information to patients with low back pain increases their satisfaction with providers and accounts for much of the difference between chiropractic and medical patients’ satisfaction.

OBJECTIVES: To determine (1) the extent of agreement between the CAGE (acronym for cut down, annoyed by criticism, guilty about drinking, eye-opener drinks) and the Short Michigan Alcoholism Screening Test—Geriatric Version (SMAST-G) in identifying older persons who may have possible alcohol use disorders (AUDs) and (2) whether persons identified as having possible AUDs by each of these screening measures differ in their drinking, demographic, or health-related characteristics. DESIGN: Secondary analysis of a cross-sectional study using data from a self-administered mailed survey sample. SETTING: Three organizations were surveyed: (1) members of the American Association of Retired Persons and, in southern California, (2) managed care enrollees in a large medical group and (3) attendees of a community-based senior health center. PARTICIPANTS: One thousand eight hundred eighty-nine persons aged 55 and older completing a health risk appraisal for older persons (Health Risk Appraisal for the Elderly (HRA-E)). MEASUREMENTS: The HRA-E included items on drinking behaviors (including amount of alcohol use, the CAGE, and the SMAST-G) and health and demographic characteristics. RESULTS: Twenty-six percent of all persons screened positive on the CAGE or the SMAST-G. Fewer than half of all persons screening positive on either the CAGE or the SMAST-G, screened positive on both measures. Among current drinkers, persons screening positive on the SMAST-G alone drank less than persons screening positive on the CAGE alone, and these persons drank less than those screening positive on both the SMAST-G and the CAGE. More men screened positive on the CAGE alone than on the SMAST-G alone. CONCLUSION: Fewer than half of persons screening positive on either the CAGE or the SMAST-G screened positive on both measures, suggesting that these instruments may be capturing different aspects of unsafe drinking. A screening strategy employing both brief measures may identify more AUDs among older persons having differing demographic and health characteristics.

To the Editor: Socioeconomic inequalities in lung cancer incidence have been consistently reported. Contradictory findings, however, have been found regarding the extent to which smoking accounts for these inequalities.1,2 A recent study concluded that smoking alone accounted for all socioeconomic inequalities in lung cancer risk, and that the remaining association between socioeconomic status and lung cancer risk reported in previous studies after adjustment for smoking was due to incomplete adjustment for smoking.3 As residual confounding by smoking can never be ruled out, we investigated inequalities in lung cancer risk in the subgroup of never-smokers. We used data from 14 case–control studies participating to the International Lung Cancer Consortium from Europe, North America, and Asia. The association of lung cancer risk with education (up to lower secondary, upper secondary, tertiary) was assessed with unconditional logistic regression using generalized estimating equations models to account for heterogeneity that may be due to variability between study populations. In total, 484 male cases, 2644 male controls, 1209 female cases, and 3283 female controls were included. Among men, higher lung cancer risk was reported among the least educated men in all regions, except in Spain where the opposite association was observed (Table; eTables 1–3, http://links.lww.com/EDE/A833). The increased odds ratio was appreciable among men in the intermediate education group in France and Italy. Among women, little association between education and lung cancer risk was reported, with an odds ratio for women in the intermediate education group close to 1.00 in all models. We found larger inequalities in studies with population-based controls than with hospital-based controls. TABLE Age-Adjusted Associations of Education with Lung Cancer by Region and Source of Controls Among Never-Smokers Although we conducted analyses among never-smokers, residual confounding by smoking cannot be totally ruled out. Some never-smokers may actually be former smokers. However, studies consistently reported a high agreement between self-reported and biologically assessed smoking status, with differences limited to light smokers or ex-smokers who stopped a long time ago and no difference by socioeconomic characteristics.4 Smoking status may also be more accurately reported among cases, which would lead to an underestimation of the association. According to Nyberg et al,4 this misreporting could explain an association of 1.12 between education and lung cancer in the situation where there is no association, and we found more pronounced associations among men who had never smoked. All this evidence suggests that this misclassification is limited and does not account for our findings. Our findings are consistent with the sparse studies conducted among never smokers.1,2 Several explanations may be suggested. First, occupational exposures are more frequent among men and among the least educated groups, and may partly account for our findings.5 The evidence regarding other risk factors is less clearcut. The association between environmental tobacco smoke and lung cancer is modest, and this exposure is often more prevalent among women.6 No association has been found between vegetable consumption or body mass index and lung cancer risk among never-smokers.7,8 Second, the never-smoking population may exhibit different characteristics in different countries. In North America, our most-educated category is large, and due to the various stages of the smoking epidemic, there are more never-smokers among highly educated men. Consequently, highly educated never-smoking men are more selected in Europe and may exhibit a better profile, especially regarding occupational exposures. Never-smokers are likely to differ from the general population, with a healthier lifestyle or less occupational exposures, and our results can probably not totally be extrapolated to the general population. However, we investigated inequalities among all subjects with a careful adjustment for smoking. The results were consistent with our findings among never smokers (see eAppendix, http://links.lww.com/EDE/A833). Our study therefore suggests that smoking may not account for all educational differences in lung cancer risk.

Background Peroxisome proliferator-activated receptors (PPARs) are transcriptional factors involved in several biological processes such as inflammation, cancer growth, progression and apoptosis that are important in lung and upper aero-digestive tract (UADT) cancer outcomes. Nonetheless, there are no published studies of the relationship between PPARs gene polymorphisms and survival of patients with lung cancer or UADT cancers. Methods 1212 cancer patients (611 lung, 303 oral, 100 pharyngeal, 90 laryngeal, and 108 esophageal) were followed for a median duration of 11 years. We genotyped three potentially functional single nucleotide polymorphisms (SNPs) using Taqman – rs3734254 of the gene PPARD and rs10865710 and rs1801282 of the gene PPARG – and investigated their associations with lung and UADT cancer survival using Cox regression. A semi-Bayesian shrinkage approach was used to reduce the potential for false positive findings when examining multiple associations. Results The variant homozygote CC (vs. TT) of PPARD rs3734254 was inversely associated with mortality of both lung cancer (adjusted hazard ratio [aHR]=0.63, 95% confidence interval [CI]=0.42, 0.96) and UADT cancers (aHR=0.51, 95% CI=0.27, 0.99). Use of the semi-Bayesian shrinkage approach yielded a posterior aHR for lung cancer of 0.66 (95% posterior limits=0.44, 0.98) and a posterior aHR for UADT cancers of 0.58 (95% posterior limits=0.33, 1.03). Conclusion Our findings suggest that lung-cancer patients with the CC variant of PPARD rs3734254 may have a survival advantage over lung-cancer patients with other gene variants.

Despite persistent schooling-related health disparities in the United States, little is known about the multigenerational effects of schooling on adult health. As expected lifespans increase, direct influences of grandparental schooling on grandchildren's health may become increasingly important. We used multigenerational data spanning 41 years from a national sample of US families to investigate associations of grandparents’ educational attainment with global health status, smoking, and obesity in their grandchildren who were aged 25–55 years in 2009. We estimated total effects of grandparental schooling and, by using marginal structural models, we estimated controlled direct effects that were independent of parents’ and participants’ schooling. Among whites, lower levels of grandparental schooling were monotonically associated with poor health status, current smoking, and obesity in adult grandchildren. There was also evidence suggesting direct effects, which was stronger for poor health status among participants whose highest-educated grandparent lived in the same state. Among blacks, the only association suggesting a total or direct effect of grandparental schooling was for smoking. Despite the relative imprecision of our estimates and possible residual bias, these results suggest that higher levels of grandparental schooling may benefit the health of grandchildren in adulthood, especially among whites. Furthermore, part of those apparent effects, especially for obesity, may not be mediated by parents’ and grandchildren's schooling.

Guidelines have recommended single pool Kt/V 1.2 as the minimum dose for chronic hemodialysis (HD) patients on thrice weekly HD. The Dialysis Outcomes and Practice Patterns Study (DOPPS) has shown that "low Kt/V" (1.2) is more prevalent in Japan than many other countries, though survival is longer in Japan. We examined trends in low Kt/V, dialysis practices associated with low Kt/V, and associations between Kt/V and mortality overall and by gender in Japanese dialysis patients. We analyzed 5784 HD patients from Japan DOPPS (1999-2011), restricted to patients dialyzing for1 year and receiving thrice weekly dialysis. Logistic regression models estimated the relationships of patient characteristics with Kt/V. Logistic models also were used to estimate the proportion of low Kt/V cases attributable to various treatment practices. Multivariable Cox regression was used to estimate the associations of low Kt/V, blood flow rate (BFR), and treatment time (TT), with all-cause mortality. From 1999 to 2009, the prevalence of low Kt/V declined in men (37-27%) and women (15-10%). BFR200 mL/min, TT240 minutes, and dialyzate flow rate (DFR) 500 mL/min were common (35, 13, and 19% of patients, respectively) and strongly associated with low Kt/V. Fifteen percent of low Kt/V cases were attributable to BFR200 and 13% to TT240, compared to only 3% for DFR500. Lower Kt/V was associated with elevated mortality, more so among women (hazard ratio [HR] = 1.13 per 0.1 lower Kt/V, 95% CI: 1.07-1.20) than among men (HR = 1.06 per 0.1 lower Kt/V, 95% CI: 1.00-1.12). The relatively large proportion of low Kt/V cases in Japanese facilities may potentially be reduced 30% by increasing BFR to 200 mL/min and TT to 4 hours thrice weekly in HD patients. Associations of low Kt/V with elevated mortality suggest that modification of these practices may further improve survival for Japanese HD patients.

Leoncini, Emanuele Ricciardi, Walter Cadoni, Gabriella Arzani, Dario Petrelli, Livia Paludetti, Gaetano Brennan, Paul Luce, Daniele Stucker, Isabelle Matsuo, Keitaro Talamini, Renato La Vecchia, Carlo Olshan, Andrew F Winn, Deborah M Herrero, Rolando Franceschi, Silvia Castellsague, Xavier Muscat, Joshua Morgenstern, Hal Zhang, Zuo-Feng Levi, Fabio Dal Maso, Luigino Kelsey, Karl McClean, Michael Vaughan, Thomas L Lazarus, Philip Purdue, Mark P Hayes, Richard B Chen, Chu Schwartz, Stephen M Shangina, Oxana Koifman, Sergio Ahrens, Wolfgang Matos, Elena Lagiou, Pagona Lissowska, Jolanta Szeszenia-Dabrowska, Neonila Fernandez, Leticia Menezes, Ana Agudo, Antonio Daudt, Alexander W Richiardi, Lorenzo Kjaerheim, Kristina Mates, Dana Betka, Jaroslav Yu, Guo-Pei Schantz, Stimson Simonato, Lorenzo Brenner, Hermann Conway, David I Macfarlane, Tatiana V Thomson, Peter Fabianova, Eleonora Znaor, Ariana Rudnai, Peter Healy, Claire Boffetta, Paolo Chuang, Shu-Chun Lee, Yuan-Chin Amy Hashibe, Mia Boccia, Stefania eng Netherlands 2013/11/26 06:00 Eur J Epidemiol. 2014 Jan;29(1):35-48. doi: 10.1007/s10654-013-9863-2. Epub 2013 Nov 24.; International audience; Several epidemiological studies have shown a positive association between adult height and cancer incidence. The only study conducted among women on mouth and pharynx cancer risk, however, reported an inverse association. This study aims to investigate the association between height and the risk of head and neck cancer (HNC) within a large international consortium of HNC. We analyzed pooled individual-level data from 24 case-control studies participating in the International Head and Neck Cancer Epidemiology Consortium. Odds ratios (ORs) and 95 % confidence intervals (CIs) were estimated separately for men and women for associations between height and HNC risk. Educational level, tobacco smoking, and alcohol consumption were included in all regression models. Stratified analyses by HNC subsites were performed. This project included 17,666 cases and 28,198 controls. We found an inverse association between height and HNC (adjusted OR per 10 cm height = 0.91, 95 % CI 0.86-0.95 for men; adjusted OR = 0.86, 95 % CI 0.79-0.93 for women). In men, the estimated OR did vary by educational level, smoking status, geographic area, and control source. No differences by subsites were detected. Adult height is inversely associated with HNC risk. As height can be considered a marker of childhood illness and low energy intake, the inverse association is consistent with prior studies showing that HNC occur more frequently among deprived individuals. Further studies designed to elucidate the mechanism of such association would be warranted.

Lifetime contraceptive use as reported by a representative sample of 764 homeless women in Los Angeles was examined overall and for different age and ethnic subgroups and contrasted with expressed willingness to use specific methods. Over 80% of the women reported condom use. However, less than 5% had ever used female condoms, although 38% of the overall sample and 73% of the teenagers said they were willing to try them. Similar gaps between reported use and endorsement were found for other particular methods. Native Americans had relatively low use of virtually all contraceptive methods, and over 80% of African-Americans rejected implants. Our findings suggest that age-related factors and ethno-cultural perceptions may deter some homeless women from using contraception. In any case, gaps between realized use and willingness to use may represent missed opportunities to prevent the high rates of unintended pregnancies and sexually transmitted infections found among homeless women.

We examined factors predicting knowledge of one's blood pressure, total cholesterol, and high-density lipoprotein levels (HDL) among older persons who reported a recent blood pressure or cholesterol test. Data come from a self-administered, health risk assessment that was mailed to health plan members, age 55 and older, in a Santa Barbara, California medical group. Despite their universal access to health care and high levels of reported compliance with preventive health care screening practices, 41%, 49%, and 77% of respondents reported that they did not know their blood pressure, cholesterol, or HDL levels, respectively. After controlling for potential confounders, age and low income were inversely associated with the respondents' ability to report each level. In addition, current smoking and obesity were inversely associated with self-reported knowledge of both cholesterol measures. Persons taking medication for hypertension or hypercholesterolemia were much more likely than those not taking medication to be able to report their blood pressure and cholesterol levels. Except for persons currently undergoing treatment for related conditions, these results suggest that a substantial proportion of the older persons at high risk for cardiovascular disease do not know their levels of these important biological risk factors. This lack of knowledge has important implications for public health education, and may hinder risk-reduction efforts among the elderly.

The etiology of penile cancer is poorly understood, with neonatal circumcision being one of the few recognized nondemographic risk factors. Multiple logistic regression was used to analyze interview data from 100 matched case–control pairs; cases of carcinoma in situ (CIS) and invasive carcinoma of the penis were analyzed separately as well as together. Phimosis was strongly associated with invasive carcinoma (adjusted odds ratio [OR] = 16; 95% confidence interval [CI] = 4.5–57) but not CIS (OR = 1.7; 95% CI = 0.32–7.8), and these associations persisted when the analyses were restricted to uncircumcised subjects. Neonatal circumcision was inversely associated with invasive carcinoma (OR = 0.41; 95% CI = 0.13–1.1) but not CIS, and the observed association with invasive carcinoma was weakened appreciably when the analysis was restricted to subjects with no history of phimosis (OR = 0.79; 95% CI = 0.29–2.6). Other factors positively associated with invasive carcinoma or CIS or both were injury to the penis, cigarette smoking, physical inactivity and, to a lesser extent, genital warts and other infections or inflammation of the penis. Conclusions: Although many effects were imprecisely estimated in this study, the protective effect of circumcision on invasive penile cancer appears to be mediated in large part by phimosis; furthermore, the effects of certain factors such as phimosis and circumcision appear to differ for CIS and invasive carcinoma.

Treatment preferences of groups (e.g., clinical centers) have often been proposed as instruments to control for unmeasured confounding-by-indication in instrumental variable (IV) analyses. However, formal evaluations of these group-preference-based instruments are lacking. Unique challenges include the following: (i) correlations between outcomes within groups; (ii) the multi-value nature of the instruments; (iii) unmeasured confounding occurring between and within groups. We introduce the framework of between-group and within-group confounding to assess assumptions required for the group-preference-based IV analyses. Our work illustrates that, when unmeasured confounding effects exist only within groups but not between groups, preference-based IVs can satisfy assumptions required for valid instruments. We then derive a closed-form expression of asymptotic bias of the two-stage generalized ordinary least squares estimator when the IVs are valid. Simulations demonstrate that the asymptotic bias formula approximates bias in finite samples quite well, particularly when the number of groups is moderate to large. The bias formula shows that when the cluster size is finite, the IV estimator is asymptotically biased; only when both the number of groups and cluster size go to infinity, the bias disappears. However, the IV estimator remains advantageous in reducing bias from confounding-by-indication. The bias assessment provides practical guidance for preference-based IV analyses. To increase their performance, one should adjust for as many measured confounders as possible, consider groups that have the most random variation in treatment assignment and increase cluster size. To minimize the likelihood for these IVs to be invalid, one should minimize unmeasured between-group confounding. Copyright © 2014 John Wiley & Sons, Ltd.

We conducted a meta-analysis of 36 papers published between 1974 and 1990 to estimate the effects of intrauterine device (IUD) use and Dalkon Shield use, in particular, on pelvic inflammatory disease (PID). The number of women studied in each report ranged from 50 to 26,507. For general IUD use, analyses were separated by type of PID (symptomatic or asymptomatic) because of extreme rate-ratio heterogeneity across studies. Dalkon Shield rate ratios were more homogeneous and were considered in a single meta-regression. There was substantial heterogeneity, however, in all three meta-regressions; the rate-ratio estimates ranged from 0.51 to 12 for IUD use and symptomatic PID, from 1.0 to 132 for IUD use and asymptomatic PID, and from 0.32 to 28 for Dalkon-Shield use and PID. This heterogeneity appeared to be due to differences in reference groups, study populations, and characteristics of study design. We observed consistent, positive associations of IUD use with both symptomatic and asymptomatic PID. These associations were largest for the Dalkon Shield.

The purpose of this study was to examine the independent and interactive effects of HIV-1 serostatus and cocaine on neuropsychological (NP) performance in a sample of 237 gay and bisexual urban-dwelling African American men. Consistent with current evidence, it was expected that the greatest neuropsychological performance deficits would be evident (1) in the symptomatic seropositives (SSPs), especially in domains affected by HIV (i.e., memory and psychomotor speed), and on tests that are sensitive to subtle slowing; (2) in those who are recent and frequent cocaine abusers; and (3) in those who are both HIV seropositive and cocaine abusers. Multivariate analyses controlling for age and alcohol use confirmed expectations, with symptomatic seropositives (SSPs) evidencing significantly poorer psychomotor speed than the seronegatives (SNs), and slower reaction time and poorer nonverbal memory than the asymptomatic seropositives (ASPs). Moderate to heavy recent cocaine use was associated with slower psychomotor speed. However, contrary to expectations, no interaction of serostatus and cocaine was noted for any NP domain, and the expected serostatus and cocaine effects on verbal memory and frontal systems were not obtained. Level of alcohol consumption exacerbated the detrimental effects of HIV-1 on a computerized reaction time test which is especially sensitive to subtle slowing. This study provides one of the first descriptions of the neuropsychological effects of HIV–AIDS in a noninjection drug-using community sample of gay and bisexual African American men. (JINS, 2000, 6, 322–335.)

Background: Findings from animal and human studies confirm that diphtheria and tetanus toxoids and pertussis (DTP) and tetanus vaccinations induce allergic responses; associations between childhood vaccinations and subsequent allergies have been reported recently. Objective: The association of DTP or tetanus vaccination with allergies and allergy-related respiratory symptoms among children and adolescents in the United States was assessed. Methods: Data were used from the Third National Health and Nutrition Examination Survey on infants aged 2 months through adolescents aged 16 years. DTP or tetanus vaccination, lifetime allergy history, and allergy symptoms in the past 12 months were based on parental or guardian recall. Logistic regression modeling was performed to estimate the effects of DTP or tetanus vaccination on each allergy. Results: The odds of having a history of asthma was twice as great among vaccinated subjects than among unvaccinated subjects (adjusted odds ratio, 2.00; 95% confidence interval, 0.59 to 6.74). The odds of having had any allergy-related respiratory symptom in the past 12 months was 63% greater among vaccinated subjects than unvaccinated subjects (adjusted odds ratio, 1.63; 95% confidence interval, 1.05 to 2.54). The associations between vaccination and subsequent allergies and symptoms were greatest among children aged 5 through 10 years. Conclusions: DTP or tetanus vaccination appears to increase the risk of allergies and related respiratory symptoms in children and adolescents. Although it is unlikely that these results are entirely because of any sources of bias, the small number of unvaccinated subjects and the study design limit our ability to make firm causal inferences about the true magnitude of effect. (J Manipulative Physiol Ther 2000;23:81–90)

Although low-back pain and depression are common comorbidities, the mechanisms responsible for their association remain unclear. The effects of proinflammatory cytokines on the hypothalamic-pituitary-adrenal (HPA) axis lead to the hypothesis that allergic reactions, as markers for inflammation-associated activation of the HPA axis, result in aberrant responses to subsequent stressors. Data from 6,836 US adults 20-39 years old from the Third National Health and Nutrition Examination Survey (1988-1994) were used. Subjects responded to questions regarding low-back pain in the past 12 months and history of asthma, hay fever, and other allergies. The history and onset of major depression were obtained from the Diagnostic Interview Schedule. Logistic regression modeling was used to estimate the associations between allergies and depression and low-back pain. Subjects with a history of any allergy were more likely to report low-back pain (odds ratio = 1.51; 95% confidence interval: 1.16, 1.96), to be diagnosed with major depression (odds ratio = 1.58; 95% confidence interval: 1.13, 2.21), and much more likely to have both major depression and low-back pain (odds ratio = 3.03; 95% confidence interval: 1.32, 6.92). Hypersensitivity reactions may prime the HPA axis to respond aberrantly to stressors, resulting in physical and behavioral consequences.

We conducted a retrospective cohort study of 6107 aerospace workers to examine whether exposure to chemicals--primarily hydrazine fuels--during rocket-engine fueling and testing affects cancer mortality. When conditional logistic regression analysis was applied and adjusted for confounding variables, the estimated rate ratio for lung cancer mortality, comparing exposed to unexposed workers from the same facility, ranged from 1.68 (95% confidence interval, 1.12 to 2.52) to 2.10 (95% confidence interval, 1.36 to 3.25), depending on job-duration threshold (6 or 24 months) and lag (0 to 15 years). Similar results were obtained for hemato- and lymphopoietic cancer and for bladder and kidney cancer mortality, but estimates for these cancers were imprecise. We concluded that occupational exposure to hydrazine or other chemicals associated with rocket-engine testing jobs increased the risk of dying from lung cancer, and possibly other cancers, in this population of aerospace workers; however, our results need to be replicated in other populations.

Following mild head injury, a subgroup of individuals exhibit a constellation of chronic symptoms, a condition Alexander (1995) labeled Persistent Post-Concussive Syndrome (PPCS). He implicated neurological factors in the initial phase of the syndrome but psychological factors in the maintenance of symptoms. However, it is unclear as to whether an initial mild head injury is necessary or sufficient to cause the symptoms of PPCS. We first outline a study design comparing a mild closed-head injury group to both a normal and an other injury control group to answer this question. Next, we review the literature since 1960 to determine the findings of any studies using this design. The results of the literature review indicate that few such studies exist. To date, those that have been done suggest that there is no strong evidence for a specific effect for mild head injury on cognitive functioning. We discuss directions for future research given these findings.

PURPOSE: We assess the effect of comorbidity on self-reported use of health care for back problems in the United States. METHODS: Data from the 1989 National Health Interview Survey (NHIS) were used to perform cross-sectional analyses of adults who reported a back-related condition. The presence of one or more nonback-related conditions (and associated disability and health care) were the primary predictor variables. Weighted logistic regression modeling was performed to estimate odds ratios (ORs) adjusted for the effects of covariates. RESULTS: The 1989 NHIS included 84,572 adults, of which 4790 (5.7%) reported at least one back-related condition. Of these, 931 (19.6%) sought health care for their back condition during the 2-week reference period. Among all adults with reported back problems, those with disabling comorbidities and those who sought care for their comorbidities during the reference period were less likely to have sought back care than were those with no comorbidities. Subjects with back-related disabilities who reported nondisabling comorbidities without associated health care were much more likely to have sought back care than were similar subjects without any comorbidities. CONCLUSIONS: The decision to seek care for a back problem is a complex process that depends upon the presence and impact of other conditions and the use of care for these conditions. Comorbid back problem sufferers may not seek back care when afflicted with other disabling conditions or conditions that may be perceived to be more amenable to care.

Background and Methods A retrospective cohort study was conducted to estimate the effects of low-level exposure to external (penetrating) radiation on cancer mortality among 4,563 workers monitored for external radiation between 1950 and 1993 at a nuclear research and production facility in Southern California. Results Of the 875 deaths that occurred before 1995, 258 were due to cancer as the underlying cause. External comparisons of male subjects with the U.S. white male population indicated that the workers had lower rates of dying from all causes and all cancers, but a higher rate of dying from leukemia. Internal comparisons of workers exposed at different dose levels, using risk-set analyses with adjustment for confounders, demonstrated an increased mortality rate in workers exposed to 200 mSv for hemato- and lymphopoietic cancers and for lung cancer. Mortality rates for total cancers and “radiosensitive” solid cancers increased monotonically with cumulative radiation dose, but no trends were observed for “nonradiosensitive” cancers. Conclusions Despite possible residual confounding and low precision for estimating effects on specific cancers, these findings indicate that chronic, low-level radiation exposure may have more generalized carcinogenic effects than have been observed in most previous investigations. Such effects may have become evident as a result of the relatively long follow-up period in the present study. Am. J. Ind. Med. 35:21–31, 1999. © 1999 Wiley-Liss, Inc.

BackgroundTardive dyskinesia is important in the side-effect profile of antipsychotic medication.AimsThe development of tardive dyskinesia was evaluated in patients treated with double-blind, randomly assigned olanzapine or haloperidol for up to 2.6 years.MethodsTardive dyskinesia was assessed by the Abnormal Involuntary Movement Scale (AIMS) and Research Diagnostic Criteria for Tardive Dyskinesia (RD-TD); it was defined as meeting RD-TD criteria at two consecutive assessments. The risk of tardive dyskinesia, the relative risk, incidence rate, and incidence rate ratio were estimated.ResultsThe relative risk of tardive dyskinesia for the overall follow-up period for haloperidol (n=522) v. olanzapine (n=1192) was 2.66 (95% CI=1.50–4.70). Based on data following the initial six weeks of observation (during which patients underwent medication change and AIMS assessments as frequently as every three days), the one-year risk was 0.52% with olanzapine (n=513) and 7.45% with haloperidol (n=114). The relative risk throughout this follow-up period was 11.37 (95% Cl=2.21–58.60).ConclusionOur results indicated a significantly lower risk of tardive dyskinesia with olanzapine than with haloperidol.

Although studies generally support a positive association between alcohol consumption and lung-cancer risk, the relationship between specific alcoholic beverages and lung-cancer risk has been inconsistent. We examined recent and past alcoholic beverage intake among 261 incident cases and 615 population controls enrolled in a lung-cancer case-control study of African Americans and Caucasians in Los Angeles County between 1991 and 1994. An in-person interview elicited information about past alcohol intake from ages 30 to 40 y, smoking, other lung-cancer risk factors, as well as recent intake of alcohol, and recent dietary intake. An association was observed between recent hard-liquor consumption and lung-cancer risk. The odds ratio (OR) for 1 or more drinks (1.5 oz or 0.051 mL) per day of hard liquor compared with infrequent liquor drinking (0-3 drinks per month), adjusted for smoking, the matching factors, saturated fat and other alcoholic beverages was 1.87 [95% confidence interval (CI) = 1.02-3.42]. No appreciable association was observed for total alcohol, whereas small inverse associations were observed for beer and wine, although confidence intervals were wide. An elevated lung-cancer risk was also observed for past liquor consumption (between ages 30 and 40 y). The adjusted OR for 1 or more drinks per day of liquor compared with infrequent drinkers was 1.83 (95% CI = 1. 06-3.15). Confounding of the association between alcohol and lung cancer by smoking was apparent. Although we devoted considerable efforts to adjusting for smoking in our analyses, residual confounding is still possible because smoking and alcohol are closely associated. In addition, case-control studies including this study should be viewed with caution because of possible selection bias. An increased risk of lung cancer might occur with moderate drinking of hard liquor but confirmation is required in larger studies.

Some studies indicate that chlorination by-products in drinking water may contribute slightly to breast cancer risk. This ecologic study describes the association between total trihalomethane levels in publicly supplied water and the incidence of female invasive breast cancer. We included 71 North Carolina water suppliers serving at least 10,000 customers in the summer of 1995 as the units of analysis. We estimated incidence rates using 6,462 cases who were either white or black and between 35 and 84 years old and were linked by zip codes to the water supplier. We treated ecologic measurements of age, income, education, urban status, and race as potential confounders. Total trihalomethane levels were not associated materially with breast cancer risk, adjusting for potential confounders. The rate ratio for 80.0 parts per billion (ppb) or more vs less than 40.0 ppb total trihalomethanes was 1.1 [95% confidence interval (CI) = 0.9-1.2]. When stratified by race, the observed association for the aforementioned total trihalomethane category was not very different in black women (rate ratio = 1.2; 95% CI = 0.8-1.8) than in white women (rate ratio = 1.1; 95% CI = 0.9-1.3). These ecologic data are compatible with trihalomethanes in drinking water being either unrelated or weakly related to breast cancer risk.

This study's goals were to (a) determine whether sending a survey by certified mail results in a higher response rate from physicians compared to sending by first-class mail and (b) evaluate the cost-effectiveness of this method. The study sample was 409 physicians who were nonrespondents to two previous mailings of a medical specialty society survey. Eligible physicians were designated at random to receive afinal mailing either by U.S. Postal Service certified mail including a return-receipt postcard or by first-class mail. There was a higher response rate from the certified mail group compared with the first-class mail group (41.3% versus 24.8%; relative risk = 1.66, 95% Confidence Interval 1.25, 2.21). A cost-effectiveness analysis showed that the cost per respondent was higher using certified mail versus first-class mail in the third mailing ($2.77 versus $2.34). Thus, use of certified mail is effective in increasing survey response but more costly.

PurposeAlthough single nucleotide polymorphisms (SNPs) of NBS1 have been associated with susceptibility to lung and upper aerodigestive tract (UADT) cancers, their relations to cancer survival and measures of effect are largely unknown.MethodsUsing follow-up data from 611 lung cancer cases and 601 UADT cancer cases from a population-based case-control study in Los Angeles, we prospectively evaluated associations of tobacco smoking and 5 NBS1 SNPs with all-cause mortality. Mortality data were obtained from the Social Security Death Index. We used Cox regression to estimate adjusted hazard ratios (HR) for main effects and ratios of hazard ratios (RHR) derived from product terms to assess hazard ratio variations by each SNP. Bayesian methods were used to account for multiple comparisons.ResultsWe observed 406 (66%) deaths in lung cancer cases and 247 (41%) deaths in UADT cancer cases with median survival of 1.43 and 1.72years, respectively. Ever tobacco smoking was positively associated with mortality for both cancers. We observed an upward dose-response association between smoking pack-years and mortality in UADT squamous cell carcinoma. The adjusted HR relating smoking to mortality in non-small cell lung cancer (NSCLC) was greater for cases with the GG genotype of NBS1 rs1061302 than for cases with AA/AG genotypes (semi-Bayes adjusted RHR=1.97; 95% limits=1.14, 3.41).ConclusionsA history of tobacco smoking at cancer diagnosis was associated with mortality among patients with lung cancer or UADT squamous cell carcinoma. The HR relating smoking to mortality appeared to vary with the NBS1 rs1061302 genotype among NSCLC cases.

PURPOSE: A substantial proportion of adults experience traumatic events each year, yet little is known about the effects of different types of traumatic events on depression severity over time. We prospectively assessed the effects of traumatic event exposure during a 1-year period on changes in depression severity during that period among a representative sample of adults living in Detroit, Michigan in the United States. METHODS: We used data from 1,054 participants in the first two waves of the Detroit Neighborhood Health Study (2008–2010). Depression severity was measured with the Patient Health Questionnaire-9 (PHQ-9). Negative binomial regression was used to estimate the effect of traumatic event exposure on depression severity at Wave 2, adjusting for Wave 1 PHQ-9 score and potential confounders. RESULTS: The mean depression severity score at Wave 2 among those exposed to at least one traumatic event during follow-up was 1.71 times higher than among those with no traumatic event exposure [95 % confidence interval (CI) 1.27–2.29]. Also positively associated with depression severity at Wave 2 (vs. no traumatic events) were assaultive violence (mean ratio 2.49, 95 % CI 1.41–4.38), injuries and other directly experienced shocking events (mean ratio 2.59, 95 % CI 1.62–3.82), and three or more traumatic events (mean ratio 2.58, 95 % CI 1.62–4.09). CONCLUSIONS: Violence, injuries, and other directly experienced traumatic events increase depression severity and may be useful targets for interventions to alleviate the burden of depression in urban areas.

Educational disparities in health persist after adjustment for income and occupation, suggesting that other purely cognitive and psychosocial mechanisms may be involved. Unlike occupation- or income-mediated effects, effects of cognitive and psychosocial gains-as reflected in academic achievement-may be apparent even before schooling is completed.We used data spanning 10 years on a national U.S. cohort of 2546 children aged 3-14 years at baseline to estimate the effects of academic achievement, measured by standardized tests of cognitive achievement, on future health. We used marginal structural models to address potential mutual influence of achievement and health on each other over time.One SD higher academic achievement 1997-2002 was associated with a lower prevalence of poorer health status in 2007 in girls (prevalence ratio = 0.87 [(95% confidence interval) 0.78-0.97]) but not in boys (prevalence ratio = 0.96 [0.86-1.08]). Higher achievement was also weakly associated with lower body mass index and less psychological distress among girls only.Academic achievement may benefit future health but a number of questions remain unanswered, including reasons for the gender differences and how academic achievement-related health disparities may progress over the life course and interact with other social determinants of health.

There is limited information about the clinical and prognostic significance of patient-reported recovery time.Prospective cohort study.6,040 patients in the DOPPS (Dialysis Outcomes and Practice Patterns Study).Answer to question "How long does it take you to recover from a dialysis session?" categorized as follows: fewer than 2, 2-6, 7-12, or longer than 12 hours.Cross-sectional and longitudinal associations between recovery time and patient characteristics, hemodialysis treatment variables, health-related quality of life (HRQoL), and hospitalization and mortality.32% reported recovery time shorter than 2 hours; 41%, 2-6 hours; 17%, 7-12 hours; and 10%, longer than 12 hours. Using proportional odds (ordinal) logistic regression, shorter recovery time was associated with male sex, full-time employment, and higher serum albumin level. Longer recovery time was associated with older age, dialysis vintage, body mass index, diabetes, and psychiatric disorder. Greater intradialytic weight loss, longer dialysis session length, and lower dialysate sodium concentration were associated with longer recovery time. In facilities that used uniform dialysate sodium concentrations for ≥90% of patients, the adjusted OR of longer recovery time, comparing dialysate sodium concentration140 vs 140 mEq/L, was 1.72 (95% CI, 1.37-2.16). Recovery time was correlated positively with symptoms of kidney failure and kidney disease burden score and inversely with HRQoL mental and physical component summary scores. Using Cox regression, adjusting for potential confounders not influenced by recovery time, it was associated positively with first hospitalization and mortality (adjusted HRs for recovery time12 vs 2-6 hours 1.22 [95% CI, 1.09-1.37] and 1.47 [95% CI, 1.19-1.83], respectively).Answers are subjective and not supported by physiologic measurements.Recovery time can be used to identify patients with poorer HRQoL and higher risks of hospitalization and mortality. Interventions to reduce recovery time and possibly improve clinical outcomes, such as increasing dialysate sodium concentration, need to be tested in randomized trials.

It is unknown whether regular patient-doctor contact (PDC) contributes to better outcomes for patients undergoing hemodialysis. Here, we analyzed the associations between frequency and duration of PDC during hemodialysis treatments with clinical outcomes among 24,498 patients from 778 facilities in the international Dialysis Outcomes and Practice Patterns Study (DOPPS). The typical facility PDC frequency, estimated by facility personnel, was high (more than once per week) for 55% of facilities, intermediate (once per week) for 24%, and low (less than once per week) for 21%. The mean ± SD estimated duration of a typical interaction between patient and physician was 7.7 ± 5.6 minutes. PDC frequency and duration varied across DOPPS phases and countries; the proportion of facilities with high PDC frequency was 17% in the United States and 73% across the other countries. Compared with high PDC frequency, the adjusted hazard ratio (HR) for all-cause mortality was 1.06 (95% confidence interval [CI], 0.96 to 1.17) for intermediate PDC frequency and 1.11 (95% CI, 1.01 to 1.23) for low PDC frequency (P=0.03 for trend). Furthermore, each 5-minutes-shorter duration of PDC was associated with a 5% higher risk for death, on average (HR, 1.05; 95% CI, 1.01 to 1.09), adjusted for PDC frequency and other covariates. Multivariable analyses also suggested modest inverse associations between both PDC frequency and duration with hospitalization but not with kidney transplantation. Taken together, these results suggest that policies supporting more frequent and longer duration of PDC may improve patient outcomes in hemodialysis.

Wyss, Annah Hashibe, Mia Chuang, Shu-Chun Lee, Yuan-Chin Amy Zhang, Zuo-Feng Yu, Guo-Pei Winn, Deborah M Wei, Qingyi Talamini, Renato Szeszenia-Dabrowska, Neonila Sturgis, Erich M Smith, Elaine Shangina, Oxana Schwartz, Stephen M Schantz, Stimson Rudnai, Peter Purdue, Mark P Eluf-Neto, Jose Muscat, Joshua Morgenstern, Hal Michaluart, Pedro Jr Menezes, Ana Matos, Elena Mates, Ioan Nicolae Lissowska, Jolanta Levi, Fabio Lazarus, Philip La Vecchia, Carlo Koifman, Sergio Herrero, Rolando Hayes, Richard B Franceschi, Silvia Wunsch-Filho, Victor Fernandez, Leticia Fabianova, Eleonora Daudt, Alexander W Dal Maso, Luigino Curado, Maria Paula Chen, Chu Castellsague, Xavier de Carvalho, Marcos Brasilino Cadoni, Gabriella Boccia, Stefania Brennan, Paul Boffetta, Paolo Olshan, Andrew F eng R03 CA113157/CA/NCI NIH HHS/ R24 HD041025/HD/NICHD NIH HHS/ T32-CA09330/CA/NCI NIH HHS/ T32ES007018/ES/NIEHS NIH HHS/ Meta-Analysis Research Support, N.I.H., Extramural 2013/07/03 06:00 Am J Epidemiol. 2013 Sep 1;178(5):679-90. doi: 10.1093/aje/kwt029. Epub 2013 Jun 30.; International audience; Cigar and pipe smoking are considered risk factors for head and neck cancers, but the magnitude of effect estimates for these products has been imprecisely estimated. By using pooled data from the International Head and Neck Cancer Epidemiology (INHANCE) Consortium (comprising 13,935 cases and 18,691 controls in 19 studies from 1981 to 2007), we applied hierarchical logistic regression to more precisely estimate odds ratios and 95% confidence intervals for cigarette, cigar, and pipe smoking separately, compared with reference groups of those who had never smoked each single product. Odds ratios for cigar and pipe smoking were stratified by ever cigarette smoking. We also considered effect estimates of smoking a single product exclusively versus never having smoked any product (reference group). Among never cigarette smokers, the odds ratio for ever cigar smoking was 2.54 (95% confidence interval (CI): 1.93, 3.34), and the odds ratio for ever pipe smoking was 2.08 (95% CI: 1.55, 2.81). These odds ratios increased with increasing frequency and duration of smoking (Ptrend

An ecologic study focuses on the comparison of groups, rather than individuals; thus, individual-level data are missing on the joint distribution, of variables within groups. Variables in an ecologic analysis may be aggregate measures, environmental measures, or global measures. The purpose of an ecologic analysis may be to make biologic inferences about effects on individual risks or to make ecologic inferences about effects on group rates. Ecologic study designs may be classified on two dimensions: (a) whether the primary group is measured (exploratory vs analytic study); and (b) whether subjects grouped by place (multiple-group study), by time (time-trend study), or place and time (mixed study). Despite several practical advantages of ecologic studies, there are many methodologic problems that severely limit causal inference, including ecologic and cross-level bias, problems of confounder control, within-group misclassification, lack of adequate data, temporal ambiguity, collinearity, and migration across groups.

BackgroundThe long-term symptom profile of chronic out-patients was studied.Method. 242 out-patients receiving neuroleptic medications (109 with schizophrenia and 133 non-schizophrenics), were studied for positive (SAPS) and negative (SANS) symptoms at baseline and at 24 months to investigate whether these symptom groups changed over out-patient maintenance treatment.ResultsOverall and within groups, negative symptoms decreased and positive symptoms increased. While the sums of the SANS scores for the schizophrenic patients were initially higher, their mean SANS score dropped more over time (P< 0.001), to show no difference from non-schizophrenics at follow-up. Positive symptoms increased in both groups, although schizophrenics were higher at both times; sub-scales within the SANS showed different patterns of change.ConclusionSupport is found for a multidimensional view of both positive and negative symptoms and for a reconsideration of the notion of ‘progressive downward course’ in schizophrenia.

We conducted a population-based case-control study in women in high-risk manufacturing occupations to examine occupational injury and its association with possible risk factors inside and outside the work place. The primary hypothesis was that women with young children are at greater risk of occupational injury than are women without young children, owing to the responsibility and fatigue associated with raising young children. The odds of reported injury was 2.9 times greater in women with a child less than 6 years of age than in women without children less than age 6 [odds ratio (OR) = 2.9; 95% confidence interval (CI) = 1.5-5.6]. The same effect was not observed for women with older children. Other predictors of injury were a history of previous injury (OR = 2.7; 95% CI = 1.8-3.9) and a body mass index greater than or equal to 25 (OR = 1.6; 95% CI = 1.08-2.4). We found small or zero effects for age, years of work experience, total number of children at home, ethnicity, marital status, and shift worked. These findings indicate that factors outside the work place, such as the presence of young children at home, may increase the risk of occupational injury for women employed in manufacturing jobs.

Sudden death is common in hemodialysis patients, but whether modifiable practices affect the risk of sudden death remains unclear.This study analyzed 37,765 participants in 12 countries in the Dialysis Outcomes and Practice Patterns Study to explore the association of the following practices with sudden death (due to cardiac arrhythmia, cardiac arrest, and/or hyperkalemia): treatment time [TT]210 minutes, Kt/V1.2, ultrafiltration volume5.7% of postdialysis weight, low dialysate potassium [K(D)3]), and prescription of Q wave/T wave interval-prolonging drugs. Cox regression was used to estimate effects on mortality, adjusting for potential confounders. An instrumental variable approach was used to further control for unmeasured patient-level confounding.There were 9046 deaths, 26% of which were sudden (crude mortality rate, 15.3/100 patient-years; median follow-up, 1.59 years). Associations with sudden death included hazard ratios of 1.13 for short TT, 1.15 for large ultrafiltration volume, and 1.10 for low Kt/V. Compared with K(D) ≥3 mEq/L, the sudden death rate was higher for K(D) ≤1.5 and K(D)=2-2.5 mEq/L. The instrumental variable approach yielded generally consistent findings. The sudden death rate was elevated for patients taking amiodarone, but not other Q wave/T wave interval-prolonging drugs.This study identified modifiable dialysis practices associated with higher risk of sudden death, including short TT, large ultrafiltration volume, and low K(D). Because K(D)3 mEq/L is common and easy to change, K(D) tailoring may prevent some sudden deaths. This hypothesis merits testing in clinical trials.

Asthma has been hypothesized to be associated with lung cancer (LC) risk. We conducted a pooled analysis of 16 studies in the International Lung Cancer Consortium (ILCCO) to quantitatively assess this association and compared the results with 36 previously published studies. In total, information from 585 444 individuals was used. Study-specific measures were combined using random effects models. A meta-regression and subgroup meta-analyses were performed to identify sources of heterogeneity. The overall LC relative risk (RR) associated with asthma was 1.28 [95% confidence intervals (CIs) = 1.16-1.41] but with large heterogeneity (I2 = 73%, P < 0.001) between studies. Among ILCCO studies, an increased risk was found for squamous cell (RR = 1.69, 9=%, CI = 1.26-2.26) and for small-cell carcinoma (RR = 1.71, 9=% CI = 0.99-2.95) but was weaker for adenocarcinoma (RR = 1.09, 95% CI = 0.88-1.36). The increased LC risk was strongest in the 2 years after asthma diagnosis (RR = 2.13, 95% CI = 1.09-4.17) but subjects diagnosed with asthma over 10 years prior had no or little increased LC risk (RR = 1.10, 95% CI = 0.94-1.30). Because the increased incidence of LC was chiefly observed in small cell and squamous cell lung carcinomas, primarily within 2 years of asthma diagnosis and because the association was weak among never smokers, we conclude that the association may not reflect a causal effect of asthma on the risk of LC. © The Author 2011. Published by Oxford University Press. All rights reserved.

Li, Qian Chuang, Shu-Chun Eluf-Neto, Jose Menezes, Ana Matos, Elena Koifman, Sergio Wunsch-Filho, Victor Fernandez, Leticia Daudt, Alexander W Curado, Maria Paula Winn, Deborah M Franceschi, Silvia Herrero, Rolando Castellsague, Xavier Morgenstern, Hal Zhang, Zuo-Feng Lazarus, Philip Muscat, Joshua McClean, Michael Kelsey, Karl T Hayes, Richard B Purdue, Mark P Schwartz, Stephen M Chen, Chu Benhamou, Simone Olshan, Andrew F Yu, Guopei Schantz, Stimson Ferro, Gilles Brennan, Paul Boffetta, Paolo Hashibe, Mia eng K07CA104231/CA/NCI NIH HHS/ P01CA068384/CA/NCI NIH HHS/ P30ES010126/ES/NIEHS NIH HHS/ P50CA90388/CA/NCI NIH HHS/ R01CA048896/CA/NCI NIH HHS/ R01CA078609/CA/NCI NIH HHS/ R01CA100679/CA/NCI NIH HHS/ R01CA51845/CA/NCI NIH HHS/ R01CA61188/CA/NCI NIH HHS/ R01DA11386/DA/NIDA NIH HHS/ R01DE012609/DE/NIDCR NIH HHS/ R01DE13158/DE/NIDCR NIH HHS/ R03 CA113157-01/CA/NCI NIH HHS/ R03 CA113157-02/CA/NCI NIH HHS/ R03 DE016611/DE/NIDCR NIH HHS/ R03 DE016611-01/DE/NIDCR NIH HHS/ R03 DE016611-02/DE/NIDCR NIH HHS/ R03CA113157/CA/NCI NIH HHS/ R03CA77954/CA/NCI NIH HHS/ R21ES011667/ES/NIEHS NIH HHS/ R24 HD050924/HD/NICHD NIH HHS/ T32CA09142/CA/NCI NIH HHS/ U01CA96134/CA/NCI NIH HHS/ Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't 2011/12/17 06:00 Int J Cancer. 2012 Oct 1;131(7):1686-99. doi: 10.1002/ijc.27405. Epub 2012 Jan 27.; International audience; To investigate the potential role of vitamin or mineral supplementation on the risk of head and neck cancer (HNC), we analyzed individual-level pooled data from 12 case-control studies (7,002 HNC cases and 8,383 controls) participating in the International Head and Neck Cancer Epidemiology consortium. There were a total of 2,028 oral cavity cancer, 2,465 pharyngeal cancer, 874 unspecified oral/pharynx cancer, 1,329 laryngeal cancer and 306 overlapping HNC cases. Odds ratios (OR) and 95% confidence intervals (CIs) for self reported ever use of any vitamins, multivitamins, vitamin A, vitamin C, vitamin E, and calcium, beta-carotene, iron, selenium and zinc supplements were assessed. We further examined frequency, duration and cumulative exposure of each vitamin or mineral when possible and stratified by smoking and drinking status. All ORs were adjusted for age, sex, race/ethnicity, study center, education level, pack-years of smoking, frequency of alcohol drinking and fruit/vegetable intake. A decreased risk of HNC was observed with ever use of vitamin C (OR = 0.76, 95% CI = 0.59-0.96) and with ever use of calcium supplement (OR = 0.64, 95% CI = 0.42-0.97). The inverse association with HNC risk was also observed for 10 or more years of vitamin C use (OR = 0.72, 95% CI = 0.54-0.97) and more than 365 tablets of cumulative calcium intake (OR = 0.36, 95% CI = 0.16-0.83), but linear trends were not observed for the frequency or duration of any supplement intake. We did not observe any strong associations between vitamin or mineral supplement intake and the risk of HNC.

Background: A history of diabetes is associated with an increased risk of several types of cancers. Whether diabetes is a risk factor for head and neck cancer (HNC) has received little attention. Methods: We pooled data from 12 case–control studies including 6,448 cases and 13,747 controls, and estimated OR and 95% CI for the associations between diabetes and HNC, adjusted for age, education level, sex, race/ethnicity, study center, cigarette smoking, alcohol use, and body mass index. Results: We observed a weak association between diabetes and the incidence of HNC overall (OR, 1.09; 95% CI: 0.95–1.24). However, we observed a modest association among never smokers (OR, 1.59; 95% CI: 1.22–2.07), and no association among ever smokers (OR, 0.96; 95% CI: 0.83–1.11); likelihood ratio test for interaction P = 0.001. Conclusion: A history of diabetes was weakly associated with HNC overall, but we observed evidence of effect modification by smoking status, with a positive association among those who never smoked cigarettes. Impact: This study suggests that glucose metabolism abnormalities may be a HNC risk factor in subgroups of the population. Prospective studies incorporating biomarkers are needed to improve our understanding of the relationship between diabetes and HNC risk, possibly providing new strategies in the prevention of HNC. Cancer Epidemiol Biomarkers Prev; 21(2); 294–304. ©2011 AACR.

Chuang, Shu-Chun Jenab, Mazda Heck, Julia E Bosetti, Cristina Talamini, Renato Matsuo, Keitaro Castellsague, Xavier Franceschi, Silvia Herrero, Rolando Winn, Deborah M La Vecchia, Carlo Morgenstern, Hal Zhang, Zuo-Feng Levi, Fabio Dal Maso, Luigino Kelsey, Karl McClean, Michael D Vaughan, Thomas Lazarus, Philip Muscat, Joshua Ramroth, Heribert Chen, Chu Schwartz, Stephen M Eluf-Neto, Jose Hayes, Richard B Purdue, Mark Boccia, Stefania Cadoni, Gabriella Zaridze, David Koifman, Sergio Curado, Maria Paula Ahrens, Wolfgang Benhamou, Simone Matos, Elena Lagiou, Pagona Szeszenia-Dabrowska, Neonilla Olshan, Andrew F Fernandez, Leticia Menezes, Ana Agudo, Antonio Daudt, Alexander W Merletti, Franco Macfarlane, Gary J Kjaerheim, Kristina Mates, Dana Holcatova, Ivana Schantz, Stimson Yu, Guo-Pei Simonato, Lorenzo Brenner, Hermann Mueller, Heiko Conway, David I Thomson, Peter Fabianova, Eleonora Znaor, Ariana Rudnai, Peter Healy, Claire M Ferro, Gilles Brennan, Paul Boffetta, Paolo Hashibe, Mia eng K07CA104231/CA/NCI NIH HHS/ P01CA068384/CA/NCI NIH HHS/ P30 CA015704/CA/NCI NIH HHS/ P30ES010126/ES/NIEHS NIH HHS/ P50CA90388/CA/NCI NIH HHS/ R01 CA100679/CA/NCI NIH HHS/ R01 CA100679-09/CA/NCI NIH HHS/ R01 ES014843/ES/NIEHS NIH HHS/ R01CA048996/CA/NCI NIH HHS/ R01CA078609/CA/NCI NIH HHS/ R01CA100679/CA/NCI NIH HHS/ R01CA30022/CA/NCI NIH HHS/ R01CA51845/CA/NCI NIH HHS/ R01CA61188/CA/NCI NIH HHS/ R01DA11386/DA/NIDA NIH HHS/ R01DE012609/DE/NIDCR NIH HHS/ R01DE13158/DE/NIDCR NIH HHS/ R03CA113157/CA/NCI NIH HHS/ R03CA77954/CA/NCI NIH HHS/ R03DE016611/DE/NIDCR NIH HHS/ R21ES011667/ES/NIEHS NIH HHS/ R24 HD050924/HD/NICHD NIH HHS/ T32CA09142/CA/NCI NIH HHS/ U01CA96134/CA/NCI NIH HHS/ Research Support, N.I.H., Extramural Research Support, N.I.H., Intramural Research Support, Non-U.S. Gov't Netherlands 2011/11/01 06:00 Cancer Causes Control. 2012 Jan;23(1):69-88. doi: 10.1007/s10552-011-9857-x. Epub 2011 Oct 29.; International audience; We investigated the association between diet and head and neck cancer (HNC) risk using data from the International Head and Neck Cancer Epidemiology (INHANCE) consortium. The INHANCE pooled data included 22 case-control studies with 14,520 cases and 22,737 controls. Center-specific quartiles among the controls were used for food groups, and frequencies per week were used for single food items. A dietary pattern score combining high fruit and vegetable intake and low red meat intake was created. Odds ratios (OR) and 95% confidence intervals (CI) for the dietary items on the risk of HNC were estimated with a two-stage random-effects logistic regression model. An inverse association was observed for higher-frequency intake of fruit (4th vs. 1st quartile OR = 0.52, 95% CI = 0.43-0.62, p (trend) < 0.01) and vegetables (OR = 0.66, 95% CI = 0.49-0.90, p (trend) = 0.01). Intake of red meat (OR = 1.40, 95% CI = 1.13-1.74, p (trend) = 0.13) and processed meat (OR = 1.37, 95% CI = 1.14-1.65, p (trend) < 0.01) was positively associated with HNC risk. Higher dietary pattern scores, reflecting high fruit/vegetable and low red meat intake, were associated with reduced HNC risk (per score increment OR = 0.90, 95% CI = 0.84-0.97).

We studied a quantitative electroencephalographic (EEG) measure, coherence, in 28 patients with acquired immune deficiency syndrome (AIDS) and 56 uninfected volunteers. Compared with uninfected subjects, AIDS patients had increased coherence in the 6- to 10-Hz band. The largest increases in coherence were between frontal and occipital regions and between temporal and frontal regions. Coherence within contiguous regions was less affected. Eight of the 28 AIDS patients (29%) had clinically abnormal EEG findings, compared with four of the 56 uninfected control subjects (7%). Among the AIDS patients, 12 had normal neuropsychological performance, nine had mild impairment, and six had moderate impairment. Coherence was increased in each subgroup of AIDS patients, including those with normal neuropsychologic performance and/ or normal clinical EEG results. AIDS patients were then classified by quantitative EEG power in frontal head regions as “abnormal” (the upper third of patients) or “normal” (the remainder). Increased coherence was found among both groups. Because the development of abnormal neuropsychological performance or a clinically abnormal EEG examination indicates relatively advanced central nervous system disease, alterations in specific coherence measures may detect subclinical effects of the human immunodeficiency virus on brain function before other changes are evident.

Edefonti, V Hashibe, M Ambrogi, F Parpinel, M Bravi, F Talamini, R Levi, F Yu, G Morgenstern, H Kelsey, K McClean, M Schantz, S Zhang, Z Chuang, S Boffetta, P La Vecchia, C Decarli, A eng CA100679/CA/NCI NIH HHS/ CA78609/CA/NCI NIH HHS/ P50CA90388/CA/NCI NIH HHS/ R01CA51845/CA/NCI NIH HHS/ R01DA11386/DA/NIDA NIH HHS/ R03CA113157/CA/NCI NIH HHS/ R03CA77954/CA/NCI NIH HHS/ R21ES011667/ES/NIEHS NIH HHS/ T32CA09142/CA/NCI NIH HHS/ U01CA96134/CA/NCI NIH HHS/ Meta-Analysis Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't England 2011/11/30 06:00 Ann Oncol. 2012 Jul;23(7):1869-80. doi: 10.1093/annonc/mdr548. Epub 2011 Nov 28.; International audience; BACKGROUND: The association between dietary patterns and head and neck cancer has rarely been addressed. PATIENTS AND METHODS: We used individual-level pooled data from five case-control studies (2452 cases and 5013 controls) participating in the International Head and Neck Cancer Epidemiology consortium. A posteriori dietary patterns were identified through a principal component factor analysis carried out on 24 nutrients derived from study-specific food-frequency questionnaires. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated using unconditional logistic regression models on quintiles of factor scores. RESULTS: We identified three major dietary patterns named 'animal products and cereals', 'antioxidant vitamins and fiber', and 'fats'. The 'antioxidant vitamins and fiber' pattern was inversely related to oral and pharyngeal cancer (OR=0.57, 95% CI 0.43-0.76 for the highest versus the lowest score quintile). The 'animal products and cereals' pattern was positively associated with laryngeal cancer (OR=1.54, 95% CI 1.12-2.11), whereas the 'fats' pattern was inversely associated with oral and pharyngeal cancer (OR=0.78, 95% CI 0.63-0.97) and positively associated with laryngeal cancer (OR=1.69, 95% CI 1.22-2.34). CONCLUSIONS: These findings suggest that diets rich in animal products, cereals, and fats are positively related to laryngeal cancer, and those rich in fruit and vegetables inversely related to oral and pharyngeal cancer.

Fractures are a recognized consequence of androgen deprivation therapy (ADT); however, less is known about the incidence of fracture in relation to the timing of ADT use or the impact of fracture on mortality in men with prostate cancer.Using data from the Surveillance, Epidemiology, and End Results-Medicare linked database, we estimated adjusted hazard ratios (aHRs) using time-dependent Cox regression for fracture incidence related to the recency of exposure and dose among prostate cancer patients on gonadotropin-releasing hormone (GnRH) agonists, as well as mortality associated with fractures.In our cohort of 80 844 patients, ADT was associated with an increased rate of fracture in both non-metastatic patients (aHR = 1.34; 95% confidence interval [CI] = 1.29-1.39) and metastatic patients (aHR = 1.51; 95%CI = 1.36-1.67). Fracture rates increased with increasing cumulative GnRH dose but decreased with increasing number of months since last use in each dose category. The mortality rate doubled for men experiencing a fracture after their diagnosis compared with that for men who did not experience a fracture (aHR = 2.05; 95%CI = 1.98-2.12).ADT in elderly men with prostate cancer increased the incidence of fractures, and the effect appears to diminish with increasing time since the last dose of a GnRH agonist. Experiencing a fracture after the diagnosis of prostate cancer was associated with decreased survival.