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Background Phthalates are ubiquitous endocrine disrupting chemicals present in a wide variety of consumer products. However, the personal characteristics associated with phthalate exposure are unclear. Objectives We sought to describe personal, behavioral, and reproductive characteristics associated with phthalate metabolite concentrations in an ongoing study nested within the Women's Health Initiative (WHI). Materials and Methods We measured thirteen phthalate metabolites in two or three archived urine samples collected in 1993–2001 from each of 1257 WHI participants (2991 observations). We fit multivariable generalized estimating equation models to predict urinary biomarker concentrations from personal, behavioral, and reproductive characteristics. Results Older age was predictive of lower concentrations of monobenzyl phthalate (MBzP), mono-carboxyoctyl phthalate (MCOP), mono-3-carboxypropyl phthalate (MCPP), and the sum of di-n-butyl phthalate metabolites (ΣDBP). Phthalate metabolite concentrations varied by race/region, with generally higher concentrations observed among non-Whites and women from the West region. Higher neighborhood socioeconomic status predicted lower MBzP concentrations, and higher education predicted lower monoethyl phthalate (MEP) and higher concentrations of the sum of metabolites of di-isobutyl phthalate (ΣDiBP). Overweight/obesity predicted higher MBzP, MCOP, monocarboxynonyl phthalate (MCNP), MCPP, and the sum of metabolites of di(2-ethylhexyl) phthalate (ΣDEHP) and lower MEP concentrations. Alcohol consumption predicted higher concentrations of MEP and ΣDBP, while current smokers had higher ΣDBP concentrations. Better diet quality as assessed by Healthy Eating Index 2005 scores predicted lower concentrations of MBzP, ΣDiBP, and ΣDEHP. Conclusion Factors predictive of lower biomarker concentrations included increased age and healthy behaviors (e.g. lower alcohol intake, lower body mass index, not smoking, higher quality diet, and moderate physical activity). Racial group (generally higher among non-Whites) and geographic regions (generally higher in Northeast and West compared to South regions) also were predictive of phthalate biomarker concentrations.

Background Growing laboratory and animal model evidence supports the potentially carcinogenic effects of some phthalates, chemicals used as plasticizers in a wide variety of consumer products, including cosmetics, medications, and vinyl flooring. However, prospective data on whether phthalates are associated with human breast cancer risk are lacking. Methods We conducted a nested case-control study within the Women’s Health Initiative (WHI) prospective cohort (n = 419 invasive case subjects and 838 control subjects). Control subjects were matched 2:1 to case subjects on age, enrollment date, follow-up time, and WHI study group. We quantified 13 phthalate metabolites and creatinine in two or three urine samples per participant over one to three years. Multivariable conditional logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for breast cancer risk associated with each phthalate biomarker up to 19 years of follow-up. Results Overall, we did not observe statistically significant positive associations between phthalate biomarkers and breast cancer risk in multivariable analyses (eg, 4th vs 1st quartile of diethylhexyl phthalate, OR = 1.03, 95% CI = 0.91 to 1.17). Results were generally similar in analyses restricted to disease subtypes, to nonusers of postmenopausal hormone therapy, stratified by body mass index, or to case subjects diagnosed within three, five, or ten years. Conclusions In the first prospective analysis of phthalates and postmenopausal breast cancer, phthalate biomarker concentrations did not result in an increased risk of developing invasive breast cancer.

Context Phthalates are endocrine-disrupting chemicals that could disrupt normal physiologic function, triggering detrimental impacts on bone. Objective We evaluated associations between urinary phthalate biomarkers and BMD in postmenopausal women participating in the prospective Women’s Health Initiative (WHI). Methods We included WHI participants enrolled in the BMD substudy and selected for a nested case-control study of phthalates and breast cancer (N = 1255). We measured 13 phthalate biomarkers and creatinine in 2 to 3 urine samples per participant collected over 3 years, when all participants were cancer free. Total hip and femoral neck BMD were measured at baseline and year 3, concurrent with urine collection, via dual-energy x-ray absorptiometry. We fit multivariable generalized estimating equation models and linear mixed-effects models to estimate cross-sectional and longitudinal associations, respectively, with stratification on postmenopausal hormone therapy (HT) use. Results In cross-sectional analyses, mono-3-carboxypropyl phthalate and the sum of di-isobutyl phthalate metabolites were inversely associated with total hip BMD among HT nonusers, but not among HT users. Longitudinal analyses showed greater declines in total hip BMD among HT nonusers and with highest concentrations of mono-3-carboxyoctyl phthalate (–1.80%; 95% CI, –2.81% to –0.78%) or monocarboxynonyl phthalate (–1.84%; 95% CI, –2.80% to –0.89%); similar associations were observed with femoral neck BMD. Among HT users, phthalate biomarkers were not associated with total hip or femoral neck BMD change. Conclusion Certain phthalate biomarkers are associated with greater percentage decreases in total hip and femoral neck BMD. These findings suggest that phthalate exposure may have clinically important effects on BMD, and potentially fracture risk.

Background Recent experimental work has shown that phthalates may increase inflammation. Prior research has not examined the role of exposure to phthalates in relation to inflammatory status among postmenopausal women who are at higher risk of developing inflammation-related chronic disorders. Objectives We aimed to examine the associations of urinary phthalate biomarker concentrations with circulating levels of c-reactive protein [CRP] and interleukin-6 [IL-6] among 443 postmenopausal women selected into a breast cancer case-control study nested within the Women's Health Initiative (WHI). Methods A total of 13 phthalate metabolites were measured in urine samples provided at WHI enrollment from 1993 to 1998. We also measured baseline levels of CRP and IL-6 in these women's serum or plasma samples. Multivariable linear models were used to investigate the role of each phthalate biomarker in relation to CRP and IL-6, adjusting for potential confounding factors and specifically evaluating the role of BMI. Results In adjusted models we observed positive associations of monocarboxynonyl phthalate (MCNP) with CRP (β = 0.092; 95% CI 0.026, 0.158) and IL-6 (β = 0.108; 95% CI 0.013, 0.204). These positive associations were attenuated and non-significant, however, after further adjustment for body mass index (BMI). In contrast, we observed inverse associations of monoethyl phthalate (MEP) (β = −0.019; 95% CI -0.036, −0.001) and monobenzyl phthalate (MBzP) (β = −0.034; 95% CI -0.058, −0.010) with CRP levels only after adjustment for BMI. Other phthalate biomarkers examined were not significantly associated with either CRP or IL-6 levels. Conclusions Overall, these results do not suggest an important role for phthalates in promoting an inflammatory response. Future prospective studies are warranted to improve understanding of these associations, particularly in clarifying the role of BMI.

Skeletal muscles can undergo atrophy and/or programmed cell death (PCD) during development or in response to a wide range of insults, including immobility, cachexia, and spinal cord injury. However, the protracted nature of atrophy and the presence of multiple cell types within the tissue complicate molecular analyses. One model that does not suffer from these limitations is the intersegmental muscle (ISM) of the tobacco hawkmoth Manduca sexta. Three days before the adult eclosion (emergence) at the end of metamorphosis, the ISMs initiate a nonpathological program of atrophy that results in a 40% loss of mass. The ISMs then generate the eclosion behavior and initiate a nonapoptotic PCD during the next 30 h. We have performed a comprehensive transcriptomics analysis of all mRNAs and microRNAs throughout ISM development to better understand the molecular mechanisms that mediate atrophy and death. Atrophy involves enhanced protein catabolism and reduced expression of the genes involved in respiration, adhesion, and the contractile apparatus. In contrast, PCD involves the induction of numerous proteases, DNA methylases, membrane transporters, ribosomes, and anaerobic metabolism. These changes in gene expression are largely repressed when insects are injected with the insect steroid hormone 20-hydroxyecdysone, which delays death. The expression of the death-associated proteins may be greatly enhanced by reductions in specific microRNAs that function to repress translation. This study not only provides fundamental new insights into basic developmental processes, it may also represent a powerful resource for identifying potential diagnostic markers and molecular targets for therapeutic intervention.

Background/Objectives Women with premenstrual syndrome (PMS) are encouraged to reduce sugar and increase fiber intake to reduce symptoms. However, research supporting these recommendations is limited, and their role in PMS development is unclear. This study examines the relation between carbohydrate and fiber intake and the risk of PMS nested within the prospective Nurses’ Health Study II cohort. Subjects/Methods Carbohydrate and fiber intake were assessed at baseline and three additional times during follow-up by food frequency questionnaire. Incident cases of PMS were identified by self-reported PMS diagnosis during 14 years of follow-up and validated by supplemental questionnaire (n=1 234). Women were classified as controls if they did not report PMS diagnosis during follow-up and confirmed minimal or no premenstrual symptoms (n=2 426). We estimated relative risks (RR) and 95% confidence intervals (CI) using multivariable logistic regression. Results Total carbohydrate intake two to four years before reference year was not associated with PMS development (RR quintile 5 versus 1 = 0.99; 95% CI = 0.74-1.33). Intakes of specific carbohydrates or fibers were not associated with PMS development, except maltose. Adjusting for body mass index, smoking, and other factors, women with the highest maltose intake (median = 3.0 g/day) had a RR of 1.45 (95% CI = 1.11-1.88) compared to those with the lowest intake (median = 1.2 g/day). Conclusions Overall, carbohydrate and fiber consumption was not associated with risk of PMS. As this is the first study to suggest that maltose may be associated with PMS development, further replication is needed.

Approximately 8–20 % of reproductive-aged women experience premenstrual syndrome (PMS), substantially impacting quality of life. Women with PMS are encouraged to reduce fat intake to alleviate symptoms; however, its role in PMS development is unclear. We evaluated the association between dietary fat intake and PMS development among a subset of the prospective Nurses’ Health Study II cohort. We compared 1257 women reporting clinician-diagnosed PMS, confirmed by premenstrual symptom questionnaire and 2463 matched controls with no or minimal premenstrual symptoms. Intakes of total fat, subtypes and fatty acids were assessed via FFQ. After adjustment for age, BMI, smoking, Ca and other factors, intakes of total fat, MUFA, PUFA and trans-fat measured 2–4 years before were not associated with PMS. High SFA intake was associated with lower PMS risk (relative risk (RR) quintile 5 (median=28·1 g/d) v. quintile 1 (median=15·1 g/d)=0·75; 95 % CI 0·58, 0·98; Ptrend=0·07). This association was largely attributable to stearic acid intake, with women in the highest quintile (median=7·4 g/d) having a RR of 0·75 v. those with the lowest intake (median=3·7 g/d) (95 % CI 0·57, 0·97; Ptrend=0·03). Individual PUFA and MUFA, including n-3 fatty acids, were not associated with risk. Overall, fat intake was not associated with higher PMS risk. High intake of stearic acid may be associated with a lower risk of developing PMS. Additional prospective research is needed to confirm this finding.

Approximately 80% of reproductive age women experience physical or emotional symptoms before onset of menses. Of these women, ∼20% experience symptoms severe enough to interfere with social functioning and life activities, and meet clinical criteria for premenstrual syndrome (PMS). More than 100 different symptoms are associated with PMS. Symptom groupings tend to be stable within an individual, but vary distinctly between women. Potential differences in the etiology of symptoms suggest that PMS may have subtypes that represent distinct entities.The goal of this study was to identify symptom patterns using factor analysis. We then used linear regression to evaluate relations between PMS risk factors with factor scores for the symptom patterns. Analysis included: (1) 414 healthy women aged 18-30 years; (2) the subgroup of these women meeting established criteria for PMS (n = 80). All participants provided information on the occurrence and severity of 26 premenstrual symptoms by validated questionnaire.Four distinct symptom patterns emerged, labeled Emotional, Psychological/Cognitive, Physical, and Consumption. We observed a linear relationship between body mass index and the Consumption pattern in both the total study population (p = 0.03) and the PMS subset (p = 0.04). Additionally, in the total population, physical activity was inversely associated with the Physical pattern (p = 0.04), but positively associated with the Consumption pattern (p = 0.03). Results from this study are consistent with previously identified patterns and suggest that distinct subtypes of PMS exist.Future studies of behavioral factors should evaluate associations with symptom patterns in addition to PMS as an aggregate disorder.

Skeletal muscle mass can increase during hypertrophy or decline dramatically in response to normal or pathological signals that trigger atrophy. Many reports have documented that the number of nuclei within these cells is also plastic. It has been proposed that a yet-to-be-defined regulatory mechanism functions to maintain a relatively stable relationship between the cytoplasmic volume and nuclear number within the cell, a phenomenon known as the “myonuclear domain” hypothesis. While it is accepted that hypertrophy is typically associated with the addition of new nuclei to the muscle fiber from stem cells such as satellite cells, the loss of myonuclei during atrophy has been controversial. The intersegmental muscles from the tobacco hawkmoth Manduca sexta are composed of giant syncytial cells that undergo sequential developmental programs of atrophy and programmed cell death at the end of metamorphosis. Since the intersegmental muscles lack satellite cells or regenerative capacity, the tissue is not “contaminated” by these nonmuscle nuclei. Consequently, we monitored muscle mass, cross-sectional area, nuclear number, and cellular DNA content during atrophy and the early phases of cell death. Despite a ∼75–80% decline in muscle mass and cross-sectional area during the period under investigation, there were no reductions in nuclear number or DNA content, and the myonuclear domain was reduced by ∼85%. These data suggest that the myonuclear domain is not an intrinsic property of skeletal muscle and that nuclei persist through atrophy and programmed cell death.

Background Some phthalates are endocrine disrupting chemicals used as plasticizers in consumer products, and have been associated with obesity in cross-sectional studies, yet prospective evaluations of weight change are lacking. Our objective was to evaluate associations between phthalate biomarker concentrations and weight and weight change among postmenopausal women. Methods We performed cross-sectional (N = 997) and longitudinal analyses (N = 660) among postmenopausal Women’s Health Initiative participants. We measured 13 phthalate metabolites and creatinine in spot urine samples provided at baseline. Participants’ weight and height measured at in-person clinic visits at baseline, year 3, and year 6 were used to calculate body mass index (BMI). We fit multivariable multinomial logistic regression models to explore cross-sectional associations between each phthalate biomarker and baseline BMI category. We evaluated longitudinal associations between each biomarker and weight change using mixed effects linear regression models. Results In cross-sectional analyses, urinary concentrations of some biomarkers were positively associated with obesity prevalence (e.g. sum of di (2-ethylhexyl) phthalate metabolites [ΣDEHP] 4th vs 1st quartile OR = 3.29, 95% CI 1.80–6.03 [p trend

ObjectiveTo examine the relationship between protein intake and the risk of incident premenstrual syndrome (PMS).DesignNested case–control study. FFQ were completed every 4 years during follow-up. Our main analysis assessed protein intake 2–4 years before PMS diagnosis (for cases) or reference year (for controls). Baseline (1991) protein intake was also assessed.SettingNurses’ Health Study II (NHS2), a large prospective cohort study of registered female nurses in the USA.ParticipantsParticipants were premenopausal women between the ages of 27 and 44 years (mean: 34 years), without diagnosis of PMS at baseline, without a history of cancer, endometriosis, infertility, irregular menstrual cycles or hysterectomy. Incident cases of PMS (n 1234) were identified by self-reported diagnosis during 14 years of follow-up and validated by questionnaire. Controls (n 2426) were women who did not report a diagnosis of PMS during follow-up and confirmed experiencing minimal premenstrual symptoms.ResultsIn logistic regression models adjusting for smoking, BMI, B-vitamins and other factors, total protein intake was not associated with PMS development. For example, the OR for women with the highest intake of total protein 2–4 years before their reference year (median: 103·6 g/d) v. those with the lowest (median: 66·6 g/d) was 0·94 (95 % CI 0·70, 1·27). Additionally, intakes of specific protein sources and amino acids were not associated with PMS. Furthermore, results substituting carbohydrates and fats for protein were also null.ConclusionsOverall, protein consumption was not associated with risk of developing PMS.

Author(s): Brearley, Ann M; Bigelow, Carol; Poisson, Laila M; Grambow, Steven C; Nowacki, Amy S | Abstract: The use of real and relevant data in the statistics classroom is an ideal for many teachers of statistics, as these offer clear benefits for engagement with the kinds of real world applications that students will encounter in the future. Yet, the time required to identify and obtain well-documented data and to prepare classroom teaching materials is often prohibitive. In this paper we review the many benefits of using real and relevant data, and use these to define the characteristics of a well-documented health sciences data resource. We review the barriers to using real and relevant data in teaching. Lastly, we introduce the Teaching of Statistics in the Health Sciences (TSHS) Resources Portal (https://www.causeweb.org/tshs/), a source for well-documented health-related datasets and teaching materials. This dynamic resource provides a means to both obtain and contribute peer-reviewed educational materials. The target audience of the tool is teachers of statistics in health sciences settings, particularly those who teach introductory and applied courses in the graduate or post-graduate setting, but we expect that other statistics educators seeking rich, well-documented datasets will also find the Portal a useful resource.

Background: Results from prospective studies on the association between urinary levels of melatonin and risk of postmenopausal breast cancer have been mixed. Several although not all studies have found lower urinary levels of melatonin in women who developed breast cancer compared with cancer-free women. Methods: We examined the association between urinary levels of melatonin and breast cancer risk in postmenopausal women in a case–control study nested in the Women's Health Initiative Observational Cohort. Levels of 6-sulfatoxymelatonin were measured in first morning voids from 258 women who later developed breast cancer and from 515 matched controls. Multivariable conditional logistic regression was used to calculate ORs and 95% confidence intervals (CI). Results: Fully adjusted risk estimates of breast cancer, relative to the lowest quartile level of creatinine-adjusted melatonin, were 1.07 (95% CI, 0.67–1.71), 1.26 (95% CI, 0.79–2.01), and 1.25 (95% CI, 0.78–2.02) for women in the second, third, and highest quartile (Ptrend = 0.27). Comparable results for cases diagnosed less than four years after urinary collection and matched controls were 1.0, 1.25 (95% CI, 0.51–3.06), 1.85 (95% CI, 0.75–4.57), and 1.94 (95% CI, 0.75–5.03; Ptrend = 0.11). Melatonin levels and breast cancer were not associated in cases diagnosed four or more years after urinary collection and matched controls (Ptrend = 0.89). Conclusions: We found no evidence that higher urinary levels of melatonin are inversely associated with breast cancer risk in postmenopausal women. Impact: Accumulating discrepancies in results across studies warrant further exploration. Cancer Epidemiol Biomarkers Prev; 23(4); 629–37. ©2014 AACR.

Background Although obstructive lung disease (OLD), which includes COPD, affects all the populations, Hispanics seem to be protected against COPD development and progression. Whether this advantage translates into a survival benefit for this population is unknown. We aimed to determine the risk for OLD in Mexican Americans, the largest US Hispanic subgroup, compared with non-Hispanic whites and to assess all-cause mortality in subjects with OLD. Methods We assessed the relationships between Mexican American ethnicity and spirometric OLD and risk of death among 6,456 US adults aged ≥ 40 years who participated in the Third National Health and Nutritional Examination Survey Follow-up Study. We used logistic and Cox regression analyses to estimate the OR for OLD among Mexican Americans and the hazard ratio (HR) for all-cause mortality among Mexican Americans with OLD, respectively. Results After adjustment for demographic factors, socioeconomic status, and COPD risk factors, Mexican Americans had decreased odds of OLD diagnosis compared with whites (OR, 0.72 [95% CI, 0.54-0.95]). Among the 1,734 participants with OLD, 1,054 (60.8%) died during median follow-up of 12 years. In an adjusted model, Mexican Americans had no advantage in mortality from all causes (HR, 0.88 [95% CI, 0.69-1.13]). After accounting for the fact that some Mexican Americans may have moved back to Mexico and died there (thus, had no US death certificate), there was still no difference in mortality between these groups. Conclusions Although Mexican Americans appear to have lower risk for OLD, subjects of this ethnicity with OLD do not seem to have a survival advantage.

Soldier equipment compromises task performance as temporal constraints during critical situations and load increase inertial and interactive forces during movement. Methods are necessary to optimise equipment that relate task performance to underlying coordination and perception-action coupling. Employing ecological task analysis and methods from dynamical systems theory, equipment load and coordination was examined during two sub-tasks embedded in combat performance, threat discrimination and dynamic marksmanship. Perception-action coupling was degraded with load during threat discrimination, leading to delays in functional reaction time. Reduced speed and accuracy during dynamic marksmanship under load was related to disrupted segmental coordination and adaptability during postural transitions between targets. These results show how reduced performance under load relates to coordination changes and perception-action coupling. These changes in functional capability are directly related to soldier survivability in combat. The methods employed may aid equipment design towards more optimised performance by modifying equipment or its distribution on humans.

Background: Comorbidities adversely impact heart failure (HF) outcomes. Telehealth can assist healthcare providers, especially nurses, in guiding their patients to follow the HF regimen. However, factors, including comorbidity patterns, that act in combination with telehealth to reduce home care nursing utilization are still unclear. Purpose: The purpose of this article was to examine the association of the comorbidity characteristics of HF patients with nursing utilization along with withdrawal from telehealth service during an episode of teleYhome care. Methodology: A descriptive, correlational study design using retrospective chart review was used. The sample comprised Medicare patients admitted to a New England home care agency who had HF as a diagnosis and had used telehealth from 2008 to 2010. The electronic documentation at the home care agency served as the data source, which included Outcome and Assessment Information Set data of patients with HF. Logistic and multiple regression analyses were used to analyze data. Results: The sample consisted of 403 participants, of whom 70% were older than 75 years, 55% were female, and 94% were white. Comorbidities averaged 5.19 (SD, 1.92), ranging from 1 to 11, and nearly 40% of the participants had 5 or more comorbidities. The mean (SD) nursing contacts in the sample was 9.9 (4.7), ranging from 1 to 26, and 52 (12.7%) patients withdrew from telehealth service. For patients with HF on telehealth, comorbidity characteristics of anemia, anxiety, musculoskeletal, and depression were significantly associated with nursing utilization patterns, and renal failure, cancer, and depression comorbidities were significantly associated with withdrawal from telehealth service. Clinical Implications: Knowledge of the association of comorbidity characteristics with the home care service utilization patterns of patients with HF on telehealth can assist the home health nurse to develop a tailored care plan that attains optimal patient outcomes. Knowledge of such associations would also focus home care resources, avoiding redundancy of resource utilization in this era of strained healthcare resources.

Activation of inflammatory pathways is one plausible mechanism underlying the association between obesity and increased breast cancer risk. However, macrophage infiltration and local biomarkers of inflammation in breast adipose tissue have seldom been studied in association with obesity. Gene expression profiles of normal breast tissue from reduction mammoplasty patients were evaluated by whole genome microarrays to identify patterns associated with obesity status (normal-weight, body mass index (BMI)

Acheron (Achn) is a new member of the Lupus Antigen family of RNA binding proteins. Previous studies have shown that Achn controls developmental decisions in neurons and muscle. In the human mammary gland, Achn expression is restricted to ductal myoepithelial cells. Microarray analysis and immunohistochemistry have shown that Achn expression is elevated in some basal-like ductal carcinomas. To study the possible role of Achn in breast cancer, we engineered human MDA-MB-231 cells to stably express enhanced green fluorescent protein-tagged wild-type Achn (AchnWT), as well as Achn lacking either its nuclear localization signal (AchnNLS) or its nuclear export signal (AchnNES). In in vitro assays, AchnWT and AchnNES, but not AchnNLS, enhanced cell proliferation, lamellipodia formation, and invasive activity and drove expression of the elevated expression of the metastasis-associated proteins MMP-9 and VEGF. To determine if Achn could alter the behavior of human breast cancer cells in vivo, Achn-engineered MDA-MB-231 cells were injected into athymic SCID/Beige mice. AchnWT and AchnNES-expressing tumors displayed enhanced angiogenesis and an approximately five-fold increase in tumor size relative to either control cells or those expressing AchnNLS. These data suggest that Achn enhances human breast tumor growth and vascularization, and that this activity is dependent on nuclear localization.

Flaxseed is a rich source of dietary lignans. Experimental studies suggest lignans may exert breast cancer preventive effects through hormonal mechanisms. Our aim was to study the effects of flaxseed on serum sex hormones implicated in the development of breast cancer. Forty-eight postmenopausal women participated in a 12-wk preintervention-postintervention study. Participants consumed 7.5 g/day of ground flaxseed for the first 6 wk and 15.0 grams/day for an additional 6 wk. Nonsignificant declines were noted over the 12 wk (95% confidence intervals) for estradiol (pg/ml), estrone (pg/ml), and testosterone (pg/ml): -4.4 (-12.6 to 3.9), -3.3 (-7.7 to 1.2), -4.7 (-17.8 to 8.5), respectively. Changes tended to be more pronounced in overweight/obese women, particularly for estrone (-6.5, -11.9 to -1.2; P = .02). Our results suggest that dietary flaxseed may modestly lower serum levels of sex steroid hormones, especially in overweight/obese women.

Metabolic acidosis is common in patients with end-stage renal disease (ESRD). Studies suggest that correction of acidosis may improve nutritional status and patient outcomes. The purpose of this study was to examine the effects of increasing delivered bicarbonate dose from 35 mmol/L to 39 mmol/L with respect to nutrition-related outcomes in maintenance hemodialysis patients (MHD).This was a longitudinal, observational study conducted at 4 dialysis centers in western Massachusetts. Patients were followed for 6 months after change in bicarbonate dose protocol.The study sample consisted of 248 patients who had been on MHD for at least 1 year on the standard bicarbonate dialysate of 35 mmol/L without oral bicarbonate supplements.Measures of interest included predialysis serum bicarbonate, albumin, hemoglobin, potassium, phosphorus, calcium, and parathyroid hormone (iPTH), as well as protein catabolic rate (nPCR). A subset of patients (n = 35) was examined for changes via Subjective Global Assessment (SGA).Serum bicarbonate improved significantly from baseline (21.7 +/- 2.8 mmol/L; mean +/- SD) at 3 months (23.3 +/- 3.3) and 6 months (23.1 +/- 3.3) (P.0001). Phosphorus decreased from 6.0 +/- 2.0 mmol/L at baseline to 5.7 +/- 1.7 mmol/L (P =.02) at 6 months, although calcium, iPTH, and potassium remained relatively stable. Serum bicarbonate was inversely and significantly correlated with nPCR at baseline (r = -0.23; P.05) and 3 months (r = -0.22; P.05). The nPCR decreased significantly (P =.001) from baseline (0.99 +/- 0.26) at 6 months (0.93 +/- 0.23), whereas the serum albumin and SGA scores did not differ.Increasing delivered bicarbonate dose improves serum bicarbonate and may decrease catabolism. Further study is needed to confirm the potential nutritional benefits.

Aims: To identify sociodemographic and occupational determinants of knee related disability discharge from the US Army among enlisted women, and to investigate effect modification. Methods: A case-control study of 692 cases of knee related disability discharge and 2080 incidence density matched controls nested within the population of all 244 000 enlisted women on active duty in the US Army, 1980–97. We used logistic regression to identify determinants of disability, stratified to explore effect modification by demographic and work characteristics. Results: The risk of disability discharge was twice as high (odds ratio (OR) 2.4, 95% confidence interval (CI): 1.71 to 3.47) for the oldest (33–60 years) versus the youngest (17–21 years) women. Non-whites had lower risk than whites (OR 0.5, 95% CI: 0.41 to 0.60), as did married (OR 0.7, 95% CI: 0.54 to 0.81) relative to non-married women. Those of lower rank (pay grades E1–E3) were at five times the risk of disability discharge compared to those of higher ranks (pay grades E4–E9, OR 5.0, 95% CI: 2.86 to 8.33), while ORs were highest for those with longer duration of service compared to women on active duty for a year or less (OR 1.4, 95% CI: 0.8 to 2.55 after 12 years). Race modified several effects, including that of rank. Age, duration of service, and pay grade were too highly correlated to draw firm conclusions about their independent modifying effects on risk of disability discharge from the Army. Conclusions: Sociodemographic factors had larger effects than occupational characteristics on risk of knee related disability discharge from the US Army. Interactions suggest subgroups at differing risk levels that might be targeted for more detailed investigations.

Racial and ethnic disparities exist in cancer screening and management among Hispanics. Although cancer poses a burden among Hispanic women compared to non-Hispanic white women (nHw), screening rates for breast, colorectal and cervical cancer in Hispanic women lag behind nHw. The Hispanic population is heterogeneous and comprises individuals with diverse heritages. Furthermore, considerable variations in health outcomes and practices have been observed across Hispanic subgroups, supporting the relevance of studying each subgroup separately. Since early detection can reduce the burden of cancer, it is important to identify factors that can predict cancer screening within subgroups of Hispanic women. We sought to assess the role of acculturation in adherence to recommended cancer screening practices among Hispanic postmenopausal women, and to assess whether this association varies by Hispanic subgroup using data from the Women's Health Initiative. We included women who identified themselves as Hispanic in the baseline questionnaire (N=3, 263). All women who reported a personal history of cancer other than non-melanoma skin cancer were excluded from the study. Only women without a hysterectomy were included in the cervical cancer screening analysis (N=1,754). Acculturation was measured using self-reported country of birth, language preference and length of residency in the United States (US). Cancer screening adherence was assessed based on the American Cancer Society guidelines in place at the beginning of the study in 1993. The study outcomes were self-reported breast cancer screening (mammography use) and cervical cancer screening (Pap smear use) during the past year and colorectal cancer screening (sigmoidoscopy or colonoscopy use) within five years prior to the interview. Logistic regression was used to estimate the prevalence odds ratio for three types of cancer screening (breast, cervical and colorectal) according to the acculturation level among Hispanic women and within subgroups (Cuban (N=137), Mexican (N=1,151), Puerto Rican (N=289) and Other Hispanic (N=693)), with adjustment for age, alcohol use, family history of cancer, body mass index, physical activity level, and smoking status. Prevalence of breast, colorectal and cervical cancer screening was 68.7%, 55.9% and 47.1%, respectively. Highly acculturated women (US-born, English language preference and living in the US longer than in their country of origin) were more likely to be screened for breast (OR=2.12; 95% CI: 1.57-2.86), cervical (OR=1.46; 95% CI: 0.98-2.18) and colorectal cancer (OR=4.61; 95% CI: 3.27-6.50) within guidelines compared to Hispanic women with low acculturation level. Adjusting for socioeconomic factors attenuated the strength of these associations. For receipt of mammogram, subgroup analysis showed that acculturation mattered in the receipt of a mammogram only for Mexican/Mexican American women (OR=1.35; 95% CI: 1.01-1.82) for high vs. moderate/low acculturation. High acculturation was associated with greater adjusted odds of colorectal cancer screening among Mexican/Mexican American (OR=1.46; 95% CI: 1.10-1.95), Cuban women (OR=18.17; 95% CI: 2.17-152.37), and women from other Hispanic origins (OR=1.50; 95% CI: 1.07-2.11) when compared to women from their same national origin with a moderate/low acculturation level. No significant association between acculturation and cervical cancer screening were observed within the subgroups. These data show important differences in the impact of acculturation on cancer screening uptake among subgroups of Hispanic women. These findings will be useful to develop educational programs, and culturally tailored strategies for each Hispanic subgroup with the end goal of reducing the observed racial and ethnic disparities existent in cancer and promoting colorectal and breast cancer screening. Citation Format: Mary Vanellys Diaz-Santana, Susan Hankinson, Susan Sturgeon, Carol Bigelow, Milagros Rosal, Judith Ockene, Katherine W. Reeves. Exploring the role of acculturation in breast, colorectal and cervical cancer screening among Hispanic women. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B70.

OBJECTIVES—To update and assess mortality from neoplasms to 31 December 1995 among 10 109 men employed in a job exposed to vinyl chloride for at least 1 year between 1942 and 1972 at any of 37 North American factories. Previous analyses indicated associations between employment in vinyl production and increased mortality risk from cancers of the liver and biliary tract, due to increased mortality from angiosarcoma of the liver, and brain cancer. METHODS—Standardised mortality ratio (SMR) analyses, overall and stratified by several work related variables, were conducted with United States and state reference rates. Cox's proportional hazards models and stratified log rank tests were used to further assess occupational factors. RESULTS—895 of 3191 deaths (28%) were from malignant neoplasms, 505 since the previous update to the end of 1982. Mortality from all causes showed a deficit (SMR 83, 95% confidence interval (95% CI) 80 to 86), whereas mortality from all cancers combined was similar to state referent rates. Mortality from cancers of the liver and biliary tract was clearly increased (SMR 359, 95% CI 284 to 446). Modest excesses of brain cancer (SMR 142, 95% CI 100 to 197) and cancer of connective and soft tissue (SMR 270, 95% CI 139 to 472) were found. Stratified SMR and Cox's proportional hazard analyses supported associations with age at first exposure, duration of exposure, and year of first exposure for cancers of the liver and soft tissues, but not the brain. CONCLUSIONS—Excess mortality risk from cancer of the liver and biliary tract, largely due to angiosarcoma, continues. Risk of mortality from brain cancer has attenuated, but its relation with exposure to vinyl chloride remains unclear. A potentially work related excess of deaths from cancer of connective and soft tissue was found for the first time, but was based on few cancers of assorted histology. Keywords: vinyl chloride; angiosarcoma; liver; brain; connective tissue; soft tissue; neoplasms

Background and Purpose —Anecdotal reports suggest that a loss of distinction between gray (GM) and white matter (WM) as adjudged by CT scan predicts poor outcome in comatose patients after cardiac arrest. To address this, we quantitatively assessed GM and WM intensities at various brain levels in comatose patients after cardiac arrest. Methods —Patients for whom consultation was requested within 24 hours of a cardiac arrest were identified with the use of a computerized database that tracks neurological consultations at our institution. Twenty-five comatose patients were identified for whom complete medical records and CT scans were available for review. Twenty-five consecutive patients for whom a CT scan was interpreted as normal served as controls. Hounsfield units (HUs) were measured in small defined areas obtained from axial images at the levels of the basal ganglia, centrum semiovale, and high convexity area. Results —At each level tested, lower GM intensity and higher WM intensity were noted in comatose patients compared with normal controls. The GM/WM ratio was significantly lower among comatose patients compared with controls ( P P =0.035, 1-tailed t test). Using receiver operating characteristic curve analysis, we determined that a difference in GM/WM ratio of 1.18. The empirical risk of death was 21.67 for comatose patients with a value below threshold. Conclusions —The ratio in HUs of GM to WM provides a reproducible measure of the distinction between gray and white matter. A lower GM/WM ratio is observed in comatose patients immediately after cardiac arrest. The basal ganglia level seems to be the most sensitive location on CT for measuring this relationship. Although a GM/WM ratio

The effects of an ergonomic intervention on musculoskeletal discomfort in 118 video display terminal (VDT) users were assessed 1 year after intervention. The intervention consisted of recommended changes to workstations, which were based on the evaluation of 15 ergonomic characteristics. Compliance with the intervention was at least 75% for most workstation characteristics. Reduction in discomfort was substantial and was highest for the wrist/hand (57%), lower back (43%), and neck/shoulder (41%) severity of discomfort outcomes. Neither compliance with intervention on individual workstation characteristics nor summary intervention scores were associated with reduction in discomfort. Our results demonstrate that although reduction of musculoskeletal discomfort may be observed in the context of an intervention study, it may be difficult to link these benefits to specific interventions.

Associations between selected sites of musculoskeletal discomfort and ergonomic characteristics of the video display terminal (VDT) workstation were assessed in analyses controlling for demographic, psychosocial stress, and VDT use factors in 273 VDT users from a large administrative department. Significant associations with wrist/hand discomfort were seen for female gender; working 7+ hours at a VDT; low job satisfaction; poor keyboard position; use of new, adjustable furniture; and layout of the workstation. Significantly increased odds ratios for neck/shoulder discomfort were observed for 7+ hours at a VDT, less than complete job control, older age (40 to 49 years), and never/infrequent breaks. Lower back discomfort was related marginally to working 7+ hours at a VDT. These results demonstrate that some characteristics of VDT workstations, after accounting for psychosocial stress, can be correlated with musculoskeletal discomfort.

Limited information is available on trends in the incidence of and mortality due to cardiogenic shock complicating acute myocardial infarction. We studied the incidence of cardiogenic shock complicating acute myocardial infarction and in-hospital death rates among patients with this condition in a single community from 1975 through 1997.We conducted an observational study of 9076 residents of metropolitan Worcester, Massachusetts, who were hospitalized with confirmed acute myocardial infarction in all local hospitals during 11 one-year periods between 1975 and 1997. Our study included periods before and after the advent of reperfusion therapy.The incidence of cardiogenic shock remained relatively stable over time, averaging 7.1 percent among patients with acute myocardial infarction. The results of a multivariable regression analysis indicated that the patients hospitalized during recent study years were not at a substantially lower risk for shock than patients hospitalized in the mid-to-late 1970s. Patients in whom cardiogenic shock developed had a significantly greater risk of dying during hospitalization (71.7 percent) than those who did not have cardiogenic shock (12.0 percent, P0.001). A significant trend toward an increase in in-hospital survival among patients with cardiogenic shock in the mid-to-late 1990s was found in crude and adjusted analyses.Our findings indicate no significant change in the incidence of cardiogenic shock complicating acute myocardial infarction over a 23-year period. However, the short-term survival rate has increased in recent years at the same time as the use of coronary reperfusion strategies has increased.

Objectives To describe sex differences in symptom presentation after acute myocardial infarction (AMI) while controlling for differences in age and other potentially confounding factors. Background Although several studies have examined sex differences in diagnosis, management, and survival after AMI, limited data exist about possible sex differences in symptom presentation in the setting of AMI. Methods Community-based study of patients hospitalized with confirmed AMI in all 16 metropolitan Worcester, Mass., hospitals (1990 census population=437,000). Men ( n = 810) and women ( n = 550) hospitalized with validated AMI in 1986 and 1988 comprised the study sample. Results After simultaneously controlling for age, medical history, and AMI characteristics through regression modeling, men were significantly less likely to complain of neck pain (adjusted odds ratio (OR) = 0.52; 95% CI: 0.35, 0.78), back pain (OR = 0.38; 95% CI: 0.26, 0.56), jaw pain (OR = 0.50; 95% CI: 0.31, 0.81), and nausea (O.R. = 0.58; 95% CI: 0.45, 0.75) than women. Conversely, men were significantly more likely to report diaphoresis (OR = 1.27; 95% CI: 1.00, 1.61) than women. There were no statistically significant sex differences in complaints of chest pain though men were more likely to complain of this symptom. Conclusions The results of this population-based observational study suggest differences in symptom presentation in men and women hospitalized with AMI. These findings have implications for public and health care provider education concerning recognition of sex differences in AMI-related symptoms and health care seeking behaviors. (Am Heart J 1998;136:189-95.)

Buts: deux essais controles et randomises de programmes de traitement hospitalier de l'abus de drogues ont revele que les differents programmes etaient egalement efficaces, en se basant sur les resultats de ceux qui etaient assignes aux traitements. Cette etude avait pour but de comparer l'efficacite relative des programmes, en se basant sur les resultats de ceux qui participaient a un programme de traitement specifique comme prevu. Projet: analyses secondaires des donnees de deux essais controles randomises simultanes, avec stratification en fonction de la duree actuelle du sejour. Cadre: deux services hospitaliers de traitement de l'abus de drogue aux Etats-Unis. Participants: 628 clients ont ete recrutes sur une periode de deux ans, representant 85% de tous les clients admis, 91% de tous les clients, admissibles, et 95% de ceux appeles a participer. Interventions: dans le premier etablissement, les clients ont ete randomises par rapport aux versions sur 6 mois ou sur 12 mois d'un programme therapeutique communautaire traditionnel. Dans le second etblissement, les clients ont ete randomises par rapport aux versions sur 3 moisou sur 6 mois d'un programme therapeutique communautaire modifie qui mettait l'accent sur la prevention et l'education sanitaire. Mesures: le temps entre l'admission et le premier usage de drogue (sauf l'alcool) ; et les scores composes obtenus avec l'Index de Severite de l'Addiction (ASI) pour la severite des problemes avec la drogue, l'alcool, la justice et l'emploi. Resultats: 539 clients (86%) ont ete convies a un entretien de suivi au moins 16,5 mois apres leur admission. Dans l'essai de prevention des rechutes, les bienfaits d'un programme sur 6 mois etaient generalement limites a ceux qui restaient au moins 40 jours. Dans l'essai therapeutique communautaire, parmi ceux qui restaient au moins 171 jours, le programme sur 12 mois avait un effet benefique sur l'emploi. Par ailleurs, il existait des differences incoherentes entre les programmes sur 6 mois et sur 12 mois. Conclusions: en moyenne, les clients qui restaient en traitement au moins 80 jours beneficiaient du fait de continuer un traitement jusqu'a 6 mois, mais pas au-dela. Reciproquement, ceux admis aux programmes d'une duree prevue plus longue et qui abandonnaient le traitement avant la fin avaient de moins bons resultats que ceux qui abandonnaient dans des programmes plus courts. Donc, bien qu'une duree planifiee plus longue puisse etre efficace, elle n'est pas forcement effective.

OBJECTIVE: This study assessed the effects of planned duration of residential drug abuse treatment on recovery from drug use and on human immunodeficiency virus (HIV) risk behaviors. METHODS: Two concurrent randomized controlled trials of programs differing in planned duration were conducted: 6-month vs 12-month versions of a traditional therapeutic community program, and 3-month vs 6-month versions of a modified therapeutic community incorporating a relapse prevention and health education program. Outcomes, measured at least 16.5 months after admission, included time from admission to first drug use; severity of drug, alcohol, legal, and employment problems; and risky drug injection and sexual behaviors. RESULTS: Among 539 clients (86% of those enrolled), there were no significant effects of planned duration of treatment upon Addiction Severity Index scores or HIV risk behavior. In the relapse prevention program, clients randomized to the 6-month program had a longer time to first drug use than those in the 3-month program (hazard ratio = 0.74; 95% confidence interval = 0.58, 0.93). Employment problems at follow-up were significantly less severe among clients treated in the therapeutic community than among those in the relapse prevention program. CONCLUSIONS: No overall benefit of extending treatment beyond 6 months was found.

Data from homecare electronic health records were used to explore the association of patient characteristics with re-hospitalizations of patients with heart failure (HF) during a 60-day period of telemonitoring following hospital discharge. Data from 403 Medicare patients with HF who had used telehealth from 2008 to 2010 were analysed. There were 112 all-cause (29%) and 73 cardiac-related (19%) re-hospitalizations within 60 days of being admitted to the homecare agency. In adjusted analyses, the patients’ prescribed number of medications and type of prescribed cardiac medications were significantly (P

Iron, potassium, zinc, and other minerals might impact the development of premenstrual syndrome (PMS) through multiple mechanisms, but few studies have evaluated these relations. We conducted a case-control study nested within the prospective Nurses' Health Study II (1991–2001). Participants were free from PMS at baseline. After 10 years, 1,057 women were confirmed as PMS cases and 1,968 as controls. Mineral intake was assessed using food frequency questionnaires completed in 1991, 1995, and 1999. After adjustment for calcium intake and other factors, women in the highest quintile of nonheme iron intake had a relative risk of PMS of 0.64 (95% confidence interval (CI): 0.44, 0.92; P for trend = 0.04) compared with women in the lowest quintile. Women in the highest quintile of potassium intake had a relative risk of 1.46 (95% CI: 0.99, 2.15; P for trend = 0.04) compared with women in the lowest quintile. High intake of zinc from supplements was marginally associated with PMS (for intake of ≥25 mg/day vs. none, relative risk = 0.69, 95% CI: 0.46, 1.02; P for trend = 0.05). Intakes of sodium, magnesium, and manganese were unrelated to PMS risk. These findings suggest that dietary minerals may be useful in preventing PMS. Additional studies are needed to confirm these relations.

OBJECTIVE: This study assessed maternal attitudes about the physician's role in child health promotion. METHODS: Home interviews were conducted with 200 Massachusetts mothers (with one child age 2 to 3 years) enrolled in a health maintenance organization. RESULTS: Mothers chose growth and nutrition, physical development, and illness as the most important topics and felt that providers have the ability to prevent problems and to help. Psychosocial and safety issues were less important, although mothers felt susceptible to these issues and believed they greatly affected children's health. CONCLUSIONS: On all issues, mothers believed physicians were more effective in helping families after, not before, problems arose. The Health Belief Model provided insight into attitudes and possible interventions.

WE WERE STRUCK by the title of the paper recently published by Soldin et al. in the February issue of Thyroid (“Lack of a relation between human neonatal thyroxine and pediatric neurobehavioral disorders” (1) for its provocative, if unintended, implication that neonatal thyroxine (T4) is not associated with specific neurobehavioral deficits. Clearly, neonatal thyroxine may be associated with a variety of neurobehavioral deficits (2–5), and new research is revealing associations between neuropsychological outcome and subtle maternal thyroid hormone insufficiency (6–9). In contrast to the implication of the title, the hypothesis under investigation was that “intrauterine thyroid dysfunction is an early factor in the development of neurobehavioral disorders” in humans. Clearly, this hypothesis has important implications for human health. To test this hypothesis, Soldin et al. (1) utilized a case-control study design in which the hypothesized causal pathway of interest (insufficient levels of free T4 during fetal brain development leading to deficiencies in central nervous system [CNS] development) was presumed to be represented adequately by relationships between neonatal levels of T4 and a hospital clinic diagnosis of any of the following: attention-deficit hyperactivity disorders (ADHD), autism spectrum disorder, behavioral disorder, cognitive disorder, developmental delay, emotional disorder, learning disability, or speech/language disorder. However, we contend that the choices of neonatal T4 as a proxy measure of intrauterine thyroid status, and the use of hospital diagnoses of broad and heterogeneous neurobehavioral disorders limits the ability to adequately test this hypothesized causal pathway of interest. In the first case, the choice of neonatal T4 as a proxy measure of intrauterine thyroid status is not appropriate for reason of (at least) the findings of Haddow et al. (8), who observed that neonatal T4 is not reflective of maternal thyroid status, and that of Calvo et al. (10) who observed that the fetus is exposed to biologically relevant levels of free T4 that are likely to be affected by subtle changes (e.g., hypothyroxinemia) in maternal free T4 rather than in neonatal T4 (11). The issues germane to the use of hospital diagnoses are more complex. Soldin et al. (1) identified cases based on the sole criterion of a hospital clinic diagnosis—rendering the cases a disproportionate representation of higher severity disease; this has implications for the generalizability of study findings. Although the controls were intended to be identified as children without a hospital clinic diagnosis of a neurobehavioral disorder and with neonatal T4 determinations made at the same time as those of the cases, there was no assessment of the “controls” to verify his or her control status as having no diagnosis of disease made elsewhere (e.g., pediatric practices) in any year up to the time when the matched case was diagnosed. Moreover, no information was collected on potential confounders and modifiers of the relationships between neonatal T4 and neurobehavioral disorder. Therefore, the data collected were biased toward the null in that, among the cases, some normal levels of neonatal T4 are likely “misrepresentations” of potentially low, or infrequently high, levels of free T4 in utero, rendering cases spuriously similar to controls; and the controls likely include some children with a neurobehavioral disorder, the diagnosis being made in a nonhospital setting, rendering the controls spuriously similar to the cases. Finally, the available data include no low levels of T4. This precludes the discovery of any of the relationships of interest and the reported odds ratios are estimates of relationships that are not of interest; namely those between disease and variations in normal levels of T4 on the second day after birth. Further confusing the interpretation of the reported odds ratios is that it is not known what they are actually

Randomized controlled trials were conducted at two residential drug abuse treatment facilities to compare programs that differed in planned duration. One trial compared a 6-month and a 12-month therapeutic community program (n = 184), and the second compared a 3-month and a 6-month relapse prevention program (n = 444). Retention rates over comparable time periods differed minimally by planned treatment duration, and the longer programs had lower completion rates. There was no effect in either trial of planned treatment duration on changes in psychosocial variables between admission and exit or on rates or patterns of drug use at follow-up between 2 and 6 months after exit.

This article examines the legal involvement of 438 clients randomized to three- and six-month versions of a residential drug abuse treatment program with respect to early attrition (before 40 days in treatment) and later attrition (40-79 days in treatment). Concern about legal problems was reported by 21% of subjects in response to an open-ended question about factors that led to admission; 42% had other legal circumstances that were determined either from documented evidence of legal involvement from chart review or from self-report through structured questioning about legal status. For those with "concern about legal problems" the early attrition rate was 16%, compared with 33% for those with no legal factors--odds ratio (OR) .38 with 95% confidence interval (95% CI) (.20,.73) and the later attrition rate was 25%, OR .76, 95% CI (.39,1.48). Those subjects with "legal circumstances" only had an early attrition rate of 29%--OR .86, 95% CI (.54,1.37) and a later attrition rate of 19%, OR .53, 95% CI (.29,.98) compared to those with no legal factors. There was little evidence of confounding in any of these results from adjusted analyses. Findings suggest that only self-reported concern about legal status as a problem mentioned at entry to treatment is significantly associated with lower early attrition and there is no significant relationship of legal factors with later attrition.

We investigated the outcomes of a 21-day inpatient drug detoxification and rehabilitation program including length of stay, transfer to further treatment, and HIV risky behavior. Clients (n = 567) were predominantly White, male, currently unemployed, and their treatment was not covered by third party payment. 78% were detoxified with methadone. The median length of stay was 18 days. Higher education, not living with spouse or children, English as primary language, admission during fall or winter months, and greater knowledge of HIV transmission were independent predictors of greater length of stay. Among those with follow-up (n = 450), 19% were transferred to residential drug-free programs and 7% to outpatient programs. Taking into account loss to follow-up, the overall rate of treatment transfer could be as low as 21%. Greater length of stay was associated with higher rates of transfer to residential treatment. Relapse rates to either any drug use or injection drug use were lower among subjects transferred to residential treatment than either clients transferred to outpatient programs or those with no further treatment. Among subjects who continued to inject drugs at follow-up, no reduction in HIV risky behaviors was found regardless of further treatment. We conclude that detoxification programs have the potential for reducing relapse to drug use when followed by residential drug-free treatment.

The validity of drug and sexual behavior data collected by drug user treatment staff using a short clinical risk assessment among 387 injection drug users is evaluated using in-depth, confidential interview process. Moderate to high agreement levels were found for most, but not all, variables. Participants consistently reported less risky behaviors on the clinical risk assessment than on the in-depth interview. More easily recalled information can be accurately gathered through a short clinical risk assessment. However, in-depth, confidential interviewing is important when gathering self-reports of the frequency of drug and sexual behaviors.

This study aimed to identify factors which predict participation of drug users in HIV-1 antibody testing. The study was part of a randomized controlled trial of three small group AIDS educational programs, in a 21-day in-patient drug detoxification and rehabilitation program. Subjects (n = 497) were clients admitted to the program who consented to participate in the evaluation and who completed baseline data collection. All subjects received pre-test counseling. Testing was offered after 1 week in treatment; 52% decided to be tested. Factors which predicted participation in testing included: no previously reported positive result, a longer stay in treatment, a greater frequency of injection, a greater perceived probability of being infected, and the type of AIDS education. Both actual and perceived level of risk, and the type of AIDS education provided can affect participation in testing programs.

We investigated the associations of self-reported HIV status and risky injection practices with dependent variables measuring readiness and motivation for treatment and depression among 550 clients at two residential drug abuse treatment programs. The results suggest that a positive HIV status may be associated with motivation for treatment independently of and more strongly than risky behavior. In multivariable analyses, HIV status was associated with a scale measuring cons of drug use (P = 0.006). Risky behavior was associated with the dependent variables only in univariate analyses. The univariate association between risky behavior and depression was confounded by social desirability bias. Further research is needed to determine whether HIV-related variables predict retention or outcome of treatment.

The authors investigated the test-retest reliability of the Addiction Severity Index (ASJ) composite scores and the use of “free-living vs. institutionalized” reporting periods among 112 patients admitted to either of two residential, drug-free treatment programs in New England. Alcohol and drug scores were substantially lower for institutionalized vs. free-living reporting periods. Intraclass correlation coefficients were high (> 0.80) for the alcohol, drug, employment, and legal scores, but lower (0.50–0.59) for the psychiatric and medical scores and did not differ substantially by type of reporting period or by lag period between end of the reporting period and the interview. The use of free-living reporting periods yields more valid ASI scores for drugs and alcohol, in particular, and yields comparable reliability.

Objectives. This study explored the recognition and treatment of osteoporosis and vertebral fracture among older women by primary care physicians. Methods. Data from the National Ambulatory Medical Care Survey from 1993 to 1997 were examined for evidence of diagnosis and treatment of osteoporosis or vertebral fracture during visits by White women 60 years and older to primary care physicians. Results. Fewer than 2% of the women received diagnoses of osteoporosis or vertebral fracture, although expected prevalence is 20% to 30%. Appropriate drug treatment, including antiresorptive agents and calcium and vitamin D, was offered to only 36% of the diagnosed patients. Conclusions. Few cases of osteoporosis or vertebral fracture in older women are being diagnosed and treated by primary care physicians.

Statins are prescribed to lower cholesterol, but also have anti-inflammatory properties. Some observational studies suggest that statins may reduce mortality from sepsis.Using a highly detailed administrative database, we conducted an observational cohort study of all patients aged ≥18 years who received a discharge diagnosis of pneumonia from 2003-2005 at 376 hospitals. Patients with contraindications to statins, and those unable to take oral medications or discharged within 2 days were excluded. We used multivariable logistic regression and propensity matching to compare mortality among patients who did and did not receive statins on hospital day 1 or 2.Of the 121,254 patients who met the inclusion criteria, median age was 74; 56% were female and 70% were white; 19% received a statin on day 1 or 2. Compared to patients who did not receive statins, statin-treated patients were less likely to be admitted to intensive care (15.7% vs 18.1%, p 0.001), require mechanical ventilation (6.9% vs. 9.3%, p 0.001), or die in hospital (3.9% vs 5.7%, p 0.001). After multivariable adjustment, including the propensity for statin treatment and severity at presentation, mortality was lower in statin-treated patients [OR for propensity-adjusted 0.86 (95% CI 0.79 to 0.93) OR for propensity-matched 0.90, (0.82 to 0.99)]. For patients admitted to intensive care the adjusted odds ratio for mortality with statins was 0.93 (95% CI 0.81 to 1.06), whereas outside intensive care it was 0.79 (95% CI 0.71 to 0.87).Inpatient treatment with statins is associated with a modest reduction in pneumonia mortality outside of intensive care.