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Effect Modification (effect + modification)

Distribution by Scientific Domains

Medical Sciences	80%
Life Sciences	20%

Selected Abstracts

Validation Study of Genetic Associations with Coronary Artery Disease on Chromosome 3q13-21 and Potential Effect Modification by Smoking

ANNALS OF HUMAN GENETICS, Issue 6 2009
Benjamin D. Horne
Summary The CATHGEN study reported associations of chromosome 3q13-21 genes (KALRN, MYLK, CDGAP, and GATA2) with early-onset coronary artery disease (CAD). This study attempted to independently validate those associations. Eleven single nucleotide polymorphisms (SNPs) were examined (rs10934490, rs16834817, rs6810298, rs9289231, rs12637456, rs1444768, rs1444754, rs4234218, rs2335052, rs3803, rs2713604) in patients (N = 1618) from the Intermountain Heart Collaborative Study (IHCS). Given the higher smoking prevalence in CATHGEN than IHCS (41% vs. 11% in controls, 74% vs. 29% in cases), smoking stratification and genotype-smoking interactions were evaluated. Suggestive association was found for GATA2 (rs2713604, p = 0.057, OR = 1.2). Among smokers, associations were found in CDGAP (rs10934490, p = 0.019, OR = 1.6) and KALRN (rs12637456, p = 0.011, OR = 2.0) and suggestive association was found in MYLK (rs16834871, p = 0.051, OR = 1.8, adjusting for gender). No SNP association was found among non-smokers, but smoking/SNP interactions were detected for CDGAP (rs10934491, p = 0.017) and KALRN (rs12637456, p = 0.010). Similar differences in SNP effects by smoking status were observed on re-analysis of CATHGEN. CAD associations were suggestive for GATA2 and among smokers significant post hoc associations were found in KALRN, MYLK, and CDGAP. Genetic risk conferred by some of these genes may be modified by smoking. Future CAD association studies of these and other genes should evaluate effect modification by smoking. [source]

Serum Carotenoids and Cerebral White Matter Lesions: The Rotterdam Scan Study

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2001
Tom Den Heijer MSc
OBJECTIVES: To study the relation between serum levels of carotenoids and white matter lesions (WMLs) on magnetic resonance imaging (MRI). DESIGN: Evaluation of cross-sectional data from a cohort study. SETTING: The Rotterdam Scan Study. PARTICIPANTS: Two hundred and three nondemented older persons, age 60 to 90, from the Rotterdam Scan Study. MEASUREMENTS: Serum levels of carotenoids were determined. WMLs on MRIs were rated separately into periventricular and subcortical WMLs. Odds ratios (ORs) for the presence of severe WMLs (upper decile) were calculated per standard deviation (SD) increase in serum carotenoid level and per SD increase in overall carotenoid serum level. Effect modification by smoking status was studied through stratified analyses. RESULTS: Increasing levels of all the separate carotenoids were associated with less severe periventricular WMLs, which reached statistical significance for the overall carotenoid serum level (OR 0.4 per SD; 95% confidence interval (CI) = 0.2,0.9). We found no association between carotenoid levels and the presence of severe subcortical WMLs (OR 1.2 per SD; 95% CI = 0.7,2.0). The association of carotenoid levels with severe periventricular WMLs was more marked in those who ever smoked (OR 0.1 per SD; 95% CI = 0.0,0.9) than in those who had never smoked (OR 0.9 per SD; 95% CI = 0.4,2.1). CONCLUSIONS: These findings are compatible with the view that high levels of carotenoids may protect against WMLs in the periventricular region, in particular in smokers. Longitudinal studies with repeated measurements of both carotenoids and WMLs are necessary to explore this hypothesis further. [source]

Relationship Between Post-traumatic Stress Disorder and Pain in Two American Indian Tribes

PAIN MEDICINE, Issue 1 2005
Dedra Buchwald MD
ABSTRACT Objectives., To estimate the association of lifetime post-traumatic stress disorder (PTSD) and pain in American Indians, and determine if tribe, sex, cultural and psychosocial factors, or major depression influence the magnitude of this association. Design., A cross-sectional probability sample survey completed between 1997 and 2000. A structured interview was conducted by trained, tribal members to gather information on demographic and cultural features, physical health status, psychiatric disorders, and functional status. Setting., General community. Participants., A total of 3,084 individuals randomly selected from the tribal rolls of a Southwestern (N = 1,446) and a Northern Plains (N = 1,638) tribal group who were 15,54 years of age and lived on or within 20 miles of their reservations. Outcome Measures., Bodily pain subscale of the Short Form-36. Linear regression models were fit to examine the association between lifetime PTSD and pain, adjusting for demographic, cultural, psychosocial features, painful medical conditions, and major depression. Results., The prevalence of lifetime PTSD was 16% in the Southwestern and 14% in the Northern Plains; women were nearly twice as likely as men to have lifetime PTSD in both tribes. The final adjusted model demonstrated that mean Short Form-36 bodily pain subscale scores were lower (indicating more pain) among individuals with lifetime PTSD than those without lifetime PTSD. Effect modification by tribe, sex, and depression was not observed. Conclusions., Lifetime PTSD was strongly associated with bodily pain in this rural sample of American Indians. Clinicians should be aware of, and address, the link between physical pain syndromes and PTSD. [source]

Dementia, cognitive impairment and mortality in persons aged 65 and over living in the community: a systematic review of the literature

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2001
Michael E. Dewey
Abstract Background No recent attempt has been made to synthesise information on mortality and dementia despite the theoretical and practical interest in the topic. Our objective was to estimate the influence on mortality of cognitive impairment and dementia. Methods Data sources were Medline, Embase, personal files and colleagues' records. Studies were considered if they included a majority of persons aged 65 and over at baseline either drawn from a total community sample or drawn from a random sample from the community. Samples from health care facilities were excluded. The search located 68 community studies. Effect sizes were extracted from the studies and if they were not included in the published studies, effect sizes were calculated where possible: this was possible for 23 studies of cognitive impairment and 32 of dementia. No attempt was made to contact authors for missing data. Results For the studies of cognitive impairment Fisher's method (a vote counting method), gave a p -value (from eight studies) of 0.00001. For studies of dementia, age-adjusted confidence intervals (CI) were pooled (odds ratio (OR) 2.63 with 95% CI 2.17 to 3.21 from six studies). Conclusions Levels of cognitive impairment commonly found in community studies give rise to an increased risk of mortality, and this appears to be true even for quite mild levels of impairment. The analysis confirms the increased risk of mortality for dementia, but reveals a dearth of information on the causes of the excess mortality and on possible effect modification by age, dementia subtype or other variables. Copyright © 2001 John Wiley & Sons, Ltd. [source]

Hypoxia and oxidation levels of DNA and lipids in humans and animal experimental models

IUBMB LIFE, Issue 11 2008
Peter Møller
Abstract The objective of this review was to evaluate the association between hypoxia and oxidative damage to DNA and lipids. Evaluation criteria encompassed specificity and validation status of the biomarkers, study design, strength of the association, dose-response relationship, biological plausibility, analogous exposures, and effect modification by intervention. The collective interpretation indicates persuasive evidence from the studies in humans for an association between hypoxia and elevated levels of oxidative damage to DNA and lipids. The levels of oxidatively generated DNA lesions and lipid peroxidation products depend on both the duration and severity of the exposure to hypoxia. Largest effects are observed with exposure to hypoxia at high altitude, but other factors, including ultraviolet light, exercise, exertion, and low intake of antioxidants, might contribute to the effect observed in subjects at high altitude. Most of the animal experimental models should be interpreted with caution because the assays for assessment of lipid peroxidation products have suboptimal validity. © 2008 IUBMB IUBMB Life, 60(11): 707,723, 2008 [source]

Employment and quality of life in liver transplant recipients

LIVER TRANSPLANTATION, Issue 9 2007
Sammy Saab
The purposes of liver transplantation (LT) include the extension of survival, improvement in quality of life, and the return of the recipient as a contributing member of society. Employment is one measure of the ability to return to society. The aim of this study is to determine the factors affecting employment/subemployment after LT. A total of 308 adult liver transplant recipients who were seen at the University of California, Los Angeles were administered the Medical Outcomes Short Form 36 (SF-36) and a questionnaire regarding work history and insurance coverage. Multivariate analysis were used to identify independent variables associated with posttransplantation employment. Interaction terms were used to examine effect modification. Of 308 transplant recipients, 218 (70.8%) worked prior to transplantation, and 78 (27%) worked posttransplantation. Pretransplant variables that were independently associated with posttransplantation employment included the following: lack of disability income (odds ratio [OR] = 1.86; 95% confidence interval [CI], 1.32-7.18; P = 0.36); health maintenance organization (HMO)/preferred provider organization (PPO) insurance (OR = 3.08; 95% CI, 1.32-7.18; P < 0.01); the number of hours worked (OR = 1.17; 95% CI, 1.08-1.28; P < 0.01); and the lack of diabetes mellitus (OR = 0.23; 95% CI, 0.70-0.73; P < 0.01). An interaction term between disability income and hours worked prior to transplantation (OR = 0.16; 95 % CI, 0.03-0.83; P = 0.03) was independently associated with posttransplantation employment. In a separate regression model of SF-36 responses, posttransplantation physical functioning (OR = 1.17; 95% CI, 1.10-1.26; P < 0.01) and role-physical (OR = 1.1; 95% CI, 1.02-1.16; P < 0.01) were independently associated with employment after transplantation. In conclusion, HMO or PPO insurance, lack of disability income coverage prior to transplant, the absence of diabetes mellitus, the number of hours worked prior to transplantation, and high physical functioning were associated with posttransplantation employment. Liver Transpl 13:1330,1338, 2007. © 2007 AASLD. [source]

Neonatal jaundice: a risk factor for infantile autism?

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 6 2008
Rikke Damkjær Maimburg
Summary In a previous study, we found that infants transferred to a neonatal ward after delivery had an almost twofold increased risk of being diagnosed with infantile autism later in childhood in spite of extensive controlling of obstetric risk factors. We therefore decided to investigate other reasons for transfer to a neonatal ward, in particular hyperbilirubinaemia and neurological abnormalities. We conducted a population-based matched case,control study of 473 children with autism and 473 matched controls born from 1990 to 1999 in Denmark. Cases were children reported with a diagnosis of infantile autism in the Danish Psychiatric Central Register. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals [CI] and likelihood ratio tests were used to test for effect modification. We found an almost fourfold risk for infantile autism in infants who had hyperbilirubinaemia after birth (OR 3.7 [95% CI 1.3, 10.5]). In stratified analysis, the association appeared limited to term infants (,37 weeks gestation). A strong association was also observed between abnormal neurological signs after birth and infantile autism, especially hypertonicity (OR 6.7 [95% CI 1.5, 29.7]). No associations were found between infantile autism and low Apgar scores, acidosis or hypoglycaemia. Our findings suggest that hyperbilirubinaemia and neurological abnormalities in the neonatal period are important factors to consider when studying causes of infantile autism. [source]

Allergy and infectious disease histories and the risk of childhood acute lymphoblastic leukaemia

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 2 2005
Paula F. Rosenbaum
Summary Infectious disease histories were evaluated in a population-based case-control study of childhood acute lymphoblastic leukaemia (ALL) as it has been hypothesised that delays in early infections are associated with an increased risk of disease. Allergy histories were also assessed as part of a broader evaluation of the role of immune factors in ALL. Cases (n = 255) were diagnosed between 1980 and 1991 at one of four referral centres in a 31-county area of New York State; controls (n = 760) were a random sample of live births from the same region, frequency matched to cases by sex, race and birth year. Data were collected by mailed questionnaire, completed by case and control parents in 1995. Allergy and infectious histories before the age at leukaemia diagnosis for cases and an equivalent age for controls were evaluated. The adjusted odds ratio and 95% confidence interval [CI] associated with a positive history of any allergy was 0.58 [95% CI 0.38, 0.88] compared with a negative allergy history. The occurrence of several common childhood illnesses before 25 months of age and ALL were assessed, with both weak positive and weak inverse associations observed. Overall, these analyses provide little support for the hypothesis that infection delay in early life is associated with an increased risk of ALL. Children with positive allergy histories reported significantly more infections than those with negative histories; however, effect modification of the infection-ALL associations by child allergy history was not observed. Nonetheless, these observations suggest the importance of assessing both allergy and infectious histories and their possible interactions when evaluating the association between these immune factors and childhood ALL. [source]

Radiation and breast carcinogenesis,

PEDIATRIC BLOOD & CANCER, Issue 5 2001
John D. Boice Jr.
Abstract With the possible exception of radiation-induced leukemia, more is known about radiation-induced breast cancer than any other malignancy [1, 2]. Fourteen cohort studies have provided quantitative information on the level of risk following a wide range of doses in different populations around the world. Comprehensive studies have been conducted in Canada, Germany, Japan, Sweden and other Nordic countries, the United Kingdom, and the USA (Table I). Key features are the linearity in the dose response (i.e., a straight line adequately fits the observed data), and the effect modification of age at exposure (i.e., risk is inversely related to exposure age and exposures past the menopausal ages appear to carry a very low risk); and the minimal effect of fractionating dose on subsequent risk [3]. A recent combined analysis of almost 78,000 women and 1,500 breast cancer cases from eight cohorts confirmed the downturn in risk at the highest dose levels (related in part to the killing of cells rather than transformation) and that fractionation of dose has little influence on risk, at least on an absolute scale [4]. It is not known whether persons predisposed to cancer are at enhanced risk of radiation-induced breast cancer from low-dose exposures, although this seems unlikely [5]. New data on the effects of high doses following childhood exposures will be forthcoming from long-term studies of the survivors of childhood cancer (6,8). Med. Pediatr. Oncol. 36:508,513, 2001. © 2001 Wiley-Liss, Inc. [source]

Mortality patterns among workers exposed to arsenic, cadmium, and other substances in a copper smelter

AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 8 2009
Gary M. Marsh PhD
Abstract Objective To evaluate the long-term mortality experience of workers exposed to arsenic, cadmium, and other substances at a copper mine and smelter in Copperhill, Tennessee studied earlier as part of an industry-wide study. Methods Subjects were 2,422 male workers employed three or more years in the smelter or mill between 1/1/46 until the plant strike and scale-down of operations in April 1996. Vital status was determined through 2000 for 99.4% of subjects and cause of death for 91.3% of 878 deaths. Historical exposures were estimated for lead, SO2, arsenic, cadmium, dust, and cobalt. We computed standardized mortality ratios (SMRs) based on U.S. and local county rates and modeled internal relative risks (RRs). Results We observed overall deficits in deaths based on national and local county comparisons from all causes, all cancers and most of the cause of death categories examined. We found limited evidence of increasing mortality risks from cerebrovascular disease with increasing duration and cumulative arsenic exposure, but no evidence of an exposure,response relationship for cadmium exposure and bronchitis. Conclusions Our limited evidence of an association between inhaled arsenic exposure and CVD is an exploratory finding not observed in other epidemiology studies of more highly exposed occupational populations. Possible alternative explanations include chance alone and uncontrolled confounding or effect modification by co-exposures or other factors correlated with arsenic exposure and unique to the Copperhill facility. Am. J. Ind. Med. 52:633,644, 2009. © 2009 Wiley-Liss, Inc. [source]

Outdoor exposure to airborne polycyclic organic matter and adverse reproductive outcomes: A pilot study

AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 3 2001
Zdravko P. Vassilev MD
Abstract Background To investigate the association between outdoor airborne polycyclic organic matter (POM) and adverse reproductive outcomes in New Jersey, we used a cross-sectional design combining air quality data from the USA EPA Cumulative Exposure Project and individual data on pregnancy outcomes from birth and fetal death certificates at the census tract level. Methods After excluding plural births and chromosomal anomalies, 221,406 live births and 1,591 fetal deaths registered in New Jersey during the years of 1990 and 1991 were included. The exposure estimates were derived from modeled average POM concentrations for each census tract in the state. Results After adjustment for potential confounders, the odds ratios (OR) for very low birth weight for the highest exposure compared to the lowest exposure group was 1.31 (95% CI 1.15,1.51); among term births, high POM exposure was associated with low birth weight OR,=,1.31 (95% CI 1.21,1.43), with fetal death OR,=,1.19 (95% CI 1.02,1.39) and with premature birth OR,=,1.25 (95% CI 1.19,1.31). The univariate stratified analyses suggested effect modification of all observed associations by maternal alcohol consumption. Conclusions This study found associations between outdoor exposure to modeled average airborne POM and several adverse pregnancy outcomes. The data and methods utilized in this pilot study may be useful for identifying hazardous air pollutants requiring in-depth investigation. Am. J. Ind. Med. 40:255,262, 2001. © 2001 Wiley-Liss, Inc. [source]

Epidemiology: Theory, study design, and planning for education

THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 3 2000
PhD Assistant Professor, Shelley A. Harris MSc
Abstract Many health professionals have received formal training in epidemiology; however, much of it has been limited to introductory courses at the undergraduate level. Further, continuing education for health professionals has focused historically on substantive rather than methodologic issues in epidemiology. A methodologic focus is recommended to improve continuing education for the health of the public. It is crucial to equip educators and health professionals with the necessary tools or resources to understand study design, conduct research, analyze and interpret data, and critically evaluate published research. Thus, in this article, a general overview of epidemiologic study design and some of the most common methodologic issues are presented. Issues such as confounding, effect modification, measurement error, and power and sample size are highlighted. A broader recognition of these issues by educators and health professionals may ultimately help to improve public health by facilitating effective educational interventions, proper study design, analysis, interpretation, and application of epidemiologic research. [source]

Validation Study of Genetic Associations with Coronary Artery Disease on Chromosome 3q13-21 and Potential Effect Modification by Smoking

The effect of alcohol on radiographic progression in rheumatoid arthritis

ARTHRITIS & RHEUMATISM, Issue 5 2010
M. J. Nissen
Objective Alcohol consumption reduces the risk of development of rheumatoid arthritis (RA) and significantly attenuates the development of erosive arthritis in animal models. It remains unknown whether alcohol consumption influences joint damage progression in RA. This study was undertaken to compare the rates of radiographic damage progression in alcohol drinkers and nondrinkers in a large prospective cohort of patients with RA. Methods All patients in the population-based Swiss Clinical Quality Management in RA registry database with at least 2 sequential radiographs were included. Joint erosions were assessed in 38 joints in the hands and feet using a validated scoring method. The rate of progression of erosions was analyzed using multivariate regression models for longitudinal data and was adjusted for potential confounders. Results The study included 2,908 patients with RA with a mean of 4 sequential radiographs and 3.9 years of followup. A trend toward reduced radiographic progression existed in drinkers compared with nondrinkers, with a mean rate of erosive progression of 0.99% (95% confidence interval [95% CI] 0.89,1.09) and 1.13% (95% CI 1.01,1.26) at 1 year, respectively. Alcohol consumption displayed a J-shaped dose-response effect, with a more favorable evolution in occasional consumers (P = 0.01) and daily consumers (P = 0.001) as compared with nondrinkers, while heavy drinkers demonstrated worse radiographic evolution (P = 0.0001). We found significant effect modification by sex, with male drinkers displaying significantly less erosive progression compared with male nondrinkers (mean 0.86% [95% CI 0.70,1.03] versus 1.35% [95% CI 1.02,1.67]; P = 0.007). Conclusion Our findings indicate a trend toward reduced radiographic progression in alcohol drinkers compared with nondrinkers, specifically in occasional and daily alcohol consumers. In particular, male patients with RA who consume alcohol demonstrate less radiographic progression than do male nondrinkers. [source]

Maternal caffeine consumption and risk of cardiovascular malformations,,

BIRTH DEFECTS RESEARCH, Issue 7 2007
Marilyn L. Browne
Abstract BACKGROUND: The physiologic effects and common use of caffeine during pregnancy call for examination of maternal caffeine consumption and risk of birth defects. Epidemiologic studies have yielded mixed results, but such studies have grouped etiologically different defects and have not evaluated effect modification. METHODS: The large sample size and precise case classification of the National Birth Defects Prevention Study allowed us to examine caffeine consumption and specific cardiovascular malformation (CVM) case groups. We studied consumption of caffeinated coffee, tea, soda, and chocolate to estimate total caffeine intake and separately examined exposure to each caffeinated beverage. Smoking, alcohol, vasoactive medications, folic acid supplement use, and infant gender were evaluated for effect modification. Maternal interview reports for 4,196 CVM case infants overall and 3,957 control infants were analyzed. RESULTS: We did not identify any significant positive associations between maternal caffeine consumption and CVMs. For tetralogy of Fallot, nonsignificant elevations in risk were observed for moderate (but not high) caffeine intake overall and among nonsmokers (ORs of 1.3 to 1.5). Risk estimates for both smoking and consuming caffeine were less than the sum of the excess risks for each exposure. We observed an inverse trend between coffee intake and risk of atrial septal defect; however, this single significant pattern of association might have been a chance finding. CONCLUSIONS: Our study found no evidence for an appreciable teratogenic effect of caffeine with regard to CVMs. Birth Defects Research (Part A), 2007. © 2007 Wiley-Liss, Inc. [source]

Effect of familial history and smoking on common cancer risks in Japan

CANCER, Issue 10 2007
Takeshi Suzuki MD
Abstract BACKGROUND Inherited genetic predispositions are important risk factors for the development of cancer in general. To determine genetic susceptibility for 14 common cancers, a case,control study of the impact of a family history of cancer in first-degree relatives was conducted. The authors further evaluated the effect modification by habitual smoking with adjustment for other confounding environmental factors. METHODS In total, 18,836 cancer cases and 28,125 age,matched and sex,matched controls, confirmed as being free of cancer, were recruited. Odds ratios (ORs) and 95% confidence intervals were determined by multiple logistic regression analysis, including stratification by family history for 14 cancer sites and interactions with a smoking history. RESULTS The associations between family history and risk of cancer were generally stronger at the same sites than across cancer sites. Risks to first-degree relatives at the same sites were found to be significantly elevated with 8 of 14 cancer sites; especially high ORs were found for prostate and thyroid cancers. Some across-site associations were observed; in particular, a reciprocal association between breast and prostate cancer was found. The interaction between family history and smoking history for breast cancer was found to be statistically significant. There was no statistical evidence for the interactions in other sites, but among subjects with a family history, the ORs were found to be higher in smokers compared with nonsmokers. CONCLUSIONS The results of the current study support the hypothesis of a genetic susceptibility to cancers in family members. For breast cancer, the interaction between family history and smoking history was observed to be significant. Cancer 2007. © 2007 American Cancer Society. [source]

Calcium, dietary, and lifestyle factors in the prevention of colorectal adenomas

CANCER, Issue 3 2007
Eric A. Miller PhD
Abstract BACKGROUND. Many studies have suggested a role for calcium in reducing the risk of colorectal adenomas and cancer but its effectiveness may be dependent on interactions with other dietary and/or lifestyle factors. We examined the association between calcium and prevalence of adenomas and assessed whether the association was stronger in biologically plausible subgroups. METHODS. Cross-sectional data from 222 cases and 479 adenoma-free controls who underwent colonoscopies and completed food frequency and lifestyle questionnaires were used in the analyses. Multivariable logistic regression was used to estimate the association between calcium and prevalence of adenomas. Stratified analyses and the likelihood ratio test were used to examine effect modification by various demographic, lifestyle, and behavioral factors. RESULTS. Overall, little association was observed comparing total calcium intake of ,900 mg/day to <500 mg/day (adjusted odds ratio [OR] = 0.85, 95% confidence interval [CI]: 0.53,1.37). However, stronger associations were observed in patients with lower fat intake and in those who regularly (,15 times/month) took nonsteroidal antiinflammatory drugs (NSAIDs). Specifically, total calcium intake of ,900 mg/day was associated with a lower prevalence of adenomas among patients with lower fat intake (OR = 0.47, 95% CI: 0.25,0.91) but not among those with higher fat intake (OR = 1.20, 95% CI: 0.61,2.35; P -value for interaction = .01). For NSAIDs, the associations were OR = 0.37 (95% CI: 0.16,0.86) for regular NSAID users and OR = 1.27 (95% CI: 0.73,2.22) with infrequent or nonuse of NSAIDs, respectively (P = .06). CONCLUSIONS. The data suggest that a lower-fat diet and regular NSAID use may enhance calcium's effectiveness as a colorectal cancer preventive agent. Cancer 2007 © 2007 American Cancer Society. [source]

Genetic polymorphisms of cyclooxygenase-2 and colorectal adenoma risk: The Self Defense Forces Health Study

CANCER SCIENCE, Issue 3 2008
Naoyuki Ueda
Cyclooxygenase (COX) is a key enzyme in the formation of prostaglandins, and an inducible isoform of COX, COX-2, has been implicated in colorectal carcinogenesis. This study investigated the relation of COX-2 polymorphisms (,1195G>A, ,765G>C and 8160A>G) to colorectal adenomas in a case,control study of male officials in the Self Defense Forces (SDF). The study subjects were 455 cases of colorectal adenoma and 1052 controls with no polyps who underwent total colonoscopy. Genotypes were determined using the polymerase chain reaction,restriction fragment length polymorphism (PCR-RFLP) method with genomic DNA extracted from the buffy coat. Statistical adjustment was made for age, hospital, rank in the SDF, body mass index (BMI), cigarette smoking, and alcohol intake. A statistically non-significant decrease in the risk of colorectal adenomas was observed for the AA versus GG genotype of ,1195G>A polymorphism and for the GC versus GG genotype of ,765G>C polymorphism. None had the ,765CC genotype in either the case or control groups. No effect modification of overweight, smoking or alcohol use was observed for either ,1195G>A or ,765G>C polymorphism. The variant allele of the 8160A>G polymorphism was extremely rare. A haplotype of ,1195G, ,765G and 8160A alleles was associated with a modest increase in the risk (adjusted odds ratio [OR] 1.38, 95% confidence interval [CI] 0.99,1.91), and the increase was more evident for distal adenomas (adjusted OR 1.57, 95% CI 1.04,2.38). Another haplotype of ,1195A, ,765C and 8160A alleles showed an adjusted OR of 0.22 (95% CI 0.06,0.88). These findings add to evidence for the role of COX-2 in colorectal carcinogenesis and warrant further studies focusing on haplotypes. (Cancer Sci 2008; 99: 576,581) [source]

The Elder Patient with Suspected Acute Coronary Syndromes in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 8 2007
Jin H. Han MD
ObjectivesTo describe the evaluation and outcomes of elder patients with suspected acute coronary syndromes (ACS) presenting to the emergency department (ED). MethodsThis was a post hoc analysis of the Internet Tracking Registry for Acute Coronary Syndromes (i,trACS) registry, which had 17,713 ED visits for suspected ACS. First visits from the United States with nonmissing patient demographics, 12-lead electrocardiogram results, and clinical history were included in the analysis. Those who used cocaine or amphetamines or left the ED against medical advice were excluded. Elder was defined as age 75 years or older. ACS was defined by 30-day revascularization, Diagnosis-related Group codes, or death within 30 days with positive cardiac biomarkers at index hospitalization. Multivariable logistic regression analyses were performed to determine the association between being elder and 1) 30-day all-cause mortality, 2) ACS, 3) diagnostic tests ordered, and 4) disposition. Multivariable logistic regression was also performed to determine which clinical variables were associated with ACS in elder and nonelder patients. ResultsA total of 10,126 patients with suspected ACS presenting to the ED were analyzed. For patients presenting to the ED, being elder was independently associated with ACS and all-cause 30-day mortality, with adjusted odds ratios of 1.8 (95% confidence interval [CI] = 1.5 to 2.2) and 2.6 (95% CI = 1.6 to 4.3), respectively. Elder patients were more likely to be admitted to the hospital (adjusted odds ratio, 2.2; 95% CI = 1.8 to 2.6), but there were no differences in the rates of cardiac catheterization and noninvasive stress cardiac imaging. Different clinical variables were associated with ACS in elder and nonelder patients. Chest pain as chief complaint, typical chest pain, and previous history of coronary artery disease were significantly associated with ACS in nonelder patients but were not associated with ACS in elder patients. Male gender and left arm pain were associated with ACS in both elder and nonelder patients. ConclusionsElder patients who present to the ED with suspected ACS represent a population at high risk for ACS and 30-day mortality. Elders are more likely to be admitted to the hospital, but despite an increased risk for adverse events, they have similar odds of receiving a diagnostic test, such as stress cardiac imaging or cardiac catheterization, compared with nonelder patients. Different clinical variables are associated with ACS, and clinical prediction rules utilizing presenting symptoms should consider the effect modification of age. [source]

A systematic review of case,control studies of human papillomavirus infection in laryngeal squamous cell carcinoma

CLINICAL OTOLARYNGOLOGY, Issue 4 2004
L. Rees
A role for human papillomavirus (HPV) has been suggested in laryngeal squamous cell carcinoma (LSCC). In order to quantitate the available evidence, we reviewed studies examining the risk of laryngeal cancer-associated HPV. PubMed was searched for case,control studies conducted worldwide and published in any language since 1966. Relevant papers were hand-searched and cross-referenced. Six studies met the inclusion criteria. The studies are heterogeneous in the methods used to harvest tissue samples and techniques for detecting the virus within the tissue. HPV-16 positivity among cases ranged from 2.7% to 46.9% and 0,5.7% among controls. Two studies showed a significantly increased risk of LSCC if HPV-16 was present (OR 18.5, 95% CI 2.2,154.8, OR 2.6, 95% CI 1.1,6.0). An increased risk was also observed for glottic versus supraglottic cancer in one study (OR 9.69, 95% CI 1.47,64.04). The direction of effect is towards an increase in risk of LSCC in people with evidence of HPV-16 infection. There is marked heterogeneity in the methods used to detect the virus and frequency with which it is detected. An adequately powered study using a reliable detection technique is required to confirm and quantify this risk and to examine effect modification. [source]