Risk factors for first nonfatal myocardial infarction (MI) in women younger than age 50 years were evaluated in a case-control study of 255 women with MI and 802 controls. The relative risk of MI ...increased with the amount smoked. The estimated risk of MI for current smokers of 35 or more cigarettes per day was ten times that of women who never smoked; an estimated 65% of MIs were attributable to cigarette smoking. The relative risk of MI increased markedly with increasing levels of total plasma cholesterol and decreasing levels of high-density lipoproteins, and the effects of the two factors appeared to be independent. Other factors significantly associated with MI were hypertension, angina pectoris, diabetes mellitus, blood group A, and a history of MI or stroke before age 60 years in a mother or sibling. Factors not significantly associated with MI were obesity, history of preeclamptic toxemia, and type A personality. Women who were postmenopausal appeared to have a lower risk of MI than premenopausal women of similar ages. Of the identified risk factors, the most prominent was cigarette smoking, a habit that is amenable to change.
Previous studies have suggested that people who consume a moderate amount of alcohol have a reduced risk of coronary heart disease compared with nondrinkers. This hypothesis was further tested in the ...period April 1980-April 1983 in a study of 2,170 men with first nonfatal myocardial infarction and 981 hospital controls, all under 55 years of age. The relative risk estimate for men who drank between one and seven times per week compared with never drinkers was 1.2 (95% confidence interval, 0.8-1.8) when age and cigarette smoking were taken into account and 1.1 (0.7-1.7) when personality type was also taken into account. There was no evidence of a reduced risk for users who drank primarily one type of alcoholic beverage (beer, wine, or liquor) or within categories of dose measured in ounces consumed per week. The findings were not materially changed when other risk factors for myocardial infarction were taken into account. The results of this study suggest that moderate alcohol consumption does not reduce the risk of nonfatal myocardial infarction.
Falls are common among older adults and may be related to depressive symptoms (DS). With advancing age, there is an onset of chronic conditions, sensory impairments, and activity limitations that are ...associated with falls and with depressive disorders. Prior cross-sectional studies have observed significant associations between DS and subsequent falls as well as between fractures and subsequent clinical depression and DS.
The directionality of these observed relationship between falls and DS is in need of elaboration given that cross-sectional study designs can yield biased estimates of the DS-falls relationship.
Using 2006–2010 Health and Retirement Study data, cross-lagged panel structural equation models were used to evaluate associations between falls and DS among 7233 community-dwelling adults ages ≥65. Structural coefficients between falls and DS (in 2006→2008, 2008→2010) were estimated.
A good-fitting model was found: Controlling for baseline (2006) physical functioning, vision, chronic conditions, and social support and neighborhood social cohesion, falls were not associated with subsequent DS, but a 0.5 standard deviation increase in 2006 DS was associated with a 30% increase in fall risk two years later. This DS-falls relationship was no longer significant when use of psychiatric medications, which was positively associated with falls, was included in the model.
Using sophisticated methods and a large U.S. sample, we found larger magnitudes of effect in the DS-falls relationship than in prior studies—highlighting the risk of falls for older adults with DS. Medical providers might assess older individuals for DS as well as use of psychotropic medications as part of a broadened falls prevention approach. National guidelines for fall risk assessments as well as quality indicators for fall prevention should include assessment for clinical depression.
•We evaluated bi-directional associations between falls and depressive symptoms.•Depressive symptoms were associated with increased fall risk.•Fall risk was not associated with increased depressive symptoms.•Psychiatric medications mediated the depressive symptoms—falls association.
This study compared the impact of helpful and hindering events, as perceived by 40 clients, in two forms of psychotherapy: an exploratory, relationship-oriented therapy, and a prescriptive, ...cognitive/behavioural therapy. All clients received eight sessions of each type of treatment in a crossover design. Events were obtained by self-report both during and at the end of each period, and content analysed for type of therapeutic impact by three trained raters. Results showed that during treatment the most commonly occurring helpful impacts across both types of treatments were 'problem solution', 'awareness' and 'reassurance', while the most commonly occurring hindering impact was 'unwanted thoughts'. Similar impacts were reported at the end of each period, with the addition of 'personal contact'. In addition, it was found that 'problem solution' and 'reassurance' impacts were more commonly reported in prescriptive treatment, whereas 'awareness' and 'personal contact' impacts were more prevalent in exploratory treatment. Only the prevalence of 'unwanted thoughts' was correlated (negatively) with outcome. Some possible reasons for the lack of correlation between reported impacts and outcome are suggested.
Breast cancer and cigarette smoking Rosenberg, L; Schwingl, P J; Kaufman, D W ...
The New England journal of medicine,
01/1984, Letnik:
310, Številka:
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Journal Article
Recenzirano
It has been suggested that cigarette smoking may reduce the incidence of breast cancer, perhaps by as much as 20 per cent. To evaluate the relation between breast-cancer risk and smoking, we studied ...2160 women with breast cancer and 717 controls who had been admitted to the hospital for cancer of the ovary, cancer of the colon or rectum, malignant melanoma, or lymphoreticular cancers. As compared with women who had never smoked, the estimated relative risk of breast cancer was 1.1 for current smokers of any amount (95 per cent confidence interval, 0.9 to 1.3), and 1.0 (0.8 to 1.3) for heavy smokers (15 or more cigarettes per day). Allowance for all identified potential confounding factors did not materially alter the results. There was no indication that age at commencement of smoking was related to the risk, nor was there evidence of an effect of smoking within the categories of age at first pregnancy or age at menopause. The data provide evidence against the hypothesis that smoking may reduce the incidence of breast cancer by 20 per cent.
Explores how lawyers identify & deal with conflicts of interest. Data were obtained from interviews with the person(s) responsible for conflict-of-interest issues in 128 IL law firms of varied sizes. ...Of the random sample of firms, 92% participated, & in 13% of these, there were interviews with more than one person. Circumstances in which conflicts of interest can arise were explored, including confusion about who is/is not a client, competing interests of different clients, & shifting webs of affiliations. It is noted that the number of potential conflicts grows exponentially as a firm becomes larger. While a few of the smallest firms simply hoped the problem would vanish, most firms invested considerable time/money to establish databases & review systems. These conflict-detecting systems, encouraged by legal malpractice insurance systems, were generally accepted passively by individual lawyers, even the "cybersurveillance" common in large firms. The implications of this kind of social control are discussed in relation to individual lawyers, clients, & firms. Quotations from the interviews are included. 3 Figures, 13 References. J. Lindroth
A case-control study of 155 women with pelvic inflammatory disease (PID) and 305 controls with other conditions was carried out. Compared with other methods of contraception, the age-adjusted ...relative risk estimate for use of any intrauterine device (IUD) within one month of admission was 8.6 (95% confidence limits, 5.3 and 13.8); for past use, the estimate was 1.6 (confidence limits, 0.6 and 4.0). The estimated risk was highest for users of the Dalkon Shield (11 cases and two controls), lowest for users of copper-containing devices (40 cases and 34 controls), and intermediate for users of other IUDs, principally the Lippes Loop (32 cases and 23 controls). Compared with copper-containing IUDs, the relative risk estimate for the Dalkon Shield was 6.5 (confidence limits, 1.5 and 27.5). When the Dalkon Shield and copper-containing IUDs were compared, in turn, with the Lippes Loop, the estimated risk was increased for the former and reduced for the latter, but the differences were not statistically significant. Nine of the 11 cases using the Dalkon Shield (82%) had severe PID (diagnosed at surgery or because of purulent cervical discharge), compared with 12 of 40 copper device users (30%) and nine of 32 Lippes Loop users (28%). The risk of PID did not seem to be related to duration of use of any of the three IUDs. This study confirms that IUD use increases the risk of PID. It also suggests that the Dalkon Shield is more harmful than other devices.
Objective
To estimate expenditures for fall‐related injuries (FRIs) among older Medicare beneficiaries.
Data Sources
The 2007–2009 Medicare claims and 2008 Health and Retirement Study (HRS) data for ...5,497 (228 FRI and 5,269 non‐FRI) beneficiaries.
Study Design
FRIs were indicated by inpatient/outpatient ICD‐9 diagnostic codes for fractures, trauma, dislocations, and by e‐codes. A pre‐post comparison group design was used to estimate the differential change in pre‐post expenditures for the FRI relative to the non‐FRI cohort (FRI expenditures). Out‐of‐pocket (OOP) costs, service category total annual FRI‐related Medicare expenditures, expenditures related to the type of initial FRI treatment (inpatient, ED, outpatient), and the risk of persistently high expenditures (4th quartile for each post‐FRI quarter) were estimated.
Principal Findings
Estimated FRI expenditures were $9,389 (95 percent CI: $5,969–$12,808). Inpatient, physician/outpatient, skilled nursing facility, and home health comprised 31, 18, 39, and 12 percent of the total. OOP costs were $1,363.0 (95 percent CI: $889‐$1,837). Expenditures for FRIs initially treated in inpatient/ED/outpatient settings were $21,424/$6,142/$8,622. The FRI cohort had a 64 percent increased risk of persistently high expenditures. Total Medicare expenditures were $13 billion (95 percent CI: $9–$18 billion).
Conclusions
FRIs are associated with substantial, persistent Medicare expenditures. Cost‐effectiveness of multifactorial falls prevention programs should be assessed using these expenditure estimates.
Purpose: The dose-limiting toxicities, maximum tolerated dose, pharmacokinetic profile, and preliminary antitumor activity of neratinib
(HKI-272), an irreversible pan ErbB inhibitor, were determined ...in patients with advanced solid tumors.
Experimental Design: Neratinib was administered orally as a single dose, followed by a 1-week observation period, and then once daily continuously.
Planned dose escalation was 40, 80, 120, 180, 240, 320, 400, and 500 mg. For pharmacokinetic analysis, timed blood samples
were collected after administration of the single dose and after the first 14 days of continuous daily administration.
Results: Dose-limiting toxicity was grade 3 diarrhea, which occurred in one patient treated with 180 mg and in four patients treated
with 400 mg neratinib; hence, the maximum tolerated dose was determined to be 320 mg. Other common neratinib-related toxicities
included nausea, vomiting, fatigue, and anorexia. Exposure to neratinib was dose dependent, and the pharmacokinetic profile
of neratinib supports a once-a-day dosing regimen. Partial response was observed for 8 (32%) of the 25 evaluable patients
with breast cancer. Stable disease ≥24 weeks was observed in one evaluable breast cancer patient and 6 (43%) of the 14 evaluable
non–small cell lung cancer patients.
Conclusion: The maximum tolerated dose of once-daily oral neratinib is 320 mg. The most common neratinib-related toxicity was diarrhea.
Antitumor activity was observed in patients with breast cancer who had previous treatment with trastuzumab, anthracyclines,
and taxanes, and tumors with a baseline ErbB-2 immunohistochemical staining intensity of 2+ or 3+. The antitumor activity,
tolerable toxicity profile, and pharmacokinetic properties of neratinib warrant its further evaluation.
In this randomized, controlled trial in Africa and India, combination antiretroviral therapy was more effective than standard therapy in preventing mother-to-child transmission of HIV but was ...associated with increased toxic effects.
Antiretroviral regimens used for the prevention of mother-to-child transmission of the human immunodeficiency virus (HIV) have evolved from the first successful trial that used zidovudine single-drug prophylaxis in 1994 to current triple-drug regimens.
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Although there are clear benefits of combination antiretroviral therapy (ART) for the mother and infant, these do not come without risks; some studies have shown higher rates of adverse pregnancy outcomes with maternal ART than with regimens containing fewer antiretroviral agents.
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The Promoting Maternal and Infant Survival Everywhere (PROMISE) trial compared the relative efficacy and safety of various proven antiretroviral strategies for the prevention of . . .
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