Consideration Of Other Risk Factors Research Articles

Predicting Risk of Colorectal Cancer After Adenoma Removal in a Large Community-Based Setting.

Colonoscopy surveillance guidelines categorize individuals as high or low risk for future colorectal cancer (CRC) based primarily on their prior polyp characteristics, but this approach is imprecise, and consideration of other risk factors may improve postpolypectomy risk stratification. Among patients who underwent a baseline colonoscopy with removal of a conventional adenoma in 2004-2016, we compared the performance for postpolypectomy CRC risk prediction (through 2020) of a comprehensive model featuring patient age, diabetes diagnosis, and baseline colonoscopy indication and prior polyp findings (i.e., adenoma with advanced histology, polyp size ≥10 mm, and sessile serrated adenoma or traditional serrated adenoma) with a polyp model featuring only polyp findings. Models were developed using Cox regression. Performance was assessed using area under the receiver operating characteristic curve (AUC) and calibration by the Hosmer-Lemeshow goodness-of-fit test. Among 95,001 patients randomly divided 70:30 into model development (n = 66,500) and internal validation cohorts (n = 28,501), 495 CRC were subsequently diagnosed; 354 in the development cohort and 141 in the validation cohort. Models demonstrated adequate calibration, and the comprehensive model demonstrated superior predictive performance to the polyp model in the development cohort (AUC 0.71, 95% confidence interval [CI] 0.68-0.74 vs AUC 0.61, 95% CI 0.58-0.64, respectively) and validation cohort (AUC 0.70, 95% CI 0.65-0.75 vs AUC 0.62, 95% CI 0.57-0.67, respectively). A comprehensive CRC risk prediction model featuring patient age, diabetes diagnosis, and baseline colonoscopy indication and polyp findings was more accurate at predicting postpolypectomy CRC diagnosis than a model based on polyp findings alone.

Association of maternal and paternal perinatal depression and anxiety with infant development: A longitudinal study

BackgroundMaternal and paternal perinatal depression and anxiety are theorised to adversely impact infant development. Yet, few studies have assessed both mental health symptoms and clinical diagnoses within the one study. Moreover, research on fathers is limited. This study therefore aimed to examine the association between symptoms and diagnoses of maternal and paternal perinatal depression and anxiety with infant development. MethodData were from the Triple B Pregnancy Cohort Study. Participants included 1539 mothers and 793 partners. Depressive and anxiety symptoms were assessed using the Edinburgh Postnatal Depression Scale and Depression Anxiety Stress Scales. Major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder, and agoraphobia were assessed using the Composite International Diagnostic Interview in trimester three. Infant development was assessed at 12-months using the Bayley Scales of Infant and Toddler Development. ResultsAntepartum, maternal depressive and anxiety symptoms were associated with poorer infant social-emotional (d = −0.11, p = .025) and language development (d = −0.16, p = .001). At 8-weeks postpartum, maternal anxiety symptoms were associated with poorer overall development (d = −0.11, p = .030). No association was observed for clinical diagnoses in mothers, nor paternal depressive and anxiety symptoms or clinical diagnoses; albeit risk estimates were largely in the expected direction of adverse effects on infant development. ConclusionsEvidence suggests that maternal perinatal depression and anxiety symptoms may adversely impact infant development. Effects were small but findings underscore the importance of prevention, early screening and intervention, alongside consideration of other risk factors during early critical periods.

Assessment of Hormonal Contraceptive Utilization and Associated Odds of Hypercoagulopathy in Patients with Venous Malformations Using a National Claims Database.

Vascular anomalies that exhibit a slow velocity of blood flow, specifically venous malformations (VM), are associated with hypercoagulability. There is limited literature on the utilization of hormonal contraceptives (HCs) and the development of clotting events in female individuals diagnosed with VM. We aimed to characterize HC utilization and associated odds of hypercoagulopathy in patients with VM of child-bearing age. Using a national administrative claims database, we identified female patients with VM aged 15-49 years and a control population, matched for age and length of insurance enrollment, from 2016 to 2021. Multivariable logistic regression was used to estimate the odds of hypercoagulation events associated with HC use. Two hundred and sixty-seven (47.2%) patients with VM and 1284 (45.4%) control patients utilized HCs during the study period. Oral contraceptives were the most common HC for patients with and without VM (73.8% and 76.9% of those taking HCs, respectively), and estrogen-containing combination HCs (70.4% in patients with VM and 75.9% in controls) were more prevalent than progestin-only HCs in both populations. Despite a heightened baseline odds of hypercoagulopathy in patients with VM relative to patients without VM (odds ratio = 12.54; 95% confidence interval 7.73-20.3), HC use was not associated with an increased odds of hypercoagulation in the VM subpopulation (odds ratio = 0.82; 95% confidence interval 0.46-1.46). In contrast, tobacco use (odds ratio = 2.12; 95% confidence interval 1.09-4.12) and a history of coagulopathy (odds ratio = 3.92; 95% confidence interval 1.48-10.36) were predictive of thromboembolic events in the VM cohort. These findings suggest that patients with VM may safely use HCs with careful consideration of other risk factors for thromboses.

Ukrainian FRAX version in the male osteoporosis management

Background. At present, FRAX is a well-known and widely-used risk assessment tool for major osteoporotic fractures. The Ukrainian version of the FRAX algorithm was presented in 2016; with the “intervention threshold” for additional DXA examination and antiosteoporotic treatment of the Ukrainian women published in 2019. However, the data on its possible uses in men are limited. The purpose of the study was to evaluate the possibilities of using the previously developed criteria of the Ukrainian FRAX algorithm in Ukrainian men. Materials and methods. We examined 653 outpatients aged 40–88 years (mean age (M±SD)— 60.5±11.8 years). We analyzed the results both in the general group and in the age subgroups; in particular, with an account of low-trauma fractures, included in the FRAX calculation, and compared them with the corresponding indices of the Ukrainian women. Results. The most frequent (26.6 %) risk factor for osteoporotic fractures in the group of Ukrainian men was a history of low-trauma fracture (the corresponding index in women was 51.3 %), its presence being the reason for antiosteoporotic treatment initiating. Following upon the risk of major osteoporotic fractures calculated by FRAX, only 6.7 % of men without previous fractures were found to require additional DXA examination in order to re-evaluate the osteoporotic fracture risk, and none had a high fracture risk. 73 % of men without fractures did not have any risk factor included in the FRAX algorithm. Conclusions. This study showed a greater need for both antiosteoporotic treatment without DXA assessment and additional densitometric examination for the osteoporotic fracture risk assessment for the Ukrainian women rather than men, along with a special attention to the presence of previous fractures in men, and consideration of other risk factors for osteoporosis, even those not included in this FRAX algorithm.

A Prospective Analysis of Plasma Phospholipid Fatty Acids and Breast Cancer Risk in 2 Provinces in Canada.

ABSTRACTBackgroundStudies suggest that fatty acid status influences breast cancer etiology, yet the roles of individual fatty acids in breast cancer risk are unclear, specifically when central adiposity and menopausal status are considered.ObjectivesThis study examined the associations of fatty acid status with breast cancer risk including location, menopausal status, and waist-to-hip ratio as key variables.MethodsPrediagnostic plasma phospholipid fatty acids were measured in women with breast cancer (n = 393) and age-matched controls (n = 786) from a nested case-control prospective study within Alberta's Tomorrow Project (ATP) and British Columbia Generations Project (BCGP) cohorts. Binary logistic regression models were used to evaluate associations of fatty acids and breast cancer risk with subgroup analysis for menopausal status and waist-to-hip ratio.ResultsWomen from BCGP had a higher n–3 (ɷ-3) fatty acid status compared with the ATP (6.4% ± 0.08% vs. 5.3% ± 0.06%; P < 0.001), so subsequent analysis was blocked by cohort. Overall, fatty acids had inconsistent associations with risk. In the ATP among premenopausal women, total long-chain n–3 fatty acids (ORQ4vsQ1 = 1.78; 95% CI: 0.58, 5.43; P-trend = 0.007, P-interaction = 0.07) were positively associated with breast cancer risk, whereas in BCGP, DHA (ORQ4vsQ1 = 0.66; 95% CI: 0.28, 1.53; P-trend = 0.03, P-interaction = 0.05) and total long-chain n–3 fatty acids (ORQ4vsQ1 = 0.66; 95% CI: 0.28, 1.54; P-trend = 0.03) were associated with decreased cancer risk when the waist-to-hip ratio was <0.85.ConclusionsOur findings suggest that regional variations in fatty acid status influence breast cancer risk, resulting in positive associations of total long-chain n–3 fatty acids in premenopausal ATP women and negative associations of these fatty acids in BCGP women with a waist-to-hip ratio below guidelines. This study highlights the complexity and difficulty in using fatty acid status to predict breast cancer risk in diverse populations without the consideration of other risk factors.

Cancer incidence in the vicinity of a waste incineration plant in the Nice area between 2005 and 2014

IntroductionFew studies on cancer incidence have been conducted since the adoption of the EU 2000/76/EC waste incineration directive which aimed to limit dioxin emission levels to less than 0.1 ng TEQ/m3 before December 31, 2005. ObjectiveTo measure cancer incidence among the population exposed to atmospheric emissions from the waste incineration plant near the town of Nice (South-Eastern France), compared to the unexposed population of the Alpes-Maritimes department (A-M). MethodsAll primary invasive cancers and haematological malignancies diagnosed among AM residents between 2005 and 2014 were recorded. The exposed surface was modeled on an average dioxin deposition model ≥4.25 ng/m2/year. Each case was geolocated and assigned to one of 36 predefined geographic units of exposed area, or one of 462 units in the unexposed area. The adjusted incidence rate, the standardized incidence ratio and the Comparative Morbidity Figure were calculated for two periods: 2005–2009/2010-2014. ResultsWe recorded 80,865 new cancers in the A-M population. Between 2005 and 2009, we observed a higher incidence among exposed women of acute myeloid leukaemia, myelodysplastic syndromes and myeloma and, among exposed men, of soft tissue sarcomas, myeloma and lung cancer. Between 2010 and 2014, there was no excess incidence among women, while among men incidence of myeloma and lung cancer remained higher. ConclusionOnly among men, the incidence of myeloma and lung cancer remained higher in the exposed area during the second period. The EU directive resulting in the limitation of atmospheric emissions from incinerators could explain the decrease in incidence of cancers with protracted latency. Consideration of other risk factors and further data collection will be necessary to validate this hypothesis.

The use of ABI in screening for diabetes-related lower limb peripheral arterial disease in IDF middle- and low-income countries: a scoping review

The burden of disease from diabetic foot ulcers linked to peripheral arterial disease (PAD) is complicated by limited resources in low- to middle-income countries (LMIC). This precludes the widespread use of sophisticated imaging methods. Screening for PAD can include the use of low-cost tests such as the ankle brachial index (ABI). A scoping review was performed to identify what is known about the use of ABI in screening for diabetes-related PAD in LMIC. LMIC were defined as per the International Diabetes Federation Atlas. The following databases were searched using a comprehensive search term: Cochrane Library, EbscoHost, PubMed, Web of Science, Science Direct, Scopus, and Google Scholar. A total of 400 records were gleaned. The publication abstracts were screened through several rounds to select only those in which ABI was used in the context of screening for PAD to prevent diabetic foot disease. Twenty publications were included, from MLIC countries such as Brazil, Nigeria, Kenya, Uganda, South Africa, India, China, Singapore, Korea, Taiwan, Hong Kong, Indonesia, Thailand, and the Philippines. Ten ancilliary publications were identified. The widespread reporting and large scale use of ABI in PAD screening in Asia are evident, compared to fewer reports from Africa and South America. Many Asian publications report using faster, automated ABI equipment in conjunction with handheld Doppler evaluation of flow signals. Despite concerns regarding the potential for false elevations secondary to vessel calcification and non-compressibility, ABI remains a useful first encounter test in screening for PAD. Asian publications endorse and report the use of ABI firmly within the core clinical examination and consideration of other risk factors for PAD. No publications were found on large-scale use of automated ABI in the South African or greater African context of diabetic foot screening.

Thyroid cancer risks among medical radiation workers in South Korea, 1996\u20132015

BackgroundThyroid cancer rates, especially among children, are known to be increased by radiation exposure. However, little is known about the impact of chronic low-dose radiation exposure on thyroid cancer risk in adulthood. This study examined radiation effects on thyroid cancer rates as well as an overall evaluation of thyroid cancer risk among medical radiation workers.MethodsData on all diagnostic medical radiation workers enrolled in the national dosimetry registry between 1996 and 2011 were linked with the cancer registry data through 2015. Standardized incidence ratios (SIRs) were used to compare the observed cancer incidence rates in this population to those for the general population while internal comparisons were used to estimate relative risks (RRs) for occupational history and excess relative risks (ERRs) were used to quantify the radiation dose-response relationship.ResultsOverall, 827 thyroid cancer cases were reported among 93,922 medical radiation workers. Thyroid cancer SIRs were significantly higher than expected for both men (SIR 1.72, 95% confidence interval [CI] 1.53 to 1.91) and women (SIR 1.18, 95% CI 1.08 to 1.28). However, RRs for thyroid cancer by job title and duration of employment showed no particular pattern among diagnostic medical radiation workers. There were no indications of a significant dose effect on thyroid cancer rates for either men (ERR/100 mGy 0.07, 95% CI -0.38 to 0.53) or women (ERR/100 mGy -0.13, 95% CI -0.49 to 0.23). The findings were similar for different job titles or when limited to workers employed for at least one year.ConclusionsWhile thyroid cancer incidence rates among Korean medical radiation workers were somewhat higher than those in the general population, there was no significant evidence that this increase was associated with occupational radiation dose. Additional follow-up together with consideration of other risk factors should provide useful information on thyroid cancer rates in this cohort.

Evaluation of various equations for estimating renal function in elderly Chinese patients with type 2 diabetes mellitus.

BackgroundThe clinical assessment of kidney function based on the estimated glomerular filtration rate (GFR) in older patients remains controversial. This study evaluated the concordance and feasibility of using various creatinine-based equations for estimating GFR in elderly Chinese patients with type 2 diabetes mellitus (T2DM).MethodsA cross-sectional analytical study was conducted in 21,723 older diabetic patients (≥60 years) based on electronic health records (EHR) for Minhang District, Shanghai, China. The concordance of chronic kidney disease (CKD) classification among different creatinine-based equations was assessed based on Kappa values, intraclass correlation coefficient (ICC) statistics, and the eGFR agreement between the equations was tested using Bland–Altman plots. The GFR was estimated using the Cockcroft–Gault (CG), Berlin Initiative Study 1 (BIS1), simplified Modification of Diet in Renal Disease (MDRD), MDRD modified for Chinese populations (mMDRD), chronic kidney disease epidemiology collaboration (CKD-EPI), CKD-EPI in Asians (CKD-EPI-Asia), and Ruijin equations.ResultsOverall, the proportion of CKD stages 3–5 (eGFR <60 mL/min/1.73 m2) was calculated as 28.9%, 39.1%, 11.8%, 8.4%, 14.3%, 11.5%, and 12.7% by the eGFRCG, eGFRBIS1, eGFRMDRD, eGFRmMDRD, eGFRCKD-EPI, eGFRCKD-EPI-Asia, and eGFRRuijin equations, respectively. The concordance of albuminuria and decreased eGFR based on the different equations was poor by both the Kappa (<0.2) and ICC (<0.4) statistics. The CKD-EPI-Asia equation resulted in excellent concordance with the CKD-EPI (ICC =0.931), MDRD (ICC =0.963), mMDRD (ICC =0.892), and Ruijin (ICC =0.956) equations for the classification of CKD stages, whereas the BIS1 equation exhibited good concordance with the CG equation (ICC =0.809). In addition, significant differences were observed for CKD stage 1 among all these equations.ConclusionAccurate GFR values are difficult to estimate using creatinine-based equations in older diabetic patients. Kidney function is complex, and the staff need to be aware of the individualized consideration of other risk factors or markers of reduced renal function in clinical practice.

Serum chloride and sodium concentration as a predictor of acute kidney injury in premature newborns

Introduction/Objective. Hyperchloremia is often registered in adults? studies after administration with 0.9% sodium chloride, which contributes to the development of acute kidney injury (AKI) as it leads to vasoconstriction of renal blood vessels. The aim of this study was to determine the correlation of sodium and chloride imbalance with the development of AKI, with consideration of other risk factors for this disorder. Methods. This retrospective study included 146 randomly selected preterm infants hospitalized at the Neonatal Intensive Care Unit from 2008 to 2015. Results. Among the patients registered for the study, 23.97% developed AKI, and they were of a significantly lower gestational age (26.3 ? 2.8 weeks vs. 31.7 ? 2.90 weeks, p &lt; 0.05); birth weight (971.31 ? 412.1 g vs. 1,753.3 ? 750.3 g, p &lt; 0.05); Apgar score in the first (3.2 ? 1.7 vs. 5.7 ? 2.4, p &lt; 0.05) and fifth minute (5.3 ? 1.7 vs. 7.1 ? 1.8, p &lt; 0.05) of life compared to those without AKI. The neonates with AKI had significantly higher maximum chloremia (Clmax: 114.1 ? 8.4 vs. 111.7 ? 4.6, p = 0.029) and maximum natremia (Namax: 147.9 ? 8.8 vs. 142.9 ? 4, p &lt; 0.05). Each of these parameters is (independently) a statistically significant risk factor for the development of AKI, and gestational age is the strongest (OR = 1 / 0.643 = 1.55; 95% CI 1.24?1.94). Mortality in neonates with AKI was higher than in neonates without AKI (19.4% vs. 92.7%, p &lt; 0.05). Conclusion. Hyperchloremia and hypernatremia are more common in the premature newborns with AKI compared to the premature newborns without AKI. Higher maximum sodium and chloride values are independent risk factors for AKI.

Ultrasensitive Prostate Specific Antigen and its Role after Radical Prostatectomy: A Systematic Review

Prostate specific antigen is an important tool to monitor patients with prostate cancer after radical prostatectomy. Ultrasensitive prostate specific antigen assays are increasingly used with a lower limit of detection as low as 0.001 ng/ml. We systematically reviewed currently available ultrasensitive prostate specific antigen technologies and the role of this method in monitoring patients after radical prostatectomy. We searched the relevant literature using the MEDLINE® database. For various study objectives the series eligible for review provided serial ultrasensitive prostate specific antigen (lower detection limit less than 0.1 ng/ml) data on men after radical prostatectomy as well as comparative data on standard prostate specific antigen (lower detection limit 0.1 ng/ml or greater). Ultrasensitive prostate specific antigen could potentially detect prostate cancer recurrence years earlier than standard prostate specific antigen assays. The specificity of detectable ultrasensitive prostate specific antigen is low. Ultrasensitive prostate specific antigen kinetics may improve the positive predictive value for detecting cancer recurrence. However, the usefulness of prostate specific antigen doubling time at the ultrasensitive level remains controversial. Undetectable nadir ultrasensitive prostate specific antigen after radical prostatectomy confers a low risk of disease recurrence while a detectable nadir above 0.01 ng/ml requires additional measurement and consideration of other risk factors to determine management and avoid overtreatment. This monitoring method may spare patients with high risk disease adjuvant radiation therapy and enable more selective early salvage radiation. Currently no data demonstrate improved survival after early salvage therapy prompted by ultrasensitive prostate specific antigen surveillance. Ultrasensitive prostate specific antigen is useful in the early diagnosis of cancer recurrence after radical prostatectomy but specificity is poor. To date there is a lack of evidence that earlier detection of recurrence translates into prolonged time to metastasis. Integrating ultrasensitive prostate specific antigen with other clinicopathological factors can help determine optimal adjuvant and salvage therapy.

Impact of Age on the Association Between CKD and the Risk of Future Coronary Events

Elucidation of the relationship between age, kidney function, and absolute coronary risk would facilitate efforts to promote chronic kidney disease (CKD) as a high-risk state for future vascular events and justify current recommendations for statin treatment in CKD. Population-based study. 1,268,538 people with data for estimated glomerular filtration rate and albuminuria who were treated in a single Canadian province. CKD risk groups (G1, G2, G3a, G3b, and G4 had estimated glomerular filtration rate ≥90, 60-89.9, 45-59.9, 30-44.9, and 15-29.9 mL/min/1.73 m2, respectively; A1, A2, and A3 had albuminuria with albumin-creatinine ratio [ACR]<30 mg/g or dipstick urinalysis negative, ACR of 30-300 mg/g or dipstick trace or 1+, and ACR >300 mg/g or dipstick ≥ 2+, respectively) and age (<40, 40-49, ≥50 years). Rates of coronary death or nonfatal myocardial infarction (expressed per 1,000 person-years), stratified by age, sex, and CKD stage. The first available serum creatinine value and the corresponding date were set as the index serum creatinine value and index date, respectively. ACR or dipstick urinalysis data were obtained from the periods defined by 6 months before and after the index creatinine value. Absolute rates of coronary death or nonfatal myocardial infarction were consistently greater than 10 per 1,000 person-years for people with CKD and 50 years or older, regardless of CKD stage. However, absolute rates of the composite outcome were consistently less than 10 per 1,000 person-years for those younger than 50 years. Single Canadian province, median follow-up only 4.0 years. People with CKD who are 50 years or older should be considered at the highest risk of coronary events. In contrast, consideration of other risk factors will be required when assessing future risk among people with CKD who are younger than 50 years.

Learning About Causal Mechanisms: Bounding the Indirect Effect of Oil Through State Weakness on Civil War

Conflict scholars have devoted considerable attention to the natural resource curse, and specifically to connections between natural resources, state weakness, and civil war. Many have posited a state weakness mechanism - that significant oil production causes state weakness, and state weakness consequently increases the likelihood of civil war onset. In this paper, I develop nonparametric methods for bounding mechanism-specific causal effects to show, using standard measures, that the state weakness mechanism does not exist in the short or medium term. In only two cases is there the possibility of a medium term effect, and the state weakness mechanism is unlikely to be operative even in these two cases. Furthermore, the methods introduced in this paper do not rely on assumptions about unmeasured confounders, so this result is robust to the consideration of other risk factors for civil war onset. The state weakness mechanism may still exist in the form of long term effects or an effect that reinforces pre-existing war and/or state weakness. However, the null hypothesis of no long-term and/or reinforcing effect cannot be rejected without the use of additional assumptions.

Reducing the Risk of Cancer Treatment-Associated Bone Loss in Patients With Breast Cancer

Women with breast cancer, especially those receiving aromatase inhibitors, are at higher risk for bone loss and fracture. Postmenopausal women may already have multiple risk factors for fracture, and breast cancer therapies compound these risks. Current guidelines for bone health management in women with breast cancer are based on bone mineral density (BMD) measurements; however, many risk factors for fracture are independent of bone mineral density. Thus, consideration of other risk factors for fracture, including cancer therapies, aromatase inhibitor therapy, and age, may be necessary to accurately identify patients at high risk for bone loss. Bisphosphonates, inhibitors of osteoclast-mediated osteolysis, may be efficacious for the prevention of aromatase inhibitor-associated bone loss. Several clinical trials evaluating zoledronic acid in this setting have produced favorable results. In the Austrian Breast and Colorectal Cancer Study Group (ABCSG)-12 trial, patients receiving anastrozole or tamoxifen plus goserelin experienced significant bone loss, and zoledronic acid treatment prevented bone loss in both groups. Results from the parallel studies Z-FAST, ZO-FAST, and E-ZO-FAST indicate that upfront zoledronic acid treatment increases BMD in patients receiving letrozole. These preliminary results are encouraging and suggest that zoledronic acid is an effective preventative therapy for bone loss in breast cancer patients receiving aromatase inhibitors.

The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents

The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents

SONOGRAPHIC MARKERS OF FETAL ANEUPLOIDY

A variety of ultrasound findings can be identified in fetuses with fetal aneuploidy. Typical findings vary with both the chromosome abnormality and gestational age at time of the ultrasound examination. Increased NT is the primary marker during the first trimester, whereas a variety of markers may be seen during the second trimester. The presence of ultrasound markers increases the risk for fetal aneuploidy, whereas a normal ultrasound reduces the risk. Optimal risk assessment includes consideration of other risk factors including maternal age, family history, and biochemical markers. It is expected that combined risks, incorporating ultrasound findings and biochemistry, will be available in the near future. How first-trimester screening is integrated with second-trimester screening remains to be determined.

Ten-year follow-up results from the Goettingen Risk, Incidence and Prevalence Study (GRIPS). I. Risk factors for myocardial infarction in a cohort of 5790 men

Besides the accepted major risk factors for myocardial infarction (MI), cholesterol, hypertension and smoking, several other variables such as lipoproteins, apolipoproteins, fibrinogen and family history of MI, have been considered, but their usefulness as predictors of MI is controversially discussed. The Göttingen Risk Incidence and Prevalence Study (GRIPS) aimed to evaluate the independent impact of the latter in comparison to the established risk factors. GRIPS is a prospective cohort study, which included 5790 men, aged 40–59.9 years, without cardiovascular disease at baseline. Multivariate logistic regression models for the estimation of the MI risk based on the 10-year follow-up data from 97.4% of the study participants established LDL cholesterol as the strongest predictor of MI. It was followed by family history of MI, Lp(a), age, smoking, systolic blood pressure, HDL cholesterol (inversely related) and plasma glucose ( P<0.00l). Apolipoprotein B as well as the ratios total/HDL cholesterol, LDL/HDL cholesterol and Apo B/AI were less effective predictors than LDL cholesterol and did not contribute independently to the estimation of MI risk. Similarly apoprotein AI was a weaker predictor of MI risk then HDL cholesterol. GRIPS is the first prospective cohort study which clearly justifies the key role of LDL cholesterol in preventive strategies. However, the data also give strong support for the additional consideration of other risk factors for a valid estimation of the MI risk for an individual subject.

Dietary micronutrients and cervical dysplasia in southwestern American Indian women.

American Indian women in the Southwest have high rates of cervical cancer and cervical dysplasia in contrast to low rates of cancers for other sites. Despite their high rates of cervical disease, no published information has specifically examined risk factors for cervical cancer or cervical dysplasia among American Indian women. We carried out a pilot case-control study of cervical dysplasia in southwestern American Indian women to examine the relationship of dietary intake of vitamin C, folacin, vitamin E, carotenoids, and retinol with cervical cytological abnormalities. Twenty-four-hour dietary recalls were collected from women with cervical dysplasia (n = 42) and women with normal cervical cytologies (n = 58). Macro- and micronutrient intake was estimated from these recalls utilizing food and nutrient data from the USDA Survey Nutrient Database. Although mean differences between cases and controls were not statistically significant for any of the micronutrients examined, women with low intake of vitamin C, folacin, and vitamin E were at increased risk of having cervical dysplasia when the data were analyzed as stratified for level of intake (low vs. high intake odds ratios were 3.0 for vitamin C, 3.3 for folacin, and 1.7 for vitamin E). The relationship between dietary micronutrients and cervical dysplasia among American Indian women warrants further investigation using more refined measures of dietary micronutrient intake, together with consideration of other risk factors for cervical disease.

Diagnostic radiography as a risk factor for chronic myeloid and monocytic leukaemia (CML).

This interview study included 136 Los Angeles County residents aged 20-69 with CML diagnosed from 1979 to 1985 (cases) and 136 neighbourhood controls. During the 3-20 years before diagnosis of the case, more cases than controls had radiographic examinations of the back, gastrointestinal (GI) tract and kidneys, and cases more often had GI and back radiography on multiple occasions (odds ratio (OR) for back X-rays on five or more occasions = 12.0; P less than 0.01). Published estimates were used to assign a minimum dose to the active bone marrow for various radiographic procedures. ORs were estimated for cumulative marrow doses for each of four time periods (3-5 years, 6-10 years, 11-20 years and 3-20 years before the diagnosis of the case). The ORs for exposure to 0.99, 100-999, 1000-1999 and greater than or equal to 2000 mrad in the 3-20 years before diagnosis were 1.0, 1.4, 1.6 and 2.4 (P for highest exposure category and P for trend both less than 0.05). The association was strongest for the period 6-10 years before diagnosis, and the effects of radiation exposure during this period remained significant after consideration of other risk factors in a logistic regression analysis.

When and how far should we lower blood pressure?

The accuracy of the diagnosis of mild or borderline hypertension is dubious. Perhaps up to one-third of such patients are wrongly categorized when more accurate measures are taken, largely because of the "defense" reaction. The recent trials of mild hypertension are discussed. Patients with a diastolic blood pressure in the range of 95 to 100 mm Hg should only begin treatment after careful assessment and consideration of other risk factors.