High Alcohol Consumption Research Articles

Choosing the Right Treatment Option for the Right R/M HNSCC Patient: Should We Adhere to PFE for First-Line Therapy?

BackgroundThe landmark EXTREME trial established cisplatin, 5-fluorouracil and cetuximab (PFE) as first-line chemotherapy (1L-ChT) for recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). We were interested in outcome differences of R/M HNSCC in 1L-ChT and factors influencing outcome in certain subgroups, especially patients receiving PFE, and the value of PFE compared to other 1L-ChT regimens to provide real world evidence (RWE).MethodsFor this retrospective monocentric study, 124 R/M HNSCC patients without curative surgical or radiotherapy options receiving at least one cycle of 1L-ChT were eligible. We analyzed their outcome using Kaplan-Meier plot and Cox regression to identify predictors for prolonged survival.ResultsSubgroups benefiting significantly from PFE were patients suffering from an index HNSCC outside the oropharynx. The PFE regimen proved to be superior to all other 1L-ChT regimens in clinical routine. Significant outcome differences between PFE treatment within or outside controlled trials were not seen.ConclusionThis retrospective analysis provides RWE for factors linked to improved outcome. Subgroup analyses highlight the lasting value of PFE among the growing spectrum of 1L-ChT. Importantly, fit smokers with high level alcohol consumption benefit from PFE; considering the patient’s lifestyle factors, PFE should not be ignored in decision-making.

Overestimation of alcohol consumption norms as a driver of alcohol consumption: a whole-population network study of men across eight villages in rural, southwestern Uganda.

Little is known about how perceived norms about alcohol consumption may influence high alcohol consumption rates in Uganda. This study estimated the accuracy of perceived norms about men's alcohol consumption and estimated the association between perceived norms and personal alcohol consumption. Cross-sectional, whole-population, sociocentric social network study. Eight rural villages in Rwampara District, southwestern Uganda in 2016-18. A total of 719 men aged 18years and older (representing 91% of permanent resident men). Self-reported frequent (≥4days per week) and heavy alcohol consumption (six or more drinks on one occasion, more than three occasions of intoxication, or spending an excessive amount on alcohol). Participants also reported whether they thought most other men in their village engaged in frequent and heavy alcohol consumption (perceived norms). Using the network study design, we calculated alcohol consumption behavior within villages and social networks. Perceived norms were compared with aggregated self-reports. Multivariable Poisson regression models were used to estimate the association between perceived norms and individual behavior. Throughout villages, frequent and heavy alcohol consumption ranged from 7 to 37%. However, 527 (74%) participants perceived, contrary to fact, that most other men in their villages frequently consumed alcohol, and 576 (81%) perceived that most others heavily consumed alcohol. Overestimation of alcohol consumption by others was pervasive among socio-demographic subgroups and was present irrespective of the actual consumption behavior at the village level and within social networks. Men who misperceived these alcohol consumption behaviors as being common were more likely to engage in frequent [adjusted relative risk (aRR)=3.98; 95% confidence interval (CI)=1.69-9.34) and heavy (aRR=4.75; 95% CI=2.33-9.69) alcohol consumption themselves. Most men in eight rural Ugandan villages incorrectly thought that frequent and heavy alcohol consumption were common among men in their villages. These misperceived norms had a strong positive association with individual drinking behavior.

Age-specific atrial fibrillation incidence, attributable risk factors and risk of stroke and mortality: results from the MORGAM Consortium

BackgroundThe main aim was to examine age-specific risk factor associations with incident atrial fibrillation (AF) and their attributable fraction in a large European cohort. Additionally, we aimed to examine risk...

Abstract 793: Potential impact of time trend of lifestyle factors on burden of gastrointestinal cancer in China

Abstract BACKGROUND: Colorectal, esophageal, stomach, and liver cancers are four major gastrointestinal (GI) cancers that have 2-3 times the age-standardized incidence rates in China compared to the global average. Examining the time trend of risk factors associated with GI cancer would help us project the future trend of GI cancer incidence in China and guide public health policymaking. METHODS: We estimated the time trend of relevant dietary and lifestyle factors in China based on data from the China Health and Nutrition Survey 1991-2011. We applied the comparative risk assessment method to estimate the population attributable fraction (PAF%) and the absolute number of GI cancer events attributable to all non-optimal levels of each risk factor. We have also projected the lifestyle factors and the estimated burden of GI cancer in the next 30 years. RESULTS: In 2011, the overall estimated PAF% by all risk factors under study is 73% for esophageal cancer, 59% for colorectal cancer, 47% for gastric cancer, and 35% for liver cancer. Smoking, low fruit intake, high red meat consumption, high body mass index (BMI), and high alcohol consumption were the top 5 contributors to GI cancer incidence in China; each accounted for 173, 134, 132, 125, and 91 thousand GI cancer cases, respectively. For specific cancer sites, high red meat consumption accounted for the most cases of colorectal cancer in 2011 (N = 51,405; PAF% = 19%) and is projected to have higher PAF% from 15% in 1997 to 23% in 2041. High BMI is responsible for the most liver cancer cases in 2011 (N = 55,244; PAF% = 17%) and has an increasing trend in expected PAF% from 7% in 1991 to 20% in 2041; low fruit intake is the top contributor for esophageal cancer in 2011 (N = 85,345; PAR% = 29%) with a downward trend in the next few decades (PAF% from 33% in 1997 to 23% in 2041); high sodium intake represented the highest PAF% for gastric cancer in 2011 (68,858 cases, PAF% = 17%), but is expected to be overpassed by smoking, high BMI, and red meat consumption in 2015-2025. CONCLUSIONS: China has witnessed significant transitions in lifestyle, including diet, physical activity, and obesity. The impact of the lifestyle risk factors on the risk of GI cancer has been increasing from 1991 to 2011 and is projected to continue growing. High red meat consumption and high BMI call for extra attention as they are among the top contributors to GI cancer and are expected to have stronger impacts in the next 30 years in China. Citation Format: You Wu, Yanping Li, Edward Giovannucci, Frank B. Hu. Potential impact of time trend of lifestyle factors on burden of gastrointestinal cancer in China [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 793.

Protective Behavioral Strategies and Alcohol Use While Pregaming: The Moderating Role of Depression and Anxiety Symptoms

Background The study evaluated the moderating role of anxiety and depression symptoms on the association between subscales on the Protective Behavioral Strategies for Pregaming (PBSP) scale (safety and familiarity, setting drink limits, pacing drinking, and minimizing intoxication) and alcohol consumption during pregaming. Methods: Participants were 359 traditional age undergraduate college students (M = 20, SD = 1.37; 61.7% female; 61.2% White) who reported pregaming in the past year. All participants completed measures through an online survey which evaluated PBSP, depression and anxiety symptoms, and alcohol use during pregame events in the past month. Results: Among students with high depression symptoms, the more frequent use of PBSP to minimize intoxication was not associated with alcohol consumption levels, whereas among those with low depression symptoms, higher use of PBSP to minimize intoxication was associated with higher alcohol consumption. Among those with high anxiety symptoms, the more frequent use of PBSP to minimize intoxication was associated with lower alcohol consumption at pregaming events, whereas among those with low anxiety symptoms, the use of this PBSP was associated with higher alcohol consumption. The more frequent use of PBSP related to safety and familiarity among those with high anxiety symptoms was unrelated to alcohol consumption during pregaming, whereas among those low in anxiety symptoms, the more frequent use of this PBSP was associated with lower alcohol consumption. Conclusion: The findings begin to inform clinical care and intervention techniques aimed at reducing harm associated with risky drinking practices among a vulnerable subset of college students.

Effects of alcohol consumption on circulating lipid in fatty liver disease and Represent Potential cardio metabolic risk markers in Kathmandu

liver is the principal site for formation and clearance of lipoproteins in our body. Alcohol-induced fatty liver (steatosis) was believed to result from excessive generation of reducing equivalents from ethanol metabolism, thereby increasing fat accumulation. Liver disease is the greatest cause of death related to alcohol and a major public health problem especially in developing country. High alcohol consumption is a major cause of morbidity, yet alcohol is associated with both favorable and adverse effects on cardio metabolic risk markers. After consent, the present study examined aged ≥ 35 years from Kathmandu between 2019 and 2020. Data on current drinking status, age, ethnic group, educational background, waist circumference, body mass index, blood pressure, and lipid profile was measured. Baseline venous blood sample was collected aseptically according to World Health Organization (WHO) guidelines with various inclusion and exclusion criteria. Processing was done in central diagnostic laboratory and research center. Out of 780 patients 17% were female and 83% were male. Mean ± standard deviation of age, bmi, waist circumference, hipcircumference, waisthipratio, blood pressure were 45.93 ± 10.92, 29.41 ± 2.98, 100.97 ± 7.0, 105.94 ± 6.5, 0.94 ± 0.1, and 132 ± 12/83 ± 17 respectively. TG/HDL-C ratio, LDL-C/HDL-C ratio, TG, cholesterol, and lipid accumulation product significantly higher in drinkers than normal reference range. Majority were ethnic group with low socioeconomic and literate background. Abnormalities in lipid profile are correlated with alcohol consumption, which calls for intervention strategies to prevent dyslipidemia and control risk factors for cardiovascular disease. Alcohol consumption is associated with a complex metabolic signature, including aberrations in multiple biomarkers for elevated cardio metabolic risk factors.

Genetic differences in ethanol consumption: effects on iron, copper, and zinc regulation in mouse hippocampus.

One common characteristic of neurodegenerative diseases is dysregulation of iron, usually with observed increases in its concentration in various regions. Heavy alcohol consumption is believed to contribute to such iron dysregulation in the brain with accompanying dementia. To examine this effect and related genetic-based individual differences in an animal model, we subjected female mice from 12 BXD recombinant inbred strains to 16weeks of alcohol consumption using the drinking in the dark (DID) method. Daily consumption was recorded and at the end of 16weeks hippocampus tissues harvested. Concentrations of iron, copper and zinc were measured using X-ray fluorescence technology. The results showed that, DID increased iron overall across all strains, ranging from 3 to 68%. Copper and Zinc both decreased, ranging from 0.4-42 and 5-35% respectively. Analysis of variance revealed significant strain by treatment interactions for all three metals. Additionally, in the DID group, we observed strain differences in reduction of hippocampus mass. These findings are particularly interesting to us because high alcohol consumption in humans has been associated with neurodegeneration and dementia related to disruption of iron regulation. The findings of alcohol consumption associated decreases in copper and zinc are novel. The role of copper regulation and neurological function related to alcohol consumption is as yet largely unexplored. The role of zinc is better known as a neuromodulator in the hippocampus and appears to be protective against neurological damage. It would seem then, that the alcohol-related decrease in zinc in the hippocampus would be of concern and warrants further study.

Socio-demographic factors and lifestyle associated with symptomatic hemorrhoids: Big data analysis using the National Health insurance Service-National Health screening cohort (NHIS-HEALS) database in Korea

The prevalence of hemorrhoids has been reported to be 7-14%. However, there have been no large-scale studies. This study aims to investigate the incidence of hemorrhoids in Korea by analyzing big data and to find the associated risk factors. This was a retrospective analysis using the Health Insurance Cohort database of the National Health Insurance Corporation of Korea in 2002-2015. The study was divided into two models: the diagnostic (DM) and surgical model (SM). Socio-demographic and lifestyle behavioral characteristics were analyzed as risk factors. Overall, 467,567 participants were included. The incidence density of hemorrhoids was 13.9 and 5.7 per 1000 person-years in the DM and SM, respectively. Hemorrhoids occurred more frequently in men and metropolitan areas in both models. The incidence was highest in the 40s. The incidence rates were highest in the high income, smoking, alcohol and the exercise group of 1-4 times a week in both models. The adjusted hazard ratio (HR) was higher in men and decreased with increasing age. It was higher in the metropolitan area. The high-income level and alcohol consumption were risk factors in the DM and SM, respectively. The HR of the exercise group was higher than that of the non-exercise group in both models. The diagnostic and surgical incidence density was 13.9 and 5.7 per 1000 person-years, respectively. Hemorrhoids occurred most frequently in men in their 40s. The metropolitan area, high income level and alcohol consumption were associated with an increased frequency of hemorrhoids.

Synergistic Effects of Aldehyde Dehydrogenase 2 Polymorphisms and Alcohol Consumption on Cognitive Impairment after Ischemic Stroke in Han Chinese.

Aldehyde dehydrogenase 2 (ALDH2) polymorphisms are related to both stroke risk and alcohol consumption. However, the influence of ALDH2 polymorphisms and alcohol consumption on cognitive impairment after ischemic stroke remains unknown, as do the possible mechanisms. We enrolled 180 Han Chinese ischemic stroke patients from four community health centers in Bengbu, China. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and two different MoCA cutoff scores were used to define cognitive impairment in ischemic stroke patients. The ALDH2 genotypes were determined using polymerase chain reaction and direct sequencing. To assess the associations of ALDH2 polymorphisms and alcohol consumption with cognitive impairment after ischemic stroke, we performed binary logistic regression analysis with odds ratios. We revealed that individuals with the ALDH2 wild-type genotype were more likely to have high MoCA scores than those with the mutant and heterozygous types (p = 0.034). In addition, using two MoCA cutoff scores, the percentage of moderate to excessive alcohol consumption in the cognitive impairment group was higher than that in the nonimpairment group (p = 0.001). The levels of 4-hydroxy-2-nonenal (p = 0.001) and swallowing function (p = 0.001) were also higher in the cognitive impairment group than in the nonimpairment group. Moreover, after adjusting for other potential risk factors, ALDH2 polymorphisms and alcohol consumption had a significant synergistic effect on cognitive impairment (p = 0.022). Specifically, the ALDH2∗2 mutant allele and higher alcohol consumption were associated with cognitive impairment and swallowing ability after ischemic stroke. Targeting ALDH2 may be a useful biomarker for cognitive rehabilitation following ischemic stroke.

Changes in Visual Performance under the Effects of Moderate-High Alcohol Consumption: The Influence of Biological Sex.

The purpose of this study was to analyze the changes in visual functions under the effects of moderate–high breath alcohol concentrations (BrACs), and the influence of biological sex on visual deterioration, considering different factors. A total of 37 healthy habitual alcohol users were enrolled in the experiment. The participants underwent a baseline session and a second session after an intake of 450 mL of red wine, so that all of them reached a BrAC above 0.25 mg/L. Visual performance was assessed by measuring the contrast sensitivity function, the halo perception, the stereopsis, and finally the retinal image quality. A Visual Deterioration Score (VDS) was calculated using the deterioration of these visual variables. All visual functions analyzed were significantly impaired following alcohol consumption (p < 0.05). The VDS was associated with the BrAC (ρ = −0.476). The VDS was also significantly higher in females, with the BrAC having a significant effect on the variability of the VDS in males and females (p < 0.05). However, the body mass index showed no significant effect (p > 0.05). Visual functions were significantly impaired under the influence of alcohol, and this deterioration was greater in females. The deterioration depends on the BrAC reached, being the primary thing responsible for the differences observed between males and females.

Characteristics Associated with the Use of Diagnostic Prostate Biopsy and Biopsy Outcomes in Australian Men.

Population characteristics associated with the use of prostate biopsy are poorly understood. We described the use of diagnostic prostate biopsy and subsequent biopsy outcomes in a population-based Australian cohort. A total of 91,764 men from the Sax Institute's 45 and Up Study (New South Wales, Australia) recruited during 2006 to 2009 were included. Self-completed baseline questionnaires and linked administrative health data were used. Study period was from the date of recruitment to December 2013. Cox regression and logistic regression identified factors associated with receipt of biopsy and subsequent prostate cancer diagnosis. During the study period, 5,089 participants had a diagnostic prostate biopsy, and 2,805 men (55.1% of those biopsied) received a cancer diagnosis. Men with a family history of prostate cancer (HR 1.55; 95% confidence interval (CI), 1.43-1.68), severe lower urinary tract symptoms (HR 1.62; 95% CI, 1.41-1.86), or a record of medication for benign prostatic hyperplasia (HR 1.34; 95% CI, 1.23-1.47) had increased risks of receiving a biopsy. Men with a family history of prostate cancer had increased odds of a positive biopsy (OR 1.21; 95% CI, 1.01-1.43). High alcohol consumption (≥21 drinks per week compared with 1-6 drinks per week) was associated with decreased risk of biopsy (HR 0.88; 95% CI, 0.80-0.96) but increased odds of a positive biopsy (OR 1.63; 95% CI, 1.32-2.02). Certain characteristics are associated with both undertaking diagnostic prostate biopsy and positive biopsy outcomes. This highlights the need to improve management of specific groups of men, especially those with clinical symptoms that overlap with prostate cancer, in their investigation for prostate cancer.

1077-P: Alcohol Consumption, Smoking Habits, and the Risk of Incident Glomerular Hyperfiltration in Subjects with Impaired Fasting Glucose

Although glomerular hyperfiltration (GHF) is a major risk of diabetic nephropathy and it is important to prevent GHF in subjects with prediabetes, it is not known which factors are associated with the risk of GHF. We prospectively examined the relationship of alcohol consumption and smoking habits to the risk of GHF in subjects with impaired fasting glucose (IFG). Study population was 2811 middle-aged Japanese men who had IFG, no proteinuria, no GHF, and no low estimated glomerular filtration rate (eGFR) at baseline, and who did not have low eGFR before the onset of GHF during the follow-up period. GHF was defined as eGFR ≥117 mL/min/1.73 m2, which was the upper 2.5th percentile value of eGFR in the all study population of our cohort. Low eGFR was defined as eGFR &amp;lt;60 mL/min/1.73 m2. Based on daily alcohol consumption, subjects were classified as follows: non-drinkers, 0.1-23.0, 23.1-46.0, and ≥46.1 g ethanol/day. As for smoking habits, subjects were divided into non-smokers, past smokers, and current smokers. During the 6-year follow-up period, 103 men developed GHF. After adjusted for BMI, fasting plasma glucose, systolic blood pressure, use of anti-hypertensive medications, and regular physical exercise, both daily alcohol consumption and smoking habits were independently associated with the risk of the incident GHF. Multiple-adjusted HRs of incident GHF for those who drank 0.1-23.0, 23.1-46.0, and ≥46.1 g ethanol/day were 0.94 (95% CI, 0.46-1.95), 1.34 (0.66-2.70), and 2.48 (1.19-5.15), respectively, compared with non-drinkers. Multiple-adjusted HRs of those for past smokers and current smokers were 0.86 (0.42-1.75), and 1.77 (1.00-3.14), respectively, compared with non-smokers. In conclusion, high daily alcohol consumption and current smoking increased the risk of GHF in subjects with IFG. Disclosure M. Shibata: None. T. Hayashi: None. K. K. Sato: None. S. Uehara: None. N. Nishida: None. K. Okamura: None. I. Shibata: None. H. Koh: None. K. Oue: None. M. Morimoto: None.

An epidemiological review of pancreatic cancer with special reference to India

Pancreatic cancer (PC) is a rare cancer site, ranked 14th in incidence and 7th in mortality in the world. In India, pancreas ranks 24th with 10860 new cases (1.03%) and 18th in mortality. Although PC is a rare site, it is a leading mortality site across the globe and very little data are available about the epidemiology of PC. It is hypothesized that due to the changing lifestyle globally and, in India, the rates of PC will increase in the near future. Thus, this study aims to report PC incidence, mortality, globally but with more emphasis with respect to Indian population and associated factors for PC, since changing lifestyle has had an impact on the occurrence of the disease over the years. Incidence and mortality rates are obtained from GLOBOCAN-2018 and cancer incidence in five continents (CI5- XI), and Indian Council of Medical Research publication on Indian cancer registry database. Incidence is higher in elderly population (more than 50% in 65–75 years). The incidence is highest among Northeastern Indian regions. Risk factors include smoking, high alcohol consumption, non-vegetarian diets (modifiable) and age, race, and the genetic predispositions (non-modifiable) risk factors. No case–control studies on risk factors are reported yet based on the Indian population. Increase of PC numbers is a cause for concern, since it mostly manifests on the lifestyle factors, which is rapidly changing in India, like in other parts of the globe. This study will be useful in giving some leads on the PC’s possible causes and thereby help in formulating strategies for reducing the burden of this disease.

Shift-Work-Play: Understanding the positive and negative experiences of male and female shift workers to inform opportunities for intervention to improve health and wellbeing

Objective: Our primary study aims are to (i) examine positive and negative aspects associated with shift work, and (ii) identify any gender differences that exist in a healthcare workforce. A secondary aim of the study was to identify opportunities for intervention, particularly in males given they have greater exposure to shift work across the population. Background: Shift work has been associated with detrimental physical and psychosocial outcomes in many studies; however, there has been little consideration of any positive perceived aspects associated with shift work. Additionally, while there has been less consideration of gender differences in medical settings such as nursing where there is a higher proportion of females working shifts. Study design and methods: Our study utilised mixed-methods, comprising a cross-sectional workforce survey given to both shift workers and non-shift workers (N=1398), and a co-design workshop aimed at male nurses, in order to identify opportunities for intervention among this group. Results: Shift workers were more likely than their non-shift work counterparts to report poorer overall health, to have higher levels of psychological distress, and to engage in greater levels of unhealthy behaviours (e.g. higher alcohol consumption, and greater levels of smoking), with these differences highest in male shift workers. Discussion: Analysis of the shift work experience revealed that the majority responses were negative (affecting sleep, diet, exercise, mental health), however one-in-five statements were positive with flexibility, and the ability to engage with services highlighted. Examining both positive and negative elements is important for providing a balanced insight into shift workers’ lives, and to inform targets for improving their health and wellbeing. Conclusion: Through identifying positive and negative elements associated with shift work it is possible to intervene to minimise the negative elements, and maximise positive elements. Our analysis highlights the importance of considering gender differences in both individual and organisational-level responses. Implications for research, policy, and practice: To effectively address the negative aspects of shift work, interventions at multiple levels involving both organisations and individuals that simultaneously target multiple outcomes (sleep, diet, exercise, opportunities to connect with peers) are likely to be more effective than individual measures alone. What is known about the topic? Shift work is common across many different industries, and is an integral part of the nursing profession, where nurses and midwives make up almost 50% of the worldwide shift working workforce. Shift work has been associated with negative impacts on individual physical and psychological health and performance outcomes such as increased error rates. What this paper adds: This study confirms that shift work is associated with negative impacts however there are positive elements associated with shift work and these include flexibility and financial benefits. Gender differences were apparent with risky alcohol use, higher smoking rates, and poorer health noted in males compared with females. Our co-design workshop identified the potential for a holistic response based on the three pillars of health: sleep, diet and exercise as likely to be more effective than an intervention addressing only one of these domains.

Patient perspectives on tablet-based technology to collect risk factor information in primary care

BackgroundPrimary care provides an opportunity to introduce prevention strategies and identify risk behaviours. Algorithmic information technology such as the Risk Factor Identification Tool (RFIT) can support primary care counseling. This study explores the integration of the tablet-based RFIT in primary care clinics to support exploration of patient risk factor information.MethodsQualitative study to explore patients’ perspectives of RFIT. RFIT was implemented in two primary care clinics in Manitoba, Canada. There were 207 patients who completed RFIT, offered to them by eight family physicians. We conducted one-on-one patient interviews with 86 patients to capture the patient’s perspective. Responses were coded and categorized into five common themes.ResultsRFIT had a completion rate of 86%. Clinic staff reported that very few patients declined the use of RFIT or required assistance to use the tablet. Patients reported that the tablet-based RFIT provided a user-friendly interface that enabled self-reflection while in the waiting room. Patients discussed the impact of RFIT on the patient-provider interaction, utility for the clinician, their concerns and suggested improvements for RFIT. Among the patients who used RFIT 12.1% smoked, 21.2% felt their diet could be improved, 9.3% reported high alcohol consumption, 56.4% reported less than 150 min of PA a week, and 8.2% lived in poverty.ConclusionRFIT is a user-friendly tool for the collection of patient risk behaviour information. RFIT is particularly useful for patients lacking continuity in the care they receive. Information technology can promote self-reflection while providing useful information to the primary care clinician. When combined with practical tools and resources RFIT can assist in the reduction of risk behaviours.

Can breast cancer be stopped? Modifiable risk factors of breast cancer among women with a prior benign or premalignant lesion.

Physical inactivity, high postmenopausal body mass index, alcohol consumption and use of menopausal hormone therapy are established risk factors for breast cancer. Less is known about whether these factors influence the risk of progression of benign and premalignant breast lesions to invasive breast cancer. This registry-based cohort study was based on women with a precancerous lesion who were followed for breast cancer. The cohort consisted of 11 270 women with a benign lesion, 972 women with hyperplasia with atypia and 2379 women with carcinoma in situ diagnosed and treated after participation in BreastScreen Norway, 2006-2016. Information on breast cancer risk factors was collected by a questionnaire administered with the invitation letter. Cox regression analysis was used to estimate the association between breast cancer and physical activity, body mass index, alcohol consumption, tobacco smoking and menopausal hormone therapy, adjusted for age. During follow-up, 274 women with a benign lesion, 34 women with hyperplasia with atypia and 118 women with carcinoma in situ were diagnosed with invasive breast cancer. We observed an increased risk of breast cancer associated with use of menopausal hormone therapy for women with a benign or premalignant lesion. Alcohol consumption and tobacco smoking showed suggestive increased risk of breast cancer among women with a benign lesion. We were only to a limited degree able to identify associations between modifiable risk factors of breast cancer and the disease among women with a precancerous lesion, and a larger study is needed to confirm or refute associations.

Deficit of β-endorphin neurons in the hypothalamus and high expression of MOR in mesolimbic structures are related to high alcohol consumption in outbred rats.

Clinical studies have postulated that β-endorphin deficiency generates excessive alcohol consumption, and it has been shown that the reduction of β-endorphin neurons increases alcohol intake in animal models. The β-endorphin produce their rewarding effect when they act mainly on the μ-opioid receptors (MOR) located in mesolimbic structures. Thus, it is possible that individual differences in these components of the endogenous opioid system are related to different levels of alcohol consumption. The present study thus examines the relation between two levels of alcohol consumption and intrinsic characteristics of the components of the opioid system in outbred Wistar rats that were not genetically selected. We analyzed the number of β-endorphin-positive neurons in the arcuate nucleus (ArN) and the expression of μ-opioid receptors (MOR) in regions of the reward system, such as the nucleus accumbens (NAc), amygdala (Amy), and ventral tegmental area (VTA) in outbred rats with low (LC) or high (HC) voluntary alcohol consumption. Findings showed that the HC rats had a lower number of β-endorphin-positive neurons in the hypothalamic ArN and a higher expression of MOR in the NAc and VTA, compared to the LC rats. No changes in the expression of MOR in the Amy were observed between the two groups. Results suggest that intrinsic variability in the number of β-endorphin neurons and in the expression of MOR in the LC and HC rats could explain their different patterns for alcohol intake.

Early occurrence of pseudocysts in acute pancreatitis – A multicenter international cohort analysis of 2275 cases

BackgroundPseudocysts being the most frequent local complications of acute pancreatitis (AP) have substantial effect on the disease course, hospitalization and quality of life of the patient. Our study aimed to understand the effects of pre-existing (OLD-P) and newly developed (NEW-P) pseudocysts on AP. MethodsData were extracted from the Acute Pancreatitis Registry organized by the Hungarian Pancreatic Study Group (HPSG). 2275 of 2461 patients had uploaded information concerning pancreatic morphology assessed by imaging technique. Patients were divided into “no pseudocyst” (NO-P) group, “old pseudocyst” (OLD-P) group, or “newly developed pseudocyst” (NEW-P) groups. ResultsThe median time of new pseudocyst development was nine days from hospital admission and eleven days from the beginning of the abdominal pain. More NEW-P cases were severe (15.9% vs 4.7% in the NO-P group p < 0.001), with longer length of hospitalization (LoH) (median: 14 days versus 8 days, p < 0.001), and were associated with several changed laboratory parameters. OLD-P was associated with male gender (72.2% vs. 56.1%, p = 0.0014), alcoholic etiology (35.2% vs. 19.8% in the NO-P group), longer hospitalization (median: 10 days, p < 0.001), a previous episode of AP (p < 0.001), pre-existing diagnosis of chronic pancreatitis (CP) (p < 0.001), current smoking (p < 0.001), and increased alcohol consumption (unit/week) (p = 0.014). ConclusionMost of the new pseudocysts develop within two weeks. Newly developing pseudocysts are associated with a more severe disease course and increased length of hospitalization. Pre-existing pseudocysts are associated with higher alcohol consumption and smoking. Because CP is more frequently associated with a pre-existing pseudocyst, these patients need closer attention after AP.

Association Between Blood Pressure Classification Using the 2017 ACC/AHA Blood Pressure Guideline and Retinal Atherosclerosis.

We aimed to explore the association between the blood pressure (BP) classification defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline and the prevalence of retinal atherosclerosis. This study was a retrospective observational cross-sectional analysis using the JMDC Claims Database. We analyzed 280,599 subjects not taking any antihypertensive medications. According to the 2017 ACC/AHA guideline, each subject was categorized as having normal BP (n = 159,524), elevated BP (n = 35,603), stage 1 hypertension (n = 54,795), or stage 2 hypertension (n = 30,677) using the BP value at the initial health checkup. Retinal photographs were assessed according to the Keith-Wagener-Barker system. The median age was 46 years, and 50.4% subjects were men. Retinal atherosclerosis, defined as Keith-Wagener-Barker system grade ≥1, was observed in 3.2% in normal BP, 5.2% in elevated BP, 7.7% in stage 1 hypertension, and 18.7% in stage 2 hypertension. Compared with normal BP, elevated BP (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.23-1.38), stage 1 hypertension (OR, 1.71; 95% CI, 1.64-1.79), and stage 2 hypertension (OR, 4.10; 95% CI, 3.93-4.28) were associated with a higher prevalence of retinal atherosclerosis. Among 92,121 subjects without obesity, high waist circumference, diabetes mellitus, dyslipidemia, cigarette smoking, and alcohol consumption, elevated BP (OR, 1.34; 95% CI, 1.19-1.51), stage 1 hypertension (OR, 1.79; 95% CI, 1.61-1.98), and stage 2 hypertension (OR, 4.42; 95% CI, 4.00-4.92) were associated with a higher prevalence of retinal atherosclerosis. This association was observed in all subgroups stratified by age or sex. Our investigation suggests that retinal atherosclerosis could start even in individuals with elevated BP and stage 1 hypertension.

Modifiable lifestyle factors associated with fragility hip fracture: a systematic review and meta-analysis.

Among the various hip fracture predictors explored to date, modifiable risk factors warrant special consideration, since they present promising targets for preventative measures. This systematic review and meta-analysis aims to assess various modifiable risk factors. We searched four online databases in September 2017. We included studies that reported on modifiable lifestyle risk factors for sustaining fragility hip fractures. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). The inclusion criteria consisted of (1) adult patients with osteoporotic hip fracture, (2) original study, (3) availability of full text articles in English, and (4) report of a modifiable lifestyle risk factor. Thirty-five studies, containing 1,508,366 subjects in total, were included in this study. The modifiable risk factors that were significantly associated with an increased risk of hip fracture were the following: weight < 58kg (128 lbs) (pooled OR 4.01, 95% CI 1.62-9.90), underweight body mass index (BMI) (< 18.5) (pooled OR 2.83, 95% CI 1.82-4.39), consumption of ≥ 3 cups of coffee daily (pooled OR 2.27, 95% CI 1.04-4.97), inactivity (pooled OR 2.14, 95% CI 1.21-3.77), weight loss (pooled OR 1.88, 95% CI 1.32-2.68), consumption of ≥ 27g (approx. > 2 standard drinks) alcohol per day (pooled OR 1.54, 95% CI 1.12-2.13), and being a current smoker (pooled OR 1.50, 95% CI 1.22-1.85). Conversely, two factors were significantly associated with a decreased risk of hip fracture: obese BMI (> 30) (pooled OR 0.58, 95% CI 0.34-0.99) and habitual tea drinking (pooled OR 0.72, 95% CI 0.66-0.80). Modifiable factors may be utilized clinically to provide more effective lifestyle interventions for at risk populations. We found that low weight and underweight BMI carried the highest risk, followed by high coffee consumption, inactivity, weight loss, and high daily alcohol consumption.