Suspected Risk Factors Research Articles

Drivers of international variation in prevalence of disabling low back pain: Findings from the Cultural and Psychosocial Influences on Disability study.

BackgroundWide international variation in the prevalence of disabling low back pain (LBP) among working populations is not explained by known risk factors. It would be useful to know whether the drivers of this variation are specific to the spine or factors that predispose to musculoskeletal pain more generally.MethodsBaseline information about musculoskeletal pain and risk factors was elicited from 11 710 participants aged 20–59 years, who were sampled from 45 occupational groups in 18 countries. Wider propensity to pain was characterized by the number of anatomical sites outside the low back that had been painful in the 12 months before baseline (‘pain propensity index’). After a mean interval of 14 months, 9055 participants (77.3%) provided follow‐up data on disabling LBP in the past month. Baseline risk factors for disabling LBP at follow‐up were assessed by random intercept Poisson regression.ResultsAfter allowance for other known and suspected risk factors, pain propensity showed the strongest association with disabling LBP (prevalence rate ratios up to 2.6, 95% CI: 2.2–3.1; population attributable fraction 39.8%). Across the 45 occupational groups, the prevalence of disabling LBP varied sevenfold (much more than within‐country differences between nurses and office workers), and correlated with mean pain propensity index (r = 0.58).ConclusionsWithin our study, major international variation in the prevalence of disabling LBP appeared to be driven largely by factors predisposing to musculoskeletal pain at multiple anatomical sites rather than by risk factors specific to the spine.SignificanceOur findings indicate that differences in general propensity to musculoskeletal pain are a major driver of large international variation in the prevalence of disabling low back pain among people of working age.

Epidemiological Investigation of Human Brucellosis in Pakistan

Background: Human brucellosis is a neglected and zoonotic disease also known as Malta fever or undulant fever. Objectives: A cross sectional study was conducted to determine the seroprevalence of brucellosis and to access the role of risk factors associated with this disease in humans of Punjab, Pakistan. Methods: A total of 250 serum samples were collected and subjected to Rose Bengal Plate Test and Enzyme Linked Immunosorbent Assay for screening of Brucella. A predesigned questionnaire was filled prior to sampling to collect data regarding socio - demographic and suspected risk factors of human brucellosis. Descriptive and bivariate statistical analysis was performed using the STATA software version 12. Results: The study showed 16% seroprevalence of brucellosis. The prevalence was statistically higher in males (24%), age group of 20 to 30 years (26.92%), rural residents, (23%) and individuals with animals at home (22.50%). Among the related risk factors, exposure to animals (OR = 1.87, 95% CI: 0.9459, 3.6973) and consuming raw milk (OR = 2.36, 95% CI: 1.1713, 4.7760) were strongly associated with the disease. Conclusions: Awareness programs in the rural population should be provided about the disease and its associated risk factors. Consuming unpasteurized milk and products should be avoided to control this disease.

Use of the Animal Trauma Triage Score, RibScore, Modified RibScore and Other Clinical Factors for Prognostication in Canine Rib Fractures.

To characterize the clinical features among dogs sustaining rib fractures and to determine if age, type and severity of injury, entry blood lactate, trauma score and rib fracture score were associated with outcome. A retrospective study was performed to include dogs that were presented with rib fractures. Risk factors evaluation included breed, age, body weight, diagnosis, presence of a flail chest, bandage use, puncture wound presence, rib fracture number, location of the fracture along the thoracic wall, hospital stay length, body weight, other fractures, pleural effusion, pulmonary contusions, pneumothorax and occurrence of an anaesthetic event. A retrospective calculation of an animal trauma triage (ATT) score, RibScore and Modified RibScore was assigned. Forty-one medical records were collected. Motor vehicular trauma represented 56% of the rib fracture aetiology, 41% of patients sustained dog bites and one case was of an unknown aetiology. Significant correlations with risk factors were found only with the ATT score. All patients that died had an ATT score ≥ 5. The ATT score correlated positively with mortality (p < 0.05) with an ATT score ≥ 7 was 88% sensitive and 81% specific for predicting mortality. A 1-point increase in ATT score corresponded to 2.1 times decreased likelihood of survival. Mean hospital stay was 3 days longer for dog bite cases. There was no increased mortality rate in canine patients that presented with the suspected risk factors. The only risk factor that predicted mortality was the ATT score.

Recurrence in Benign Paroxysmal Positional Vertigo: A Large, Single-Institution Study.

To report rates of recurrence in benign paroxysmal positional vertigo (BPPV) and associated patient and disease factors. Retrospective chart review. Single high-volume otology practice. Patients diagnosed with BPPV from 2007 to 2016 with documented resolution of symptoms. Diagnostic and particle repositioning maneuvers for BPPV. BPPV recurrence, time to recurrence, and ear(s) affected at recurrence. A total of 1,105 patients meeting criteria were identified. Of this population, 37% had recurrence of BPPV in either ear or both ears. Overall same-ear recurrence rate was 28%; 76% of recurrences involved the same ear(s) as initial presentation. Recurrences that occurred after longer disease-free intervals were more likely to involve the opposite ear than early recurrences (p = 0.02). Female sex (40.4% versus 32.7%, p = 0.01) and history of previous BPPV (57.5% versus 32.4%, p < 0.0005) were associated with increased risk of recurrence, while history of Menière's disease, diabetes mellitus, and traumatic etiology were not. Approximately, half (56%) of recurrences occurred within 1 year of resolution. A large single-institution study of recurrence in BPPV is presented along with Kaplan-Meier disease-free survival curves. Female sex and history of previous BPPV were associated with increased recurrence, while previously suspected risk factors for recurrence including history of Menière's disease, diabetes, and trauma were not. Remote recurrence is more likely to involve the contralateral ear than early recurrence. These data solidify the expected course of treated BPPV allowing for improved clinical care and patient counseling.

The Period 2 Enhancer Nobiletin as Novel Therapy in Murine Models of Circadian Disruption Resembling Delirium.

Delirium occurs in approximately 30% of critically ill patients, and the risk of dying during admission doubles in those patients. Molecular mechanisms causing delirium are largely unknown. However, critical illness and the ICU environment consistently disrupt circadian rhythms, and circadian disruptions are strongly associated with delirium. Exposure to benzodiazepines and constant light are suspected risk factors for the development of delirium. Thus, we tested the functional role of the circadian rhythm protein Period 2 (PER2) in different mouse models resembling delirium. Animal study. University experimental laboratory. Wildtype, Per2 mice. Midazolam, lipopolysaccharide (lipopolysaccharide), constant light, nobiletin, or sham-treated animals. Midazolam significantly reduced the expression of PER2 in the suprachiasmatic nucleus and the hippocampus of wild-type mice. Behavioral tests following midazolam exposure revealed a robust phenotype including executive dysfunction and memory impairment suggestive of delirium. These findings indicated a critical role of hippocampal expressed PER2. Similar results were obtained in mice exposed to lipopolysaccharide or constant light. Subsequent studies in Per2 mice confirmed a functional role of PER2 in a midazolam-induced delirium-like phenotype. Using the small molecule nobiletin to enhance PER2 function, the cognitive deficits induced by midazolam or constant light were attenuated in wild-type mice. These experiments identify a novel role for PER2 during a midazolam- or constant light-induced delirium-like state, highlight the importance of hippocampal PER2 expression for cognitive function, and suggest the PER2 enhancer nobiletin as potential therapy in delirium-like conditions associated with circadian disruption.

Clinical analysis of difficulty in removing peripherally inserted central catheters

Objective To analyze the relevant materials of cases found with difficulty in removing peripherally inserted central catheters (PICC) and to preliminarily explore its causes and risk factors. Methods The medical history of totally 26 patients with difficulty in removing PICC in the Department of Vascular Surgery of Tianjin Medical University General Hospital between May 2012 and December 2016 was retrospectively analyzed with descriptive statistical analysis. Results Among these patients, 13 received PICC radiography plus perspective PICC extubation; 7 received PICC extubation through venotomy with general or local anesthesia; and 1 received PICC extubation by precava and right ventricular angiography and right intracardiac insertion through femoral vein. The suspected risk factors to difficulty in removing PICC included age, hematological malignancy, chemotherapy, discharge with PICC, infection, transfusion history, duration of PICC and level of D-double polymer. The causes of difficulty in extubation mainly were phlebothrombosis, catheter fracture, adhesion between catheters and vessel wall, local fibrous tissue package in catheters, catheter deformation and circuity in venous vein. Conclusions During the period with catheters, catheter maintenance and management shall be strictly performed with regular check over D-double polymer and routine ultrasonic testing before extubation. When removing the catheter, nurses should pay attention to psychological nursing for patients to reduce the incidence of extubation difficulty and improve patients' satisfaction. Key words: Peripherally inserted central catheter; Extubation difficulty; Influencing factors

Nut Consumption and Survival in Patients With Stage III Colon Cancer: Results From CALGB 89803 (Alliance).

PurposeObservational studies have reported increased colon cancer recurrence and mortality in patients with states of hyperinsulinemia, including type 2 diabetes, obesity, sedentary lifestyle, and high glycemic load diet. Nut intake has been associated with a lower risk of type 2 diabetes, metabolic syndrome, and insulin resistance. However, the effect of nut intake on colon cancer recurrence and survival is not known.Patients and MethodsWe conducted a prospective, observational study of 826 eligible patients with stage III colon cancer who reported dietary intake on food frequency questionnaires while enrolled onto a randomized adjuvant chemotherapy trial. Using Cox proportional hazards regression, we assessed associations of nut intake with cancer recurrence and mortality.ResultsAfter a median follow-up of 6.5 years, compared with patients who abstained from nuts, individuals who consumed two or more servings of nuts per week experienced an adjusted hazard ratio (HR) for disease-free survival of 0.58 (95% CI, 0.37 to 0.92; Ptrend = .03) and an HR for overall survival of 0.43 (95% CI, 0.25 to 0.74; Ptrend = .01). In subgroup analysis, the apparent benefit was confined to tree nut intake (HR for disease-free survival, 0.54; 95% CI, 0.34 to 0.85; Ptrend = .04; and HR for overall survival, 0.47; 95% CI, 0.27 to 0.82; Ptrend = .04). The association of total nut intake with improved outcomes was maintained across other known or suspected risk factors for cancer recurrence and mortality.ConclusionDiets with a higher consumption of nuts may be associated with a significantly reduced incidence of cancer recurrence and death in patients with stage III colon cancer.

Impact of Green Tea Catechin ECG and Its Synthesized Fluorinated Analogue on Prostate Cancer Cells and Stimulated Immunocompetent Cells.

Among the known or suspected risk factors, inflammation plays an important role in infectious and non-infectious pathways leading to cancer. Green tea polyphenols have been associated with reducing inflammation and protection against carcinogenesis, especially in prostate cancer. While most of the research in this field, so far, has focussed on epigallocatechin-3-O-gallate only, we studied epicatechin-3-O-gallate, the second most abundant green tea polyphenol with essential therapeutic potential, to obtain a more detailed understanding of its anti-tumor and anti-inflammatory action. Furthermore, to improve the bioactivity of (-)-epicatechin-3-O-gallate, we synthesized a difluoro analogue, called (-)-5,7-difluoro-epicatechin-3-O-gallate. Both compounds reduced cell proliferation of human primary inflammatory lymphocytes in an apoptosis-specific fashion, while (-)-5,7-difluoro-epicatechin-3-O-gallate had a significantly higher activity compared to the natural product (-)-epicatechin-3-O-gallate. Treatment of low-metastatic LNCaP and high-metastatic PC-3 prostate cancer cells with (-)-epicatechin-3-O-gallate and (-)-5,7-difluoro-epicatechin-3-O-gallate demonstrated a dose-dependent inhibition of cell viability in the low micromolar range. These effects suggest that (-)-epicatechin-3-O-gallate and the more effective (-)-5,7-difluoro-epicatechin-3-O-gallate could be therapeutically used to inhibit tumorigenesis during initiation, promotion, and progression by diminishing the amount of inflammation due to a reduction of inflammatory lymphocytes. Further studies are needed to prove this in in vivo experiments.

Statin use and risk of renal cell carcinoma in three prospective cohort studies.

679 Background: Evidence on statin use and incidence of renal cell carcinoma (RCC) is mixed. Previous results from the Nurses’ Health Study (NHS) and Health Professionals Follow-up Study (HPFS) found a suggestive protective effect in women but not in men (Liu et al, Cancer 2012). We conducted an updated analysis of statin use and risk of total and fatal RCC in the NHS, HPFS, and NHS 2 cohorts, with more than twice as many cases. Methods: We examined the associations between statin use and risk of RCC from 1990 to 2016 in HPFS (men), 1994 to 2016 in NHS (women), and 1999 to 2015 in NHS 2 (women). Information on statin use was collected every two years. We used Cox proportional hazards models, adjusting for known and suspected risk factors, to estimate hazard ratios (HR) and 95% confidence intervals (CI) for use of statins and risk of total and fatal RCC, RCC by stage at diagnosis, and clear cell RCC. We pooled results across cohorts using a random effects model. Results: We documented 661 cases of RCC (310 in HPFS, 255 in NHS, 96 in NHS 2), of which 132 (20%) were fatal. Of the 661 cases, 458 (69%) were clear cell. The pooled multivariable HR for total RCC was 1.01 (95% CI 0.84-1.21) for current statin use, updated over time. Current use was not associated with risk of fatal, advanced (stage T3 or higher), or localized (stage T1 or T2) disease. There were no associations between duration of statin use and risk of RCC; compared to never users, those with less than four years of total use had an HR of 0.91 (95% CI 0.71-1.18), and those with four or more years of use had an HR of 1.03 (95% CI 0.84-1.27). Among men, statin use was associated with increased risk of clear cell RCC (HR for current use: 1.48, 95% CI 1.04-2.11; HR for 4 or more years of use: 1.58, 95% CI 1.05-2.36). Statins were not associated with risk of clear cell RCC in women (HR for current use: 0.77, 95% CI 0.58-1.03; p-value for heterogeneity across cohorts = 0.02). Conclusions: Overall, statin use was not associated with risk of RCC in three large, prospective cohorts of US women and men. Statin use was associated with increased risk of clear cell RCC among men.

Dietary acrylamide intake and risk of renal cell carcinoma in two large prospective cohorts.

677 Background: Acrylamide, which has been classified as a probable human carcinogen, is formed during the processing and cooking of many commonly consumed, carbohydrate-rich foods. Accumulating evidence suggests that dietary intake of acrylamide intake is not associated with the risk of most cancers in humans. A meta-analysis of five epidemiological studies, however, found a suggestion of an increased risk of kidney cancer with higher acrylamide intakes. We investigated this association in two large, prospective cohorts. Methods: Acrylamide intake was calculated from food frequency questionnaires completed every four years in the Nurses’ Health Study (NHS; 1980-2014; n = 88,770) and the Health Professionals Follow-up Study (HPFS; 1986-2014; n = 47,802). Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association with renal cell carcinoma (RCC), adjusting for known and suspected risk factors. Results: We documented 569 incident cases of RCC during follow-up, 337 in women and 232 in men. There was no association between cumulative average acrylamide intake and risk of RCC risk in women (HR for top versus bottom quartile of intake: 0.85; 95% CI: 0.62-1.18; p-value for linear trend across quartiles: 0.42) or men (HR: 1.09; 95% CI: 0.77-1.55; p-trend: 0.96). Baseline acrylamide intake was also unassociated with RCC risk. Acrylamide intake was not associated with risk of fatal RCC, risk among never-smokers, or risk of clear cell RCC. Intake of foods and food groups that are the major contributors to acrylamide intake – breads, baked goods, breakfast cereal, potatoes, and coffee – were likewise not associated with risk of total or fatal RCC in women or in men. Conclusions: Dietary acrylamide was not associated with the risk of RCC in two long-term, prospective cohorts of women and men with updated measures of dietary intakes. This analysis of renal cell carcinoma adds to the body of evidence that dietary acrylamide is not an important risk factor for cancer in humans.

Epidemiology of dermatophyte infections among school children in Menoufia Governorate, Egypt.

Most superficial mycotic infections of human skin are due to dermatophytes. Children are frequently affected due to different predisposing factors, particularly overcrowding in classrooms. This study aimed to estimate the prevalence of dermatophytes infections and their related risk factors among school children in Menoufia Governorate, Egypt. Six public primary and preparatory schools were randomly selected and their pupils (n=3464) were asked to complete a predesigned questionnaire covering both personal data and suspected risk factors for superficial dermatophyte infections. The children were also examined for dermatological diseases. Any suspected lesions were biopsied for mycological examination. The prevalence of clinically suspected dermatophytes infections was 1.41%, whereas the prevalence of culture confirmed cases was 0.98%. The most common clinical type was tinea capitis with a prevalence of 1.01%. Microsporum canis was the only isolated organism from the suspicious lesions with a 69.4% positivity rate. A higher prevalence was observed among boys, low socio-economic pupils and those with a family history of dermatophyte infections. Pet contact and sharing towels and caps among pupils were significant risk factors. Dermatophyte infection is still prevalent among basic school pupils. Fortunately, it is related to preventable risk factors. We recommend regular screening and use of educational health programmes for kids to control it.

Risk factors of soil-transmitted helminth infection among elementary school students

Background Helminth infection remains a health problem, especially in school-aged children. Mass eradication programs with a single dose of anti-helminthic drugs were employed by the local government in some endemic areas in Bali. However, the effectiveness of the programs has not been well evaluated.Objective To investigate prevalence and possible risk factors of helminth infection, including nutritional status, in elementary school students from endemic areas who participated in mass eradication programs.Methods This cross-sectional study involved 126 students from Elementary School No. 3 Gegelang, Karangasem, Bali, a location that had recently undergone a mass eradication program. Diagnoses were based on direct smear examination of fecal specimens. Information on suspected risk factors and nutritional status were collected by questionnaire and anthropometric measurement, respectively. Statistical analyses included Chi-square and odds ratio, using SPSS v21 software.Results The prevalence of helminth infection was 31.7% with etiologies of Trichuris trichuria (75%), Ascaris lumbricoides (17.5%), or both infections (7.5%). Habits of not using footwear [OR=4.88; 95%CI 1.15 to 20.65], not keeping nails trimmed [OR=3.33; 95%CI 1.07 to 10.37], and absence of a proper toilet [OR=4.31; 95%CI 1.93 to 9.64] were found to be significant risk factors for helminth infection. However, we found no significant association between helminth infection and nutritional status, although a considerable number of students had less than normal reference values, in terms of weight, height, and BMI for age.Conclusion The prevalence of helminth infection continues to be high, with personal hygiene and sanitation as significant risk factors. History of mass eradication programs did not confer an effective protection against helminth infection.

Risk factors of soil-transmitted helminth infection among elementary school students

Background Helminth infection remains a health problem, especially in school-aged children. Mass eradication programs with a single dose of anti-helminthic drugs were employed by the local government in some endemic areas in Bali. However, the effectiveness of the programs has not been well evaluated.Objective To investigate prevalence and possible risk factors of helminth infection, including nutritional status, in elementary school students from endemic areas who participated in mass eradication programs.Methods This cross-sectional study involved 126 students from Elementary School No. 3 Gegelang, Karangasem, Bali, a location that had recently undergone a mass eradication program. Diagnoses were based on direct smear examination of fecal specimens. Information on suspected risk factors and nutritional status were collected by questionnaire and anthropometric measurement, respectively. Statistical analyses included Chi-square and odds ratio, using SPSS v21 software.Results The prevalence of helminth infection was 31.7% with etiologies of Trichuris trichuria (75%), Ascaris lumbricoides (17.5%), or both infections (7.5%). Habits of not using footwear [OR=4.88; 95%CI 1.15 to 20.65], not keeping nails trimmed [OR=3.33; 95%CI 1.07 to 10.37], and absence of a proper toilet [OR=4.31; 95%CI 1.93 to 9.64] were found to be significant risk factors for helminth infection. However, we found no significant association between helminth infection and nutritional status, although a considerable number of students had less than normal reference values, in terms of weight, height, and BMI for age.Conclusion The prevalence of helminth infection continues to be high, with personal hygiene and sanitation as significant risk factors. History of mass eradication programs did not confer an effective protection against helminth infection.

Risk of pancreatic cancer in Minia district, Egypt

Background: Pancreatic cancer is considered one of the most lethal malignant neoplasms. Therefore, a better understanding of the etiology and identifying the risk factors are essential for the development of preventive strategies. Methods: This case-control study included pancreatic cancer patients attending Minia Cancer Center during the period from June 2014 to December 2015 and controls from the general population. Several suspected risk factors were evaluated during personal interviews with the study participants. Statistical analysis included crude odds ratio (OR) and multivariable logistic regression with an adjusted OR and 95% confidence interval (CI). Results: The study included 224 subjects, 75 pancreatic cancer cases, and 149 controls. Cases had higher age and male gender than controls. Bivariate analyses showed that age, sex, smoking, family history of pancreatic cancer, physical activity, mental stress, age at first birth, hormonal contraception, diabetes, hepatitis C virus (HCV) infection, pancreatitis, and cholecystitis were associated with pancreatic cancer. In the final multivariable analysis, smoking, physical activity, diabetes, HCV infection, and cholecystitis were significantly associated with pancreatic cancer risk. Conclusions: Pancreatic cancer risk is associated with some potentially modifiable factors like tobacco smoking and low physical activity and related health problems as diabetes, HCV infection, and cholecystitis. Control of known risk factors for pancreatic cancer should be considered to help in risk reduction and prevention.

Pre-Zika descriptive epidemiology of microcephaly in Texas, 2008-2012.

There are limited population-based studies on microcephaly. We characterized the epidemiology of microcephaly in Texas during a 5-year period (2008-2012), prior to the Zika epidemic in the Western hemisphere (2015). The associations of suspected risk factors were compared across four clearly defined case groups. Data from the Texas Birth Defects Registry were used to calculate the prevalence of congenital microcephaly and crude and adjusted prevalence ratios using Poisson regression. Twelve maternal and infant factors were assessed across case groups, which included total (explained + unexplained), explained (e.g., syndromic), unexplained, and severe unexplained microcephaly (head circumference <3rd percentile). The birth prevalence for total and total severe microcephaly were 14.7 and 4.8 per 10,000 livebirths, respectively. For explained and unexplained cases, significantly elevated risks were noted for mothers who were older (35+), less educated (≤12 years), diabetic (pre-pregnancy or gestational), or had a preterm delivery. Unlike explained cases, however, mothers who were non-White or smoked had an increased risk for unexplained microcephaly. Furthermore, young maternal age (<20), multiparity, and higher BMI reduced the risk for unexplained microcephaly. For severe unexplained cases, the risk profile was similar to that for all unexplained cases-with the exception of null associations noted for diabetes and birth year. We found that risk patterns for microcephaly varied across case groupings. Risk factors included maternal race/ethnicity, age, and smoking during pregnancy. Among severe unexplained cases, notable positive associations were seen among mothers who were non-Hispanic Black or less educated, while inverse associations were noted for obesity.

Perforation risk and intra-uterine devices: results of the EURAS-IUD 5-year extension study

Objectives: The objective of this analysis was to identify intra-uterine devices (IUD) perforations detected from 12 to 60 months following IUD insertion, and to combine this information with (our previously published) data about perforations detected in the first 12 months to calculate cumulative perforation rates.Methods and materials: Prospective, non-interventional cohort study with new users of levonorgestrel-releasing intra-uterine systems (LNG-IUS) and copper-IUD. The original cohort included 61,448 women followed for 12 months. Of these, we had sufficient resources to perform an additional follow-up and analysis at 60 months in 39,009 women. Inclusion criteria for this analysis was insertion prior to 31 July 2010. All potential cases were validated via the health care professional or medical records. Crude and adjusted relative risks were calculated using a logistic regression model.Results: We identified 23 additional perforations (19 LNG-IUS and 4 copper-IUD) more than 12 months after insertion. Added to perforations detected at 12 months, the overall perforation rate was 2.1 per 1000 insertions (95% CI: 1.6–2.8) for LNG-IUS users (40 + 19 perforations/27,630 insertions) and 1.6 per 1000 insertions (95% CI: 0.9–2.5) for copper-IUD users (14 + 4 perforations/11,379 insertions). LNG-IUS users had a borderline higher risk of perforation compared with copper-IUD users (ORadj 1.7; 95% CI: 1.0–2.8). Forty-five (58%) of the 77 perforations were associated with suspected risk factors. Breastfeeding (RR 4.9, 95% CI: 3.0–7.8) and time since delivery (RR 3.0, CI: 1.5–5.4) remained significant risk factors in perforations detected after 12 months. No perforations resulted in serious injury to intra-abdominal or pelvic structures.Conclusions: The incidence of uterine perforations in this study was low, although higher than the commonly reported rate. Approximately one third of perforations are detected 12 months after insertion. Clinical sequalae of perforations are generally mild and associated with a very low risk of injury to intra-abdominal and pelvic structures.ImplicationsUterine perforation is a rare risk associated with intra-uterine device use. Late diagnosed perforations can occur, although women can be reassured that the morbidity associated with detection and removal is low.

Hazardous air pollutants and primary liver cancer in Texas.

The incidence of hepatocellular carcinoma (HCC), the most common primary liver cancer, is increasing in the US and tripled during the past two decades. The reasons for such phenomenon remain poorly understood. Texas is among continental states with the highest incidence of liver cancer with an annual increment of 5.7%. Established risk factors for HCC include Hepatitis B and C (HBV, HCV) viral infection, alcohol, tobacco and suspected risk factors include obesity and diabetes. While distribution of these risk factors in the state of Texas is similar to the national data and homogeneous, the incidence of HCC in this state is exceptionally higher than the national average and appears to be dishomogeneous in various areas of the state suggesting that other non-recognized risk factors might play a role. No population-based studies are currently available investigating the effect of exposure to Hazardous Air Pollutants (HAPs) as a contributing risk factor for liver cancer. Incidence rate of liver cancer in Texas by counties for the time period between 2002 and 2012 was obtained from the Texas Cancer Registry (TCR). Through Principal Component Analysis (PCA) a subgroup of pollutants, explaining almost all the dataset variability, were identified and used to cluster Texas counties. The analysis generated 4 clusters showing liver cancer rate either higher or lower than national average in association with either high or low levels of HAPs emission in the environment. The study shows that the selected relevant HAPs, 10 among 253 analyzed, produce a significant correlation (P = 0.01–0.05) and some of these have been previously identified as carcinogens. An association between the increased production and consequent exposure to these HAPs and a higher presence of liver cancer in certain counties is suggested. This study provides a new insight on this complex multifactorial disease suggesting that environmental substances might play a role in the etiology of this cancer.

Risk factors for breast cancer in the breast cancer risk model study of Guam and Saipan

BackgroundChamorro Pacific Islanders in the Mariana Islands have breast cancer incidence rates similar to, but mortality rates higher than, those of U.S. women. As breast cancer risk factors of women of the Mariana Islands may be unique because of ethnic and cultural differences, we studied established and suspected risk factors for breast cancer in this unstudied population. MethodsFrom 2010–2013, we conducted retrospective case-control study of female breast cancer (104 cases and 185 controls) among women in the Mariana Islands. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each of various lifestyle-related factors from logistic regression of breast cancer, in all women and in pre- and postmenopausal women separately. Tests for interaction of risk factors with ethnicity were based on the Wald statistics for cross-product terms. ResultsOf the medical and reproductive factors considered — age at menarche, breastfeeding, number of live births, age at first live birth, hormone use, and menopause — only age at first live birth was confirmed. Age at first live birth, among parous women, was higher among cases (mean 24.9 years) than controls (mean 23.2 years); with increased breast cancer risk (OR=2.53; 95% CI, 1.04–6.19 for age≥30y compared to <20y, P for trend=0.01). Of the lifestyle factors —body mass index, waist circumference, physical activity, alcohol and betel-nut intake, and education — only waist circumference (OR=1.65; 95% CI 0.87–3.14 for the highest tertile group compared to the lowest, P for trend=0.04) was significantly associated with breast cancer risk and only in Filipino women. The association with many other established risk factors, such as BMI, hormone use and physical activity, were in the expected direction but were not significant. Associations for family history of breast cancer and alcohol intake were not evident ConclusionsThe results provide a basis for cancer prevention guidance for women in the Mariana Islands.

Acanthamoeba keratitis in noncompliant soft contact lenses users: Genotyping and risk factors, a study from Cairo, Egypt.

The study aimed to diagnose AK in soft CL users presenting with infectious keratitis, and to identify the prevalent genotypes isolated from different cases. Another aim was to determine the CL hygiene-related risk behaviors, and to explore the risk of water exposure for developing AK. A cross sectional study was performed. A questionnaire was carried out including 260 clinically diagnosed cases as infectious keratitis (170 females and 90 males); all of them were soft CL users for the suspected risk factors. Corneal scrapes from the affected eyes were cultured to diagnose bacterial and AK. PCR was performed and the amplified products were sequenced and compared with GenBank data. The parasite was positively amplified from 32 samples (12.3%). Acanthamoeba T4 genotype was identified in 27/32 (84.4%) of isolates. Other detected genotypes belonged to T5 and T3 genotypes at rates of 9.4%, and 6.25%, respectively. The most important risk factors associated with development of AK were female sex, sleeping while wearing CL, and exposure to water resources through different practices. These practices included rinsing the CL case in tap water, swimming and/or showering while wearing CL, using multipurpose solution for cleaning the lenses, using water from over-building tanks. Rubbing the eyes due to discomfort when applying CL was an additional important risk factor associated with AK. The protective factor was regular hand washing before using CL. CL users were more exposed to AK and should gain enough health education regarding proper lens hygiene and dangers of tap water exposure.

Affective dysregulation predicts incident nonmedical prescription analgesic use among college students

IntroductionThis study investigated the relationship between four suspected risk factors—affective dysregulation, conduct problems, depressive symptoms, and psychological distress—and incident nonmedical prescription analgesic (NPA) use among college students. MethodsThe sample was derived from 929 college students from a large, mid-Atlantic university who completed the third annual College Life Study assessment (Y3) and were NPA use naïve at baseline (Y1). A series of logistic regression analyses were conducted to evaluate the predictors of incident NPA use by Y3. Separate models were developed to evaluate the association between the suspected risk factors and (a) NPA use relative to non-use of other drugs, including nonmedical use of other drug classes, (b) NPA use relative to other drug use, and (c) other drug use relative to non-use. All models included gender, parental education level, and race/ethnicity. ResultsAffective dysregulation was significantly associated with becoming an incident NPA user relative to both drug users without NPA use as well as non-users, after statistically controlling for demographic characteristics and other factors. Conduct problems in early childhood were positively related to both incident NPA use and other drug use without NPA use relative to non-users, after statistically controlling for demographic characteristics and other factors. Depressive symptoms were associated with NPA incidence at the bivariate level only. ConclusionsThese findings extend previous research suggesting that NPA use might be related to deficits in regulating negative emotional states, and highlight possible markers for screening and intervention to prevent NPA use.