Years For Non-users Research Articles

Oral Candidal Carriage and its Correlation with Salivary Oxidative Stress in Smokeless Tobacco Users

Background: Smokeless tobacco use, particularly the consumption of Naswar, is prevalent in Pakistan and has been associated with various chronic diseases, including oral cancer. Naswar is known to contain toxic heavy metals, carcinogenic substances, and microbial contaminants. This study aims to assess the oral Candida carriage and biofilm formation in Candida albicans isolates from Naswar users and its association with salivary oxidative stress. Methods: A cross-sectional study was conducted involving 150 participants, divided into Naswar users (n=75) and Non-users (n=75). Socio-demographic data, oral health, hygiene practices, and Naswar usage patterns were collected through a standardized questionnaire. Salivary samples were collected, and Candida strains were identified using culture techniques. Salivary oxidative stress was assessed using a DPPH solution-based free radical system. Results: The mean age of participants was 30 ± 7.3 years for Naswar users and 30.2 ± 7.1 years for non-users. No significant differences were observed in oral health and hygiene practices between the two groups. Among Naswar users, the most common type of product used was green moist Naswar (77.3%). Oral Candida carriage was significantly higher in Naswar users, particularly those with fungal infections of C. albicans, C. krusei, or both. These participants also exhibited elevated levels of salivary oxidative stress. Practical Implication: Public health interventions and oral health education programs should be implemented to raise awareness about the risks associated with Naswar and promote good oral hygiene practices among users. Conclusion: This study reveals significant differences in oral Candida carriage and salivary oxidative stress between Naswar users and non-users, indicating potential implications for the oral health of Naswar users. These findings underscore the need for larger prospective studies to validate the detrimental effects of Naswar use. Public health interventions targeting smokeless tobacco users should prioritize oral health promotion and emphasize the risks associated with Naswar consumption. Keywords: Candida species, smokeless tobacco, oral health, oxidative stress

Current State of Peer Learning in Radiology: A Survey of ACR Members

PurposePeer learning (PL) programs seek to improve upon the limitations of score-based peer review and incorporate modern approaches to improve patient care. The aim of this study was to further understand the landscape of PL among members of the ACR in the first quarter of 2022. MethodsMembers of the ACR were surveyed to evaluate the incidence, current practices, perceptions, and outcomes of PL in radiology practice. The survey was administered via e-mail to 20,850 ACR members. The demographic and practice characteristics of the 1,153 respondents (6%) were similar to those of the ACR radiologist membership and correspond to a normal distribution of the population of radiologists and can therefore be described as representative of that population. Therefore, the error range for the results from this survey is ±2.9% at a 95% confidence level. ResultsAmong the total sample, 610 respondents (53%) currently use PL, and 334 (29%) do not. Users of PL are younger (mode age ranges, 45-54 years for users and 55-64 years for nonusers; P < .01), more likely to be female (29% vs 23%, P < .05), and more likely to practice in urban settings (52% vs 40%, P = .0002). Users of PL feel that it supports an improved culture of safety and wellness (543 of 610 [89%]) and fosters continuous improvement initiatives (523 of 610 [86%]). Users of PL are more likely than nonusers to identify learning opportunities from routine clinical practice (83% vs 50%, P < .00001), engage in programming inclusive of more team members, and implement more practice improvement projects (P < .00001). PL users’ net promoter score of 65% strongly suggests that users of PL are highly likely to recommend the program to colleagues. ConclusionsRadiologists across a breadth of radiology practices are engaged in PL activities, which are perceived to align with emerging principles of improving health care and enhance culture, quality, and engagement.

Association of L-α Glycerylphosphorylcholine With Subsequent Stroke Risk After 10 Years

L-α glycerylphosphorylcholine (α-GPC, choline alphoscerate) is used globally by individuals older than 50 years based on its potential function as a precursor of acetylcholine. However, choline has previously been linked to a higher risk of cardiovascular disease via trimethylamine-N-oxide, a metabolite of choline by microbiota. To investigate the association between α-GPC use and subsequent 10-year stroke risk. A population-based, retrospective cohort study was conducted using data from the National Health Insurance Service of South Korea. Participants included men and women aged 50 years or older without underlying stroke or Alzheimer disease (N = 12 008 977). All participants were divided into whether they were prescribed α-GPC during 2006-2008. α-GPC users were matched with nonusers for all covariates to create a matched cohort. α-GPC use was further divided into durations less than 2, 2 to 6, 6 to 12, and more than 12 months of α-GPC prescriptions. The adjusted hazard ratios (aHRs) and 95% CIs for total stroke, ischemic stroke, and hemorrhagic stroke from January 1, 2009, to January 31, 2018, were calculated by multivariate Cox proportional hazards regression. A total of 12 008 977 individuals (6 401 965 [53.3%] women) aged 50 years or older were included in the study. The mean (SD) age was 61.6 (9.4) years for nonusers and 68.3 (10.0) years for users, and that of the matching cohort was 68.2 (9.9) years for both groups. Compared with α-GPC nonusers (n = 11 900 100), users (n = 108 877) had a higher risk for total stroke (aHR, 1.46; 95% CI, 1.43-1.48), ischemic stroke (aHR 1.36; 95% CI, 1.33-1.39), and hemorrhagic stroke (aHR, 1.36; 95% CI, 1.28-1.44). After matching for all covariates, α-GPC users had a higher risk for total stroke (aHR, 1.43; 95% CI, 1.41-1.46), ischemic stroke (aHR, 1.34; 95% CI, 1.31-1.37), and hemorrhagic stroke (aHR, 1.37; 95% CI, 1.29-1.46). Increasing intake of α-GPC was associated with a higher risk for total stroke in a dose-response manner. In this cohort study, use of α-GPC was associated with a higher 10-year incident stroke risk in a dose-response manner after adjusting for traditional cerebrovascular risk factors. Future studies are needed to determine the possible mechanisms behind the potential cerebrovascular risk-elevating effects of α-GPC.

Allopurinol and Renal Outcomes in Adults With and Without Type 2 Diabetes: A Retrospective, Population-Based Cohort Study and Propensity Score Analysis

ObjectivesElevated uric acid (UA) is common in diabetes and is implicated in the pathogenesis of chronic kidney disease (CKD). Lowering UA with allopurinol may delay CKD progression. We assessed the association between allopurinol and renal outcomes in older adults both with and without diabetes, and whether this differed by diabetes status. MethodsWe conducted a population-based, retrospective cohort study of older adults ≥66 years of age with a gout flare using administrative data from Ontario, Canada. The primary outcome was doubling of creatinine or kidney failure. Secondary outcomes were a composite of death or kidney failure, decline in estimated glomerular filtration rate by >30%, death and kidney failure. New allopurinol users were compared with nonusers using Cox proportional hazards models and inverse probability of treatment weighting (IPTW). An interaction between allopurinol use and presence or absence of diabetes was assessed. ResultsAmong 5,937 older adults with a gout flare (1,911 with diabetes), 1,304 (22%) were newly treated with allopurinol. Median follow-up time was 1.11 (interquartile range, 0.33 to 3.21) years for allopurinol users and 3.38 (interquartile range, 1.42 to 4.43) years for nonusers. There was no association between allopurinol use and the primary outcome (IPTW-adjusted hazard ratio, 0.97; 95% confidence interval, 0.72 to 1.31), and this did not differ by diabetes status. Allopurinol use was not associated with any of the secondary outcomes. ConclusionsAllopurinol use was not associated with renal outcomes in older adults with or without diabetes. This supports the interpretation of UA as a biomarker of CKD risk rather than a modifiable target for prevention or treatment of CKD.

Community Pharmacy Medicare Part D Consultations: Plan-Switching Decisions and Chronic Medication Adherence

Objectives: (1)To compare Part D plan switching for users and nonusers of a pharmacy-led Medicare Part D consultation service and (2) to evaluate the effect of service use on chronic medication adherence. Methods: This was a longitudinal study, occurring in one independently owned community pharmacy in Iowa. Medicare Part D beneficiaries who used the service were compared to nonusers. Dispensing data were used to compare planswitching and the effect of service use on chronic medication adherence between service users and nonusers. Proportion of days covered (PDC) was used to evaluate medication adherence. Results: In the 2017 and 2018 plan year, 79 and 138 Medicare beneficiaries used the service, respectively. These individuals were compared to 849 Medicare beneficiaries and a random sample of 101 beneficiaries in respective years. The respective switching rates for service users in 2018 and 2019 plan year were 43% and 15.9%, compared to 4% switching rates in both years for nonusers. Using the Medicare Part D consultation yielded a statistically significant positive effect on switching in both plan years (P values < .05) and a statistically significant positive effect on PDC between years (P value <.05). Conclusion: The use of a pharmacist-led Medicare Part D consultation resulted in increased plan switching and improved chronic medication adherence.

Difference Between Users and Nonusers of a Patient Portal in Health Behaviors and Outcomes: Retrospective Cohort Study.

BackgroundPatient portals are frequently used in modern health care systems as an engagement and communication tool. An increased focus on the potential value of these communication channels to improve health outcomes is warranted.ObjectiveThis paper aimed to quantify the impact of portal use on patients’ preventive health behavior and chronic health outcomes.MethodsWe conducted a retrospective, observational cohort study of 10,000 patients aged 50 years or older who were treated at the University of Pennsylvania Health System (UPHS) from September 1, 2014, to October 31, 2016. The data were sourced from the UPHS electronic health records. We investigated the association between patient portal use and patients’ preventive health behaviors or chronic health outcomes, controlling for confounders using a novel cardinality matching approach based on propensity scoring and a subsequent bootstrapping method to estimate the variance of association estimates.ResultsPatient-level characteristics differed substantially between portal users, comprising approximately 59.32% (5932/10000) of the cohort, and nonusers. On average, users were more likely to be younger (63.46 years for users vs 66.08 years for nonusers), white (72.77% [4317/5932] for users vs 52.58% [2139/4068] for nonusers), have commercial insurance (60.99% [3618/5932] for users vs 40.12% [1632/4068] for nonusers), and have higher annual incomes (US $74,172/year for users vs US $62,940/year for nonusers). Even after adjusting for these potential confounders, patient portal use had a positive and clinically meaningful impact on patients’ preventive health behaviors but not on chronic health outcomes.ConclusionsThis paper contributes to the understanding of the impact of patient portal use on health outcomes and is the first study to identify a meaningful subgroup of patients’ health behaviors that improved with portal use. These findings may encourage providers to promote portal use to improve patients’ preventive health behaviors.

Nass use and associated factors among outpatients in northern Afghanistan: A cross-sectional study in Andkhoy City.

INTRODUCTIONTobacco use is one of the main risk factors for a number of chronic diseases, including cancer, lung diseases, and cardiovascular diseases. Nass is a form of smokeless tobacco. It is used most commonly in Central Asia, Afghanistan, Pakistan, and Iran, and is significantly associated with oral and oesophageal cancers. The aim of this study was to determine the prevalence of nass use and its associated factors among patients attending an outpatient clinic in Afghanistan.METHODSThis cross-sectional study was performed in an outpatient clinic in Andkhoy, Afghanistan, from April to July 2017. The study included 387 consecutive patients. The data collection tool was a questionnaire, which includes three main items: demographic, physical, and biomedical measurements. We performed binary logistic regression to identify independent risk factors of nass use.RESULTSThe study included 387 participants, of whom 225 were males (58.1%) and 162 were females (41.9%). The overall prevalence of nass use was 48.8% (95% CI: 43.8–53.9%), with the Turkmen ethnic group having significantly higher prevalence than other ethnic groups (58.2%, 95% CI: 50.8–65.3% vs 41.8%, 95% CI: 34.7–49.2%). The mean and standard deviation of the age was 63.9 (17.2) years for nass users and 42.3 (17.4) years for non-users.Based on a multivariate analysis, family history of nass use (OR=31.4, 95% CI: 12.5–78.5), illiteracy (OR=8.9, 95% CI: 2.5–31.2), rural residence (OR=2.0, 95% CI: 1.0–3.9), and unemployment (OR=5.4, 95% CI: 1.4–21.4) were associated with nass use.CONCLUSIONSOur results indicate that about half of the participants were nass users, and nass use associated factors were family history of nass use, illiteracy, unemployment, and rural residency in outpatient clinics in Afghanistan. More surveillance data are needed on a national level to inform the development of strategies for the prevention and control of nass consumption in Afghanistan.

Retention of Ultrasound Skills and Training in “Point-of-Care” Cardiac Ultrasound

Although the growth of point-of-care ultrasound has resulted in a proliferation of teaching programs,few data exist on the maintenance of proficiency. The aim of this study was to evaluate the retention of cardiac ultrasound skills and training in physicians up to 7years after a formal focused curriculum in residency. Thirty internal medicine physicians, deemed proficient at graduation and having passed a practical examination that confirms imaging skills and knowledge base when a score of ≥80% correct is attained, were retested. Twenty graduates (the NOPREP group) did not study any relevant material, and 10 graduates (the PREP group) were encouraged to study online videos. Scores were categorized by length of time (1-7years) from graduates' last performance of ultrasound. The mean original test score of the physicians was 90±6%. With retesting NOPREP (n=20), seven physicians were within 1year of their last use, and five (71%) repassed the examination, scoring 80±15%. Among the remaining 13 NOPREP physicians who had >1year of nonuse, none repassed, scoring 58±17%. In retesting PREP (n=10), one physician was within 1year of last use and repassed, scoring 95%. Among the remaining nine PREP physicians with >1year since last use, three (33%) repassed (P=.05), scoring 72±21%. Diagnostic knowledge was significantly higher when good-quality images were obtained. Learned skills in cardiac ultrasound diminish notably within 2years of nonuse.

Statins and physical activity in older men: the osteoporotic fractures in men study.

Muscle pain, fatigue, and weakness are common adverse effects of statin medications and may decrease physical activity in older men. To determine whether statin use is associated with physical activity, longitudinally and cross-sectionally. Men participating in the Osteoporotic Fractures in Men Study (N = 5994), a multicenter prospective cohort study of community-living men 65 years and older, enrolled between March 2000 and April 2002. Follow-up was conducted through 2009. Statin use as determined by an inventory of medications (taken within the last 30 days). In cross-sectional analyses (n = 4137), statin use categories were users and nonusers. In longitudinal analyses (n = 3039), categories were prevalent users (baseline use and throughout the study), new users (initiated use during the study), and nonusers (never used). Self-reported physical activity at baseline and 2 follow-up visits using the Physical Activity Scale for the Elderly (PASE). At the third visit, an accelerometer measured metabolic equivalents (METs [kilocalories per kilogram per hour]) and minutes of moderate activity (METs ≥3.0), vigorous activity (METs ≥6.0), and sedentary behavior (METs ≤1.5). At baseline, 989 men (24%) were users and 3148 (76%) were nonusers. The adjusted difference in baseline PASE between users and nonusers was -5.8 points (95% CI, -10.9 to -0.7 points). A total of 3039 men met the inclusion criteria for longitudinal analysis: 727 (24%) prevalent users, 845 (28%) new users, and 1467 (48%) nonusers. PASE score declined by a mean (95% CI) of 2.5 (2.0 to 3.0) points per year for nonusers and 2.8 (2.1 to 3.5) points per year for prevalent users, a nonstatistical difference (0.3 [-0.5 to 1.0] points). For new users, annual PASE score declined at a faster rate than nonusers (difference of 0.9 [95% CI, 0.1 to 1.7] points). A total of 3071 men had adequate accelerometry data, 1542 (50%) were statin users. Statin users expended less METs (0.03 [95% CI, 0.02-0.04] METs less) and engaged in less moderate physical activity (5.4 [95% CI, 1.9-8.8] fewer minutes per day), less vigorous activity (0.6 [95% CI, 0.1-1.1] fewer minutes per day), and more sedentary behavior (7.6 [95% CI, 2.6-12.4] greater minutes per day). Statin use was associated with modestly lower physical activity among community-living men, even after accounting for medical history and other potentially confounding factors. The clinical significance of these findings deserves further investigation.

Statins and the risk of type 2 diabetes mellitus: cohort study using the UK clinical practice pesearch datalink.

BackgroundThere is strong evidence of reductions in major vascular events from statins across all cardiovascular risk categories. However, trials of statin therapy have provided conflicting results regarding statin use and type 2 diabetes (T2DM). We aimed to assess the effect of statins on T2DM development.MethodWe carried out a population-based cohort study using the Clinical Practice Research Datalink (CPRD), a database of computerized clinical records. Every patient aged 30–85 years old starting a statin between 1989 and 2009 was matched with up to five non-statin users. The observation period in CPRD ended in 31 December 2011. Cox proportional hazard regression was used to compare rates of T2DM between statin users and non-users, using propensity score method to adjust for systematic differences between groups.ResultsThe study basis comprised 2,016,094 individuals, including 430,890 people who received a statin, matched to 1,585,204 people not prescribed a statin. Mean follow-up time was 5.43 years for statin users and 3.89 years for nonusers. During follow-up 130,395 individuals developed T2DM. Statin use was associated with an increased risk of T2DM (HR 1.57; 95% CI 1.54-1.59), which increases with longer duration of use. The increased risk was smaller among people with hypertension or cardiovascular disease and was only apparent after 5 or more years treatment with statins in these groups. Conversely, age-specific risk ratios decreased in older people.ConclusionsStatin use is associated with an increased risk of T2DM. Our results suggest that the relative risk is higher among people without diagnosed hypertension or cardiovascular disease. These findings should be considered in the context of the observational nature of the data which is prone to bias and unmeasured confounding.

For Patients with Crohnʼs Disease, Biologic Agent Use Varies Inversely with Age at the Time of Diagnosis

Purpose: We have noted that patients with Crohn's disease treated in our VA hospital generally are older than those seen in community hospitals. The aim of this study was to evaluate how the use of biologics varies with age and disease duration in our patients. Methods: We reviewed the medical records of 112 veteran patients with Crohn's disease who have been treated at our hospital, and compared differences in age and a number of other demographic features between patients who have received biologics and those who have not. Results: The average age of our patients is 54.9 years (range 24-87), and 32% are currently receiving or have previously received treatment with a biologic agent (infliximab or adalimumab). For the patients who have received biologics, the average age at the time of diagnosis of Crohn's disease was 33.8 years, compared to 43.4 years for the patients who had not received biologics (p=0.002). The frequency of using biologic agents varied inversely with the age at diagnosis (see figure). For patients whose Crohn's disease was diagnosed before age 21, 66.7% have used biologics, whereas no patient >71 years of age at the time of diagnosis has used biologics. We found no significant correlation between biologic use and duration of disease (17.6 years for biologic users vs. 13.7 years for non-users, p=0.12 ), smoking status (non-smokers comprised 36% of the biologic users vs. 26% of the non-users, p=0.37 ), ethnicity (whites comprised 80.6% of the biologic users vs. 77.6% of the non-users, p=0.81) and presence of perianal disease (22.2% in biologic users vs. 9.6% in non-users, p=0.08).Table 1: EtOH and smoking statusConclusion: At the time of diagnosis of Crohn's disease, our patients who have been treated with biologics were almost 10 years younger than those who have not received biologics. Furthermore, the frequency of using biologic agents varies inversely with age at the time of diagnosis. It is not clear whether this reflects a difference in disease severity or response to other medications in patients who develop Crohn's disease at an earlier age, or a reluctance on the part of physicians to prescribe biologic therapy for patients who develop Crohn's disease later in life.Figure

Needle Exchange and Sexual Risk Behaviors Among a Cohort of Injection Drug Users in Chicago, Illinois

To examine the impact of a needle exchange program (NEP) on sexual risk behaviors of injecting drug users (IDUs). : Between 1997 and 2000, 889 IDUs in Chicago were recruited from NEPs and an area with no NEP into a cohort study. They were interviewed and tested for HIV at baseline and 3 annual follow-up visits. Random-effect logistic models were used to compare NEP users and nonusers regarding the number of sex partners, number of unprotected sex acts, and frequency of condom use. Compared to NEP nonusers, NEP users had a similar number of sex partners over time, but had 49% higher odds of using condoms with their main partners (P = 0.047). At baseline, there was no difference between NEP users and nonusers in episodes of vaginal intercourse, but over time the odds of having a higher number of unprotected instances of vaginal intercourse were reduced by 26% per year for NEP users but only 10% per year for nonusers (P = 0.02). This study suggests that NEP participation may help reduce the absolute risk of HIV sexual transmission.

Impact of statin therapy on survival in epithelial ovarian cancer

Objective 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors, or statins, are common therapeutic agents in the management of dyslipidemias. Epidemiologic and pharmacologic data also suggest statins have an effect on cancer biology. We sought to determine the association between use of statins and epithelial ovarian cancer survival, disease progression, and clinico-pathologic factors. Methods After IRB approval, we performed a retrospective review of all patients with advanced stage (III/IV) epithelial ovarian or primary peritoneal cancer undergoing primary cytoreductive surgery by a gynecologist oncologist between 6/1996 and 6/2001. Abstracted data included statin use at time of initial cytoreductive surgery, as well as clinico-pathologic factors and survival. Statistical analysis included Fisher's exact test, Kaplan–Meier survival, and Cox regression analyses. Results 126 patients met criteria for review. Seventeen (14%) patients were undergoing concurrent statin therapy at time of initial cytoreductive surgery. Statin users were statistically older (median age 67 years, versus 60 years for non-users, p = 0.002) and had a greater incidence of diabetes mellitus (18% versus 3% in non-users, p = 0.03). Of the entire cohort, 21 patients (17%) were suboptimally cytoreduced after initial surgery, with residual disease > 1 cm; statin use did not correlate with incidence of optimal resection ( p = 0.3). Median progression-free survival for statin users was 24 months, compared to 16 months for statin non-users ( p = 0.007). Similarly, overall survival was significantly longer for statin users (62 months) compared to statin non-users (46 months, p = 0.04). Multivariable analysis identified statin use as an independent positive prognostic factor, after controlling for age, stage, grade, and suboptimal cytoreduction ( p = 0.02). Conclusions These data indicate statin use in patients diagnosed with epithelial ovarian cancer is associated with improved survival, and suggest a potential suppressive impact of HMG-CoA reductase inhibitors on tumor biology. Studies are proposed to explore the molecular mechanisms underlying these clinical observations.

Complementary and Alternative Medicine Among Advanced Cancer Patients Enrolled on Phase I Trials: A Study of Prognosis, Quality of Life, and Preferences for Decision Making

We sought to describe complementary and alternative medicine (CAM) usage among phase I trial participants and to describe these patients' treatment decision-making preferences, awareness of prognosis, survival, and quality of life. Advanced cancer patients enrolling onto phase I trials were surveyed regarding biologically based CAM use. Decision-making preferences and awareness of prognosis were assessed using validated and/or standardized instruments. The Functional Assessment of Cancer Therapy-General instrument was used to assess quality of life. Univariate and multivariate analyses were performed to detect differences between CAM users and nonusers. Of 212 interviewed patients, 34% (n = 72) described taking biologically based CAM. Median age of those taking biologically based CAM was 55 years, compared with 62 years for nonusers (P < .005). There were no statistically significant differences found between CAM usage and preferences for degree of patient involvement in medical decision making. Those patients who acknowledged that their deaths were likely to occur within 1 year were more likely to admit to prior CAM use (70% v 34%; P = .02). CAM users had poorer overall quality of life compared with nonusers (87.0 +/- 12.4 v 91.2 +/- 14.7; P = .007). No differences in survival were identified. Prior CAM use among phase I cancer trial patients studied was common and associated with age, stated acknowledgment of prognosis, and quality of life. Patients enrolling onto early-phase trials should be questioned about CAM use. Additional study is needed to determine the frequency of use of those biologically based CAM agents that threaten the accuracy of early-phase cancer trial data.

β-blockers reduce bone resorption marker in early postmenopausal women

There is evidence to suggest that beta-blockers used in the management of cardiovascular disease may also modulate bone metabolism and reduce bone fragility. The study aimed to determine the association between beta-blocker use, serum markers of bone turnover and bone loss in early postmenopausal women. In this observational study, we evaluated beta-blocker exposure in association with serum levels of C-telopeptide and bone-specific alkaline phosphatase, and rates of bone loss. Beta-blocker use, concomitant therapy and lifestyle were documented for 197 women (50-59 years), 175 of whom had changes in whole body bone mineral density monitored over a 2-year period. Twenty-four beta-blocker users were identified at baseline. After controlling for concomitant use of hormone therapy, C-telopeptide levels were 6.7% lower among beta-blocker users (p=0.02). No association was detected between bone-specific alkaline phosphatase and beta-blocker use. Analysis of 15 beta-blocker users and 152 non-users identified 2 years post-baseline showed that levels of C-telopeptide but not bone-specific alkaline phosphatase were predictors of adjusted rates of bone loss (p=0.008 and p>0.05, respectively). Adjusted rates of bone loss were-0.001+/-0.026 g cm(-2) over 2 years for the users and-0.004+/-0.025 g cm(-2) over 2 years for non-users, but this difference was not significant. Beta-blockers might suppress bone resorption with relative preservation of bone formation. A study with greater power is required to determine whether ss-blocker use is associated with lower rates of bone loss.

Drugs and human memory (part 1): Clinical, theoretical, and methodologic issues.

Drugs and human memory (part 1): Clinical, theoretical, and methodologic issues.

Hormone replacement therapy containing progestins and given continuously increases breast carcinoma risk in Sweden.

The authors previously reported an increased risk of breast carcinoma with longer duration of hormone replacement therapy (HRT) use. It is unclear if different types of HRT confer different risks. In this study, a population-based cohort of 29,508 women were interviewed during 1990-1992 to determine whether there are any differences in breast carcinoma risk according to different types and duration of HRT use. At the end of the follow-up period in December 2001, the cohort constituted 298,649 person-years. Slightly more breast carcinoma cases were seen (n = 556) than expected (n = 508.37; standardized morbidity ratio =1.09, 95% confidence interval [CI] = 1.00-1.19). Approximately 3663 women had ever used HRT. In Cox regression models, time to breast carcinoma in relation to duration and type of HRT use was analyzed, adjusting for age at menarche, age at first full-term pregnancy, parity, age at menopause, family history of breast carcinoma, and age at interview. In women with a natural menopause, a significantly higher risk was observed for longer duration of combined continuous HRT use compared with never users (hazard ratio [HR] = 4.60, 95% CI = 2.39-8.84). Nonsignificant elevated risks also were observed for longer combined sequential (HR = 2.23, 95% CI = 0.90-5.56), gestagen only (HR = 3.74,9 5% CI = 0.94-14.97), and estriol use (HR = 1.89, 95% CI = 0.81-4.39). No increased risk was seen in women after 5 years of nonuse. When studying women who ever used only one type of HRT, even more elevated HRs for gestagen-containing preparations were seen. The highest risks were associated with the combined continuous and gestagen-only therapy in women with >/= 48 months of use. Use of estradiol without progestins did not increase breast carcinoma risk significantly. The authors estimated the cumulative risk of breast carcinoma in a 50-year-old woman with gestagen-containing therapies for >/= 48 months, with a follow-up of 10 years, to be 7% (95% CI = 5.4-11.4%) compared with 2% (95% CI = 1.6%-2.9%) for never-users of HRT. Longer use of HRT containing progestins significantly elevates breast carcinoma risk whereas estradiol use does not. Continued use of progestins rendered the highest risks. The yearly risk of breast carcinoma for long-term users of progestins is of the magnitude of 50% the risk of a BRCA1 mutation carrier.

Ten Years After Ceasing Pill Use, Former Users Have Mortality Risks Similar to Those of Never-Users

A 25-year follow-up study conducted in the UK has found that increases in mortality associated with the current use of oral contraceptives (OC) do not persist after 10 years of nonuse. Compared with women who have never used the pill current users and women who have used the pill within the previous 10 years are 90% more likely to die from circulatory diseases and more than twice as likely to die from cervical cancer although they are only 20% as likely to die from ovarian cancer. However after 10 years of nonuse former users have mortality levels similar to those among nonusers. The data for this analysis come from 46000 women recruited by their general practitioners in a 1968 study of the health of women taking OCs. Most pill formulations used by women in the study were combined preparations containing 50 mcg of estrogen. Study results are based upon 853517 person-years of experience 517519 contributed by ever-users of OC and 335998 contributed by nonusers.

Forty Years of Nonuse Implies Abandonment of Water Right

Forty years of nonuse of water right is strong evidence of an intent to abandon that right, according to the Supreme Court of Montana.

An analysis of house fly resistance to insecticides in California.

The pattern of insecticide resistance in house flies, Musca domestica L., from 6 areas of California was found to reflect the differing chemical-control practices in each area. DDT resistance continues to be high in all areas despite more than 10 years of nonuse of this compound for fly control. It shows positive correlation with diazinon resistance but not with malathion resistance, and thus its prolonged stability was likely enhanced by diazinon pressure. Dieldrin resistance also remains high, but shows no correlation with organophosphorus resistance. The non-identity of diazinon and malathion resistances was clearly discernible. High resistance to diazinon (20.7×) in the Anaheim strain was accompanied by only moderate resistance to malathion, and high resistance to malathion in the Moorpark strain was accompanied by only moderate resistance to diazinon (7.1×). The highest degree of resislance observed (at the LD90 level) by topical application of organophosphates and carbamates was: malathion >60×, diazinon 25×, ronnel 14×, fenthion 10.1×, dimethoate 4.2×, dimetilan 3.7× and Hercules 8717-E [ m -(2-propynyloxy) phenyl methylcarbamate] 3.5×.