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Modeling the involvement of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes in autoimmune and stress-related rheumatic syndromes in women.
Crofford LJ, Jacobson J, Young E
(1999) J Womens Health 8: 203-15
MeSH Terms: Animals, Autoimmune Diseases, Circadian Rhythm, Disease Models, Animal, Female, Humans, Hypothalamo-Hypophyseal System, Incidence, Male, Models, Biological, Pituitary-Adrenal System, Rheumatic Diseases, Risk Assessment, Sensitivity and Specificity, Sex Distribution, Stress, Psychological, Syndrome
Show Abstract · Added September 18, 2013
Autoimmune and stress-related rheumatic diseases are significantly more common in women than in men. Our group has focused on the role of two principal neuroendocrine axes, the hypothalamic-pituitary-adrenal (HPA) axis and the hypothalamic-pituitary-gonadal (HPG) axis, in this increased susceptibility to rheumatic disease. We review the physiology of the HPA and HPG axes and discuss their reciprocal interactions. Mechanisms by which hormones of the HPA and HPG axes influence the immune system and modulate the course of autoimmune inflammatory diseases in animal models of rheumatic disease are described. In addition, we review the data suggesting the importance of these neurohormonal systems in rheumatic diseases. These data provide insights into why women may be at increased risk and how we might better understand the mechanisms that provoke expression of rheumatic diseases in women. To advance research in this area, it is critical to develop methods to evaluate the function of the neuroendocrine axes. Secretion of both HPA and HPG axis hormones, particularly the hormones of the hypothalamus and anterior pituitary, is largely by intermittent pulses. In addition, the HPA axis exhibits a profound circadian, or near 24-hour, variation, and HPG axis hormones fluctuate over the monthly cycle. These factors make meaningful analysis of these axes quite complex. We discuss models used in the analyses of neuroendocrine axes and the use of challenge testing to assess the integrity of neuroendocrine axes.
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17 MeSH Terms
Prevalence of gonococcal and chlamydial infections in commercial sex workers in a Peruvian Amazon city.
Paris M, Gotuzzo E, Goyzueta G, Aramburu J, Caceres CF, Castellano T, Jordan NN, Vermund SH, Hook EW
(1999) Sex Transm Dis 26: 103-7
MeSH Terms: Adolescent, Adult, Chlamydia Infections, Chlamydia trachomatis, Condoms, Female, Gonorrhea, Humans, Neisseria gonorrhoeae, Odds Ratio, Peru, Pilot Projects, Prevalence, Risk Assessment, Sex Work, Urine
Show Abstract · Added March 5, 2014
BACKGROUND - Iquitos Peru, a densely populated port city housing both a large military base and a booming tourist industry, provides a thriving market for commercial sex and, consequently, sexually transmitted disease (STD). The purpose of this study was to characterize the prevalence of gonococcal and chlamydial infections among commercial sex workers (CSWs) and to correlate those findings with social/behavioral characteristics.
METHODS - One hundred CSWs, recruited through street and brothel outreach, were administered questionnaires. Urine specimens were collected for gonorrhea and chlamydia testing using ligase chain reaction assays.
RESULTS - Twenty-eight percent of CSWs were positive for chlamydia (22%) or gonorrhea (14%). Registered CSWs were more likely to have worked more than 5 years (p = 0.03), report 10 or more partners (p = 0.002), and work in brothels (p < 0.001). Significant associations were also noted between infection status and age, with adolescents at increased risk (odds ratio [OR] = 4.13, p = 0.001), and duration of employment, with those employed less than 5 years at increased risk (OR = 3.72, p = 0.04). The latter association, however, was because of age. Also, most CSWs believed themselves to be at no/small risk or didn't know their risk of future gonococcal infection (30%/12% and 25%, respectively) and AIDS (25%/8% and 35%, respectively), with 11% perceiving AIDS as more of a threat.
CONCLUSIONS - High infection rates, lack of knowledge regarding STD/HIV risk assessment, and other high-risk behavior prevalent among this population stress the need for STD intervention. The study further suggests that educational/risk assessment programs and risk reduction interventions could be successful.
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16 MeSH Terms
Occupation and pancreatic cancer risk in Shanghai, China.
Ji BT, Silverman DT, Dosemeci M, Dai Q, Gao YT, Blair A
(1999) Am J Ind Med 35: 76-81
MeSH Terms: Aged, Case-Control Studies, China, Female, Humans, Male, Middle Aged, Occupational Diseases, Odds Ratio, Pancreatic Neoplasms, Risk Assessment
Show Abstract · Added March 5, 2014
BACKGROUND - Any association between occupation and pancreatic cancer risk has not been conclusively demonstrated. A population-based case-control study was conducted to examine occupational risks of pancreatic cancer in Shanghai, China.
METHODS - The study included 451 pancreatic cancer patients newly diagnosed in 1990-1993 and 1,552 controls randomly selected from Shanghai residents. Information on a lifetime job history and other factors was obtained in a face-to-face interview.
RESULTS - Among men, an increased risk of pancreatic cancer was associated with employment as an electrician (OR = 7.5, CI = 2.6-21.8), and a positive trend in risk with increasing duration of employment was apparent (P for trend = 0.0003). Exposure to electric magnetic fields (EMF) as measured by a job exposure matrix also was associated with an increased risk among electricians. Threefold risks were observed for men with the highest level of intensity and for those with the highest probability of EMF exposure, although women with heavy EMF exposure did not experience increased risk. Among men, elevated risks also were found for metal workers (OR = 2.1, CI = 1.0-4.8); toolmakers (OR = 3.4, CI = 14-7.1); plumbers and welders (OR = 3.0, CI = 1.2-7.5); and glass manufacturers, potters, painters, and construction workers (OR = 2.6, CI = 1.1-6.3). Among women, textile workers experienced an increased risk (OR = 1.4, CI = 0.8-2.6).
CONCLUSIONS - Our results suggest that occupations associated with exposures to metal and textile dusts or certain chemicals may increase the risk of pancreatic cancer. The elevated risk among electricians may warrant further study to evaluate the possible role of EMF or other exposures.
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11 MeSH Terms
Cancer rate differentials between blacks and whites in three metropolitan areas: a 10-year comparison.
Wu LY, Semenya KA, Hardy RE, Hargreaves MK, Robinson SB, Pederson L, Sung JF, Haynes MA
(1998) J Natl Med Assoc 90: 410-6
MeSH Terms: Adult, African Continental Ancestry Group, Breast Neoplasms, Confidence Intervals, European Continental Ancestry Group, Female, Georgia, Health Surveys, Humans, Incidence, Los Angeles, Lung Neoplasms, Male, Prostatic Neoplasms, Registries, Risk Assessment, Risk Factors, Sex Distribution, Survival Rate, Tennessee, Uterine Cervical Neoplasms
Show Abstract · Added March 27, 2014
This article compares cancer rate differentials for 1989-1993 and 1979-1981 between black and whites in Los Angeles, Nashville, and Atlanta, In Los Angeles and Atlanta, the black/white relative risk of lung cancer incidence has increased. While the relative risk for prostate cancer has decreased, blacks still show an excess incidence. White women still show a higher incidence of breast cancer, but the risk is closer to one. In all three cities, the excesses of black male lung cancer and female breast cancer mortalities have increased. The excess of black prostate cancer mortality increased in Atlanta and Nashville but decreased in Los Angeles. The excess of black cervical cancer mortality fell in Los Angeles and Atlanta but rose in Nashville. These results indicate a continuing need to develop and implement culturally sensitive interventions targeted at the black population.
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21 MeSH Terms
The inappropriate use of hypothesis testing to infer safety of calcium channel blockers.
Harrell FE
(1998) Cardiovasc Drugs Ther 12: 151-3; discussion 155-6
MeSH Terms: Bayes Theorem, Calcium Channel Blockers, Humans, Myocardial Infarction, Research Design, Risk Assessment
Added February 28, 2014
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6 MeSH Terms
The dose-response model for dioxin.
Byrd DM, Allen DO, Beamer RL, Besch HR, Bylund DB, Doull J, Fleming WW, Fries A, Guengerich FP, Hornbrook R, Lasagna L, Lum BK, Michaelis EK, Morgan ET, Poland A, Rozman KK, Smith JB, Swanson HI, Waddell W, Wilson JD
(1998) Risk Anal 18: 1-2
MeSH Terms: Animals, Dose-Response Relationship, Drug, Humans, Liver Neoplasms, Experimental, Models, Biological, Polychlorinated Dibenzodioxins, Rats, Risk Assessment, United States, United States Environmental Protection Agency
Added May 26, 2014
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10 MeSH Terms
Detection of Pneumocystis carinii DNA in air samples: likely environmental risk to susceptible persons.
Bartlett MS, Vermund SH, Jacobs R, Durant PJ, Shaw MM, Smith JW, Tang X, Lu JJ, Li B, Jin S, Lee CH
(1997) J Clin Microbiol 35: 2511-3
MeSH Terms: Air Microbiology, DNA, Bacterial, DNA, Ribosomal, Disease Susceptibility, HIV Infections, Hospitals, Housing, Humans, Lung, Pneumocystis, Pneumocystis Infections, Risk Assessment
Show Abstract · Added March 5, 2014
The means by which humans acquire Pneumocystis carinii is not well understood. Whether it can be acquired from specific environmental sources or transmitted from person to person has not been determined. This study was designed to detect nucleic acids of P. carinii in air samples from various locations, including P. carinii-infected patients' homes and hospital rooms, non-P. carinii-infected patients' hospital rooms, empty hospital rooms, offices at Indiana University, and other homes in different locations. DNA was extracted from cellulose-ester filters through which air samples had been filtered, and the P. carinii DNA was amplified by PCR with primers specific for the internal transcribed spacer regions of rRNA. P. carinii DNA was found in 17 of 30 air samples (57%) from the rooms of P. carinii-infected patients. It was also found in 6 of the 21 other hospital rooms sampled (29%) but was not found in any of the offices, storage areas, or control homes. Environmental sampling suggests that the airborne presence of P. carinii genetic material and infectious organisms is plausible. The organism was also detected in locations where P. carinii patients were not immediately proximate, such as the hospital rooms of non-P. carinii-infected patients.
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12 MeSH Terms
Reassessing the cardiac risk profile in chronic hemodialysis patients: a hypothesis on the role of oxidant stress and other non-traditional cardiac risk factors.
Becker BN, Himmelfarb J, Henrich WL, Hakim RM
(1997) J Am Soc Nephrol 8: 475-86
MeSH Terms: Heart Diseases, Humans, Models, Cardiovascular, Oxidative Stress, Renal Dialysis, Risk Assessment, Risk Factors, Time Factors
Added May 20, 2014
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8 MeSH Terms
The effect of folic acid supplementation on the risk for cancer or dysplasia in ulcerative colitis.
Lashner BA, Provencher KS, Seidner DL, Knesebeck A, Brzezinski A
(1997) Gastroenterology 112: 29-32
MeSH Terms: Adult, Cohort Studies, Colitis, Ulcerative, Colorectal Neoplasms, Female, Folic Acid, Hematinics, Humans, Male, Odds Ratio, Precancerous Conditions, Risk Assessment
Show Abstract · Added September 30, 2015
BACKGROUND & AIMS - Two case-control studies have shown that folate may protect against neoplasia in ulcerative colitis. This historical cohort study was performed to better define this association.
METHODS - The records of 98 patients with ulcerative colitis who had disease proximal to the splenic flexure for at least 8 years were reviewed. Documented folate use of at least 6 months was deemed a positive exposure.
RESULTS - Of the patients, 29.6% developed neoplasia and 40.2% took folate supplements. The adjusted relative risk (RR) of neoplasia for patients taking folate was 0.72 (95% confidence interval [CI], 0.28-1.83). The dose of folate varied with the risk of neoplasia (RR, 0.54 for 1.0 mg folate; RR, 0.76 for 0.4 mg folate in a multivitamin compared with patients taking no folate). Folate use also varied with the degree of dysplasia (RR for cancer, 0.45; RR for high-grade dysplasia, 0.52; RR for low-grade dysplasia, 0.75 compared with patients with no dysplasia) (P = 0.08).
CONCLUSIONS - Although not statistically significant, the RR for folate supplementation on the risk of neoplasia is < 1 and shows a dose-response effect, consistent with previous studies. Daily folate supplementation may protect against the development of neoplasia in ulcerative colitis.
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12 MeSH Terms
Physical restraint use in the hospital setting: unresolved issues and directions for research.
Mion LC, Minnick A, Palmer R
(1996) Milbank Q 74: 411-33
MeSH Terms: Behavior Control, Beneficence, Federal Government, Government Regulation, Health Services Research, Hospital-Patient Relations, Humans, Inpatients, Liability, Legal, Moral Obligations, Nursing Service, Hospital, Patient Advocacy, Patient Rights, Personal Autonomy, Restraint, Physical, Risk Assessment, Risk Management, United States, Utilization Review
Show Abstract · Added January 20, 2015
Although the use of physical restraint has declined in nursing homes, the practice remains widespread in hospitals. The use of physical restraint in hospitals was reviewed to identify the current clinical, legal, and ethical issues and the implications for policy and further research. Clinicians use physical restraints to prevent patient falls, to forestall disruption of therapy, or to control disruptive behavior, but they vary in how they determine to institute these restraints. The evidence to support the reasons for their determinations is not compelling. Fear of litigation remains a powerful motivator. The ethical dilemma of autonomy versus beneficence has not been resolved satisfactorily for patients in this setting. The lack of large-scale studies in any of these areas makes it difficult for policy makers to determine whether it is necessary to address hospital physical restraint practices through additional regulation.
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19 MeSH Terms