Biomedical subjects

Bernard Rosner

Publications and source records attributed to Bernard Rosner.

66 records · Page 4Linked to original sources

PubMed2002

Use of postmenopausal hormones, alcohol, and risk for invasive breast cancer.

BACKGROUND: Physiologic evidence suggests that use of alcohol increases the risk for breast cancer through a hormonal mechanism, but the relationship among breast cancer, alcohol, and postmenopausal hormones (PMH) remains unclear. OBJECTIVE: To examine the relation between concurrent use of alcohol and PMH and invasive breast cancer. DESIGN: Prospective cohort study SETTING: Nurses' Health Study. PARTICIPANTS: 44 187 postmenopausal women. MEASUREMENTS: Self-reported data on PMH use and breast cancer obtained from biennial questionnaires completed from 1980 to 1994 and average alcohol consumption in 1980, 1984, 1986, and 1990. RESULTS: 1722 women developed invasive breast cancer. Risk for breast cancer was elevated in women who currently used PMH for 5 or more years and did not drink alcohol (relative risk, 1.32 [95% CI, 1.05 to 1.66]) and those who never used PMH but drank 20 or more g (1.5 to 2 drinks) of alcohol daily (relative risk, 1.28 [CI, 0.97 to 1.69]). Current users of PMH for 5 or more years who consumed 20 or more g of alcohol daily had a relative risk for breast cancer nearly twice (1.99 [CI, 1.42 to 2.79]) that of nondrinking nonusers of PMH. A hypothetical postmenopausal woman whose lifetime risk for breast cancer is 4% could increase her risk to 8% with 5 or more years of current PMH use and consumption of more than one alcoholic drink daily. CONCLUSIONS: Both alcohol consumption and PMH use were associated with an increased incidence of breast cancer. Women who are currently taking PMH may want to consider the added risks of regular alcohol consumption.

Alcohol Drinking↗

PubMed2002

Frequency of analgesic use and risk of hypertension in younger women.

BACKGROUND: In addition to their antipyretic, anti-inflammatory, and pain-relieving effects, analgesics may interfere with blood pressure regulation. However, little prospective information is available on the association between analgesic use and the risk of hypertension. METHODS: We performed a prospective study of 80 020 women aged 31 to 50 years who participated in the Nurses' Health Study II and had no previous history of hypertension. Frequency of use (in days per month) of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen was collected by mailed questionnaire in 1995. Incident cases of physician-diagnosed hypertension were identified by self-report on the 1997 biennial questionnaire. RESULTS: During 164 090 person-years of follow-up, 1650 incident cases of hypertension were identified. At least 1 d/mo, 51.2% of the cohort used aspirin, 76.7% used NSAIDs, and 72.5% used acetaminophen. After adjusting for age, all 3 classes of analgesics were associated with an increased risk of incident hypertension (P<.001 for trend). After further adjustment for all 3 analgesics and other potential risk factors, only NSAIDs and acetaminophen (P<.001 for trend for both) were significantly associated with risk of hypertension. Compared with nonusers, the relative risk of hypertension for women taking NSAIDs 22 d/mo or more was 1.86 (95% confidence interval, 1.51-2.28) and for those taking acetaminophen 22 d/mo or more was 2.00 (95% confidence interval, 1.52-2.62). CONCLUSIONS: Use of NSAIDs and use of acetaminophen were significantly associated with increased risk of hypertension, but aspirin use was not. A substantial proportion of hypertension in the United States, and the associated morbidity and mortality, may be due to the use of these medications.

Acetaminophen↗

PubMed2002

Correlates of bone and blood lead levels among middle-aged and elderly women.

In 1993-1995, the authors evaluated risk factors for elevated blood and bone lead levels in 264 Boston, Massachusetts, area women previously selected for a case-control study of lead and hypertension. Bone lead was measured at the tibia and patella with K x-ray fluorescence. Blood lead was analyzed by graphite furnace atomic absorption. Participants were aged 46-74 years and had mean lead levels of 3 (standard deviation, 2) micro g/dl (blood), 13 (standard deviation, 9) micro g/g (tibia), and 17 (standard deviation, 11) micro g/g (patella). In multivariate linear regression models, use of postmenopausal estrogen (inverse) and alcohol intake (positive) were significantly associated with blood lead levels. Both bone lead measures were significantly and positively associated with blood lead but only among postmenopausal women not using estrogen; for example, an increase from the first to the fifth quintile of tibia lead level (19 micro g/g) was associated with a 1.7- micro g/dl increase in blood lead (p = 0.0001) in this group. Older age and lower parity were associated with higher tibia lead; only age was associated with patella lead. The observed interaction of bone lead with estrogen status in determining blood lead supports the hypothesis that increased bone resorption, as occurs postmenopausally because of decreased estrogen production, results in heightened release of bone lead stores into blood.

Aged↗

PubMed2002

Smoking cessation and risk of cataract extraction among US women and men.

Although the observational evidence linking cigarette smoking with risk of senile cataract is well-established, it is unclear whether any benefit is obtained from quitting smoking. Therefore, in this study, the authors examined the association between time since quitting smoking and incidence of cataract extraction in women and men enrolled in the Nurses' Health Study and the Health Professionals Follow-up Study, respectively. There were 4,281 incident physician-confirmed cases of cataract and 1,038,493 accumulated person-years of follow-up. Compared with current smokers, former smokers who had quit smoking 25 or more years previously had a 20% lower risk of cataract extraction after adjustment for age, average number of cigarettes smoked per day, and other potential risk factors (relative risk (RR) = 0.80, 95% confidence interval (CI): 0.71, 0.91). However, risk among past smokers did not decrease to the level seen among never smokers (for never smokers, RR = 0.64, 95% CI: 0.52, 0.79). The observed relation was similar when data were examined by cataract subtype (>25 years since quitting vs. current smoking: primarily nuclear cataract, RR = 0.82, 95% CI: 0.68, 0.97; primarily posterior subcapsular cataract, RR = 0.90, 95% CI: 0.71, 1.13). These findings suggest that any healing from damage due to cigarette smoking occurs at a very modest pace, and they emphasize the importance of never starting to smoke or quitting early in life.

Aged↗

PubMed2002

Long-term treatment of erythropoietic protoporphyria with cysteine.

A Phase III 3 year placebo-controlled trial, in which patients were blinded as to when placebo was given, was conducted to determine if the administration of L-cysteine-HCl was effective in preventing or ameliorating the photosensitivity associated with erythropoietic protoporphyria. Forty-seven patients participated in the trial. Placebo was administered in the first month of the trial and then 500 mg of cysteine was given in two divided doses per day for the duration of the study. To measure efficacy, baseline and follow-up visit history forms and light-exposure diaries were filled in by the patients, and those seen in Boston were phototested. Analysis of the data from the questionnaires, the minutes of symptom-free light exposure recorded in diaries and history forms and the results of the phototests showed that cysteine increased the time of symptom-free light exposure to a statistically significant degree.

Adult↗

PubMed2002

Piriformis syndrome: diagnosis, treatment, and outcome--a 10-year study.

OBJECTIVES: To validate an operational definition of piriformis syndrome based on prolongation of the H-reflex with hip flexion, adduction, and internal rotation (FAIR) and to assess efficacy of conservative therapy and surgery to relieve symptoms and reduce disability. DESIGN: Before-after trial of cohorts identified by operational definition. SETTING: Outpatient departments of 2 hospitals and 4 physicians' offices. Surgery performed at 3 hospitals. PATIENTS: Consecutive sample of 918 patients (1014 legs) with follow-up on 733. INTERVENTION: Patients with significant (3 standard deviations [SDs]) FAIR tests received injection, physical therapy, and serially reported pain and disability assessments. Forty-three patients (6.47%) had surgery. MAIN OUTCOME MEASURES: Likert pain scale. Subjective estimates of disablement in activities of daily living and instrumental activities of daily living. RESULTS: At 3 SDs, the FAIR test had sensitivity and specificity of.881 and.832, respectively. Seventy-nine percent (514/655) of FAIR test positive (FTP) patients improved 50% or more from injection and physical therapy at a mean follow-up of 10.2 months. Average improvement was 71.1%. Of 385 FTP patients with disability data, mean disability fell from 35.37% prestudy (SD =.2275) to 12.96% poststudy (SD =.1752), a 62.8% improvement. Twenty-eight surgical FTP patients (68.8%) showed 50% or greater improvement; mean improvement was 68% at a mean follow-up of 16 months. Surgery reduced the mean FAIR test to 1.35 +/- 2.17 months postoperatively. FTP patients generally improved 10% to 15% more than others after conservative treatment. CONCLUSIONS: The FAIR test correlates well with a working definition of piriformis syndrome and is a better predictor of successful physical therapy and surgery than the working definition. The FAIR test, coupled with injection and physical therapy and/or surgery, appears to be effective means to diagnose and treat piriformis syndrome.

Activities of Daily Living↗

PubMed2002

Postmenopausal hormone use and lens opacities.

PURPOSE: Women are at higher risk for age-related cataract than men, and it has been hypothesized that this difference is due in part to gender-related hormonal differences. METHODS: We investigated the association between postmenopausal hormone use and lens opacities in a population of 480 postmenopausal women from the Nurses' Health Study for whom we had prospectively collected exposure data. Participants received standardized eye exams; the Lens Opacity Classification System III (LOCS III) was used to measure the degree of opacification. RESULTS: A total of 342 women had some opacity in one or both eyes. Overall, we did not observe a significant association between current hormone use and presence of any type of opacity (compared to never users, multivariate relative risk: 0.85; 95% confidence interval (CI): 0.54-1.34). In ordinal logistic regression compared to never users, current hormone users had multivariate relative risks of cortical opacities of 0.80 (95% CI: 0.54-1.19) and for past users the relative risk was 0.76 (95% CI: 0.48-1.22). For nuclear opacities, the comparable relative risk for current use of hormones was 0.77 (95% CI: 0.52-1.13), and for past use the relative risk was 1.48 (95% CI: 0.92-2.34). Current use of estrogen-only preparations was associated with a 49% decreased risk of nuclear opacities compared to never use (multivariate relative risk 0.51, 95% CI: 0.29-0.89). CONCLUSIONS: While the overall findings are null, they do not exclude the possibility of a protective effect, particularly among current estrogen users.

Cataract↗

PubMed2002

BOTOX and physical therapy in the treatment of piriformis syndrome.

OBJECTIVE: This study evaluates the efficacy of botulinum toxin A injections used in conjunction with physical therapy for the treatment of piriformis syndrome. DESIGN: This a double-blind, placebo controlled clinical trial using electrophysiologic criteria for patient selection and a visual analog scale to assess treatment efficacy in relieving pain. RESULTS: As measured on the visual analog scale, patients injected with botulinum toxin A experienced more relief from pain than patients receiving lidocaine with steroid (P < 0.05) and more relief than patients receiving placebo (P = 0.001). CONCLUSIONS: Injection with botulinum toxin A is an effective adjunct to physical therapy in the treatment of piriformis syndrome. H-reflex prolongation by flexion, adduction, and internal rotation (FAIR test) beyond 1.86 msec (3 SD) of the mean is a clinical indication of piriformis syndrome.

Botulinum Toxins, Type A↗

PubMed2002

Neonatal blood pressure and salt taste responsiveness.

To test the association between neonatal blood pressure (BP) and salt taste response, 283 healthy hospitalized neonates were administered small drops (0.06 mL) of water and 0.1 molar (mol/L) and 0.3 mol/L NaCl solutions by means of cannulas through a nipple with a pressure transducer to record sucking responses. Neonatal and 1-month BPs were recorded by ultrasound. Mean number of sucks per burst was scored as "aversive" if the 0.3 mol/L salt minus water difference score was < or =-10 mean sucks per burst, "preferential" if this difference was >0, and "neutral" otherwise. Babies with "preferential" responses had higher diastolic BPs than those with neutral (1.9 mm Hg) or aversive responses (3.1 mm Hg) (P trend=0.05). After adjustment for age, gender, birth weight, and activity for babies with at least one grandparent receiving antihypertensive medication, mean adjusted systolic pressure was 6.7 mm Hg higher (P=0.003) (P trend=0.003) and mean adjusted diastolic pressure was 5.0 mm Hg higher (P=0.010) (P trend=0.011) in neonates with preferential versus aversive salt taste responses. There was no relation of BP to sucking responses to sweet (sucrose) stimuli. Neonates can distinguish between dilute salt solutions and water. This response is related to BP and might be a potential risk factor for high BP later in life.

Blood Pressure↗

PubMed2002

Breathing easy: a prospective study of optimism and pulmonary function in the normative aging study.

Although there is good evidence that emotions are associated with chronic airways obstruction, evidence for the influence of psychological factors on the level and decline of pulmonary function is sparse. Optimism has been linked to enhanced well-being, whereas pessimism has been identified as a risk factor for poor physical health. This investigation examines prospectively the effects of optimism versus pessimism on pulmonary function. Data are from the Veterans Administration Normative Aging Study, an ongoing cohort of older men. In 1986, 670 men completed the revised Minnesota Multiphasic Personality Inventory from which we derived the bipolar Revised Optimism-Pessimism Scale. During an average of 8 years of follow-up, an average of 3 pulmonary function exams were obtained. Men with a more optimistic explanatory style had significantly higher levels of forced expiratory volume in 1 sec (FEV1) and forced vital capacity (both p < .01). Interactions between time and optimism suggested that rate of decline in FEV1 over time was slower in men with a more optimistic explanatory style relative to men who were more pessimistic. These data are the first to link optimism with higher levels of pulmonary function and slower rate of pulmonary function decline in older men, a protective effect that is independent of smoking.

Adult↗

PubMed2002

Disease progression in patients with dominant retinitis pigmentosa and rhodopsin mutations.

PURPOSE: To measure the rate of progression of retinal degeneration in patients with retinitis pigmentosa due to dominant rhodopsin mutations and to determine whether the rate of progression correlates with the location of the altered amino acid in the rhodopsin molecule. METHODS: Change in ocular function was observed for an average of 8.7 years in 140 patients. After censoring data to eliminate "ceiling" and "floor" effects, longitudinal rates of change were compared, after weighting by follow-up time and number of visits, with rates inferred from cross-sectional analyses of the data from baseline visits. Mean rates of change were compared among groups of patients with mutations affecting the globule, plug, or C-terminal region of the protein after adjusting for age, gender, and baseline function. RESULTS: Mean annual exponential rates of decline were 1.8% for visual acuity, 2.6% for visual field area, and 8.7% for ERG amplitude. The rates of visual acuity and ERG amplitude decline were significantly faster, and the rate of visual field area decline was significantly slower, than those inferred from baseline visits. Rates of acuity loss did not vary significantly with the region affected by the mutation. In contrast, the mean annual rate of field loss in the C terminus group (7.4%) was significantly faster than that in the globule (1.7%) or plug (1.1%) group. The mean annual rate of ERG decline was also significantly faster in the C terminus group (13.5%) than in the globule (8.5%) or plug (3.7%) groups and significantly faster in the globule group than in the plug group. CONCLUSIONS: Rates of decline in visual function for groups of patients with rhodopsin mutations cannot be accurately inferred from cross-sectional analyses of baseline visits. Average rates of decline of visual field area and ERG amplitude are fastest in patients with mutations affecting the C-terminal region.

Adolescent↗

PubMed1990

The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation.

BACKGROUND: Nonrheumatic atrial fibrillation increases the risk of stroke, presumably from atrial thromboemboli. There is uncertainty about the efficacy and risks of long-term warfarin therapy to prevent stroke. METHODS: We conducted an unblinded, randomized, controlled trial of long-term, low-dose warfarin therapy (target prothrombin-time ratio, 1.2 to 1.5) in patients with nonrheumatic atrial fibrillation. The control group was not given warfarin but could choose to take aspirin. RESULTS: A total of 420 patients entered the trial (212 in the warfarin group and 208 in the control group) and were followed for an average of 2.2 years. Prothrombin times in the warfarin group were in the target range 83 percent of the time. Only 10 percent of the patients assigned to receive warfarin discontinued the drug permanently. There were 2 strokes in the warfarin group (incidence, 0.41 percent per year) as compared with 13 strokes in the control group (incidence, 2.98 percent per year), for a reduction of 86 percent in the risk of stroke (warfarin:control incidence ratio = 0.14; 95 percent confidence interval, 0.04 to 0.49; P = 0.0022). There were 37 deaths altogether. The death rate was markedly lower in the warfarin group than in the control group: 2.25 percent as compared with 5.97 percent per year, for an incidence ratio of 0.38 (95 percent confidence interval, 0.17 to 0.82; P = 0.005). There was one fatal hemorrhage in each group. The frequency of bleeding events that led to hospitalization or transfusion was essentially the same in both groups. The warfarin group had a higher rate of minor hemorrhage than the control group (38 vs. 21 patients). CONCLUSIONS: Long-term low-dose warfarin therapy is highly effective in preventing stroke in patients with non-rheumatic atrial fibrillation, and can be quite safe with careful monitoring.

Aged↗