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PubMed2006

Urinary incontinence after radical retropubic prostatectomy is not related to patient body mass index.

To determine if a relationship exists between patient body habitus and urinary incontinence after radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. A questionnaire developed by combining parts of lower urinary tract symptom questionnaires concerning voiding symptoms after RRP was mailed to 268 consecutive patients who underwent RRP over a 2-year period. The interval between surgery and questionnaire administration was greater than 24 months for each patient. No interval was greater than 54 months. The questionnaire attempted to overcome the subjectivity of patient documented urinary incontinence by probing different aspects of each patient's voiding symptoms. Body mass index (BMI), obtained from preoperative anesthesia records, was used as the measurement for body habitus. Pearson correlations were used to determine relationships between BMI and responses and the independent t-test was used to determine differences between grouped responses and BMI. One hundred and eighty-two of 268 (68%) questionnaires were returned. No relationship was detected between BMI and patient estimates of urinary control, QOL relating to urinary symptoms, severity of stress incontinence, or use of protection (pad use). As well, no statistically significant relationship was found between BMI and a patient's willingness to undergo RRP again, based on his voiding symptoms, if given the choice. In conclusion, although patient body habitus may be related to other clinical outcomes following RRP, there does not appear to be a relationship of BMI to post-RRP urinary incontinence.

Adult↗
PubMed2002

Knowledge of health care benefits among patients with depression.

OBJECTIVE: To evaluate the accuracy of patient self-reports of health care insurance coverage relative to actual health care benefits and to explore patient predictors of accuracy among patients with depression. METHODS: Data were analyzed from 767 patients with current depressive symptoms and disorder who completed a self-report mail survey that included questions about health insurance and for whom we also obtained actual health care benefits records. Percentage agreement and kappa statistics were calculated for different types of benefits (medical visit, pharmacy and mental health visit copays, and mental health visit limits), and we used multivariate analysis to examine predictors of accuracy. RESULTS: Accuracy of self-reports relative to administrative data were good for measures of medical visits and prescription copays (kappa = 0.79 and 0.64), but less accurate for measures of mental health benefits (kappa = 0.19 for copays and 0.40 for visit coverage). Recent use of health care services (past 6 months) increased the accuracy of medical benefits but not of mental health benefits. Inaccuracy of mental health benefits was in the direction of patients perceiving more generous coverage than was actually available to them. Men and those with greater wealth were more knowledgeable about their medical benefits. Those from a nonminority ethnic group, who were less satisfied, and were less sick had better knowledge about their mental health benefits. CONCLUSIONS: Agreement between self-reports and actual benefits was stronger for general medical services than for mental health care. Background, experience, and sickness lead to more accurate recall of insurance information.

Adult↗
PubMed1996

Reported alcohol use and behavior in long-distance runners.

Because alcohol may impair sports performance, we hypothesized there would be less drinking in serious recreational runners. We used mailed questionnaires to examine drinking patterns (2-wk quantity/frequency), scores on modified versions of the Michigan Alcoholism Screening Test (brief MAST [BMAST], short MAST [SMAST]), and parental history of problem drinking in 397 men and 144 women runners participating in a 20-mile race, compared with a nonexercising control population of 138 men and 119 women. A subset of 188 pairs (104 men, 84 women) were matched for gender, age, educational level, and marital status. We used chi-square analysis, paired t-test, and ANOVA. Male gender, running, and a family history for problem drinking predicted increased total alcohol consumption. We found that male runners (vs male controls) drank more 14.2 +/- 19.6 vs 5.4 +/- 7.6 drinks.wk-2, P = 0.004) and felt guilty about their drinking (26.6% vs 13.8%, P < 0.01). Men and women runners reported more occasions of drinking than matched controls (2.8 +/- 2.7 vs 2.0 +/- 2.3.wk-2, P = 0.004). Runners with scores on the BMAST (> or = 6) or SMAST (> or = 3) suggestive of a history of problem drinking drank less than controls with a similar score. Contrary to our hypothesis, running is associated with increased alcohol consumption, except in those who report a history of problem alcohol behavior.

Adult↗
PubMed1999

Current methods of finish-line exposure by practicing prosthodontists.

PURPOSE: The purpose of this study was to survey members of The American College of Prosthodontists to evaluate current methods of finish-line exposure. In addition, frequency of use of epinephrine compounds and observed side effects were assessed. MATERIALS AND METHODS: A questionnaire was mailed to the 2,436 members of The American College of Prosthodontists. Group differences were evaluated using chi 2 analysis. RESULTS: Completed questionnaires were returned by 1,246 prosthodontists, which is a return rate of 51%. Ninety-eight percent of respondent prosthodontists use retraction cord, and 48% use a double-cord technique. Plain cord is the most commonly used cord (44%), followed by aluminum chloride-impregnated cord (18%), and epinephrine-impregnated cord (14%). Nine hundred one respondents (81%) soak the cord before placing it in the gingival sulcus. The most common medicament for soaking the cords is buffered aluminum chloride (55%). Side effects to epinephrine were reported by 387 respondents (33%), with the most common side effect reported being increased pulse rate, followed by anxiety. Approximately one quarter (24%) of the prosthodontists surveyed had observed side effects to chemical agents other than epinephrine. CONCLUSIONS: Prosthodontists throughout the country use many different techniques and agents to expose finish lines. No statistically significant differences (p > .05) were found between year of specialty training completion groups with respect to retraction cord use. Copper bands are used significantly more frequently (p < .05) in the northwest region of the United States than elsewhere.

Aluminum Chloride↗
PubMed2006

Demographic variables affecting patient referrals from general practice dentists to periodontists.

BACKGROUND: Within dentistry, a limited body of literature exists regarding the referral relationships between general practitioners (GPs) and specialists. The purpose of this study was to investigate the referral relationship between GPs and periodontists within the state of Virginia. METHODS: A survey was developed that focused on the demographic variables in the referral relationship between GPs and periodontists. The survey was mailed to 800 dentists throughout the state of Virginia. Descriptive statistics were completed along with multivariate logistic regression analysis comparing the responses with the number of patients referred per month to periodontists. RESULTS: Female respondents were more likely to refer three or more patients per month to a periodontist than a male respondent (P<0.02). Those dentists who practiced with one other dentist were twice as likely to refer more frequently when compared to solo practitioners or larger group practices (P<0.03). Dentists employing two hygienists were more likely to refer patients than those with fewer hygienists (P<0.02). Those whose practices were >5 miles from the nearest periodontist were more likely to refer patients compared to dentists geographically closer to a periodontist (P<0.02). No other variables had a significant effect on the referral of more patients per month to a periodontist. CONCLUSIONS: This study indicates that four demographic variables have a statistical influence on the number of referrals per month from a GP to a periodontist. These variables are as follows: female gender, practicing with one other dentist, employing two or more hygienists, and being >5 miles away from the nearest periodontist.

Adult↗
PubMedDate not supplied

Does a 3-day workshop for family medicine trainees improve preventive care? A randomized control trial.

OBJECTIVE: To evaluate the impact on clinical behavior of a 3-day workshop designed to increase trainees' rates of smoking cessation counseling and reminders about Pap smears in routine consultations. DESIGN: Randomized control trial. SETTING: Accredited teaching practices of the Royal Australian College of General Practitioners' Training Program. SUBJECTS: Thirty-four trainees and 1,500 consecutive adult patients ages 16-65 years. METHOD: Trainees randomly allocated to the experimental group participated in a 3-day interactive workshop on disease prevention during their 13-week family medicine term. Audiotapes of consultations with adults conducted by trainees at the beginning and end of the rotation were analyzed blind to compare assessment of patients' smoking status and, for women, date of last Pap smear. A questionnaire mailed to each patient after the consultation also allowed identification of smokers and women overdue for a smear. Consultations with these patients at risk were analyzed for preventive counseling. Inter- and intrarater reliability was calculated for audiotape analysis. RESULTS: Preworkshop rates of questions about smoking were low, occurring in 22% of consultations. While trainees allocated to the experimental workshop were more likely to ask a routine question about smoking at the end of the term than those in the control group (P = 0.01), two-thirds of smokers remained undetected irrespective of trainee group and fewer than one in five were advised to stop smoking. Reminders about Pap smears did not change as a result of training and remained low in fewer than 20% of consultations. kappa values demonstrated high reliability of audiotape analysis. CONCLUSION: This direct measurement of clinical behavior revealed that low levels of preventive care provided by trainees are resistant to skills training without reinforcement in clinical practice. In view of the importance of prevention in routine consultations, we recommend continued evaluation of more intensive educational programs. Those withstanding rigorous evaluation could be considered for implementation in similar training contexts seeking to improve the frequency and quality of disease prevention in primary medical care.

Adolescent↗
PubMed1999

ASHP national survey of pharmacy practice in acute care settings: prescribing and transcribing--1998. American Society of Health-System Pharmacists.

Results of the 1998 ASHP national survey of pharmacy practice in acute care settings that pertain to prescribing and transcribing practices are presented. Pharmacy directors at 1058 general and children's medical-surgical hospitals in the United States were surveyed by mail. Data on hospital characteristics were supplied by SMG Marketing Group, Inc.; the survey sample was drawn from SMG's hospital database. The response rate was 51.8%. Respondents reported that at least 90% of hospital and health-system pharmacy and therapeutics (P&T) committees are responsible for formulary development and management, drug policy development, medication-use evaluation, adverse-drug-reaction reporting, and medication error monitoring. More than 90% of the facilities use pharmacoeconomic, clinical and therapeutic, and cost information in formulary development; 83% have a medication-use-evaluation program designed to improve prescribing; more than 95% have P&T committees, infection control committees, and quality control committees; and more than 80% provide pharmacist consultations on drug information, dosage adjustments for patients with renal impairment, antimicrobials, and pharmacokinetics. A majority of respondents reported that accurate transcription of medication orders is ensured by use of standardized physician order forms, clarification of illegible orders, reconciliation of medication administration records (MARs) and pharmacy profiles at least daily, and use of computer-generated MARs. The 1998 ASHP survey results suggest that pharmacists in acute care settings have positioned themselves well to improve the prescribing and transcription components of the medication-use process.

Ambulatory Care↗
PubMed1995

Smoking cessation counseling by emergency physicians: opinions, knowledge, and training needs.

OBJECTIVES: To determine: 1) the extent of emergency physicians' (EPs') training in smoking cessation counseling; 2) their understanding of counseling and pharmacologic treatment techniques; 3) their current practices in screening, counseling, and referring patients who smoke; and 4) perceived barriers to routine smoking cessation counseling in emergency medical practice. METHODS: A 26-item questionnaire addressing the above issues was mailed to all 256 members of the Colorado Chapter of the American College of Emergency Physicians. RESULTS: Completed questionnaires were returned by 196 physicians (77% response rate). The majority of respondents were men (80%), practiced in urban settings (87%), and were board-certified in emergency medicine (82%). Most EPs lacked formal smoking cessation training (55%) and felt poorly prepared to counsel patients about smoking cessation (65%). A minority (27%) of the physicians reported routinely asking patients to quit smoking. The physicians with formal smoking cessation training were more likely to counsel and refer patients routinely (34% vs 20%, p = 0.03). The physicians cited the following barriers to routine smoking cessation counseling: a lack of time; a perception that patients are not interested; a belief that the ED setting is inappropriate for counseling; and a sense that counseling is ineffective. Lack of reimbursement was cited by only 13% of the respondents. The physicians who had formal smoking cessation training perceived fewer barriers to ED-based counseling. CONCLUSIONS: Emergency physicians have received little training in smoking cessation and perceive many barriers to ED-based smoking cessation interventions. Not surprisingly, they infrequently take action to encourage or assist their patients to quit smoking.

Adult↗
PubMedDate not supplied

Automated external defibrillators in National Collegiate Athletic Association Division I Athletics.

BACKGROUND: Sudden cardiac death is the leading cause of death in athletes. Evidence on current sudden cardiac death prevention through preparticipation history, physicals, and noninvasive cardiovascular diagnostics has demonstrated a low sensitivity for detection of athletes at high risk of sudden cardiac death. Data are lacking on automated external defibrillator programs specifically initiated to respond to rare dysrhythmia in younger, relatively low-risk populations. METHODS: Surveys were mailed to the head athletic trainers of all National Collegiate Athletic Association Division I athletics programs listed in the National Athletic Trainers' Association directory. In all, 303 surveys were mailed; 186 departments (61%) responded. RESULTS: Seventy-two percent (133) of responding National Collegiate Athletic Association Division I athletics programs have access to automated external defibrillator units; 54% (101) own their units. Proven medical benefit (55%), concern for liability (51%), and affordability (29%) ranked highest in frequency of reasons for automated external defibrillator purchase. Unit cost (odds ratio = 1.01; 95% confidence interval, 1.01-1.0), donated units (odds ratio = 1.92; confidence interval, 3.66-1.01), institution size (odds ratio =.0001; confidence interval, 1.3 E-4 to 2.2E-05), and proven medical benefit of automated external defibrillators (odds ratio = 24; confidence interval, 72-8.1) were the most significant predictors of departmental defibrillator ownership. Emergency medical service response time and sudden cardiac death event history were not significantly predictive of departmental defibrillator ownership. The majority of automated external defibrillator interventions occurred on nonathletes. CONCLUSIONS: Many athletics medicine programs are obtaining automated external defibrillators without apparent criteria for determination of need. Usage and maintenance policies vary widely among departments with unit ownership or access. Programs need to approach the issue of unit acquisition and implementation with knowledge of the surrounding emergency medical service system, geography of their individual sports medicine facilities, numbers and relative risk of their athletes, and budgetary constraints.

Chi-Square Distribution↗
PubMed2005

Perspectives on the impact of ovarian cancer: women's views of quality of life.

PURPOSE/OBJECTIVES: To describe quality-of-life (QOL) concerns particular to women with ovarian cancer and to examine whether subgroups of patients with ovarian cancer have significantly different QOL concerns. DESIGN: Mailed survey. SAMPLE: Readership of an ovarian cancer newsletter. METHODS: A total of 1,383 surveys were received in response to the survey's inclusion in the November 2002 issue of Conversations! The International Newsletter for Those Fighting Ovarian Cancer, a monthly newsletter circulated to 3,300 women with ovarian cancer (response rate = 42%). Women were asked to complete the 45-item City of Hope QOL Ovarian Cancer Tool (QOL-OVCA) and a short demographic questionnaire. MAIN RESEARCH VARIABLES: Patients' QOL-OVCA scores were compared across six independent variables, including disease status, age at diagnosis, stage at diagnosis, marital status, household income, and use of alternative therapy, controlling for survival time. FINDINGS: Ovarian cancer survivors reported significant QOL concerns across dimensions of physical, psychological, social, and spiritual well-being. CONCLUSIONS: Patients with ovarian cancer experience particular QOL concerns requiring support. Future research is needed to describe the needs of survivors in more diverse populations and to develop and test interventions that can address these QOL concerns. IMPLICATIONS FOR NURSING: Women with ovarian cancer experience QOL concerns common to other patients with cancer and some that are particular to ovarian cancer. Nurses should assess for and aggressively address these QOL concerns.

Adult↗
PubMed2001

Nonresponse in a follow-up to a representative telephone survey of adult drinkers.

OBJECTIVE: Examined predictors of nonresponse among respondents who agreed to receive a follow-up questionnaire on alcohol use after participating in a representative telephone survey, and among respondents who did and did not return the follow-up questionnaire. METHOD: A total of 2,072 (52.2% female) respondents to a representative monthly telephone survey were assessed on sociodemographic variables and alcohol use. Respondents were asked whether they would be willing to fill out an additional mailed questionnaire on alcohol use and attitudes toward drinking. Almost half (n = 956; 46%) of respondents agreed to participate in the follow-up survey; 430 (45%) of those individuals completed and returned the questionnaire. RESULTS: Agreement to receive the follow-up questionnaire was unrelated to alcohol use. Regarding gender, men were 1.42 times more likely than women to exhibit nonresponse in returning the follow-up questionnaire (95% CI: 1.08-1.42). After adjusting for the impact of demographic factors, respondents who consumed alcohol at least once per week were 1.43 times more likely than respondents who drank less frequently to exhibit nonresponse in returning the questionnaire (95% CI: 1.05-1.93). Respondents who consumed five or more standard drinks at least once per week were 1.83 times more likely to exhibit nonresponse in returning the questionnaire, compared with respondents who engaged in heavy drinking less frequently (95% CI: 1.15-2.92). CONCLUSIONS: Mailout questionnaires following a representative telephone survey may bias samples toward obtaining fewer men, fewer weekly drinkers and fewer heavier drinkers. Although the magnitude of these biases were relatively small, epidemiological studies on alcohol use may wish to oversample men and heavier drinkers in follow-up studies recruiting from population surveys.

Adult↗
PubMed1998

Dental fear among university students: implications for pharmacological research.

University students are often subjects in randomized clinical trials involving anxiolytic and analgesic medications used during clinical dental and medical procedures. The purpose of this study was to describe a typical university student population available for research by using data from a mail survey. Subjects were 350 students chosen randomly from all enrolled, full-time, traditional students on the main campus at the University of Washington in Seattle, WA. The aim was to determine the extent and nature of dental anxiety in this population. In addition, the relationships between subject willingness to receive dental injections and general and mental health and medical avoidance and medical fears were examined. The Dental Anxiety Scale (DAS) was used to measure dental anxiety. Dental anxiety was prevalent in this population; 19% of students reported high rates of dental fear. Thirteen percent of students had never had a dental injection. Students with no experience with dental injections were more reluctant than those with experience to receive an injection if one were needed. DAS scores were correlated with injection reluctance. Students who were reluctant to go ahead with a dental injection also reported poorer general and mental health than those who were less reluctant. These students also reported higher medical avoidance and medical anxiety scores. University students provide a rich source of potential subjects for clinical research. The student population, like the community at large, contains people with high levels of dental and medical fear.

Anesthesia, Dental↗
PubMed1995

Trend analysis of changes in family practice residency graduates' practice characteristics and comparison with recent graduates.

BACKGROUND AND OBJECTIVES: Graduate follow-up studies provide medical educators with important evaluation information and insight into graduates' practices. This study compares early practice choices of two cohorts of family practice residents who graduated a decade apart. The earlier cohort's changes in practice characteristics over a 10-year period were also analyzed. METHODS: Using a mailed survey, graduates of the University of California-Davis Family Practice Residency Network have been periodically surveyed since 1978. Using data from these surveys, early practice choices of the two cohorts were compared. In addition, the responses of the earlier cohort were tracked over time to determine whether any early practice patterns still existed. RESULTS: Significant differences in the early practice choices of the two cohorts of graduates were found in the areas of practice organization, use of mid-level practitioners, perception of need for primary care physicians, and inclusion of pregnancy care in practice. A significantly lower percentage of recent graduates had entered private practice, compared with the earlier cohort (37% vs 50%, P = .02). Recent graduates were more likely to perceive a need for primary care physicians. Finally, the early practice choice differences between the two cohorts had all but disappeared 10 years later as the earlier cohort's practices had changed to resemble more closely those of the recent graduates. CONCLUSIONS: This study concludes that the practices of both established family physicians and recent graduates are changing. Residency faculty must understand how these changes influence the skill and knowledge needs of their future graduates and should design practice management curricula accordingly.

California↗
PubMed1998

[A survey on the inclusion criteria in pediatric dialysis and transplantation programs in terminal renal failure].

OBJECTIVE: The purpose of this study was to know the current practices of Spanish pediatric nephrologists concerning the inclusion or not of children with end-stage renal disease (ESRD) in programs of dialysis and transplantation in order to open a discussion on the topic that would allow a consensus to be reached. PATIENTS AND METHODS: A descriptive and prospective study using an anonymously mailed survey to 90 members of the Spanish Pediatric Nephrology Association was carried out. RESULTS: The index of response was 43%. In 90% of the physicians polled they believe that some situations exist where it is advisable not to include a child with ERF in dialysis and, although all assure that there are no written procedures, a large majority (85%) think that they should exist, at least in the most representative cases. Serious physical and/or intellectual handicap and poor prognosis constitute the most important factors for making a decision. The expressed desire of the parents is considered the third most important factor by 56%. Of the answers, 82% placed economic cost of the substituting treatments as least important. Ninety-two percent think that not always and not in all cases is it necessary to turn to all possible technical means to extend the life. More than half (54%) think that the last decision must be taken by the physician and the family, although 44% confer this power to the Ethical Committee. CONCLUSIONS: It would be useful to develop guidelines to help pediatric nephrologists and/or ethical committees to decide, with the family of the patient, about the inclusion of the child in ESRD in programs of dialysis and transplantation.

Adolescent↗
PubMed2006

Genetic architecture of smoking behavior: a study of Finnish adult twins.

Both genetic and environmental factors affect smoking initiation and maintenance, but less is known about the genetic architecture of various other smoking-related behaviors. The aim of this study is to examine the genetic architecture of smoking behavior in a large twin cohort. Questionnaires with an extensive smoking history section were mailed to same-sex adult twins of the Finnish twin cohort. The final study population included 2923 monozygotic and 6018 dizygotic twin pairs aged 24 to 88 years. Two-stage bivariate genetic modeling of age at initiation with amount smoked (less than 20 cigarettes per day vs. 20 or more) and age at initiation with smoking cessation was done by using the Mx statistical package. For men the heritability estimate for age at initiation was .59 (95% confidence interval [CI] .49-.69), for amount smoked .54 (95% CI .45-.62) and for smoking cessation .58 (95% CI .50-.65). For women the heritability estimates were .36 (95% CI .28-.43), .61 (95% CI .46-.70) and .50 (95% CI .39-.60), respectively. The genetic correlations between age at initiation and amount smoked or smoking cessation were at most .22 in magnitude, indicating that genetic influences in age at initiation accounted for at most about 4% of the genetic factors in amount smoked or in cessation. Genetic factors are important in amount smoked and smoking cessation and they are largely independent of genetic influences on age at initiation. This has implications for defining phenotypes in searches for genes underlying smoking behaviors.

Age Factors↗
PubMed1996

Career changes among Saskatchewan physicians.

OBJECTIVE: To determine how often Saskatchewan physicians changed career paths during medical training and practice. DESIGN: Population survey (mailed questionnaire). SETTING: Saskatchewan. PARTICIPANTS: All 1077 active members of the Saskatchewan Medical Association were sent a questionnaire; 493 (45.8%) responded. OUTCOME MEASURES: Long-term career goal or plan in next-to-last year of undergraduate medical school, probable choice of career if forced to choose at that time, and number of physicians who changed their field of training or practice at any time since graduation. RESULTS: In all, 57.8% (237/410) of the respondents were currently practising in a field different from that planned in their next-to-last year of medical school, 63.5% (275/436) were not practising in the field they would have chosen if forced to at that time, and 42.9% (211/492) had changed their field of training or practice at some time since graduation. Older physicians, those who graduated outside of Canada and specialists were the most likely to have changed career paths, family physicians, and those who graduated in Saskatchewan were the least likely to have changed. CONCLUSION: The current system of postgraduate training in Canada does not permit career changes of the sort made by most of the practising Saskatchewan physicians in the survey sample. The implications of this new system are as yet unknown but require careful monitoring.

Adult↗
PubMed1996

[The work situation of specialists in family and community medicine educated in Asturias].

OBJECTIVE: To find out the employment situation and the career level of family doctors (FD) trained through residency in Asturias. DESIGN: A descriptive crossover study carried out with a self-filled questionnaire returned by mail. SETTING: All of Spain. PARTICIPANTS: FDs trained through residency in Asturias up to 1993. MEASUREMENTS AND MAIN RESULTS: 178 (89%) of the 200 FDs located replied. 8 who had not finished their course were excluded. Between 1979 and 1983 42 people began their training (24.7%); 42(24.7%) between 1984 and 1987; and 86 (50.5%) between 1988 and 1991. 96 worked in health centres (56.4%); 30 in hospital casualty (17.6%); 9 in administration and management (5.2%); 16 were unemployed (9.4%) and 8 in other posts (4.7%). 49 FD had a permanent post (28.8%); 32 of these had started their training before 1984. 63 (37.5%) chose family and community medicine (FCM) as a vocation. Of these, 26 began their training between 1979 and 1983, 17 between 1984 and 1987 and 20 after 1988. A significant relationship was found between starting training in 1984 or before and choosing FCM as a vocation; and also between starting FCM training in 1984 or before and having a stable job. CONCLUSIONS: The more recent FCM students had less vocational motivation for their choice of FCM and greater difficulty in obtaining a stable job, which may lead to progressive disenchantment with FCM.

Adult↗
PubMed2003

Association of aspirin and other non-steroidal anti-inflammatory drug use with incidence of non-Hodgkin lymphoma.

Non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, seem to have chemopreventive properties against several types of cancer, particularly colon cancer. Persons with rheumatoid arthritis, an autoimmune disease for which NSAIDs are used commonly, have been reported to be at lower risk of colon cancer but at elevated risk of non-Hodgkin lymphoma (NHL), raising the possibility that NSAIDs may be a risk factor for NHL. We evaluated the association of use of NSAIDs, arthritis history, and risk of NHL in a prospective cohort of 27,290 postmenopausal women from the state of Iowa. The frequency of use of aspirin and of other NSAIDs excluding aspirin (e.g., ibuprofen), as well as a physician diagnosis of rheumatoid arthritis (RA) or osteoarthritis (OA), were self-reported on a questionnaire mailed in 1992. The incidence of NHL was ascertained through annual linkages to the Iowa SEER Cancer Registry. Relative risks (RR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression. Through 7 years of follow-up, 131 cases of NHL were identified. Compared to women who did not use either aspirin or other non-aspirin NSAIDs, women using aspirin exclusively (RR = 1.71; 95% CI = 0.94-3.13), non-aspirin NSAIDs exclusively (RR = 2.39; 95% CI = 1.18-4.83), or both types of drugs (RR = 1.97; 95% CI = 1.06-3.68) were at increased risk of NHL. A diagnosis of RA (RR = 1.75; 95% CI = 1.09-2.79), but not OA (RR = 1.06; 95% CI = 0.67-1.68), was associated with risk of NHL, but the positive association of use of aspirin and other NSAIDs with NHL was independent of RA history. Multivariate adjustment for other NHL risk factors only attenuated slightly these associations, whereas exclusion of cases occurring during the first 2 years of follow-up strengthened the associations. These data suggest that use of NSAIDs, either aspirin or other non-aspirin NSAIDs, are associated positively with risk of NHL, and that this association is independent of RA history.

Age Distribution↗