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PubMed2004

Radial bone density and breast cancer risk in white and African-American women.

A number of different models for assessing individual risk of breast cancer use known risk factors such as age, age at menarche, age at first live birth, previous breast biopsies, and family history. High bone mass in white women is also associated with an increased breast cancer risk; however, bone mass as a risk factor has not been studied in African-American women. We conducted a case-control study to evaluate bone mineral density as a risk factor for breast cancer in white and African-American women. We recruited 221 women with newly diagnosed breast cancer from a comprehensive breast cancer center at a large university hospital, and 197 control women who were frequency matched for ethnicity and age. Odds ratios were based on proximal and distal radial bone density measured by peripheral bone densitometry (Norland pDEXA) and expressed as a standardized "Z-score" (age and ethnicity specific). Logistic regression models were fitted controlling for body mass index, menopausal status, age, and HRT use (ever/never and duration). With proximal bone density Z-score included in the model as a continuous variable, a one-unit increase in radial shaft bone density increased the risk of breast cancer by 25% (p=0.02). When proximal bone density Z-score was analyzed as a dichotomous variable (< or = 0, > 0) the odds ratio was 1.98 (95% CI, 1.32 to 2.97); that is, having an above average proximal bone density (age-specific) doubles the risk of breast cancer. There were no significant interactions with, and no appreciable confounding effects by, other covariates. An above-average radial shaft Z-score is a significant risk factor for breast cancer in both white and African-American women. The present study extends the association between bone mass and breast cancer risk to African-Americans, and suggests another potential application for bone density testing.

Black or African American↗
PubMed2006

Identification of several cytoplasmic HSP70 genes from the Mediterranean mussel (Mytilus galloprovincialis) and their long-term evolution in Mollusca and Metazoa.

The HSP70 protein family consists one of the most conserved and important systems for cellular homeostasis under both stress and physiological conditions. The genes of this family are poorly studied in Mollusca, which is the second largest metazoan phylum. To study these genes in Mollusca, we have isolated and identified five HSP70 genes from Mytilus galloprovincialis (Mediterranean mussel) and investigated their short-term evolution within Mollusca and their long-term evolution within Metazoa. Both sequence and phylogenetic analyses suggested that the isolated genes belong to the cytoplasmic (CYT) group of the HSP70 genes. Two of these genes probably represent cognates, whereas the remaining probably represent heat-inducible genes. Phylogenetic analysis including several molluscan CYT HSP70s reveals that the cognate genes in two species have very similar sequences and form intraspecies phylogenetic clades, differently from most metazoan cognate genes studied thus far, implying either recent gene duplications or concerted evolution. The M. galloprovincialis heat-inducible genes show intraspecies phylogenetic clustering, which in combination with the higher amino acid than nucleotide identity suggests that both gene conversion and purifying selection should be responsible for their sequence homogenization. Phylogenetic analysis including several metazoan HSP70s suggests that at least two types of CYT genes were present in the common ancestor of vertebrates and invertebrates, the first giving birth to the heat-inducible genes of invertebrates, whereas the other to both the heat-inducible genes of vertebrates and the cognate genes of all metazoans. These analyses also suggest that inducible and cognate genes seem to undergo divergent evolution.

Animals↗
PubMed2006

Pregnancy after laparoscopic adjustable gastric banding: perinatal outcome is favorable also for women with relatively high gestational weight gain.

BACKGROUND: The prevalence of morbid obesity is increasing steadily among women of reproductive age. In addition to the well-known comorbidities of the disease, it has been shown that the pregnancy outcome for obese women is worse than for women with a normal body mass index. This study aimed to evaluate the pregnancy and perinatal outcomes for women who underwent laparoscopic adjustable gastric banding (LAGB) because of morbid obesity. METHODS: This prospective, population-based study was conducted in a general surgery clinic of a tertiary hospital serving as a referral center for bariatric operations. All the patients underwent LAGB by the pars flaccida technique. A database containing information regarding age, pre- and postoperative weight and body mass index, weight gain, and LAGB-related or -unrelated complications during pregnancy was constructed for all women of childbearing age who underwent LAGB. A questionnaire was designed to provide perinatal data concerning both mother and neonate. RESULTS: The 74 women enrolled in this study had 81 single tone pregnancies. Their body mass index decreased significantly after LAGB, from 43.3 +/- 5.8 to 30.3 +/- 3 kg/m2 at conception (p < 0.0001). The average time to the first live birth after surgery was 27 +/- 3 months. Band slippage was diagnosed and treated laparoscopically in two patients (2.4%). Weight gain during pregnancy was 10.6 +/- 2.1 kg. The rates of pregnancy-induced hypertension and gestational diabetes were 7.4% and 16% of all pregnancies, respectively. In 17 cases (20%), cesarean section was performed. Delivery occurred after 39.1 weeks of gestation. The mean birth weight was 3.09 +/- 0.5 kg. Major congenital anomalies, postnatal hypoglycemia, symptomatic polycythemia or neonatal death were not recorded. CONCLUSIONS: The findings show that LAGB is safe for both mother and newborn during gestation and delivery.

Female↗
PubMed2006

Trends of breast cancer incidence and risk factor prevalence over 25 years.

INTRODUCTION: To examine the trends in the prevalence of breast cancer risk factors in relation to breast cancer incidence trends and to explore whether the changes in risk factors differed by ethnicity in Hawaii over a 25-year period. METHODS: We pooled 17 population-based epidemiological studies conducted in Hawaii between 1975 and 2001. The study population of 82,295 women included subjects of Caucasian, Japanese, Native Hawaiian, Chinese, and Filipino ancestry. We computed age-adjusted prevalence estimates by ethnic group for 5-year time periods. Logistic regression was used to evaluate trends over time. RESULTS: The prevalence of an early age at menarche, nulliparity, and parity of fewer than three children, but not that of a late age at first live birth, increased during the study period. Whereas current smoking decreased for all ethnicities over time, the age-adjusted prevalence of overweight, obesity, college education, and alcohol use increased. Trends differed by ethnicity. For Native Hawaiians, the prevalence of overweight, obesity, alcohol use and nulliparity rose over time. For Japanese, the prevalence of overweight, early age at menarche, and having fewer than three children increased. Caucasians showed an increasing prevalence of overweight, obesity, college education, and nulliparity. In Filipina women, we observed changes in reproductive behavior and increasing obesity. CONCLUSIONS: Despite a slowing trend for some breast cancer risk factors, the overall risk profile in this population may lead to further increases in breast cancer incidence. Different ethnic groups may benefit from specific prevention strategies.

Adolescent↗
PubMed2005

Are risk factors for breast cancer associated with follow-up procedures in diverse women with abnormal mammography?

OBJECTIVE: We evaluated the association of risk factors for breast cancer with reported follow-up procedures after abnormal mammography among diverse women. METHODS: Women ages 40--80 years were recruited from four clinical sites after receiving a screening mammography result that was classified as abnormal but probably benign, suspicious or highly suspicious, or indeterminate using standard criteria. A telephone-administered survey asked about breast cancer risk factors (family history, estrogen use, physical inactivity, age of menarche, age at birth of first child, parity, alcohol use), and self-reported use of diagnostic tests (follow-up mammogram, breast ultrasound, or biopsy). RESULTS: Nine hundred and seventy women completed the interview, mean age was 56, 42% were White, 19% Latina, 25% African American, and 15% Asian. White women were more likely to have a positive family history (20%), use estrogen (32%), be nulliparous (17%) and drink alcohol (62%). Latinas were more likely to be physically inactive (93%), African Americans to have early onset of menarche (53%) and Asians first child after age 30 (21%). White women were more likely to have suspicious mammograms (40%) and to undergo biopsy (45%). In multivariate models, Latinas were more likely to report breast ultrasound, physical inactive women reported fewer follow-up mammograms, and care outside the academic health center was associated with fewer biopsies. Indeterminate and suspicious mammography interpretations were significantly associated with more biopsy procedures (OR=8.4; 95% CI=3.8-18.5 and OR=59; 95% CI=35-100, respectively). CONCLUSIONS: Demographic profile and breast cancer risk factors have little effect on self-reported use of diagnostic procedures following an abnormal mammography examination. Level of mammography abnormality determines diagnostic evaluation but variance by site of care was observed.

Adult↗
PubMed1994

Selective induction of CCAAT/enhancer binding protein isoforms occurs during rat liver development.

BACKGROUND/AIMS: Recent evidence suggests that CCAAT/enhancer binding protein (C/EBP) transcription factors may regulate hepatocyte terminal differentiation. METHODS: To explore this possibility, the present study looked for variations in the expression or DNA binding activity of different C/EBP isoforms during rat postnatal liver development and determined which of the C/EBPs were expressed by adult hepatocytes in primary culture. RESULTS: In intact rats, hepatocyte proliferation is active for 2-3 weeks after birth. During this period of postnatal liver growth, several liver-specific functions emerge and C/EBP alpha, beta, and delta isoforms are induced. Nuclear expression of the 36-kilodalton C/EBP delta protein increases immediately after birth, followed first by increases in the 38-kilodalton C/EBP beta protein expression and then by increases in the 42-kilodalton C/EBP alpha protein expression. Changes in C/EBP DNA binding activity accompany developmental increases in C/EBP proteins. Messenger RNAs of all three C/EBP isoforms are expressed by mature hepatocytes in primary culture. CONCLUSIONS: Specific C/EBP isoforms are induced differentially during the course of rat postnatal liver development. Young adult rats and cultured adult hepatocytes express all three C/EBP isoforms. These results are consistent with (but do not prove) the theory that variations in C/EBP expression and function help regulate hepatocyte terminal differentiation.

Aging↗
PubMed1983

The metabolism of arachidonic acid in isolated perfused fetal and neonatal rabbit lungs.

The developmental pattern of fetal and neonatal rabbit lungs to metabolize arachidonic acid (AA) to different cyclo-oxygenase products was studied in isolated rabbit lungs, which were perfused with Krebs bicarbonate buffer. 14C-AA (66 nmol) was injected into the pulmonary circulation and the nonrecirculating perfusion effluent was collected for four minutes. About ten per cent of the injected radioactivity was found in the 0-4 min perfusion effluent. The metabolites of AA in the effluent were analyzed by thin layer chromatography. The major metabolites of AA were PGE2 and its 15-keto-derivates, but also PGF2 alpha and its 15-keto-derivates, TXB2 and 6-keto-PGF1 alpha were found in the effluent. The most drastic developmental change was the increase in the amount of 15-keto-metabolites of PGE2 from late fetal period to the lungs of one day old rabbits (1.8 fold increase between birth and first postnatal day). Smaller changes were detected in the amounts of other cyclo-oxygenase products.

Aging↗
PubMed1983

[Immunocompetence of newborn calves: evaluation of the proliferative response of lymphocytes in vitro to 3 nonspecific mitogens (concanavalin A, phytohemagglutinin, pokeweed mitogen) during the 1st 3 months of life].

A micromethod technique was used to evaluate in vitro sensitivity of the peripheric bovine lymphocytes obtained from a newly born calf, up to 3 months of age to different non-specific mitogens: Phytohemagglutinin (PHA) Concanavaline A (Con A) and Pokeweed Mitogen (PWM). The results obtained show that the calf lymphocytes respond to the 3 mitogens by a considerable cellular proliferation. The blastogenic response was found at various levels during the first 3 months of life, and appeared to stabilize at levels similar to the adult bovine. Highly sensitive variations were noted in the lymphocyte reactivity, notably with PHA and Con A. These results seem to indicate the existence of periods of T cell immunodeficiency, not only during the first few days after birth, but throughout the first months of the calves' life. It may also be indicative of the interest of immunostimulant therapy during this period, which needs further investigation.

Aging↗
PubMed1982

Time of appearance during development of differences in nigrostriatal tyrosine hydroxylase activity in two inbred mouse strains.

The greater activity of tyrosine hydroxylase (TH) in substantia nigra and corpus striata of adult BALB/cJ than CBA/J mice, is attributable to differences in the number of dopamine neurons in the ventral midbrain tegmentum. To determine if strain differences in TH activity develop postnatally we have measured the development of TH in the midbrain (SN) and in the corpus striatum (CS). In the midbrain neonatal TH activity was 20% of adult levels. Thereafter, TH activity increased rapidly achieving adult levels by 11 days. A 25% "overshoot' above adult values at 15 days was followed by a gradual decrease to adult activity at 4 weeks. In the CS neonatal activity was about 10% of adult levels and increased slowly to reach adult values at 4 weeks. Striatal choline acetyltransferase (CAT) activity in the neonate was only 3.7% of adult values and at 21 days had only reached 70% of adult activity. Neonatal glutamic acid decarboxylase (GAD) activity was relatively high in both brain regions and increased gradually to adult activity by 4 weeks. Strain differences in TH activity were not present at birth but first appeared at 9 days in SN and 11 days in CS. Once established, the differences were maintained. These results suggest that strain differences in TH are most probably a consequence of differences in postnatal neuron survival, although the possibility that some neurons lose their phenotypic expression of TH cannot be excluded.

Animals↗
PubMed1990

Difference in distribution of microtubule-associated proteins 5a and 5b during the development of cerebral cortex and corpus callosum in cats: dependence on phosphorylation.

MAP5, a microtubule-associated protein characteristic of differentiating neurons, was studied in the developing visual cortex and corpus callosum of the cat. In juvenile cortical tissue, during the first month after birth, MAP5 is present as a protein doublet of molecular weights of 320 and 300 kDa, defined as MAP5a and MAP5b, respectively. MAP5a is the phosphorylated form. MAP5a decreases two weeks after birth and is no longer detectable at the beginning of the second postnatal month; MAP5b also decreases after the second postnatal week but more slowly and it is still present in the adult. In the corpus callosum only MAP5a is present between birth and the end of the first postnatal month. Afterwards only MAP5b is present but decreases in concentration more than 3-fold towards adulthood. Our immunocytochemical studies show MAP5 in somata, dendrites and axonal processes of cortical neurons. In adult tissue it is very prominent in pyramidal cells of layer V. In the corpus callosum MAP5 is present in axons at all ages. There is strong evidence that MAP5a is located in axons while MAP5b seems restricted to somata and dendrites until P28, but is found in callosal axons from P39 onwards. Biochemical experiments indicate that the state of phosphorylation of MAP5 influences its association with structural components. After high speed centrifugation of early postnatal brain tissue, MAP5a remains with pellet fractions while most MAP5b is soluble. In conclusion, phosphorylation of MAP5 may regulate (1) its intracellular distribution within axons and dendrites, and (2) its ability to interact with other subcellular components.

Aging↗
PubMed1993

Medically unnecessary cesarean section births: introduction to a symposium.

Between 1965 and 1986, the United States cesarean section rate increased from 4.5 to 24.1%. Increasingly, childbearing women and their advocates, along with many others, have recognized that a large proportion of cesareans confers a broad array of risks without providing any medical benefit. A growing literature examines the diverse causes of medically unnecessary cesareans and the diverse effects of surgical birth on women, infants, and families. Various programs and policies have been proposed or implemented to reduce cesarean rates. In recent decades, many other nations have also experienced a sharply escalating cesarean section rate. It is reasonable to conclude that a largely uncontrolled international pandemic of medically unnecessary cesarean births is occurring. The level of political, analytic, and programmatic activity that has occurred in the U.S. regarding medically unnecessary surgical births does not seem to be paralleled in other nations with sharply escalating rates. This symposium was organized with the objective of presenting the U.S. experience with various dimensions of the problem of medically unnecessary cesareans to an international audience. Although preliminary and inadequate, it is hoped that this experience will encourage policy leaders and investigators throughout the world to recognize and address the problem of run-away cesarean section births. The first section of this introduction summarizes the U.S. experience with medically unnecessary cesareans from the perspective of trends, causes, consequences, and solutions. The second section covers the same topics, presenting selected material from various other nations throughout the world. In the course of these overviews, I introduce the symposium's seven contributions, most of which focus on circumstances in the U.S.

Cesarean Section↗
PubMed1987

Risk factors as an indicator for breast cancer screening in asymptomatic patients.

A review of breast carcinoma risk factors has established that age and sex are dominant variables. Additional epidemiological factors include family history, past medical history, menstrual status, age at birth of first child, demographic factors and reproductive history, which are of established importance as major or minor risk determinants for breast cancer. Taking into account the various epidemiological correlations and the multifactorial aetiology of this type of carcinoma, there is only a small probability that the identification of known risk factors will enable conclusive identification or prevention of the disease. Nevertheless the recognition of known risk factors may enhance screening efforts through surveillance, more selective biopsies and interval xeromammography. Total ductoglandular mastectomy may possibly be considered a beneficial approach to the management of the high-risk patient in whom preinvasive disease is detected. The identification of the high-risk patient is of paramount importance for prophylaxis. Prospective clinical trials using diagnostic approaches may include the study of genetic markers, hormones and steroid metabolites, mammographic parenchymal patterns and the analysis of genetic pedigree or other undetermined risk markers. While screening and detection programmes for breast carcinoma are not cost-effective, these intensive surveillance procedures do allow the early identification of high-risk individuals with the disease. The formulation of screening programmes which incorporate major and minor risk determinants may enhance the effectiveness of efforts to achieve diagnosis at a prognostically favourable stage of disease. Established diagnoses of stage 0 or stage I disease will translate as direct benefits to survival and reductions in economic morbidity.

Aged↗
PubMed1989

Characteristics of women with hysterectomy.

Socio-demographic and health information, including history of hysterectomy/oophorectomy, was obtained in a telephone survey of 2137 women aged 40-52. Subjects were randomly selected from a list of all women with a driver's license in Pittsburgh, Pennsylvania. Results showed that 27.3% of women surveyed reported having had a hysterectomy. Women who had undergone hysterectomy were more often black, less educated, older and heavier; and reported less frequent alcohol consumption, younger age at birth of first child and earlier menarche than women who did not report hysterectomy. Forty-seven percent of blacks reported hysterectomy compared with 24% of whites (P less than 0.01) and blacks were significantly younger at surgery than whites (mean age 38.5 vs. 39.6 yr, P less than 0.05). Results of multivariate analyses showed age, black race, less than a college education, menarche before age 12 and having no children to be associated with an increased risk of hysterectomy (P less than 0.01). Additional multivariate analyses conducted separately for blacks and whites showed that, for whites but not blacks, the higher a woman's educational attainment the less likely she was to report having had a hysterectomy (P less than 0.01). Black women with no children more often reported hysterectomy than those with children (P less than 0.01), but this relationship was not found among whites. These findings show the distribution of hysterectomy in the population to vary by race, education and parity.

Adult↗
PubMed1992

The effect of family history of cancer, religion, parity and migrant status on survival in colorectal cancer. The Melbourne Colorectal Cancer Study.

The association between 5-year survival and several risk factors was investigated in 705 histologically confirmed, new cases of colorectal adenocarcinoma as one aspect of a comprehensive population-based study of large bowel cancer incidence, aetiology and survival--the Melbourne Colorectal Cancer Study. 5-year survival was not influenced by the previously determined risk of a family history of colorectal cancer in near-relatives. Similarly, other previously determined risk factors of religion, number of children, age at birth of first child and migrant status did not influence survival.

Adenocarcinoma↗
PubMed2004

Medical history, sexual, and maturational factors and prostate cancer risk.

PURPOSE: Sexual, physical, and medical factors were investigated in a case-control study of prostate cancer. METHODS: This population-based study, conducted from 1995 to 1999 in northeastern Ontario, used cancer registry-identified cases (n=760), aged 45 to 84 years, diagnosed between 1995 and 1998. Age-frequency matched controls (n=1632) were obtained from telephone listings. Two separate logistic regression analyses considered: 1) sexual and physical; and 2) medical factors. RESULTS: For the sexual-physical model, marital status, family income, maximum height, number of marriages, having children, age at first marriage, birth, and needing to shave, and acne were not significantly related to risk. In the medical model, a family history of prostate cancer (OR, 2.99; 95% CI, 2.21-4.04) and history of venereal disease (OR, 2.12; 95% CI, 1.27-3.53) were associated with significantly increased risk. A history of allergies (OR, 0.78; 95% CI, 0.60-1.00), benign prostatic hyperplasia (OR, 0.63; 95% CI, 0.49-0.81), and an annual physical exam (OR, 0.43; 95% CI, 0.21-0.85) were associated with reduced risk. Other factors considered in the medical conditions model, body mass index, smoking non-filter cigarettes, and family income were not associated with prostate cancer. CONCLUSIONS: This study is consistent with other studies that suggest that infectious agents may be involved in prostate cancer development.

Age Factors↗
PubMed2005

Vaginal douching and associated factors among married women attending a family planning clinic or a gynecology clinic.

OBJECTIVE: The aim of this study was to determine the vaginal douching habits and associated factors of women attending two different healthcare clinics. STUDY DESIGN: This cross-sectional study was conducted between 1 and 31 May 2004. All participants were women (n=635) who attended either a university hospital gynecology clinic or a primary health care center family planning unit. One-way ANOVA, chi-squared test, and binary and multiple logistic regression analyses were used for the statistical evaluation of data. RESULTS: The mean age of the participants was 36.90+/-10.72 years (range: 18-75). Half of the participants believed vaginal douching had a positive effect on health. They believed vaginal douching demonstrates cleanliness, prevents infections and pregnancy, removes sperm following intercourse, a necessity of Islamic doctrine, and reduces symptoms like discharge, unpleasant odor, etc. Of the women, 50.2% performed vaginal douching. Vaginal douching was associated with age, education level, type of dwelling, working outside of the home, age at marriage, age at birth of first child, parity, spontaneous abortion, history of pelvic inflammatory disease, use of contraceptives, and attending a healthcare clinic. CONCLUSION: Douching is a common habit among Turkish women. Many women are not aware of the harmful effects of douching. Public health and health professionals should monitor more closely this traditional habit in Turkey.

Abortion, Spontaneous↗
PubMed2004

The value of a pilot study in breast-feeding research.

OBJECTIVE: To test the integrity of a protocol for a randomised controlled trial (RCT) to examine the effectiveness of skin-to-skin care compared to routine care on the initiation and duration of breast feeding and to provide data to be used in the power calculation for a proposed trial. DESIGN: Randomised pilot study. SETTING: Warrington Hospital, Cheshire, UK. PARTICIPANTS: Women at 36 weeks' gestation with healthy singleton pregnancies, who intended to breast feed, who had 'booked' for care at Warrington Hospital and had given informed consent to participate. Twenty-eight women were randomised in the pilot study. METHOD: Women were randomly allocated to receive either routine or skin-to-skin care following birth. The first breast feed was assessed using the Breast-feeding Assessment Tool (BAT). Mothers were followed up at discharge from hospital and again at four months to provide details of duration of breast feeding. FINDINGS: 66 women were approached to participate in the trial and 44 consented (67% consent rate). Twenty-eight women were randomised in the study and 26 breast feeds were observed (93%). The pilot study identified procedural changes that were required in the design of the main study, provided an estimate of recruitment rates and confirmed the previously calculated sample size. CONCLUSION: The pilot study demonstrated that a large RCT of skin-to-skin versus routine care was feasible. This is an example of how a pilot study has the ability to identify unforeseen challenges in the conduct of the trial as well as allowing necessary changes to be made to the design that will increase the quality of the subsequent research.

Adult↗