Predictors of screening mammography among a North and South Carolina Medicare population.

Despite guidelines recommending that women aged 40 years and older undergo screening mammography at least biennially, reports find that many women do not adhere to these recommendations. The authors' objective was to investigate the factors associated with undergoing a screening mammography. Eligible women were enrolled in Medicare during 2004 and 2005 and resided in North or South Carolina. Information on morbidities, demographics, and physician visits were assessed as predictors for whether a woman underwent a screening mammography. Approximately 50% of the women included in the study had undergone a screening mammography during the study period. An increasing number of physician visits was positively associated with having a screening mammography. Women making at least 1 visit to a gynecologist were more likely to be screened compared with women who saw only a primary care physician and/or a medical specialist. Older age, having certain morbidities, and Medicaid eligibility were inversely related to being screened.

Exposure to asbestos-containing vermiculite ore and respiratory symptoms among individuals who were children while the mine was active in Libby, Montana.

BACKGROUND: Libby, Montana, was home to the largest vermiculite ore mine in the United States. The processing, use, and transport of the ore, which was contaminated with amphibole asbestos, led to generalized contamination of the community. The mine closed in 1990. OBJECTIVES: We examined the prevalence of respiratory symptoms in 2000-2001 and their association with history of vermiculite exposure among people who were < or = 18 years of age when the mine closed. METHODS: Information on respiratory symptoms and exposure history was collected by questionnaire in 2000-2001, at which time participants were 10-29 years old. Logistic regression was used to model the associations between exposures and outcomes adjusted for age, sex, and tobacco smoke exposure. RESULTS: Of the 1,003 individuals included in the study, 10.8% reported usually having a cough, 14.5% reported experiencing shortness of breath when walking up a slight hill or hurrying on level ground, and 5.9% reported having coughed up bloody phlegm in the past year. These respiratory symptoms were positively associated with frequently handling vermiculite insulation compared with never handling vermiculite insulation. We found no association between vermiculite insulation in the house and respiratory symptoms. Respiratory symptoms were associated with other vermiculite exposures as well, and the number and frequency of these activities showed a positive trend with usually having a cough. We found no association between any of the activities and abnormal spirometry. CONCLUSIONS: These data suggest that residents of Libby, Montana, who were children when the mine closed experienced some respiratory symptoms associated with asbestos-contaminated vermiculite exposure.

Reliability of variables on the North Carolina birth certificate: a comparison with directly queried values from a cohort study.

Birth records are an important source of data for examining population-level birth outcomes, but questions about the reliability of these vital records exist. We sought to assess the reliability of birth certificate data by comparing them with data from a large prospective cohort. Pregnancy, Infection, and Nutrition cohort study participants were matched with their birth certificates to assess agreement for maternal demographics, health behaviours, previous pregnancies and major pregnancy events. Agreement among categorical variables was assessed using percentage agreement and kappa statistics; for continuous variables, Spearman's correlations and concordance correlation coefficients were used. The majority of variables had high agreement between the two data sources, especially for maternal demographic and birth outcome variables. Variables measuring anaemia, gestational diabetes and alcohol consumption showed the lowest correlations. Number of cigarettes smoked and number of previous pregnancies differed by education categories. For most variables, birth records appear to be a good source of reliable information. With the exception of a few variables that differed by education, most variables did not differ by stratum of race or education. Our research further supports the use of birth certificates as a reliable source of population-level data.

trans-Fatty acid consumption and its association with distal colorectal cancer in the North Carolina Colon Cancer Study II.

Recently, the potential health effects of trans-fatty acid consumption have raised concerns. A few studies have examined the risk of colorectal cancer with increasing consumption of trans-fatty acids, but none investigated the risk of rectal cancer, which may have different risk factors than colon cancer. Our objective was to explore the relationship between trans-fatty acid consumption and distal colorectal (sigmoid, rectosigmoid, and rectal) cancer using a case-control study of Whites (n = 1,516) and African Americans (n = 392) in North Carolina from 2001 to 2006. Matched cases and controls were interviewed about demographic information, lifestyle factors, and diet. White cases reported higher mean consumption of trans-fatty acid than White controls, but mean consumption was similar for African American cases and controls. Relative to the lowest quartile, the highest quartiles of energy-adjusted trans-fatty acid consumption were positively associated with distal colorectal cancer for Whites [adjusted ORs for the third and fourth quartiles are 1.54 (95%CI: 1.12, 2.13) and 1.45 (95%CI: 1.04, 2.03), respectively]. Consumption was not associated with distal colorectal cancer in African Americans [adjusted ORs for the third and fourth quartiles are 0.98 (95%CI: 0.47, 2.05) and 0.87 (95%CI 0.42, 1.81), respectively]. In conclusion, high consumption of trans-fatty acids was positively associated with distal colorectal cancer among Whites.

Associations between trans fatty acid consumption and colon cancer among Whites and African Americans in the North Carolina colon cancer study I.

Disparities in incidence and mortality rates of colon cancer exist between Whites and African Americans. Prior studies examined the association between trans fatty acid consumption and colorectal cancer, but none assessed this possible relationship within a large study population of African Americans and Whites. Using data from a population-based, case-control study in North Carolina, we investigated this association with attention to possible racial differences. Cases and matched controls were queried on demographic characteristics, lifestyle factors, medical history, and diet. Cases reported higher daily consumption (g/day) of trans fatty acids (mean = 5.9, SD = 2.9, median = 5.5, IQR = 3.8-7.5) compared to controls (mean = 5.2, SD = 2.4, median = 4.7, IQR = 3.5-6.4). Energy-adjusted trans fatty acid consumption was not associated with colon cancer. Compared to participants in the lowest quartile of consumption, those in the highest quartile had an adjusted odds ratio of 1.01 (95% confidence interval 0.69, 1.49) for Whites and 0.99 (95% confidence interval 0.61, 1.62) for African Americans. No association was found between increased consumption of trans fatty acid and specific tumor location (proximal or distal colon). In conclusion, trans fatty acid consumption is not associated with colon cancer and does not contribute to disparities in colon cancer rates.

The association between diabetes, insulin use, and colorectal cancer among Whites and African Americans.

Colorectal cancer and diabetes are common diseases that share many risk factors. It has been hypothesized that diabetes is a risk factor for colorectal cancer. We used two large population-based case-control studies from North Carolina to determine whether diabetes and/or insulin therapy was associated with colon cancer and/or rectal cancer (defined as cancer of the sigmoid colon, rectosigmoid, or rectum) and whether this association differed by race. Cases and matched controls from the North Carolina Colon Cancer Studies I and II were interviewed about demographics, dietary factors, diagnosis of diabetes, and use of medications to treat diabetes. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using unconditional logistic regression. Colon and rectal cancer cases reported a higher prevalence of diabetes than their respective control groups. Compared with Whites without diabetes, Whites with diabetes had adjusted ORs of 1.40 (95% CI, 0.93-2.12) for colon cancer and 1.38 (95% CI, 1.00-1.90) for rectal cancer. Diabetes was not associated with colon or rectal cancer among African Americans [OR, 1.17 (95% CI, 0.81-1.70) and 0.75 (95% CI, 0.44-1.28), respectively]. Among Whites with diabetes, insulin use was positively associated with rectal cancer. The same association was not seen for African American diabetics using insulin; however, the number of African Americans using insulin was small. In sum, diabetes was positively associated with rectal cancer and approached a positive association with colon cancer among Whites. No association was present among African Americans. Insulin use was also positively associated with rectal cancer among Whites.

Consumption of trans-fatty acid and its association with colorectal adenomas.

trans-Fatty acid consumption is known to have detrimental effects on cardiovascular health, but little is known about its role in digestive tract neoplasia. To investigate the association between colorectal adenomas and trans-fatty acid consumption, the authors utilized data from a cross-sectional study of 622 individuals who underwent complete colonoscopy between 2001 and 2002 at the University of North Carolina Hospitals. Participants were interviewed about demographic, lifestyle, and dietary factors thought to be related to colorectal cancer. trans-Fatty acid consumption, energy adjusted by the residual method, was categorized into quartiles based on its distribution in controls. Compared with participants in the lowest quartile of consumption, those in the highest quartile had an increased prevalence of colorectal adenomas, with an adjusted prevalence odds ratio of 1.86 (95% confidence interval: 1.04, 3.33). The authors further investigated the relation between trans-fatty acid consumption and colorectal neoplasia by examining the adenoma characteristics, with the adjusted prevalence odds ratios showing little or no difference by adenoma location, size, or number. These results suggest that consumption of high amounts of trans-fatty acid may increase the risk of colorectal neoplasia, and they provide additional support to recommendations to limit trans-fatty acid consumption.

Socioeconomic domains and associations with preterm birth.

Neighborhood socioeconomic effects on health have been estimated using multiple variables and indices. This inconsistent estimation approach makes comparison across geographic areas challenging. In this paper, we developed indices representing specific socioeconomic domains that can be reproduced in other areas to estimate elements of the neighborhood socioeconomic environment on health outcomes, specifically preterm birth. Using year 2000 U.S. census data and principal components analysis, socioeconomic indices were developed representing a priori - defined domains of education, employment, housing, occupation, poverty and residential stability. These socioeconomic indices were subsequently used in race-stratified multilevel logistic regression models of preterm birth in eight socioeconomically distinct study areas in the U.S. Maternal residence was obtained from birth records and was geocoded to census tracts. In maternal age and education adjusted models, living in tracts with high unemployment, low education, poor housing, low proportion of managerial or professional occupation and high poverty was associated with increased odds of preterm birth for non-Hispanic white women at most sites. Among non-Hispanic black women, similar associations were noted for tract-level low education, high unemployment, low occupation, and high poverty, but the effect estimates were generally smaller than those seen for white women. Increasing amounts of residential stability were not associated with preterm birth in these analyses. We combined the domain estimates across the eight study sites to produce pooled effect estimates for the socioeconomic domains on preterm birth. The research reported here suggests that specific neighborhood-level socioeconomic features may be especially influential to health outcomes. These socioeconomic domains represent potential targets for intervention or policy efforts designed to improve maternal and child health and reduce health disparities.

Integrating global gene expression and radiation survival parameters across the 60 cell lines of the National Cancer Institute Anticancer Drug Screen.

The 60 cell lines of the National Cancer Institute Anticancer Drug Screen (NCI-60) constitute the most extensively characterized in vitro cancer cell model. They have been tested for sensitivity to more than 100,000 potential chemotherapy agents and have been profiled extensively at the DNA, RNA, protein, functional, and pharmacologic levels. We have used the NCI-60 cell lines and three additional lines to develop a database of responses of cancer cells to ionizing radiation. We compared clonogenic survival, apoptosis, and gene expression response by microarray. Although several studies have profiled relative basal gene expression in the NCI-60, this is the first comparison of large-scale gene expression changes in response to genotoxic stress. Twenty-two genes were differentially regulated in cells with low survival after 2-Gy gamma-rays; 14 genes identified lines more sensitive to 8 Gy. Unlike reported basal gene expression patterns, changes in expression in response to radiation showed little tissue-of-origin effect, except for differentiating the lymphoblastoid cell lines from other cell types. Basal expression patterns, however, discriminated well between radiosensitive and more resistant lines, possibly being more informative than radiation response signatures. The most striking patterns in the radiation data were a set of genes up-regulated preferentially in the p53 wild-type lines and a set of cell cycle regulatory genes down-regulated across the entire NCI-60 panel. The response of those genes to gamma-rays seems to be unaffected by the myriad of genetic differences across this diverse cell set; it represents the most penetrant gene expression response to ionizing radiation yet observed.

Effects of racial density and income incongruity on pregnancy outcomes in less segregated communities.

A previous publication in this journal documented a decreased risk of adverse birth outcomes when African-American women have a positive income incongruity (defined as mothers living in a census tract with a higher household income than would be expected based on their individual education and marital status) and live in a census tract with "predominantly African-American" residents [Pickett, K. E., Collins, J. W. Jr., Masi, C. M., & Wilkinson, R. G. (2005). The effects of racial density and income incongruity on pregnancy outcomes. Social Science & Medicine, 60(10), 2229-2238.]. The communities included in that study were from Chicago and were highly segregated by race. Our objective was to repeat this analysis in a less severely segregated environment: two urban counties (Wake and Durham) in central North Carolina. Rather than assuming an absence of knowledge about the effects of interest, we used the previously published results to inform our prior distributions in a Bayesian logistic regression analysis. This approach, which is analogous to a meta-analysis of the two studies, revealed a protective effect of positive income incongruity for African-American women living in census tracts with high relative African-American density across a much wider range of residential segregation patterns. Positive income incongruity was not associated with a decreased risk of low birth weight or preterm delivery for women living in tracts with a low relative density of African-Americans. These estimates are comparable to those that might have been observed had the original authors included a much more diverse set of communities with respect to degree of segregation, and so these new results provide important information about the generality of this intriguing finding.

Cholecystectomy and the risk of colorectal adenomas.

Cholecystectomy has been identified as a risk factor for colorectal cancer, yet little attention has been given to the relationship between cholecystectomy and colorectal adenomas. Utilizing data collected in two large cross-sectional studies of colorectal adenoma risk factors, we examined the association between cholecystectomy and colorectal adenomas. In the adjusted logistic regression model, both men and women showed no effect of cholecystectomy on risk of colorectal adenomas (men: OR 0.67 [95% CI 0.30-1.47]; women: OR 1.46 [95% CI 0.92-2.29]). No effect was seen when examining the time since cholecystectomy for men. There was a slight association found for women who had a cholecystectomy less than 10 years prior (OR 2.02 [95% CI 1.06-3.87]) but no association was seen in women with cholecystectomy at least 10 years prior (OR 1.14 [95% CI 0.62-2.09]). Thus, we conclude that, although cholecystectomy is a risk factor for colorectal cancer, cholecystectomy is not a risk factor for colorectal adenomas.

Cholecystectomy and the risk of recurrent colorectal adenomas.

Prior studies have shown an increased risk of colorectal cancer following cholecystectomy, but few studies have explored the association between cholecystectomy and the risk of colorectal adenomas. We used data from three large randomized adenoma chemoprevention trials to explore the association between cholecystectomy and the occurrence of adenomas. After adjusting for confounding factors, we found no increased risk for adenomas among individuals who had undergone cholecystectomy [risk ratio (RR), 1.02; 95% confidence interval (95% CI), 0.88-1.18]. There was a slight increase in the risk of advanced recurrent adenomas (RR, 1.28; 95% CI, 0.94-1.76) and multiple advanced recurrent adenomas (RR, 1.34; 95% CI, 0.97-1.85) but the 95% CIs included the null in both cases. We conclude that the increased risk for colorectal cancer following cholecystectomy seems to be due to a biological process occurring after the adenoma has developed.

A systematic review of the literature on female sexual dysfunction prevalence and predictors.

Interest in human sexuality began in the 18th century, but formal and more rigorous studies focused on sexual satisfaction and sexual practices were published in the early 1900s. Alfred Kinsey's pioneering work on sexuality, in which he surveyed over 10,000 men and women age 16 and older, began in the late 1930s. In the mid-1960s, Masters and Johnson published their seminal work characterizing the sexual response cycle. Since then, numerous researchers have attempted to understand and to quantify "normal" sexual behaviors using survey techniques. We conducted a systematic review of the published literature on the prevalence of female sexual dysfunction overall and, more specifically, on sexual desire disorder, arousal difficulties, anorgasmia, and dyspareunia. The review also encompassed dysfunction related to the reproductive factors, such as pregnancy, hysterectomy, and menopause. We included sexual dysfunction comorbid with diabetes, depression, and antidepressant therapies. In total, 85 studies are summarized in this review, which spans literature from the early 1900s to the present. We performed a quality assessment of each study, defining quality based on the representativeness of the population studied and the rigor of the instruments used for assessing sexual dysfunction. Although none of the 85 studies included in the review met both standards of quality, some met one criterion and not the other. Definitions of female sexual dysfunction have been developed and refined recently, but there is an urgent need to determine measurable outcomes that can be used for future work.