Explanatory factors of sexual function in sexual minority women breast cancer survivors

BACKGROUND

The sexual function of sexual minority women (women with female partners) who are breast cancer survivors is mostly unknown. Our objective is to identify explanatory factors of sexual function among sexual minority women with breast cancer and compare them with a control sample of sexual minority women without cancer.

PATIENTS AND METHODS

Using a conceptual framework that has previously been applied to heterosexual breast cancer survivors, we assessed the relationship of each explanatory factor to sexual function in sexual minority women. Using generalized estimating equations, we identified explanatory factors of sexual function and identified differences by case and control status.

RESULTS

Self-perception of greater sexual attractiveness and worse urogenital menopausal symptoms explain 44% of sexual function, after controlling for case and control status. Focusing only on partnered women, 45% of sexual function was explained by greater sexual attractiveness, postmenopausal status, and greater dyadic cohesion.

CONCLUSIONS

All of the relevant explanatory factors for sexual function among sexual minority survivors are modifiable as has been suggested for heterosexual survivors. Sexual minority survivors differ from heterosexual survivors in that health-related quality of life is less important as an explanatory factor. These findings can guide adaptation of interventions for sexual minority survivors.

Cost analysis of prenatal care using the activity-based costing model: a pilot study

The cost of prenatal care in a private nurse-midwifery practice was examined using the activity-based costing system. Findings suggest that the activities of the nurse-midwife (the health care provider) constitute the major cost driver of this practice and that the model of care and associated, time-related activities influence the cost. This pilot study information will be used in the development of a comparative study of prenatal care, client education, and self care.

Uric acid induces trophoblast IL-1β production via the inflammasome: implications for the pathogenesis of preeclampsia

PROBLEM

Preeclampsia is associated with hyperuricemia, which correlates with the disease severity. Levels of circulating uric acid increase before the clinical manifestations, suggesting that they may be causally related. Uric acid, or monosodium urate (MSU), activates the Nod-like receptor, Nalp3, leading to inflammasome activation and IL-1β processing. Because preeclampsia is associated with placental immune⁄ inflammatory dysregulation, we sought to determine in the trophoblast, the presence of the Nalp3 inflammasome, and the effect of MSU on its activation.

METHOD OF STUDY

Isolated first- and third-trimester trophoblasts were assessed for expression of the inflammasome components, Nalp1, Nalp3, and ASC. First-trimester trophoblast cells were incubated with or without MSU, and after which, IL-1β secretion and processing and caspase-1 activation were determined.

RESULTS

Trophoblast cells expressed Nalp1, Nalp3, and ASC under basal conditions. Following incubation with MSU, first-trimester trophoblast IL-1β secretion was upregulated. This correlated with increased expression levels of active IL-1β and active caspase-1. ASC knockdown reduced MSU-induced IL-1β secretion.

CONCLUSION

These findings demonstrate that uric acid activates the inflammasome in the trophoblast, leading to IL-1β production. This may provide a novel mechanism for the induction of inflammation at the maternal–fetal interface leading to placental dysfunction and adverse pregnancy outcome, including preeclampsia.

Immediate and late benefits of treating very elderly people with hypertension: results from active treatment extension to Hypertension in the Very Elderly randomised controlled trial

OBJECTIVE

To assess if very elderly people with hypertension obtain early benefit from antihypertensive treatment.

DESIGN

One year open label active treatment extension of randomised controlled trial (Hypertension in the Very Elderly Trial (HYVET)).

SETTING

Hospital and general practice based centres mainly in eastern and western Europe, China, and Tunisia.

PARTICIPANTS

People on double blind treatment at the end of HYVET were eligible to enter the extension.

INTERVENTIONS

Participants on active blood pressure lowering treatment continued taking active drug; those on placebo were given active blood pressure lowering treatment. The treatment regimen was as used in the main trial-indapamide SR 1.5 mg (plus perindopril 2-4 mg if required)-with the same target blood pressure of less than 150/80 mm Hg.

MAIN OUTCOME MEASURES

The primary outcome was all stroke; other outcomes included total mortality, cardiovascular mortality, and cardiovascular events.

RESULTS

Of 1882 people eligible for entry to the extension, 1712 (91%) agreed to participate. During the extension period, 1682 patient years were accrued. By six months, the difference in blood pressure between the two groups was 1.2/0.7 mm Hg. Comparing people previously treated with active drug and those previously on placebo, no significant differences were seen for stroke (n = 13; hazard ratio 1.92, 95% confidence interval 0.59 to 6.22) or cardiovascular events (n = 25; 0.78, 0.36 to 1.72). Differences were seen for total mortality (47 deaths; hazard ratio 0.48, 0.26 to 0.87; P = 0.02) and cardiovascular mortality (11 deaths; 0.19, 0.04 to 0.87; P = 0.03).

CONCLUSION

Very elderly patients with hypertension may gain immediate benefit from treatment. Sustained differences in reductions of total mortality and cardiovascular mortality reinforce the benefits and support the need for early and long term treatment. Trial registration Clinical trials NCT00122811.

Indian Asians have poorer cardiovascular autonomic function than Europeans: this is due to greater hyperglycaemia and may contribute to their greater risk of heart disease

AIMS/HYPOTHESIS

A high prevalence of diabetes contributes to excess CHD in Indian Asians, but the underlying mechanisms are unclear. Heart rate, heart rate variability (HRV) and baroreflex sensitivity (BRS) are measures of cardiac autonomic function that are disturbed by hyperglycaemia and predict CHD. We compared these measures in Indian Asians and Europeans, and sought explanations for the observed differences.

METHODS

A representative sample of 149 Europeans and 151 Indian Asians was recruited from primary care, 66% of them men (aged 35-75 years), 34% women (aged 55-75 years). Heart rate, HRV, BRS and cardio-metabolic profiles were measured over four successive 5 min periods with continuous ECG and blood pressure monitoring.

RESULTS

Indian Asians were hyperglycaemic compared with Europeans (HbA(1c) (mean +/- SD) 6.5 +/- 1.2% vs 5.9 +/- 1.0%, p = 0.001). They had shorter mean RR intervals ((mean +/- SE) 969 +/- 13 vs 1,022 +/- 12 ms, p = 0.002), lower total RR interval power ((geometric mean, 95% CI) 925 [796-1075] vs 1,224 [1,064-1,422] ms(2), p = 0.008) and lower BRS ((mean +/- SE) 5.7 +/- 1.0 vs 6.6 +/- 1.0 ms/mmHg, p = 0.01). All measures of cardiac autonomic dysfunction were significantly associated with hyperglycaemia (mean RR interval vs HbA(1c) r = -0.22; p < 0.001). Ethnic differences in cardiac autonomic function persisted after adjustment for age, blood pressure and medication (mean RR interval 973 vs 1,021 ms, p = 0.004), but were attenuated or abolished by adjusting for HbA(1c) (979 vs 1,014 ms, p = 0.06) or other markers of hyperglycaemia.

CONCLUSIONS/INTERPRETATION

Indian Asians from the general population have impaired cardiovascular autonomic function compared with Europeans. This is due to greater hyperglycaemia in Indian Asians and may determine their increased CHD risk.

Circulating 25-Hydroxyvitamin-D and Risk of Colorectal Adenomas and Hyperplastic Polyps

Background: Colorectal adenomas are clear precursors of cancer; hyperplastic polyps have recently been hypothesized to also have malignant potential. However, these two distinct colorectal lesions are probably on different molecular pathways to neoplasia. An inverse association between vitamin D and adenoma risk has been reported, but this is the first study, to our knowledge, that examines circulating 25(OH)D in relation to risk of hyperplastic polyps.

Methods: We conducted a colonoscopy-based case-control study of adenomas and hyperplastic polyps among 474 members of a large integrated health plan. Self-administered questionnaires provided data on demographics and colorectal polyp risk factors, and we assayed plasma samples donated by participants at the time of the colonoscopy for total 25-hydroxyvitamin-D (25(OH)D) concentration. Polytomous regression was used to estimate separate odds ratios for adenomas (n = 153) and hyperplastic polyps (n = 91) by tertile of 25(OH)D.

Results: An inverse association between 25(OH)D and adenomas was observed (comparing upper to lower tertiles: adjusted OR [95%CI]: 0.60 [0.34-1.08]). After restriction of the analyses to study participants with no history of polyps, this OR estimate moved further from the null and became statistically significant (adjusted OR [95%CI]: 0.43 [0.20-0.96]). In comparison, no statistically significant association between hyperplastic polyps and 25(OH)D was observed among the full study participants (adjusted OR [95%CI]: 1.12 [0.59-2.13]) nor among those without prior polyps (adjusted OR [95%CI]: 1.27 [0.57-2.35]).

Conclusions: There is no evidence in our study that the established inverse association between circulating 25(OH)D and colorectal adenoma applies to hyperplastic polyps.

Trends and determinants of reproductive health service use among young women in the USA

BACKGROUND

This study explores the current patterns of reproductive health service use among young women in the USA and the changing influence of socio-demographic factors on the types of services used over time.

METHODS

The study population, drawn from the two last cycles of the National Survey of Family Growth, consists of women aged 15-24 (n = 2543 in 1995, n = 2157 in 2002). We examined trends in use of 'contraceptive services' and 'other reproductive health services for preventive care' and tested for changes in the patterns of use of these services over time. Logistic regression models were used to further clarify the factors associated with the use of the two types of services in 2002.

RESULTS

Results show no difference in the overall use of reproductive health services in the past year but did reveal changes in the type of service sought. Use of services for contraception increased by 10 percentage points (39.3% in 1995 to 49.7% in 2002, P < 0.001), although the use of other services remained stable (53.2% in 1995, 50.2% in 2002, P = 0.14). The patterns of use varied over time, exhibiting growing social disparities. In 2002, the use of contraceptive services depended on women's age, number of partners, personal and mother's level of education, and menstrual problems. The use of other reproductive health services for preventive care varied across women's socio-economic background.

CONCLUSION

This study demonstrates increasing social differentials in the use of reproductive health services for preventive care among young women in the USA between 1995 and 2002, a finding which calls for careful monitoring in the context of limited resources.

Assessing stroke patients’ prospective memory using virtual reality

There is a dearth of empirical evidence about prospective memory (remembering to perform actions in the future) in stroke patients. A probable reason for this is that it is difficult to perform a realistic and controlled assessment of prospective memory ability in a rehabilitation setting. Virtual reality may provide a solution to this difficulty by allowing prospective memory to be tested in a simulation of a real-life situation whilst retaining a laboratory level of scientific control. This exploratory study assessed the performance of stroke patients and age-matched control participants on event-, time- and activity-based prospective memory retrieval tasks in a personal computer-based virtual environment. Stroke patients were severely impaired at the event- and activity-based tasks compared with age-matched controls, but only marginally impaired at the time-based task. The additional knowledge gained from this form of assessment could direct rehabilitation more effectively towards specific impairments of individual patients.

Beamline I11 at Diamond: a new instrument for high resolution powder diffraction

The performance characteristics of a new synchrotron x-ray powder diffraction beamline (I11) at the Diamond Light Source are presented. Using an in-vacuum undulator for photon production and deploying simple x-ray optics centered around a double-crystal monochromator and a pair of harmonic rejection mirrors, a high brightness and low bandpass x-ray beam is delivered at the sample. To provide fast data collection, 45 Si(111) analyzing crystals and detectors are installed onto a large and high precision diffractometer. High resolution powder diffraction data from standard reference materials of Si, alpha-quartz, and LaB6 are used to characterize instrumental performance.

Evidence for HTR1A and LHPP as interacting genetic risk factors in major depression

The HTR1A -1019C>G genotype was associated with major depression in the Utah population. Linkage analysis on Utah pedigrees with strong family histories of major depression including only cases with the HTR1A -1019G allele revealed a linkage peak on chromosome 10 (maximum HLOD=4.4). Sequencing of all known genes in the linkage region revealed disease-segregating single-nucleotide polymorphisms (SNPs) in LHPP. LHPP SNPs were also associated with major depression in both Utah and Ashkenazi populations. Consistent with the linkage evidence, LHPP associations depended on HTR1A genotype. Lhpp or a product of a collinear brain-specific transcript, therefore, may interact with Htr1a in the pathogenesis of major depression.

Intensive versus conventional glucose control in critically ill patients

BACKGROUND

The optimal target range for blood glucose in critically ill patients remains unclear.

METHODS

Within 24 hours after admission to an intensive care unit (ICU), adults who were expected to require treatment in the ICU on 3 or more consecutive days were randomly assigned to undergo either intensive glucose control, with a target blood glucose range of 81 to 108 mg per deciliter (4.5 to 6.0 mmol per liter), or conventional glucose control, with a target of 180 mg or less per deciliter (10.0 mmol or less per liter). We defined the primary end point as death from any cause within 90 days after randomization.

RESULTS

Of the 6104 patients who underwent randomization, 3054 were assigned to undergo intensive control and 3050 to undergo conventional control; data with regard to the primary outcome at day 90 were available for 3010 and 3012 patients, respectively. The two groups had similar characteristics at baseline. A total of 829 patients (27.5%) in the intensive-control group and 751 (24.9%) in the conventional-control group died (odds ratio for intensive control, 1.14; 95% confidence interval, 1.02 to 1.28; P=0.02). The treatment effect did not differ significantly between operative (surgical) patients and nonoperative (medical) patients (odds ratio for death in the intensive-control group, 1.31 and 1.07, respectively; P=0.10). Severe hypoglycemia (blood glucose level, < or = 40 mg per deciliter [2.2 mmol per liter]) was reported in 206 of 3016 patients (6.8%) in the intensive-control group and 15 of 3014 (0.5%) in the conventional-control group (P<0.001). There was no significant difference between the two treatment groups in the median number of days in the ICU (P=0.84) or hospital (P=0.86) or the median number of days of mechanical ventilation (P=0.56) or renal-replacement therapy (P=0.39).

CONCLUSIONS

In this large, international, randomized trial, we found that intensive glucose control increased mortality among adults in the ICU: a blood glucose target of 180 mg or less per deciliter resulted in lower mortality than did a target of 81 to 108 mg per deciliter. (ClinicalTrials.gov number, NCT00220987.)