Proton Pump Inhibitor Use and Obesity-Associated Cancers in the Women's Health Initiative

PURPOSE

Proton pump inhibitors (PPIs) inhibit fatty acid synthase (FAS), a critical enzyme in lipogenesis, energy balance, and cancer cell survival. We aimed to evaluate the association of PPI use with incidence of common obesity- related cancers in women: postmenopausal breast, colorectal, and endometrial cancers.

METHODS

Our study included 124,931 postmenopausal who were enrolled in the Women's Health Initiative (WHI) observational study and clinical trials, and had responded to a year 3 follow-up assessment. We examined prescription and over the counter use of PPI and/or histamine 2 receptor antagonists (H2RA) at baseline and year 3, to isolate potential effects of FAS inhibition by PPI rather than simply acid suppression. Incident cancer cases were physician-adjudicated. Cox proportional hazard regression models were used to estimate multivariable hazard ratios (HR) and 95% confidence intervals (CI) for associations between PPI and/or H2RA use and cancer incidence after year 3.

RESULTS

There were 7956 PPI ever users (with or without H2RA use) and 9398 H2RA only users. PPI or H2RA use was not associated with risk of breast cancer (n=9186 cases), compared to women who did not use either agent (HR 1.01, 95% CI 0.93-1.10 and HR 0.95 95% CI 0.87-1.03, respectively). The incidence of colorectal cancer (n=2280) was significantly lower in PPI users (HR 0.75, 95% CI 0.61-0.92), but not in H2RA users (HR 1.13, 95% CI 0.97-1.31). This association was strengthened with increasing duration (p=0.006) and potency (p=0.005) of PPI use and held regardless of BMI or NSAID use. PPI or H2RA use was not associated with endometrial cancer (n=1231) (HR 0.81, 95% CI 0.61-1.07 and HR 1.13, 95% CI 0.91-1.40, respectively), but showed a trend in decreased risk with increasing PPI potency (P=0.048).

CONCLUSIONS

Among postmenopausal women, PPI use, but not H2RA use, demonstrated an inverse, dose-responsive association with colorectal cancer incidence. This was consistent with preclinical data that FAS inhibition prevents colon cancer progression and supports further investigation of this commonly used medication as a cancer preventive agent. PPI use was not associated with incidence of breast or endometrial cancer.

Unique expatriate factors associated with job dissatisfaction among nurses

AIM

To assess whether expatriate-specific factors were associated with nurses' overall job dissatisfaction after controlling for known factors.

BACKGROUND

Current evidence about job dissatisfaction among nurses in Saudi Arabia is not specific to expatriate nurses. Specific aspects such as job insecurity, fear of litigation, and language barriers have not been assessed in the context of job dissatisfaction.

INTRODUCTION

The majority of nurses in the Arab Gulf countries are expatriate. The motive for employment here is purely financial because there is no path to permanent residency.

METHODS

This was a cross-sectional electronic survey of 977 expatriate nurses in Al-Qassim, Saudi Arabia. The survey included questions on demography, job dissatisfaction (overall and related to salary, workload, and teamwork), job characteristics, job duration as an expatriate, communication issues with patients and doctors, fear of litigation, and job insecurity. We used a hierarchical logistic regression to evaluate whether unique factors were associated with overall job dissatisfaction either as a group, or individually.

RESULTS

The mean age of the nurses was 32 years, and 19% reported overall job dissatisfaction. The unique expatriate factors as a group contributed significantly to the model. Job insecurity, patient communication problems, and shorter job duration were significantly associated with higher overall job dissatisfaction.

CONCLUSIONS

Job insecurity, job duration, and patient communication were significant correlates of overall job dissatisfaction among expatriate nurses.

IMPLICATIONS FOR NURSING POLICY

A longer job contract and organizational initiatives to help new expatriate nurses acculturate will likely decrease feelings of job insecurity and increase job satisfaction.

Age at menarche, abnormal glucose tolerance and type 2 diabetes mellitus: The Rancho Bernardo Study

OBJECTIVE

We examined the association of age at menarche with risk of abnormal glucose tolerance (AGT) and type 2 diabetes in postmenopausal women.

METHODS

Participants were 997 women aged 50-92 years who had a clinic visit in 1984-87, when reproductive and diabetes history were recorded, and an oral glucose tolerance test administered. Information on age at menarche was collected in 1989. Diabetes status was based on WHO 1999 criteria, and AGT on having impaired fasting glucose (IFG) or impaired glucose tolerance (IGT).

RESULTS

The average age was 69.5 years; 12.5% had diabetes and 29.8% had AGT. Menarche was < 12 years in 14.5%, 12-15 years in 78.9% and > or = 16 years in 6.6%. Age and body mass index (BMI) predicted AGT (p < 0.001, p = 0.003, respectively), while age, BMI and family history of diabetes predicted type 2 diabetes (p < 0.001, p < 0.001, p = 0.02, respectively). Polynomial logistic regression showed no association of menarche with AGT or type 2 diabetes risk. In linear regressions, however, older age at menarche was associated with lower fasting (p = 0.01) and post-challenge plasma glucose (p = 0.03). Covariates, especially BMI, weakened these associations, although women with menarche > or = 16 years still had lower post-challenge (0.86 mmol/l, p = 0.05) and fasting glucose (0.26 mmol/l, p = 0.11) than those with menarche < 12 years.

CONCLUSIONS

Age at menarche was not associated with AGT or type 2 diabetes risk. Late age at menarche was inversely associated with fasting and post-challenge glycemia. Obesity may mediate the observed associations.

Physical and mental health correlates of pregnancy following breast cancer

e20552

Background: The possibility and safety of pregnancy after breast cancer is an important issue for many younger breast cancer survivors and their health care providers. Current research does not indicate that survival is negatively affected by pregnancy. However, the “healthy mother bias”, suggesting that survivors who go on to become pregnant are a self-selected healthier group based on their prognosis, has led to cautious interpretation of these findings. No studies have systematically evaluated the potential for this bias. Methods: This nested case-control study includes 81 participants, age 40 or younger at diagnosis, from the Women's Healthy Eating and Living Study (WHEL) (N=3,088). Our sample includes 27 cases who went on to have a child after breast cancer and 54 controls, matched on age and stage at diagnosis, who did not. We used hierarchical linear modeling to accommodate longitudinal data with individuals nested within matched sets (cases and controls). The primary aim was to evaluate the association between summary scores of health and successful pregnancy after breast cancer. The outcome variables, physical health summary score (PHSS) and mental health summary score (MHSS), were taken from the RAND 36 item health survey (SF-36). Covariates were added for adjustment and to improve model precision. Results: Controlling for other variables in the model, mean PHSS were not different among cases compared to controls (B=0.14, p=0.96) (n=152). MHSS were marginally higher among cases (B=6.40, p=0.08), as compared to controls (n=154). This difference is considered clinically significant. Conclusions: While based on a small sample size, this preliminary study did not find evidence of a healthy mother bias based on scores of physical health. However, mental health was marginally better among those who went on to have a child, indicating that the role of mental health should be evaluated in future research.

No significant financial relationships to disclose.

Serum 25-hydroxyvitamin D, parathyroid hormone, and bone mineral density in men: the Rancho Bernardo study

INTRODUCTION

This study examined the distribution and determinants of serum 25-hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) and their associations with bone mineral density (BMD) at the hip and spine in 414 older men (mean age 74 years) living in southern California.

METHODS

At a clinic visit (1997-2000), demographic and lifestyle information, fracture history, and medication use were recorded; venous blood for serum 25OHD and PTH was obtained; and BMD was measured at the hip and spine.

RESULTS

Only one man had vitamin D deficiency (25OHD <20 nmol/l), but 15.5% of the men had high parathyroid levels (PTH >or=65 pg/ml). The mean 25OHD and PTH levels were 109.0 nmol/l and 50.3 pg/ml, respectively. Overall, 21.5% used calcium and 9.7% used vitamin D supplements. Serum 25OHD decreased with age and was lowest in the winter; levels were higher in supplement users (vitamin D and/or calcium; p<0.01). Serum PTH did not vary by age or season, and it was lower in supplement users (p<0.01). After excluding 12 men who were outliers for serum 25OHD and PTH, there was no significant correlation between serum 25OHD and PTH (r=-0.05, p=0.3). In multiple adjusted models, serum 25OHD was positively associated with BMD at the hip (p=0.01) and spine (p=0.001). Serum PTH was moderately and inversely associated with BMD at the hip (p=0.04) but not at the spine (p=0.77).

CONCLUSION

We conclude that serum 25OHD is associated with bone health in older, community-dwelling men.

STD in Bangladesh's trucking industry: prevalence and risk factors

OBJECTIVES

This study characterises the prevalence of a broad spectrum of sexually transmitted diseases (STDs) (herpes simplex virus 2, syphilis, chlamydia, gonorrhoea), and examines associations between risk factors and infection in men working in Bangladesh's trucking industry. Given the high risk sexual behaviours of truck drivers and helpers in many contexts, as well as the direct health effects of STDs and their role in facilitating HIV transmission, it is important to understand the prevalence of STDs and associated risk factors in this population.

METHODS

A cross sectional study was conducted at Tejgaon truck stand, one of the largest truck stands in Dhaka, the capital city. The study group, comprising 388 truck drivers and helpers, was selected via a two tiered sampling strategy. Of 185 trucking agencies based at the truck stand, 38 agencies were randomly selected, and a mean of 10 subjects (drivers/helpers) were recruited from each agency. Urine and blood samples were collected from subjects after an interview about their lifestyle and a comprehensive physical examination. Gold standard laboratory tests were conducted for the detection of STD. Multiple logistic regression was used to assess associations between infections and potential risk factors.

RESULTS

The levels of prevalence of disease were HSV-2 (25.8%), serological syphilis (5.7%), gonorrhoea (2.1%), chlamydia (0.8%). For infection with any bacterial STD (syphilis, gonorrhoea, or chlamydia) the only significant risk factor was having sex with a commercial sex worker in the past year (OR=3.54; CI=1.29-9.72). For HSV-2, truck helpers working primarily on interdistrict routes were significantly more likely to be infected than drivers working on these routes (OR=2.51, CI=1.13--5.55).

CONCLUSIONS

The high prevalence of HSV-2, and to a lesser extent syphilis, and the low levels of condom use despite high numbers of casual sexual partners, illustrate the importance of promoting condom use, particularly in commercial sexual encounters, to men in Bangladesh's trucking industry.

Human immunodeficiency virus, hepatitis B, C and D in Bangladesh's trucking industry: prevalence and risk factors

BACKGROUND

Human immunodeficiency virus (HIV) and hepatitis B and C, viral infections with shared percutaneous, mucosal and perinatal routes of transmission, are responsible for serious morbidity and mortality globally. In Bangladesh there is a dearth of research on prevalence and risk factors for these diseases. This study examines the prevalence of HIV and hepatitis (B, C, D) and risk factors associated with infection in men in Bangladesh's trucking industry (drivers and helpers on trucks), a population at risk for sexually transmitted infections.

METHODS

The study population comprised 388 men (245 drivers, 143 helpers) working out of Tejgaon truck stand in Dhaka, Bangladesh. Subjects were selected through a two-tiered sampling strategy. Of 185 trucking agencies 38 were randomly selected and a of 10 subjects was recruited from each agency. Subjects were interviewed, underwent a comprehensive physical examination and had blood samples taken. Gold standard laboratory tests were conducted to detect HIV, hepatitis B, C, and D infections. To assess risk factors associated with current hepatitis B infections or being a carrier (HBsAg) and lifetime exposure to hepatitis B infection (anti-HBc), simple and multiple logistic regression analyses were performed.

RESULTS

The prevalence of diseases were: HIV 0%, hepatitis C <1%, hepatitis B surface antigen 5.9%, antibody to hepatitis B core antigen 48.1% (with 5 of the 23 HBsAg positive cases testing positive for HBeAg and 18 for anti-HBe), and hepatitis D 0%. Having ever received a therapeutic injection and having had relations with a commercial sex worker (CSW) in the past year were both significantly associated with lifetime exposure to hepatitis B (anti-HBc); having received a therapeutic injection in the past year was associated with being either currently infected with hepatitis B or a carrier (HBsAg).

CONCLUSIONS

The results of the study illustrate the importance of educating health care practitioners about the dangers of unsterile injections, and of educating men in the trucking industry as well as their partners (CSW in particular) about the importance of condom use, especially in high-risk sexual contacts.