Association between cigarette smoking and anxiety disorders during adolescence and early adulthood

CONTEXT: Cigarette smoking is associated with some anxiety disorders, but the direction of the association between smoking and specific anxiety disorders has not been determined. OBJECTIVE: To investigate the longitudinal association between cigarette smoking and anxiety disorders among adolescents and young adults. DESIGN: The Children in the Community Study, a prospective longitudinal investigation. SETTING AND PARTICIPANTS: Community-based sample of 688 youths (51% female) from upstate New York interviewed in the years 1985-1986, at a mean age of 16 years, and in the years 1991-1993, at a mean age of 22 years. MAIN OUTCOME MEASURE: Participant cigarette smoking and psychiatric disorders in adolescence and early adulthood, measured by age-appropriate versions of the Diagnostic Interview Schedule for Children. RESULTS: Heavy cigarette smoking (>/=20 cigarettes/d) during adolescence was associated with higher risk of agoraphobia (10.3% vs 1.8%; odds ratio [OR], 6.79; 95% confidence interval [CI], 1.53-30.17), generalized anxiety disorder (20.5% vs 3.71%; OR, 5.53; 95% CI, 1.84-16.66), and panic disorder (7.7% vs 0.6%; OR, 15.58; 95% CI, 2.31-105.14) during early adulthood after controlling for age, sex, difficult childhood temperament; alcohol and drug use, anxiety, and depressive disorders during adolescence; and parental smoking, educational level, and psychopathology. Anxiety disorders during adolescence were not significantly associated with chronic cigarette smoking during early adulthood. Fourteen percent and 15% of participants with and without anxiety during adolescence, respectively, smoked at least 20 cigarettes per day during early adulthood (OR, 0.88; 95% CI, 0.36-2.14). CONCLUSION: Our results suggest that cigarette smoking may increase risk of certain anxiety disorders during late adolescence and early adulthood. JAMA. 2000;284:2348-2351.     

GSTM1基因多态性与吸烟因素交互作用影响肺癌发生的病例对照研究

目的:探讨谷胱甘肽硫转移酶基因(GSTMl)多态性和环境因素与肺癌发生相关性。方法:采用病例对照研究方法,调查150例住院肺癌患者和150例健康体检者的生活习惯及家族史等信息,并应用PCR-RFLP技术检测研究对象的GSTM1的基因型,采用Logistic回归分析GSTMl基因型和吸烟因素与肺癌的关系,及其两者间的交互作用。结果:(1)病例组GSTMl缺失率64.0%,对照组45.3%,GSTM1基因缺失型发生肺癌的风险OR值为2.14(95%CI:1.35～3.41);吸烟因素发生肺癌的风险OR值为2.53(95%CI:1.57～4.06);(2)GSTM1基因缺失型联合吸烟的OR值5.58(95%CI:2.71～11.49),大于吸烟因素及GSTMl基因缺失型的风险OR值乘积,交互作用中的超相乘模型;(3)随着吸烟量的增加,交互作用系数γ值分别为2.315、2.088、2.035。结论:GSTMl基因缺失与吸烟是肺癌发生的风险因素,GSTMl基因缺失与吸烟因素两者存在交互作用,GSTMl基因缺失与吸烟量呈低暴露-基因效应。     

Intake of fruits and vegetables and risk of breast cancer: a pooled analysis of cohort studies

CONTEXT: Some epidemiologic studies suggest that elevated fruit and vegetable consumption is associated with a reduced risk of breast cancer. However, most have been case-control studies in which recall and selection bias may influence the results. Additionally, publication bias may have influenced the literature on associations for specific fruit and vegetable subgroups. OBJECTIVE: To examine the association between breast cancer and total and specific fruit and vegetable group intakes using standardized exposure definitions. DATA SOURCES/STUDY SELECTION: Eight prospective studies that had at least 200 incident breast cancer cases, assessed usual dietary intake, and completed a validation study of the diet assessment method or a closely related instrument were included in these analyses. DATA EXTRACTION: Using the primary data from each of the studies, we calculated study-specific relative risks (RRs) that were combined using a random-effects model. DATA SYNTHESIS: The studies included 7377 incident invasive breast cancer cases occurring among 351 825 women whose diet was analyzed at baseline. For comparisons of the highest vs lowest quartiles of intake, weak, nonsignificant associations were observed for total fruits (pooled multivariate RR, 0.93; 95% confidence interval [CI], 0.86-1.00; P for trend =.08), total vegetables (RR, 0.96; 95% CI, 0.89-1.04; P for trend =.54), and total fruits and vegetables (RR, 0.93; 95% CI, 0.86-1.00; P for trend =.12). No additional benefit was apparent in comparisons of the highest and lowest deciles of intake. No associations were observed for green leafy vegetables, 8 botanical groups, and 17 specific fruits and vegetables. CONCLUSION: These results suggest that fruit and vegetable consumption during adulthood is not significantly associated with reduced breast cancer risk.     

Risk of breast cancer with oral contraceptive use in women with a family history of breast cancer

CONTEXT: Oral contraceptive (OC) use is weakly associated with breast cancer risk in the general population, but the association among women with a familial predisposition to breast cancer is less clear. OBJECTIVE: To determine whether the association between OC use and risk of breast cancer is influenced by family history of the disease. DESIGN AND SETTING: Historical cohort study of 426 families of breast cancer probands diagnosed between 1944 and 1952 at the Tumor Clinic of the University of Minnesota Hospital. Follow-up data on families were collected by telephone interview between 1991 and 1996. PARTICIPANTS: A total of 394 sisters and daughters of the probands, 3002 granddaughters and nieces, and 2754 women who married into the families. MAIN OUTCOME MEASURE: Relative risk (RR) of breast cancer associated with history of OC use by relationship to proband. RESULTS: After accounting for age and birth cohort, ever having used OCs was associated with significantly increased risk of breast cancer among sisters and daughters of the probands (RR, 3.3; 95% confidence interval [CI], 1.6-6.7), but not among granddaughters and nieces of the probands (RR, 1.2; 95% CI, 0.8-2.0) or among marry-ins (RR, 1.2; 95% CI, 0.8-1.9). Results were essentially unchanged after adjustment for parity, age at first birth, age at menarche, age at menopause, oophorectomy, smoking, and education. The elevated risk among women with a first-degree family history of breast cancer was most evident for OC use during or prior to 1975, when formulations were likely to contain higher dosages of estrogen and progestins (RR, 3.3; 95% CI, 1.5-7.2). A small number of breast cancer cases (n = 2) limited the statistical power to detect risk among women with a first-degree relative with breast cancer and OC use after 1975. CONCLUSIONS: These results suggest that women who have ever used earlier formulations of OCs and who also have a first-degree relative with breast cancer may be at particularly high risk for breast cancer. Further studies of women with a strong family history who have used more recent lower-dosage formulations of OCs are needed to determine how women with a familial predisposition to breast cancer should be advised regarding OC use today. JAMA. 2000;284:1791-1798.     

Estrogen replacement therapy and ovarian cancer mortality in a large prospective study of US women

CONTEXT: Postmenopausal estrogen use is associated with increased risk of endometrial and breast cancer, 2 hormone-related cancers. The effect of postmenopausal estrogen use on ovarian cancer is not established. OBJECTIVES: To examine the association between postmenopausal estrogen use and ovarian cancer mortality and to determine whether the association differs according to duration and recency of use. DESIGN AND SETTING: The American Cancer Society's Cancer Prevention Study II, a prospective US cohort study with mortality follow-up from 1982 to 1996. PARTICIPANTS: A total of 211 581 postmenopausal women who completed a baseline questionnaire in 1982 and had no history of cancer, hysterectomy, or ovarian surgery at enrollment. MAIN OUTCOME MEASURE: Ovarian cancer mortality, compared among never users, users at baseline, and former users as well as by total years of use of estrogen replacement therapy (ERT). RESULTS: A total of 944 ovarian cancer deaths were recorded in 14 years of follow-up. Women who were using ERT at baseline had higher death rates from ovarian cancer than never users (rate ratio [RR], 1.51; 95% confidence interval [CI], 1.16-1.96). Risk was slightly but not significantly increased among former estrogen users (RR, 1.16; 95% CI, 0.99-1.37). Duration of use was associated with increased risk in both baseline and former users. Baseline users with 10 or more years of use had an RR of 2.20 (95% CI, 1.53-3.17), while former users with 10 or more years of use had an RR of 1.59 (95% CI, 1.13-2.25). Annual age-adjusted ovarian cancer death rates per 100 000 women were 64.4 for baseline users with 10 or more years of use, 38.3 for former users with 10 or more years of use, and 26.4 for never users. Among former users with 10 or more years of use, risk decreased with time since last use reported at study entry (RR for last use <15 years ago, 2.05; 95% CI, 1.29-3.25; RR for last use >/=15 years ago, 1.31; 95% CI, 0.79-2.17). CONCLUSIONS: In this population, postmenopausal estrogen use for 10 or more years was associated with increased risk of ovarian cancer mortality that persisted up to 29 years after cessation of use.     

PTEN IVS4基因多态性与子宫内膜息肉及子宫内膜癌风险的相关性

目的 探讨PTEN IVS4基因多态性（rs 3830675）与子宫内膜息肉及子宫内膜癌风险的关系.方法 本研究是以中国汉族人群为研究对象的病例对照研究,选取150例子宫内膜息肉患者为病例组,100例年龄相匹配的健康女性为对照组.应用聚合酶链反应-限制性片段长度多态性PCR-RFLP分析方法对单核苷酸多态性（r3830675）进行基因分型.结果 对照组、子宫内膜息肉组和子宫内膜癌组年龄、体质量指数、初产年龄、产次、吸烟及饮酒分布均无统计学差异（P＞0.05）.PTENIVS4基因型和等位基因分布在病例组和对照组中无统计学差异（χ2=0.996,df=2,P=0.608;χ2=0.651,df=1,P=0.420）.病例组与对照组携带（-/＋）、（＋/＋）基因型与（-/-）基因型相比发生子宫内膜息肉的风险无统计学差异（OR=0.864,95％ CI：0.505～1.478,P=0.593;OR=0.770,95％ CI：0.452-1.312,P=0.337）.携带等位基因[-]与等位基因[＋]相比发生子宫内膜息肉的风险也没有显著差异（OR=0.857,95％CI：0.589～1.247,P=0.420）.在病例组中,携带（-/＋）基因型较（-/-）基因型发生子宫内膜癌风险显著降低（OR=0.433,95％ CI：0.207～ 0.908,P=0.027）,等位基因[＋]较等位基因[-]发生子宫内膜癌风险显著降低（OR=0.542,95％CI：0.305～ 0.962,P=0.036）.结论 PTEN IVS4多态性可能是子宫内膜息肉恶化的危险因素.     

吸烟与胃癌关系的Meta-分析

目的探讨吸烟与胃癌的关系。方法运用Meta分析技术进行综合定量分析,并按研究类型(病例对照和队列研究)和性别(男、女)分层进行合并分析。根据资料一致性检验,采用随机效应模型(D-L法)计算合并相对危险度(RR)及其95%的可信区间(95%CI)。结果吸烟与胃癌之间总合并RR为2.14(95%CI:1.12～4.06),男性吸烟与胃癌之间总合并RR为1.70(95%CI:1.34～2.14),女性吸烟与胃癌之间总合并RR为1.83(95%CI:0.10～33.09)。结论吸烟是胃癌发病的危险因素之一,男性吸烟可能增加患胃癌的危险性,女性吸烟与胃癌的关系还需进一步研究。     

Whole grain consumption and risk of ischemic stroke in women: A prospective study

CONTEXT: Although increased intake of grain products has been recommended to prevent cardiovascular disease (CVD), prospective data examining the relation of whole grain intake to risk of ischemic stroke are sparse, especially among women. OBJECTIVE: To examine the hypothesis that higher whole grain intake reduces the risk of ischemic stroke in women. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort of 75,521 US women aged 38 to 63 years without previous diagnosis of diabetes mellitus, coronary heart disease, stroke, or other CVDs in 1984, who completed detailed food frequency questionnaires (FFQs) in 1984, 1986, 1990, and 1994, and were followed up for 12 years as part of the Nurses' Health Study. MAIN OUTCOME MEASURE: Incidence of ischemic stroke, confirmed by medical records, by quintile of whole grain intake according to FFQ responses. RESULTS: During 861,900 person-years of follow-up, 352 confirmed incident cases of ischemic stroke occurred. We observed an inverse association between whole grain intake and ischemic stroke risk. The age-adjusted relative risks (RRs) from the lowest to highest quintiles of whole grain intake were 1.00 (referent), 0.68 (95% confidence interval [CI], 0.49-0.94), 0.69 (95% CI, 0.51-0.95), 0.49 (95% CI, 0.35-0.69), and 0.57 (95% CI, 0.42-0.78; P =.003 for trend). Adjustment for smoking modestly attenuated this association (RR comparing extreme quintiles, 0.64; 95% CI, 0.47-0.89). This inverse association remained essentially unchanged with further adjustment for known CVD risk factors, including saturated fat and transfatty acid intake (multivariate-adjusted RR comparing extreme quintiles, 0.69; 95% CI, 0.50-0.98). The inverse relation between whole grain intake and risk of ischemic stroke was also consistently observed among subgroups of women who never smoked, did not drink alcohol, did not exercise regularly, or who did not use postmenopausal hormones. No significant association was observed between total grain intake and risk of ischemic stroke. CONCLUSIONS: In this cohort, higher intake of whole grain foods was associated with a lower risk of ischemic stroke among women, independent of known CVD risk factors. These prospective data support the notion that higher intake of whole grains may reduce the risk of ischemic stroke.     

Homocysteine and risk of cardiovascular disease among postmenopausal women.

CONTEXT: Individuals with elevated levels of homocysteine tend to have higher prevalence of cardiovascular disease. However, prospective studies of homocysteine are inconsistent and data among women are limited. OBJECTIVE: To determine whether elevated homocysteine levels in healthy postmenopausal women predict risk of developing cardiovascular disease. DESIGN: Prospective, nested case-control study with a mean 3-year follow-up. SETTING: The Women's Health Study, an ongoing US primary prevention trial initiated in 1993. PARTICIPANTS: From a total cohort of 28,263 postmenopausal women with no history of cardiovascular disease or cancer at baseline, 122 women who subsequently experienced cardiovascular events were defined as cases, and 244 age- and smoking status-matched women who remained free of disease during follow-up were defined as controls. MAIN OUTCOME MEASURES: Incidence of death due to cardiovascular disease, nonfatal myocardial infarction (MI), stroke, percutaneous transluminal coronary angioplasty, or coronary artery bypass graft by baseline homocysteine level. RESULTS: Of the 122 cases, there were 85 events of MI or stroke and 37 coronary revascularizations. Case subjects had significantly higher baseline homocysteine levels than controls (14.1 vs 12.4 micromol/L; P = .02). Subjects with homocysteine levels in the highest quartile had a 2-fold increase in risk of any cardiovascular event (relative risk [RR], 2.0; 95% confidence interval [CI], 1.1-3.8). This effect was largely due to an excess of cases with high levels of homocysteine; the RR for those with homocysteine levels at or higher than the 95th percentile (20.7 micromol/L) was 2.6 (95% CI, 1.1-5.7). Risk estimates were independent of traditional risk factors and were greatest for the end points of MI and stroke (RR for those with baseline homocysteine levels in the top quartile, 2.2; 95% CI, 1.1-4.6). Self-reported multivitamin supplement use at study entry was associated with significantly reduced levels of homocysteine (P<.001). However, the association between increasing quartile of homocysteine level and risk of MI or stroke remained significant in analyses controlling for baseline multivitamin supplement use (P = .003 for trend), and subgroup analyses limited to women who were (P = .02 for trend) or were not (P = .04 for trend) taking multivitamin supplements. CONCLUSIONS: Among healthy postmenopausal US women, elevated levels of homocysteine moderately increased the risk of future cardiovascular disease. Whether lowering the homocysteine level reduces risk of cardiovascular events requires testing in randomized controlled trials.     

Intake of fish and omega-3 fatty acids and risk of stroke in women

CONTEXT: Some prospective studies have shown an inverse association between fish intake and risk of stroke, but none has examined the relationship of fish and omega-3 polyunsaturated fatty acid intake with risk of specific stroke subtypes. OBJECTIVE: To examine the association between fish and omega-3 polyunsaturated fatty acid intake and risk of stroke subtypes in women. DESIGN, SETTING, AND SUBJECTS: Prospective cohort study of women in the Nurses' Health Study cohort, aged 34 to 59 years in 1980, who were free from prior diagnosed cardiovascular disease, cancer, and history of diabetes and hypercholesterolemia and who completed a food frequency questionnaire including consumption of fish and other frequently eaten foods. The 79 839 women who met our eligibility criteria were followed up for 14 years. MAIN OUTCOME MEASURE: Relative risk of stroke in 1980-1994 compared by category of fish intake and quintile of omega-3 polyunsaturated fatty acid intake. RESULTS: After 1 086 261 person-years of follow-up, 574 incident strokes were documented, including 119 subarachnoid hemorrhages, 62 intraparenchymal hemorrhages, 303 ischemic strokes (264 thrombotic and 39 embolic infarctions), and 90 strokes of undetermined type. Among thrombotic infarctions, 90 large-artery occlusive infarctions and 142 lacunar infarctions were identified. Compared with women who ate fish less than once per month, those with higher intake of fish had a lower risk of total stroke: the multivariate relative risks (RRs), adjusted for age, smoking, and other cardiovascular risk factors, were 0.93 (95% confidence interval [CI], 0.65-1.34) for fish consumption 1 to 3 times per month, 0.78 (95% CI, 0.55-1.12) for once per week, 0.73 (95% CI, 0.47-1.14) for 2 to 4 times per week, and 0.48 (95% CI, 0.21-1.06) for 5 or more times per week (P for trend =.06). Among stroke subtypes, a significantly reduced risk of thrombotic infarction was found among women who ate fish 2 or more times per week (multivariate RR, 0.49; 95% CI, 0.26-0.93). Women in the highest quintile of intake of long-chain omega-3 polyunsaturated fatty acids had reduced risk of total stroke and thrombotic infarction, with multivariate RRs of 0.72 (95% CI, 0.53-0.99) and 0.67 (95% CI, 0.42-1.07), respectively. When stratified by aspirin use, fish and omega-3 polyunsaturated fatty acid intakes were inversely associated with risk of thrombotic infarction, primarily among women who did not regularly take aspirin. There was no association between fish or omega-3 polyunsaturated fatty acid intake and risk of hemorrhagic stroke. CONCLUSIONS: Our data indicate that higher consumption of fish and omega-3 polyunsaturated fatty acids is associated with a reduced risk of thrombotic infarction, primarily among women who do not take aspirin regularly, but is not related to risk of hemorrhagic stroke.     

MicroRNA-146a前体区基因多态性与江苏地区汉族人群喉癌遗传易感性的关联性分析

目的探讨microRNA-146a（miR-146a）前体区基因多态性位点rs2910164 G〉C与喉癌的关联性。方法建立病例一对照研究,选取204例喉癌患者和440例健康对照者,收集一般人口学资料和临床病理学特征,采用TaqMan探针对miR-146a rs2910164位点进行基因分型,logistic回归模型用于评价rs2910164位点与喉癌发病风险的关联性强度。结果rs2910164多态性位点与增加罹患喉癌风险显著相关（GC/CCVS．CC：OR调整=2．49,95％CI=1．57-3．94）。分层分析显示,与携带GG基因型个体相比,携带C等位基因的吸烟、饮酒以及无肿瘤家族史个体罹患喉癌风险显著增加（P均〈0．05）,吸烟、饮酒与miR-146a rs2910164位点的共同作用效应更加显著（吸烟与rs2910164GC/CC：OR=6．39,95％CI=2．72-15．0;饮酒与rs2910164GC/CC：OR=4．19．95％CI=2．24-7．83）。结论miR-146ars2910164C等位基因与增加罹患喉癌风险有关,可以作为预测喉癌发病风险的潜在生物标志物。     

A prospective study of folate intake and the risk of breast cancer

CONTEXT: Folate is involved in DNA synthesis and methylation and may reduce breast cancer risk, particularly among women with greater alcohol consumption. OBJECTIVES: To assess the association between folate intake and risk of breast cancer and whether higher folate intake may reduce excess risk among women who consume alcohol. DESIGN: Prospective cohort study performed in 1980, with 16 years of follow-up. SETTING AND PARTICIPANTS: A total of 88818 women who completed the dietary questionnaire section of the Nurses' Health Study in 1980. MAIN OUTCOME MEASURE: Incidence of invasive breast cancer by levels of folate and alcohol intake. RESULTS: A total of 3483 cases of breast cancer were documented. Total folate intake was not associated with overall risk of breast cancer. However, among women who consumed at least 15 g/d of alcohol, the risk of breast cancer was highest among those with low folate intake. For total folate intake of at least 600 microg/d compared with 150 to 299 microg/d, the multivariate relative risk (RR) was 0.55 (95% confidence interval [CI], 0.39-0.76; P for trend = .001). This association was only slightly attenuated after additional adjustment for intake of beta carotene, lutein/zeaxanthin, preformed vitamin A, and total vitamins C and E. The risk of breast cancer associated with alcohol intake was strongest among women with total folate intake of less than 300 microg/d (for alcohol intake > or =15 g/d vs <15 g/d, multivariate RR, 1.32; 95% CI, 1.15-1.50). For women who consumed at least 300 microg/d of total folate, the multivariate RR for intake of at least 15 g/d of alcohol vs less than 15 g/d was 1.05 (95% CI, 0.92-1.20). Current use of multivitamin supplements, the major source of folate, was associated with lower breast cancer risk among women who consumed at least 15 g/d of alcohol (for current users of supplements vs never users, RR, 0.74; 95% CI, 0.59-0.93). CONCLUSIONS: Our findings suggest that the excess risk of breast cancer associated with alcohol consumption may be reduced by adequate folate intake.     

Cigarette smoking and exposure to passive smoke are risk factors for cervical cancer

Personal cigarette smoking and exposure to passive smoke as risk factors for cervical cancer were examined in a population-based, case-control study conducted in Utah. Personal cigarette smoking was found to increase the risk of cervical cancer, after adjusting for age, educational level, church attendance, and sexual activity. The adjusted risk estimate associated with being a current smoker was 3.42 (95% confidence interval [Cl], 2.10 to 5.57); for having smoked for 5 or more pack-years, it was 2.81 (95% Cl, 1.73 to 4.55); and for having smoked at least 100 lifetime cigarettes, it was 2.21 (95% Cl, 1.44 to 3.39). The adjusted risk estimate (also adjusted for actual cigarettes smoked) associated with passive smoke exposure for 3 or more hours per day was 2.96 (95% Cl, 1.25 to 7.03). Risk from passive smoking was greater in women who were not smokers (odds ratio, 3.43; 95% Cl, 1.23 to 9.54) than in women who smoked (odds ratio, 2.59; 95% Cl, 0.23 to 29.24).     

饮酒、吸烟及其交互作用与口腔癌关系的病例对照研究

目的探讨饮酒、吸烟与口腔癌的关系。方法采用病例对照研究收集相关资料,病例为福建医科大学附属第一医院口腔科经病理确诊的新发口腔癌病例206例,对照为体检人群及其他科室患者584例。每位研究对象进行面对面的问卷调查。采用非条件Logistic回归对资料进行分析,估算饮酒、吸烟与口腔癌发病风险的调整比值比（OR）及95％可信区间（95％CI）,并分析饮酒与吸烟的交互作用。结果饮酒、吸烟可显著增加口腔癌的发病风险,调整OR值为2．06（95％CI：1．33～3．20）,2．46（1．77～3．41）;开始饮酒年龄越早、平均每天饮酒精量的增加和饮酒年限的延长,饮酒者患口腔癌的危险性增大。其中平均每天饮酒精量超过60g者与口腔癌有显著关联（P〈0．05）,调整OR值为5．98（95％CI：3．26～10．95）;吸烟且饮酒者患口腔癌的危险性是不吸烟且不饮酒者的4．77倍（95％CI：2．71～8．39）,烟酒乘积项的调整OR值为3．58（95％CI：2．45～5．24）,调整后相对超危险度比（RERI）为2．87（95％CI：0．73～5．02）、归因比（AP）为0．60（95％CI：0．33～0．87）、交互作用指数（S）为4．20（95％CI：0．95～18．66）。结论饮酒、吸烟是口腔癌的危险因素,饮酒与吸烟二者有协同作用,可增加口腔癌的发病风险。     

Oral contraceptive agents and breast cancer: a population-based case-control study

In this population-based case-control study that was conducted in Adelaide, South Australia, and which involved 395 case subjects and 386 control subjects who were aged 20 years to 69 years, the adjusted relative risk of breast cancer for women who had ever used oral contraceptive agents was 1.06 (95% confidence interval [CI], 0.70-1.60). Relative risks that were associated with use of oral contraceptive agents for one month to 18 months and for 19 months or more before a first pregnancy were 1.09 (95% CI, 0.45-2.62) and 1.67 (95% CI, 0.63-4.42), respectively, but the trend was not statistically significant. Relatively-little variation in risk was found in association with the total duration of the use of oral contraceptive agents and with years since the first and the last use of oral contraceptive agents. When the risk of breast cancer in association with the use of oral contraceptive agents was examined across levels of risk factors of breast cancer (history of benign breast disease, family history of breast cancer and parity), the only relative risk which deviated markedly from unity was that which was associated with use of oral contraceptive agents in women with a history of benign breast disease; however, the relative risk of 1.77 (95% CI, 0.35-8.97) was not statistically significant. In conclusion, the results of this study support those of the majority of previous studies in showing no overall relationship between the use of oral contraceptive agents and the risk of breast cancer.     

糖尿病患者罹患肾脏恶性肿瘤危险陛的Meta分析

目的探讨糖尿病与肾脏恶性肿瘤发病风险的关系。方法通过网络检索1990年1月至2011年10月PubMed数据库糖尿病患者发生肾脏恶性肿瘤风险性的相关队列研究和病例对照研究文献,按纳入和排除标准进行筛选、资料提取,采用RevMan5．0软件完成meta分析。结果共纳入14篇文献（8项队列研究和6项病例对照研究）,共包括6,645,516例研究对象。Meta分析显示：糖尿病患者肾脏恶性肿瘤的发生率较对照组高,差异有统计学意义（OR=1．28,95％CI1．10～1．48,P〈0．05）。分层研究发现,队列研究组中的糖尿病患者患肾脏恶性肿瘤的风险性较高（OR=1．32,95％CI1．14～1．53,P〈0．05）,病例对照研究组中的糖尿病患者患肾脏恶性肿瘤的风险性并未增高（OR=1．21,95％C10．79～1．84,P〉0．05）。结论糖尿病与肾脏恶性肿瘤的发生有一定关联,但是否为肾脏恶性肿瘤发生的独立危险因素还需进一步研究。     

Tobacco smoking and pulmonary tuberculosis: a case-control study

A case-control study was carried out to assess if the tobacco smoking is associated with development of active pulmonary tuberculosis in 153 cases with active pulmonary tuberculosis and 160 control subjects. Detailed information on smoking habits was collected from cases and controls using questionnaire. It was seen that tobacco smoking was associated with pulmonary tuberculosis. The estimated crude odd's ratio (OR) of the association was 1.66 (95% confidence interval: 1.01-2.73) . The age adjusted OR was 1.70 (95% CI: 1.01-2.88), p < 0.05. The increased risk for pulmonary tuberculosis was significant in men who had smoked for over 20 years (OR 3.07; 95% CI: 1.37-6.86). The adjusted OR for heavy smokers (more than 20 bidis per day) was 2.72 (95% CI: 1.19-6.20). There was a dose-response relationship between the number of bidis smoked daily and the risk of development of pulmonary tuberculosis. The study showed that tobacco smoking is associated with pulmonary tuberculosis, with a dose-response relationship with the number of bidis consumed daily.     

小气道阻塞与非吸烟女性早期肺腺癌相关性研究

目的 探讨小气道阻塞与非吸烟女性早期肺腺癌的关系以及环境暴露与小气道阻塞的相关性. 方法 采用病例-对照研究方法,纳入非吸烟女性肺腺癌患者85人和对照组85人;用肺功能指标评价小气道情况. 结果 肺癌组FEF50%、FEF75%、MMEF75/25均较对照组明显下降,差异具有统计学意义（P〈0.01）;有被动吸烟的肺癌患者小气道阻塞调整危险度上升到3.55（95%CI为1.33～9.02）,厨房油烟暴露使小气道阻塞的调整危险度由1.90（95%CI为0.84～4.03）上升到3.61（95%CI为1.78～9.13）. 结论 小气道阻塞与非吸烟女性早期肺腺癌相关;被动吸烟和厨房油烟暴露可能是小气道阻塞的危险因素.     

Cigarette smoking and the risk of myocardial infarction, and acute non-infarct coronary events among Malaysian women

In a prospective case-control study over a two-year period involving 1006 women, 264 women with acute myocardial infarction (AMI), 305 with non-infarct acute coronary syndromes (CAD) were compared with 437 women with no coronary heart disease (Controls), to determine the relationship between cigarette smoking and other risks factors with coronary heart disease. A history of current cigarette smoking was strongly associated with the risk of coronary events for both AMI And CAD (p less than 0.001). 23.9% of patients with acute coronary syndromes were current smokers, compared with only 12.8% among controls. Overall, women smokers had about a two-fold increase in risk for all coronary events. Younger women smokers (less than 40 years) and those between 61-70 years had particularly higher risks (10.3 and 2.7 times respectively (p less than 0.01, p less than 0.02). A dose-response pattern of increased AMI risks (from 2.0 to 2.9 times) among women smokers was also found, corresponding to the number of cigarettes smoked per day (p less than 0.05). Other significant coronary risk factors established were: postmenopausal status (OR 6.5), diabetes mellitus (OR 5.1), hypertension (OR 1.6), family history of premature coronary heart disease less than 50 years (OR 1.3) and use of oral contraceptive pills (OR 1.4). Our results thus emphasize that cigarette smoking is an important determinant of acute coronary events even among Malaysian women.     

Reducing aluminum: an occupation possibly associated with bladder cancer.

A case-control study, undertaken to identify reasons for the exceptionally high incidence of bladder cancer among men in the Chicoutimi census division of the province of Quebec, revealed an increased risk associated with employment in the electrolysis department of an aluminum reduction plant. The estimated relative risk was 2.83 (95% confidence interval; 1.06 to 7.54). An interaction was found between such employment and cigarette smoking, resulting in a combined relative risk of 5.70 (95% confidence interval: 2.00 to 12.30). These findings suggest that employment in an aluminum reduction plant accounts for part of the excess of bladder cancer in the region studied.