Bladder cancer, GSTs, NAT1, NAT2, SULT1A1, XRCC1, XRCC3, XPD genetic polymorphisms and coffee consumption: a case–control study

The aim of the study was to investigate NAT1, NAT2, GSTM1, GSTT1, GSTP1, SULT1A1, XRCC1, XRCC3 and XPD genetic polymorphisms, coffee consumption and risk of bladder cancer (BC) through a hospital-based case–control study. The study population included 197 incident BC cases and 211 controls. The association between genetic polymorphisms, coffee drinking and BC risk was assessed by logistic regression taking into account age, education, tobacco smoking and occupational exposures to polycyclic aromatic hydrocarbons and aromatic amines. No association was found between the genetic polymorphisms investigated and BC risk according to coffee consumption apart of a significant increased BC risk among GSTP1 105-114 Val carriers heavy coffee drinkers (>3 cups/day) (OR 3.18, 95%CI 1.06–9.55). In conclusion our findings suggest a very limited role, if any, of genetic polymorphisms investigated in modulating the BC risk in coffee drinkers.     

Are geoprocessing, environment, and health a possible combination?

The use of geoprocessing techniques allows one to gather socioeconomic, health, and environmental data on a spatial basis. However, interpretation of associations between epidemiological and environmental variables requires the geoprocessing system design. The study scale and object choices precede conception of the system, conditioning the possible statistical and visual results. This scale must be compatible with the phenomenon on which one intends to focus, aiming at internal homogeneity and external heterogeneity of spatial units. The interdependency of spatial processes, reflected in the spatial configuration of social, environmental, and epidemiological data distribution, affects interpretation of causes for simultaneous processes. Geoprocessing allows for knowledge of the context or situational surroundings in which the damage to health takes place.     

Overcritical,Overfriendly? A Dialogue between a Sociologist and a Philosopher on Genetic Technology and its Applications

Medicine, Health Care and Philosophy -     

Interaction between dietary intake and GSTM1 and GSTT1 polymorphisms in head and neck cancer risk: a case-control study in São Paulo, Brazil

A hospital-based case-control study was conducted to investigate the potential interaction between dietary factors and polymorphisms in phase II metabolic enzymes GSTM1 and GSTT1, associated with head and neck cancer risk. The study included 103 histologically confirmed incident cases and 101 controls. Food intake was estimated with a validated food frequency questionnaire. The gene polymorphisms were evaluated by PCR. Increased risk was observed in the highest tertile of beef consumption in the presence of the GSTM1 (OR = 10.79; 95%CI: 2.17-53.64) and GSTT1 null alleles (OR = 3.41; 95%CI: 0.43-27.21). Assessment of dietary intake considering the ratio between animal product and vegetable consumption showed OR = 2.35 (95%CI: 0.27-19.85) in the intermediate tertile and OR = 3.36 (95%CI: 0.41-27.03) in the highest tertile. The results suggest a possible interaction between meat intake and GSTM1/GSTT1 polymorphisms in modulating the risk of head and neck cancer, influenced by vegetable consumption.     

Parenting,Child Behavior,and Academic and Social Functioning: Does Ethnicity Make a Difference?

Background

Most research on the relation between parenting behaviors and child outcomes has not focused on cross-ethnic variation in these relations.

Objective

This study examined if ethnicity moderates associations between parenting, child agency/persistence, and child academic achievement and social competence.

Design

Participants included 608 parents and their 5-year-old children (96 African American, 117 Hispanic, and 395 European American). Parenting was assessed with the Parent Behavior Inventory (support/engagement, hostility/coercion) and a semi-structured interaction paradigm, the NICHD 3-Boxes Task (scaffolding). Child agency/persistence also was assessed with this task. The Social Skills Rating Scale was used to assess social competence (assertion, cooperation, responsibility, self-control). The Woodcock-Johnson-Achievement Test-3rd Edition was used to assess reading and math.

Results

Child agency/persistence was related to academic achievement and support/engagement and hostility/coercion were related to child social competence. Only a few interaction effects between parenting and ethnicity were significant. Higher levels of scaffolding were related to higher scores in reading and mathematics in African American, but not in European American children. Hostility/coercion was associated with lower reading scores in European American, but not in Hispanic children. Support/engagement was related to higher levels of responsibility in both European American and African American children, but this relation was stronger in European American families.

Conclusions

There are more similarities than differences in the effects of parenting and child variables in different ethnic groups. Higher levels of scaffolding are related to higher reading and math achievement in African American families; thus strategies to increase parental scaffolding may be effective in decreasing the “achievement gap.”     

Healthcare workers and H1N1 vaccination: does having a chronic disease make a difference?

Introduction

A novel H1N1 vaccine was manufactured in response to the pandemic in 2009. This study describes the willingness to be vaccinated for H1N1 among healthcare workers (HCWs) in primary healthcare clinics with and without chronic medical conditions, their reasons for refusing vaccination and whether they sought additional information to make an informed decision for the vaccination.

Materials and methods

An anonymous survey was conducted in November 2009 among all medical, nursing, allied health and operations HCWs in nine primary care clinics in Singapore. Participants were asked if they had any chronic medical conditions associated with influenza-related complications (example: asthma, stroke, heart disease, cancer, diabetes mellitus, renal disease), their perception towards vaccination for H1N1 and against seasonal influenza within the preceding 2 years.

Results

The initial response rate was 80%, of which 711 (54.7%) of the completed surveys were analysed. Among the 711 respondents, 16.6% reported having at least 1 chronic disease. Asthma (10.8%), hypertension (10.4%) and dyslipidaemia (9.8%) were the main chronic conditions. Only 39.4% of respondents were willing to be vaccinated against H1N1. Males were 2.07 (95% CI 1.19-3.62) times more likely than females to receive the H1N1 vaccination; the 45-54 and 55+ years old were 2.12 (95% CI 1.06-4.24) and 2.44 (95% CI 1.13-5.27) times more willing than those below 25 years old; and those who considered accepting the seasonal influenza vaccine were 7.0 times more likely than those who did not (95%CI 4.48-10.92). The 2 principal barriers were “fear of side effects” and “unsure of vaccine's effectiveness”. Although 78% attended some H1N1-related talks, only 7% of all HCWs felt that they had sufficient information. Most wanted more information about the vaccine's safety profile and contraindications.

Conclusion

Fewer than 40% of HCWs expressed willingness to receive the H1N1 vaccination, lower than past rates of influenza vaccine. HCWs in primary care clinics who had a chronic condition did not perceive themselves to be at higher risk of developing H1N1-related complications and were not more willing than the rest of the HCWs to accept H1N1 vaccination. Vaccine's side effects and effectiveness were the main concerns. Uptake of H1N1 vaccine may improve with targeted health information covering the vaccine's safety profile.     

Genetic variation in Glutathione S-Transferase Omega-1, Arsenic Methyltransferase and Methylene-tetrahydrofolate Reductase, arsenic exposure and bladder cancer: a case–control study

Background

Bisphenol A (BPA) and polyfluoroalkyl chemicals (PFCs) are suspected endocrine disrupting compounds known to be ubiquitous in people's bodies. Population disparities in exposure to these chemicals have not been fully characterized.

Methods

We analyzed data from the 2003-2006 National Health and Nutrition Examination Survey. Using multivariable linear regression we examined the association between urinary concentrations of BPA, serum concentrations of four PFCs, and multiple measures of socioeconomic position (SEP): family income, education, occupation, and food security. We also examined associations with race/ethnicity.

Results

All four PFCs were positively associated with family income, whereas BPA was inversely associated with family income. BPA concentrations were higher in people who reported very low food security and received emergency food assistance than in those who did not. This association was particularly strong in children: 6-11 year-olds whose families received emergency food had BPA levels 54% higher (95% CI, 13 to 112%) than children of families who did not. For BPA and PFCs we saw smaller and less consistent associations with education and occupation. Mexican Americans had the lowest concentrations of any racial/ethnic group of both types of chemicals; for PFCs, Mexican Americans not born in the U.S. had much lower levels than those born in the U.S.

Conclusions

People with lower incomes had higher body burdens of BPA; the reverse was true for PFCs. Family income with adjustment for family size was the strongest predictor of chemical concentrations among the different measures of SEP we studied. Income, education, occupation, and food security appear to capture different aspects of SEP that may be related to exposure to BPA and PFCs and are not necessarily interchangeable as measures of SEP in environmental epidemiology studies. Differences by race/ethnicity were independent of SEP.     

Decentralization and health system performance – a focused review of dimensions,difficulties, and derivatives in India

Introduction

One of the principal goals of any health care system is to improve health through the provision of clinical and public health services. Decentralization as a reform measure aims to improve inputs, management processes and health outcomes, and has political, administrative and financial connotations. It is argued that the robustness of a health system in achieving desirable outcomes is contingent upon the width and depth of ‘decision space’ at the local level. Studies have used different approaches to examine one or more facets of decentralization and its effect on health system functioning; however, lack of consensus on an acceptable framework is a critical gap in determining its quantum and quality. Theorists have resorted to concepts of ‘trust’, ‘convenience’ and ‘mutual benefits’ to explain, define and measure components of governance in health. In the emerging ‘continuum of health services’ model, the challenge lies in identifying variables of performance (fiscal allocation, autonomy at local level, perception of key stakeholders, service delivery outputs, etc.) through the prism of decentralization in the first place, and in establishing directed relationships among them.

Methods

This focused review paper conducted extensive web-based literature search, using PubMed and Google Scholar search engines. After screening of key words and study objectives, we retrieved 180 articles for next round of screening. One hundred and four full articles (three working papers and 101 published papers) were reviewed in totality. We attempted to summarize existing literature on decentralization and health systems performance, explain key concepts and essential variables, and develop a framework for further scientific scrutiny. Themes are presented in three separate segments of dimensions, difficulties and derivatives.

Results

Evaluation of local decision making and its effect on health system performance has been studied in a compartmentalized manner. There is sparse evidence about innovations attributable to decentralization. We observed that in India, there is very scant evaluative study on the subject. We didn’t come across a single study examining the perception and experiences of local decision makers about the opportunities and challenges they faced. The existing body of evidences may be inadequate to feed into sound policy making. The principles of management hinge on measurement of inputs, processes and outputs. In the conceptual framework we propose three levels of functions (health systems functions, management functions and measurement functions) being intricately related to inputs, processes and outputs. Each level of function encompasses essential elements derived from the synthesis of information gathered through literature review and non-participant observation. We observed that it is difficult to quantify characteristics of governance at institutional, system and individual levels except through proxy means.

Conclusion

There is an urgent need to sensitize governments and academia about how best more objective evaluation of ‘shared governance’ can be undertaken to benefit policy making. The future direction of enquiry should focus on context-specific evidence of its effect on the entire spectrum of health system, with special emphasis on efficiency, community participation, human resource management and quality of services.

     

Alcohol,alcoholic beverages,and melanoma risk: a systematic literature review and dose–response meta-analysis

Purpose

Several studies in recent years have investigated the relationship between alcohol intake and melanoma risk, with conflicting results. To help clarify this issue, we conducted a literature review and dose–response meta-analysis of studies published until June 30th, 2017, that examined the association between alcohol intake (overall and by beverage type) and melanoma risk.

Methods

We used random effect models with maximum likelihood estimation to calculate summary relative risk (SRR) and 95% confidence intervals (95%CI).

Results

We included 20 independent studies (encompassing 10,555 melanoma cases and over 1.6 million non-cases/controls) published during 1986–2016, of which six had a prospective cohort study design. Adjustment for phenotypic characteristics and sunlight exposure was performed in 11 and nine studies, respectively. Alcohol intake was moderately associated with melanoma risk: the SRR were 1.29 (95% CI 1.14–1.45) for those in the highest vs. lowest category of current alcohol intake, and 1.96 (95% CI 1.02–3.76, I²?=?0%) for cumulative intake. In the dose–response analysis, the increase in risk associated with a 10 g increment in daily alcohol intake was 1.07 (95% CI 1.03–1.11). Risk estimates did not differ by gender, study design and adjustment for confounders; between-studies heterogeneity was acceptable, and there was no evidence of publication bias.

Conclusions

Our findings suggest that alcohol drinking may be moderately associated with increased melanoma risk, although residual confounding and bias cannot be ruled out. Further research is needed to confirm these findings, clarify the role of the different alcohol sources, and investigate the interaction with known melanoma risk factors.

     

'Smoke like a man, die like a man'?: a review of the relationship between gender, sex and lung cancer

Lung cancer is one of the most important 'avoidable' causes of death world-wide. It is also one in which differences in relation to sex and gender are especially significant. Increasing lung cancer deaths amongst women alongside stable or decreasing deaths amongst men in many countries have substantially altered the male:female ratio in this disease and produced a need to understand differences between men and women in lung cancer risk, and how they relate to sex and gender. This paper reviews research on differences between men and women in lung cancer incidence, mortality and survival, focusing on material which adds to our understanding of the complex differences between each group. This review suggests that the risk of lung cancer may be different for men and women in response to a complex interaction between biological factors such as hormonal difference and gendered factors such as smoking behaviour. In particular women's apparently greater relative risk of lung cancer and the differences between men and women in the risk of specific histological types of lung cancer need to be understood from a perspective in which both biological influences and gender influences are drawn out.