睡眠行为与子宫肌瘤关系

目的 探讨中老年女性睡眠行为与子宫肌瘤(UL)的关系。方法 采取以医院为基础的回顾性研究,病例为经临床诊断为UL,术后经病理证实为UL患者;对照为未患UL及其他妇科疾病的患者,病例组和对照组各385例;采用自行设计的调查表对研究对象进行调查,同时使用匹兹堡睡眠质量指数(PSQI)询问研究对象的睡眠行为;采用多因素logistic回归模型对研究对象睡眠行为与UL的比值比(OR)及其相应的95%CI=进行估计。结果 病例组睡眠质量、睡眠时间、睡眠效率、睡眠障碍、PSQI总得分均明显高于对照组(P<0.001);单因素分析结果显示,睡眠质量、睡眠效率、睡眠障碍及PSQI总分与UL的发生有关;为进一步控制多种潜在性混杂因素的影响,进行多因素logistic分析结果显示,评分>2分者睡眠质量(OR=2.030,95%CI==1.261～3.181,P<0.001)、睡眠效率(OR=2.437,95%CI==1.465～4.056,P<0.001)、睡眠障碍(OR=1.564,95%CI==1.002～1.862,P=0.023)发生UL危险性均高于评分<1分者;PSQI总分升高与UL呈正相关,总分5～10和>10分者发生UL的危险性均高于总分<5分者(OR=1.833,95%CI==1.308～2.497,P=0.002;OR=1.923,95%CI==1.515～2.687,P=0.019),并且随着评分的增加,发生UL的危险性也增加(P<0.05)。结论 睡眠可能会对UL造成影响,因此绝经前女性应提高睡眠对UL影响的意识,保持身心愉快,定期进行妇科检查,及时发现问题,预防UL的发生。     

Reproductive factors, hormonal contraception, and risk of uterine leiomyomata in African-American women: a prospective study

The authors assessed the risk of uterine leiomyomata in relation to reproductive factors and hormonal contraception in a prospective cohort study of US Black women. From March 1997 through March 2001, the authors followed 22,895 premenopausal women with intact uteri and no prior self-reported diagnosis of uterine leiomyomata. The authors used age- and time-stratified Cox regression models to estimate incidence rate ratios for self-reported uterine leiomyomata, confirmed by ultrasound or hysterectomy, in association with selected reproductive and hormonal factors. During 76,711 person-years of follow-up, 2,279 new cases of ultrasound- or hysterectomy-confirmed uterine leiomyomata were self-reported. After adjustment for age, body mass index, smoking, alcohol intake, and other reproductive covariates, the risk of ultrasound- or hysterectomy-confirmed leiomyomata was inversely associated with age at menarche, parity, and age at first birth and positively associated with years since last birth. Overweight or obesity appeared to attenuate the inverse association between parity and uterine leiomyomata. Current use of progestin-only injectables was inversely associated with risk. No consistent patterns were observed for other forms of hormonal contraception. Reproductive history is an important determinant of leiomyomata risk in premenopausal US Black women. Progestin-only injectables may reduce risk.     

Perceived racial discrimination and risk of uterine leiomyomata

BACKGROUND: The incidence of uterine leiomyomata (fibroids, myomas) is 2-3 times higher in black women than white women. Black women also report higher levels of racial discrimination. We evaluated the hypothesis that greater exposure to racism increases myoma risk in black women. METHODS: Data were derived from the Black Women's Health Study, a prospective cohort study of US black women age 21-69 years in 1995. In 1997, women reported on "everyday" and "lifetime" experiences of racism. From 1997 through 2003, we followed 22,002 premenopausal women to assess the association between self-reported racism and risk of myomas. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated from Cox regression models. RESULTS: During 107,127 person-years of follow-up, 3440 new cases of uterine myomas confirmed by ultrasound (n = 2774) or surgery (n = 666) were reported. All IRRs for "lifetime" and "everyday" experiences of racism were above 1.0. Using a summary variable that averaged the responses from 5 "everyday" racism items, multivariable IRRs comparing quartiles 2, 3, and 4 to quintile 1 (lowest) were 1.16 (95% CI = 1.04-1.29), 1.19 (1.06-1.32), and 1.27 (1.14-1.43), respectively. Multivariable IRRs comparing women who reported 1, 2, or 3 lifetime occurrences of major discrimination (ie, job, housing, or police) relative to those who reported none were 1.04 (0.96-1.13), 1.17 (1.07-1.28), and 1.24 (1.10-1.39), respectively. Results did not vary according to case definition (ultrasound vs. surgery) or health care utilization. Associations were weaker among foreign-born women and among women with higher coping skills. CONCLUSIONS: Perceived racism was associated with an increased risk of uterine myomas in US-born black women.     

Hair relaxer use and risk of uterine leiomyomata in African-American women

Hair relaxers are used by millions of black women, possibly exposing them to various chemicals through scalp lesions and burns. In the Black Women's Health Study, the authors assessed hair relaxer use in relation to uterine leiomyomata incidence. In 1997, participants reported on hair relaxer use (age at first use, frequency, duration, number of burns, and type of formulation). From 1997 to 2009, 23,580 premenopausal women were followed for incident uterine leiomyomata. Multivariable Cox regression was used to estimate incidence rate ratios and 95% confidence intervals. During 199,991 person-years, 7,146 cases of uterine leiomyomata were reported as confirmed by ultrasound (n = 4,630) or surgery (n = 2,516). The incidence rate ratio comparing ever with never use of relaxers was 1.17 (95% confidence interval (CI): 1.06, 1.30). Positive trends were observed for frequency of use (P(trend) < 0.001), duration of use (P(trend) = 0.015), and number of burns (P(trend) < 0.001). Among long-term users (≥10 years), the incidence rate ratios for frequency of use categories 3-4, 5-6, and ≥7 versus 1-2 times/year were 1.04 (95% CI: 0.92, 1.19), 1.12 (95% CI: 0.99, 1.27), and 1.15 (95% CI: 1.01, 1.31), respectively (P(trend) = 0.002). Risk was unrelated to age at first use or type of formulation. These findings raise the hypothesis that hair relaxer use increases uterine leiomyomata risk.     

高血压与男性性功能障碍发生风险的前瞻性队列研究

目的探讨高血压与男性性功能障碍发病风险的关系。方法采用前瞻性队列研究方法,随机抽取2015年中国人民解放军联勤保障部队第九二三医院进行健康体检的30~40岁已婚男性1000例进行基线调查,实际调查892人,有效应答率89.2%,剔除不符合调查条件者78例,最终可纳入研究对象为814例。按基线调查有或无高血压情况分为高血压组和正常血压组。随后开展3年随访,并剔除在随访中新发影响性功能的器质性疾病者、随访期服用降压药者、失访者,共135例。最后可纳入数据统计分析共679例。采用Cox模型分析高血压与男性性功能障碍发病风险比及95%可信区间(95%CI)。结果高血压组177例(26.07%),正常血压组502例(73.93%)。开展3年随访发现高血压组患者的性功能障碍发生率为48.58%,明显高于正常血压组的15.54%,差异有统计学意义(P<0.05)。Cox回归单因素结果显示,高血压组性功能障碍发病风险是正常血压组的2.056倍;调整高血压患者的年龄、BMI、饮酒、吸烟、职业类型、夫妻关系、高血脂症史和糖尿病史因素后,Cox回归多因素分析结果显示,高血压组性功能障碍发病风险是正常血压组的3.133倍。结论高血压是增加男性性功能障碍发生风险的危险因素,临床中应密切关注男性高血压患者的情况,并及早采取措施预防或避免性功能障碍发生。     

铁路女职工高血压、高血糖、高脂血症与子宫肌瘤风险关联性研究

目的了解子宫肌瘤的患病风险与高血压、高血糖和高脂血症之间的关系。方法采用横断面研究方法,由体检医师于2008年对济南地区铁路系统6164名已婚在职女职工进行健康检查,妇科检查内容包括B超检查和妇科常规检查,并进行血压和空腹血糖、甘油三酯、胆固醇等指标的测定。同时以问卷方式收集研究对象的基本信息和疾病史等情况。按照研究对象是否患有子宫肌瘤分为两组,采用Logistic回归分析方法在控制其他影响因素条件下分析子宫肌瘤与高血压、高血糖、高脂血症之间的关联性。结果研究对象子宫肌瘤患病率为20.93%,平均年龄(40.07±8.20)岁;高血压、高血糖和高脂血症患病率分别为8.20%、3.09%和10.68%。高血压是子宫肌瘤的独立危险因素(OR=1.316,95%CI 1.064～1.627),舒张压每升高10mmHg子宫肌瘤患病风险增加17.1%(OR=1.171,95%CI 1.045～1.312)。结论高血压是子宫肌瘤独立的危险因素,并且子宫肌瘤患病风险随着舒张压水平的升高而增加。     

Relationship between obesity and uterine leiomyomata.

Obesity is associated with many comorbid disease states including neoplasia. The increased risk of developing endometrial cancer is thought to be due to the higher level of circulating estrogens in obese women. Uterine leiomyomata (fibroids) are also thought to be influenced by estrogens. To determine whether patients presenting with symptomatic uterine fibroids were more obese than the general population, we retrospectively reviewed the hospital records of 144 women who underwent either hysterectomy or myomectomy for uterine fibroids. Obesity was defined as preoperative weight greater than 120% of desirable body weight (DBW) for the patient's height. In our investigation, 51% of the study population were obese. Moreover, 16% were severely obese (defined as greater than 150% DBW). When compared with the general population of women in the United States matched for height and age, the study population was significantly heavier. (p less than 0.0002). Patient age, parity, menopausal status, and degree of obesity did not correlate with the number of fibroids within the uterus. Fibroid size was significantly larger in nulliparous women (p less than 0.005). These results suggest that symptomatic uterine fibroids may be another comorbid disease state associated with obesity.     

Uterine leiomyomata and cesarean birth risk: a prospective cohort with standardized imaging

PurposeTo determine if women with leiomyomata detected using uniform ultrasound methods are at increased risk of cesarean birth, without regard to indication.MethodsWomen were enrolled in Right from the Start (2000–2010), a prospective pregnancy cohort. Leiomyomata were counted, categorized, and measured during first trimester ultrasounds. Women provided information about demographics and reproductive history during first trimester interviews. Route of delivery was extracted from medical records or vital records, if the former were unavailable. Generalized estimating equations were used to calculate risk ratios (RR) and 95% confidence intervals (CIs) for the risk of cesarean birth by leiomyoma presence and characteristics.ResultsAmong 2635 women, the prevalences of leiomyomata and cesarean birth were 11.2% and 29.8%, respectively. Women with leiomyomata, compared with those without, had a 27% increase in cesarean risk (RR, 1.27; CI, 1.17–1.37). The association was weaker following adjustment for maternal body mass index and age (adjusted risk ratio [ARR], 1.11; CI, 1.02–1.20). The adjusted risk was elevated for women with a single leiomyoma 3 cm or more in diameter (ARR, 1.22; CI, 1.14–1.32) and women with the largest total leiomyoma volumes (ARR, 1.59; CI, 1.44–1.76).ConclusionsWomen with leiomyomata were at increased risk for cesarean birth particularly, those with larger tumor volumes.     

A prospective study of maternal carboxyhaemoglobin and pre-eclampsia risk

Rudra CB, Williams MA, Schiff MA, Koenig JQ, Dills R, Yu J. A prospective study of maternal carboxyhaemoglobin and pre-eclampsia risk. Paediatric and Perinatal Epidemiology 2010; 24: 35–44.
We aimed to measure the relationship between early-pregnancy maternal carboxyhaemoglobin and subsequent pre-eclampsia risk. A nested case–control analysis was conducted using data from a western Washington State cohort study (1996–2004). We measured maternal whole blood carboxyhaemoglobin in 128 women who developed pre-eclampsia and 419 normotensive controls (mean gestational age at blood draw, 14.8 weeks). After adjustment for confounders, high (≥1%) vs. low (<0.7%) carboxyhaemoglobin odds ratios [OR] and 95% confidence intervals [CI] were 4.09 [1.30, 12.9] in multiparous women, 0.53 [0.23, 1.26] in primiparae and 1.11 [0.55, 2.25] in the overall study population (parity interaction P  = 0.01). The influence of parity on the association was unexpected. The association between high carboxyhaemoglobin and pre-eclampsia risk in multiparae implicates hypoxia at the fetal-maternal interface as a pathogenic mechanism. These results also suggest that the aetiology of the disease may differ according to parity.     

A prospective study of occupation and prostate cancer risk

A wide variety of occupations has been associated with prostate cancer in previous retrospective studies. Most attention has been paid to farming, metal working, and the rubber industry. Today, these results cannot be affirmed with confidence, because many associations could be influenced by recall bias, have been inconsistent, or have not been confirmed satisfactory in subsequent studies. This study was conducted to investigate and confirm these important associations in a large prospective cohort study. The authors conducted a prospective cohort study among 58,279 men. In September 1986, the cohort members (55-69 years) completed a self-administered questionnaire on potential cancer risk factors, including job history. Related job codes were clustered in professional groups. These predefined clusters were investigated in 3 time windows: 1) profession ever performed, 2) longest profession ever held, and 3) last profession held at baseline. Follow up for incident prostate cancer was established by linkage to cancer registries until December 1993. A case-cohort approach was used based on 830 cases and 1525 subcohort members. To minimize false-positive results, 99% confidence intervals (99% CI) were calculated. Although moderately decreased prostate cancer risks were found for electricians, farmers, firefighters, woodworkers, textile workers, butchers, salesmen, teachers, and clerical workers, none of the relative risks (RR) were found to be statistically significant. For road transporters, metal workers, and managers, no association with prostate cancer risk was found. Although the RR for railway workers, mechanics, welders, chemists, painters, and cooks was moderately increased, these estimates were not statistically significant. For men who reported to have ever worked in the rubber industry, we found a substantially increased prostate cancer risk, but not statistically significant (RR, 4.18; 99% CI = 0.22-80.45). For policemen, we found a substantial and marginally statistically significant increased prostate cancer risk, especially for those who reported working as a policeman for most of their occupational life (RR, 3.91; 99% CI = 1.14-13.42) or as the last profession held at baseline (RR, 4.00; 99% CI = 1.19-13.37). Most of the previously investigated associations between occupation and prostate cancer risk could not be confirmed with confidence in this prospective study. The lack of statistical significance for rubber workers could be caused by the scarcity of rubber workers in this cohort and subsequent lack of power. The results for policemen were substantial and statistically significant, although a conservative value for significance level was used.     

血脂与高血压关系的前瞻性研究

目的 探讨基线血压正常者在随访期间发展为高血压的危险与基线时不同血脂变量水平的关系.方法 2000年4月建立年龄为34～74岁共8685人的研究队列,取得基线数据.2006年6月开始对其中基线调查满5年的对象进行随访;对进入随访、符合纳入标准且资料完整的2603名基线血压正常者在中位数随访6.38年期间发展为高血压的危险与基线不同血脂变量水平的关系进行分析.结果 基线血脂水平与随访期间高血压发生率之间有一定的联系,调整性别、年龄模型中,各血脂指标变量均与高血压有联系(趋势检验P<0.01);多变量调整模型中,HDL-C[αRR=0.71(95%CI:0.61～0.99)]、非HDL-C[αRR=1.28(95%CI:1.14～1.83)]、TC/HDL-C的比值[αRR=1.41(95%CI:1.25～2.03)]和TG[αRR=1.49(95%CI:1.30～2.13)]仍与高血压有联系(趋势检验P<0.05);进一步调整BMI后,减弱了各血脂指标变量与高血压联系的aRR,但aRR仍有统计学意义;用Cox模型调整基线SBP、DBP后各血脂指标变量与高血压关系的αRR有所降低,但HDL-C、TC/HDL-C比值、TG与高血压发病率仍有显著的联系.当剔除肥胖患者(BMl≥28)和已经诊断为糖尿病的这2个与高血压明显相关的危险因子后HDL-C(趋势检验P=0.01)、TG(趋势检验P<0.05)、非HDL-C(趋势检验P<0.05)和TC/HDL-C的比值(趋势检验P<0.05)仍然与高血压有联系.结论 血脂异常可能发生在高血压之前,即使排除了肥胖和糖尿病患者,或者调整了吸烟、饮酒甚至是基线SBP、DBP水平后,HDL-C、TC/HDL-C和TG仍与高血压有联系.     

Phthalate monoesters in association with uterine leiomyomata in Shanghai

Phthalates are ubiquitous environmental pollutants because of the broad use of plastics. We conducted a case-control study to determine whether uterine leiomyomata were related to exposure to phthalates. Urine specimens and questionnaires were collected from 61 cases and 61 age-matched controls. Nine phthalate monoesters were determined by ultra performance liquid chromatography coupled with tandem mass spectroscopy. Cases had significantly higher levels of creatinine-adjusted mono-iso-butyl phthalate (MiBP), mono-n-butyl phthalate (MnBP), mono-2-ethylhexyl phthalate (MEHP), mono-2-ethyl-5-oxohexyl phthalate, mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP), mono(2-ethyl-5-carboxypentyl) phthalate (MECPP), total di(2-ethylhexyl) phthalate metabolites (∑DEHP_met), and total dibutyl phthalate metabolites (∑DBP_met) than controls. After adjusting for potential confounders, logistic regression analyses demonstrated that leiomyomata were positively associated with MiBP, MnBP, MEHP, MEHHP, MECPP, ∑DEHP_met, and ∑DBP_met. In summary, our data support the hypothesis that uterine leiomyomata are related to phthalate exposure.     

Influence of body size and body fat distribution on risk of uterine leiomyomata in U.S. black women

BACKGROUND: Uterine leiomyomata are a major source of morbidity in black women. We prospectively investigated the risk of self-reported uterine leiomyomata in relation to body mass index (BMI), weight change, height, waist and hip circumferences, and waist-to-hip ratio in a large cohort of U.S black women. METHODS: Data were derived from the Black Women's Health Study, a U.S. prospective cohort study of black women who complete biannual mailed health questionnaires. From 1997 through 2001, we followed 21,506 premenopausal women with intact uteri and no prior diagnosis of uterine leiomyomata. Cox regression models were used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs). RESULTS: After 70,345 person-years of follow up, 2146 new cases of uterine leiomyomata confirmed by ultrasound (n = 1885) or hysterectomy (n = 261) were self-reported. Compared with the thinnest women (BMI <20.0 kg/m), the multivariate IRRs for women with BMIs of 20.0-22.4, 22.5-24.9, 25.0-27.4, 27.5-29.9, 30.0-32.4, and 32.5+ kg/m were 1.34 (95% CI = 1.02-1.75), 1.39 (1.07-1.81), 1.45 (1.12-1.89), 1.47 (1.11-1.93), 1.36 (1.02-1.80), and 1.21 (0.93-1.58), respectively. IRRs were larger among parous women. Weight gain since age 18 was positively associated with risk, but only among parous women. No other anthropometric measures were associated with risk. CONCLUSIONS: BMI and weight gain exhibited a complex relation with risk of uterine leiomyomata in the Black Women's Health Study. The BMI association was inverse J-shaped and findings were stronger in parous women. Weight gain was positively associated with risk among parous women only.     

A prospective study of job strain and risk of breast cancer

BACKGROUND: There is conflicting evidence on whether stress is a risk factor for breast cancer. The present study examined prospectively the relationship between stress at work and risk of breast cancer. METHODS: Participants comprised 26 936 postmenopausal women in the Nurses' Health Study ages 46-72 who were in paid employment, and who had no previous history of cancer. Multivariate-adjusted regression analysis was used to examine the relationship between job strain (measured by the Karasek Job Content Questionnaire in 1992) and risk of incident invasive and in situ breast cancer. RESULTS: From 1992 through 1994, 219 women were diagnosed with breast cancer. No evidence was found for a relationship between job stress and risk of breast cancer. Compared with women in low strain jobs, the multivariate-adjusted relative risks of breast cancer were RR = 0.78 (95% CI : 0.52-1.16) for high-strain jobs; RR = 0.76 (95% CI : 0.49-1.17) for active jobs; and RR = 0.94 (95% CI : 0.67-1.34) for passive jobs. Although job strain was related to less breast cancer screening among women in highly demanding jobs, it was not associated with tumour size. CONCLUSIONS: Job stress was not related to an increase in the incidence of breast cancer in the present cohort of nurses.     

A prospective study of plasma vitamin D metabolites, vitamin D receptor gene polymorphisms, and risk of hypertension in men

Purpose

Laboratory studies have suggested that vitamin D inadequacy may be implicated in development of hypertension. Evidence from epidemiologic studies remains limited. We aim to examine the prospective associations of circulating vitamin D metabolites, vitamin D receptor (VDR) gene polymorphisms, and their interaction with risk of hypertension.

Methods

We conducted prospective analyses among 1,211 US men that were free of baseline hypertension and had baseline plasma 25hydroxy-vitamin D (25(OH)D) or 1,25dihydroxy-vitamin D (1,25(OH)₂D) measured and VDR BsmI or FokI polymorphisms genotyped.

Results

During 15.3-year follow-up, 695 men developed incident hypertension. After multivariable adjustment, the hazard ratios (HRs) and 95 % CIs for hypertension across increasing quartiles of plasma vitamin D metabolites were 1.00 (ref), 0.94 (0.69–1.27), 0.69 (0.50–0.96), and 0.82 (0.60–1.13) for 25(OH)D (p, trend: 0.43), and 1.00, 0.92 (0.66–1.27), 1.12 (0.82–1.54), and 1.19 (0.86–1.63) for 1,25(OH)₂D (p, trend: 0.16). Compared with carriers of VDR BsmI bb, carriers of bB or BB had a HR of 1.25 (1.04–1.51) for hypertension. For VDR FokI polymorphism, compared with carriers of FF and Ff combined, carriers of ff had a HR of 1.32 (1.03–1.70). The relation between plasma 25(OH)D and risk of hypertension did not differ by VDR BsmI and FokI polymorphisms.

Conclusions

In a prospective cohort of men, we found suggestive evidence for an inverse association between plasma 25(OH)D and risk of hypertension. We also found associations between VDR BsmI and FokI polymorphisms with hypertension risk. More research is needed to further determine the role of vitamin D in hypertension prevention.     

A prospective study of blood pressure and risk of cataract in men

PURPOSE: Cataract is the leading cause of blindness worldwide. Blood pressure has been identified as a risk factor in some, but not all, previous studies. We aimed to test prospectively the hypothesis that high blood pressure increases risk of age-related cataract. METHODS: Participants in the Physicians' Health Study of 22,071 men aged 40 to 84 years in 1982 completed annual questionnaires that provided medical history including self-reported blood pressure, treatment for hypertension, and cataract. Over 12 years, 1392 cataracts were confirmed by medical record review among 17,762 physicians with complete data and no reported cataract at baseline. We used proportional hazards regression models to examine relations of systolic blood pressure (SBP), diastolic blood pressure (DBP), hypertension, as well as antihypertensive medications with cataract, after control for potential confounding factors. RESULTS: In models adjusting for age and randomized treatment assignment, there was a significant relationship of SBP, but not DBP, hypertension, or antihypertensive medications (each p > or = 0.23) with incident cataract. Estimates were attenuated after adjusting for multiple potential confounders, although the relationship of SBP with incident cataract remained significant. The multivariate adjusted rate ratio (95% confidence interval) of cataract for SBP > or = 150 versus < 120 mm Hg was 1.31 (1.04-1.66), p for trend = 0.04. For DBP > or = 90 versus < 70 mm Hg, the estimate was 1.11 (0.84-1.45), p for trend = 0.33.CONCLUSIONS: Overall, these data suggest that the relationship of blood pressure with cataract is not strong, and is subject to confounding by other risk factors. The modest magnitude of the association with SBP and lack of significant relationships with DBP and hypertension may suggest a non-causal relationship of blood pressure with cataract.