Frequent nut consumption and decreased risk of cholecystectomy in women

BACKGROUND: Gallstone disease is a major source of morbidity in the developed countries. Nuts are rich in several compounds that may protect against gallstone disease. OBJECTIVE: The association between nut intake and cholecystectomy was examined in a large cohort of women. DESIGN: We prospectively studied nut (peanuts, other nuts, and peanut butter) consumption in relation to the risk of cholecystectomy in a cohort of 80,718 women from the Nurses' Health Study who were 30-55 y old in 1980 and had no history of gallstone disease. As part of the Nurses' Health Study, the women reported on questionnaires mailed to them every 2 y both their consumption of nuts and whether they had undergone cholecystectomy. The women were followed through 2000. RESULTS: During 1,393,256 person-years of follow-up from 1980 to 2000, we documented 7831 cholecystectomies. After adjustment for age and other known or suspected risk factors, women who consumed > or =5 units of nuts (1 unit = 1 oz or 28.6 g nuts)/wk (frequent consumption) had a significantly lower risk of cholecystectomy (relative risk: 0.75; 95% CI: 0.66, 0.85; P for trend < 0.0001) than did women who never ate nuts or who ate <1 unit/mo (rare consumption). Further adjustment for fat consumption (saturated fat, trans fat, polyunsaturated fat, and monounsaturated fat) did not materially alter the relation. In analyses examining consumption of peanuts and other nuts separately, both were associated with a lower risk of cholecystectomy. CONCLUSION: In women, frequent nut consumption is associated with a reduced risk of cholecystectomy.     

Alcohol consumption in relation to risk of cholecystectomy in women

BACKGROUND: Alcohol consumption has been linked to a lower risk of gallstone disease. However, the magnitude of the association is uncertain, and little is known about the relation of alcohol consumption patterns and individual types of alcoholic beverages to gallstone disease risk. OBJECTIVE: We prospectively examined the association between alcohol intake and cholecystectomy, a surrogate for symptomatic gallstone disease, in a large cohort of women. DESIGN: Women from the Nurses' Health Study who had no history of gallstone disease in 1980 (n = 80,898) were followed for 20 y. Alcohol consumption, which was measured every 2-4 y by food-frequency questionnaires, was used to predict subsequent cholecystectomy through multivariate analysis. RESULTS: We ascertained 7831 cases of cholecystectomy. Relative to subjects who had no alcohol intake, subjects who had alcohol intakes of 0.1-4.9, 5.0-14.9, 15.0-29.9, 30.0-49.9, and >/=50.0 g/d had multivariate relative risks of cholecystectomy of 0.95, 0.86, 0.80, 0.67, and 0.62 (95% CI: 0.49, 0.79), respectively. Relative to subjects who never consumed alcohol, subjects who consumed alcohol 1-2, 3-4, 5-6, and 7 d/wk had multivariate relative risks of cholecystectomy of 0.94, 0.88, 0.87, and 0.73 (0.63, 0.84), respectively. All alcoholic beverage types were inversely associated with cholecystectomy risk, independent of consumption patterns (for quantity of alcohol consumed, P = 0.04, 0.001, and 0.003 for wine, beer, and liquor, respectively; for frequency of alcohol consumption, P = 0.01, 0.07, and <0.0001 for wine, beer, and liquor, respectively). CONCLUSIONS: The intake of all alcoholic beverage types is inversely associated with the risk of cholecystectomy. Recommendations regarding the benefit of consuming moderate quantities of alcohol should be weighed against the potential health hazards.     

Coronary risk and estrogen use in postmenopausal women

Of some 15,500 women resident in a retirement community during an 11 year interval, 220 suffered a cardiologically ascertained first myocardial infarction. A case-control study demonstrated no association between estrogen use and myocardial infarction. The observed lack of association may be explained by an already high coronary risk in this age group, by the low daily estrogen dose, and by the short duration of estrogen use. The well-known association between hypertension and myocardial infarction was confirmed.     

Estrogen use and stroke risk in postmenopausal women.

Among postmenopausal women (58-98 years of age) in a retirement community use of oral estrogens was not significantly associated with overall risk of stroke. Estrogen use was significantly associated with blood-pressure status. An observed association between estrogen use and nonembolic cerebral infarction in women aged 70-79 may be secondary to an interaction between hypertension and estrogen usage.     

Pesticide product use and risk of non-Hodgkin lymphoma in women

A population-based, incidence case-control study was conducted among women in upstate New York to determine whether pesticide exposure is associated with an increase in risk of non-Hodgkin lymphoma (NHL) among women. The study involved 376 cases of NHL identified through the State Cancer Registry and 463 controls selected from the Medicare beneficiary files and state driver's license records. Information about history of farm work, history of other jobs associated with pesticide exposure, use of common household pesticide products, and potential confounding variables was obtained by telephone interview. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using an unconditional logistic regression model. The risk of NHL was doubled (OR = 2.12; 95% CI, 1.21-3.71) among women who worked for at least 10 years at a farm where pesticides were reportedly used. When both farming and other types of jobs associated with pesticide exposure were combined, there was a progressive increase in risk of NHL with increasing duration of such work (p = 0.005). Overall cumulative frequency of use of household pesticide products was positively associated with risk of NHL (p = 0.004), which was most pronounced when they were applied by subjects themselves. When exposure was analyzed by type of products used, a significant association was observed for mothballs. The associations with both occupational and household pesticides were particularly elevated if exposure started in 1950-1969 and for high-grade NHL. Although the results of this case-control study suggest that exposure to pesticide products may be associated with an increased risk of NHL among women, methodologic limitations related to selection and recall bias suggest caution in inferring causation.     

Non-contraceptive estrogen use and the risk of gallstone disease in women.

We interviewed 102 women, ages 41-74 years who underwent gallstone surgery between January 1979 and September 1980, and 98 controls selected from the membership files of a large prepaid health care plan in Western Washington, about their past use of certain medications, reproductive history, and physical and demographic characteristics. The risk of gallstone disease among women who used estrogens for at least one year prior to diagnosis of their condition, relative to that of other women, was 1.18 (95% CI: 0.65-2.13). Standardization for the effects of age, race, obesity, parity, thiazide use, and history of high blood pressure did not alter appreciably the estimate of relative risk. Among estrogen users, the duration of use was similar in cases and controls. Our findings suggest that if non-contraceptive estrogen use is a risk factor for gallstone disease (requiring surgery) in women, its effect is very small.     

Dietary protein and the risk of cholecystectomy in a cohort of US women: the Nurses' Health Study

In animals, vegetable protein can inhibit gallstone formation. Epidemiologic studies of dietary protein in relation to gallstone disease are sparse, and the effects of dietary protein of different origins are not clear. The authors aimed to examine the relation between dietary protein intake and risk of cholecystectomy among participants in the Nurses' Health Study, a cohort study of US women in 11 states. During 20 years of follow-up (1980-2000), the authors documented 7,831 cases of cholecystectomy. After adjustment for age, other known or suspected risk factors, and specific fats in a multivariate model, the relative risk of cholecystectomy for women in the highest quintile of dietary total protein intake compared with women in the lowest quintile was 1.00 (95% confidence interval (CI): 0.93, 1.08; p for trend = 0.46). When extreme quintiles were compared, the relative risk for animal protein intake was 1.07 (95% CI: 0.98, 1.15; p for trend = 0.08), whereas the relative risk for vegetable protein intake was 0.79 (95% CI: 0.71, 0.88; p for trend < 0.0001), with a significant dose-response relation. Additional mutual adjustment between animal and vegetable proteins did not materially alter the risks. These results suggest that increased consumption of vegetable protein in the context of an energy-balanced diet can reduce the risk of cholecystectomy in 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.     

Oral contraceptive use and risk of diabetes among Chinese women

Oral contraceptive (OC) use has been associated with alterations in carbohydrate metabolism. We examined the effect of OC use on the risk of diabetes among Chinese women. A nested case-control study was conducted among 57,130 women screened for diabetes at enrollment for the Shanghai Women's Health Study, a population-based cohort study of Chinese women aged 40-70 years in Shanghai, China. Included in this study were 259 women newly diagnosed with diabetes and 2072 age-matched controls (8 controls per case), randomly selected from women who tested negative for urine glucose. Multivariate-adjusted odds ratios (OR) and 95% confidence intervals (CI) were used to measure the strength of the association between OC use and diabetes risk. Overall, OC use was not associated with the risk of diabetes. Stratified analysis by menopausal status revealed a dose-response relationship between the duration of OC use and the risk of diabetes among premenopausal women (p for trend = 0.02), with a 3.2-fold elevated risk observed among those who used OC longer than 1 year. Risk of diabetes diminished with increasing time since last OC use (p = 0.02). Use of intrauterine devices was associated with a reduced risk of diabetes in both pre- and postmenopausal women (OR = 0.67, CI: 0.48-0.93). These findings suggest that recent use (within 5 years) and continued use (>1 year) of OCs may increase the risk of diabetes among Chinese women. However, the attributable risk for diabetes among OC users in the general population, if confirmed by further studies, appears to be small.     

Vitamin supplement use and the risk of non-Hodgkin's lymphoma among women and men

The authors examined use of individual supplements of vitamins A, C, and E only and multivitamins in relation to risk of non-Hodgkin's lymphoma in prospective cohorts of 88,410 women in the Nurses' Health Study (1980-1996), with 261 incident cases during 16 years of follow-up, and of 47,336 men in the Health Professionals Follow-Up Study (1986-1996), with 111 incident cases during 10 years of follow-up. Multivitamin use was associated with a higher risk of non-Hodgkin's lymphoma among women but not among men; the multivariate relative risks for long-term duration (10 or more years) were 1.48 (95% confidence interval (CI): 1.01, 2.16) for women and 0.85 (95% CI: 0.45, 1.58) for men. The pooled multivariate relative risk from the two cohorts was 1.18 (95% CI: 0.70, 2.02). Use of individual supplements of vitamins A, C, and E only was not associated with risk among men. An increased risk associated with the use of individual supplements of vitamins A, C, and E only among women appeared to be secondary to the use of multivitamins by the same persons. Because an elevated risk among multivitamin users was not observed consistently in the two cohorts and the pooled data were not significant, the elevated risk among women may be the result of chance.     

Fruit and vegetable consumption and risk of cholecystectomy: a prospective cohort study of women and men

Purpose

Epidemiologic data on whether consumption of fruit and vegetables (FVs) decreases the risk of gallstone disease are sparse. Therefore, we examined the association between FV consumption and the 14-year risk of symptomatic gallstone disease (defined as occurrence of cholecystectomy) in a large group of middle-aged and elderly persons.

Methods

Data from two population-based cohorts were used, which included 74,554 men and women (born 1914–1952). Participants filled in a food frequency questionnaire in the late fall of 1997 and were followed up for cholecystectomy between 1998 and 2011 via linkage to the Swedish Patient Register. Cox regression models were used to obtain hazard ratios (HRs).

Results

During 939,715 person-years of follow-up, 2120 participants underwent a cholecystectomy (1120 women and 1000 men). An inverse association between FV consumption and risk of cholecystectomy was observed in age- and sex-adjusted analyses (P _trend = .036) but not in confounder-adjusted analyses (P _trend = .43). The multivariable-adjusted HR was 0.95 (95 % CI 0.83–1.08) for the highest compared with the lowest sex-specific quartile of FV consumption. There was no evidence of interactions with age (P = .25) or sex (P = .72) in analyses pooled by sex. However, an age-by-FV consumption interaction was observed in separate analyses of women (P = .010), with decreased HRs of cholecystectomy for ages up to 60 years.

Conclusions

This study supports an inverse association between FV consumption and risk cholecystectomy in women, although the association was restricted to women aged 48–60 years. In contrast, the study does not support an association in men.

     

Networks, resources and risk among women who use drugs

The public health tradition of intervening at the environmental level has not been fully exploited in terms of HIV prevention efforts among drug users. Women who use drugs are at particularly high risk of acquiring HIV and other blood borne and sexually transmitted infections, such as hepatitis B (HBV) and hepatitis C (HCV), and could potentially benefit from environmental level interventions. In a review of the existing literature, we examine the extent to which the linkages among multiple causal levels may contribute to the disease transmission risk experienced by women who use drugs. The multiple causal levels of risk potentially involved in the transmission dynamics of infectious pathogens include biological, behavioral, dyadic relationship, network, and structural levels. Biological and behavioral risk factors have already been examined in depth; yet, little empirical research currently exists for other causal levels. Increasingly, investigators suggest that the character and dynamics of relationships with sex partners may be an important determinant of risk, both for engaging in risk behaviors and for doing so with high-risk partners. The influence of higher-order causal level factors, specifically network and structural factors, are the least well documented, but are posited to be a principal underlying cause of the current differential HIV incidence rates between men and women who use drugs. Future research should focus on these higher-order causal levels, in order to better understand disease transmission dynamics; to better evaluate the limitations, as well as the opportunities, of current intervention efforts; to develop interventions that improve and supplement current HIV prevention efforts among women who use drugs; and to inform public policy debate.     

Comparison of the risk of surgical site infection after laparoscopic cholecystectomy and open cholecystectomy.

We assessed the independent contributions of the surgical approach and other variables of the National Nosocomial Infections Surveillance System (NNIS) surgical patient component to the surgical site infection risk after cholecystectomy. Laparoscopic cholecystectomy was associated with a lower overall risk of surgical site infection and a lower risk of incisional infection but not a reduced risk of organ-space infection, compared with open cholecystectomy. The contribution of most of the variables of the NNIS surgical patient component to the risk of surgical site infection depended on the depth of the infection.     

Infection and antimicrobial use in laparoscopic cholecystectomy.

Retrospective chart review of 1,702 patients undergoing laparoscopic cholecystectomy (LC) revealed an overall infection rate of 2.3% and a surgical-site infection rate of 0.4%. Preoperative antimicrobial prophylaxis was received by 79% of patients, but only 33% of these received the agent within 1 hour or less prior to surgery. These facts suggest that antimicrobial prophylaxis may not be necessary for low-risk LC patients.     

HIV risk reduction in rural African American women who use cocaine

Research has demonstrated associations between cocaine use and sexually transmitted infections (STIs), including Human Immunodeficiency Virus (HIV). More research has been conducted among the sub-population of women, with less focus on rural African American women. Investigation of the social context that influences rural African American women's behavior that places them at risk for STI/HIV has received limited attention. The results of one component of the comprehensive study presented here focused on perceived STI/HIV risk reduction strategies of U.S. southern rural African American women who used cocaine. This ethnographic study of 30 rural African American women using cocaine was conducted over four years. Respondents described HIV risk reduction strategies and their motives for using them. Condoms were used more with casual partners (80%) than primary partners (16%) and with partners who were less known, less trusted, young, or physically or sexually "dirty." Condoms were also used to prevent pregnancy (60%) more than to prevent STI/HIV (40%). HIV testing patterns varied, as did the motives for seeking testing. The sexual behavior of the women in this study exposed them to increased risk of STI/HIV. Although many perceived that they were using sexual risk reduction strategies, these strategies were not scientifically sound risk reduction strategies. Consequently, their exposure to STI/HIV continued as they used ineffective strategies both in assessing partner risk and in implementing risk reduction behaviors.     

Determining risk between Depo-Provera use and increased uterine bleeding in obese and overweight women

BACKGROUND: Millions of women worldwide use depot medroxyprogesterone acetate (DMPA) for contraception. Common side effects include bleeding irregularities and weight gain. This study examines whether a relation exists between DMPA use in obese and overweight women and increased uterine bleeding. METHODS: Medical record data were gathered retrospectively from three family medicine clinics, documenting weight and height, DMPA therapy, and increased or excessive bleeding. Body mass index was calculated for each individual and used as the identifier for group assignment. Comorbid conditions, such as concomitant medication use, history of pregnancy while on DMPA, age, socioeconomic status (determined by insurance source), marital status, and number of children (live births only), were also documented. RESULTS: An inverse association was found, indicating that excess weight or obesity was associated with a decreased risk of (risk ratio 0.47) or possible protective factor against increased or excessive bleeding while the patient was on DMPA therapy. There was no significant outcome when consideration was made for age, marital status, socioeconomic status, medical conditions, or number of children. CONCLUSIONS: The finding that excessive weight or obesity was associated with a lower risk of increased or excessive bleeding can be advantageous when counseling this patient population on contraception options, especially with the knowledge that decreased side effects increase the propensity toward compliance and satisfaction.     

The relationship between reproductive history and cholecystectomy in older women

We examined the relationship of reproductive history to cholecystectomy in a population-based sample of 1093 women aged 50 years and older. Number of pregnancies ranged from 0 to 13. Age and obesity were each significantly and independently associated with an increased risk of cholecystectomy. When adjusted for differences in age and obesity, those who had had five or more pregnancies had a significantly increased risk of cholecystectomy. We conclude that an increased risk of gallbladder disease may follow either obesity or multiple pregnancies. One possibly unifying hypothesis for the obesity and pregnancy association is sustained hyperestrogenemia.