Alcohol consumption and the risk of incident pulmonary embolism in US women and men

Essentials

• The association of moderate alcohol consumption with pulmonary embolism (PE) risk remains unclear.
• In three large US cohorts, we evaluated the association of alcohol consumption with PE risk.
• We found no evidence of an association of alcohol consumption amount or frequency with PE risk.
• Secondary analyses of type and heavy episodic drinking also yielded null findings.

Summary

Background

Moderate alcohol consumption has been variably associated with hemostatic and fibrinolytic factor levels, but the association between alcohol consumption and the risk of incident pulmonary embolism (PE) remains uncertain.

Objective

To evaluate alcohol consumption amount and frequency in relation to PE risk.

Methods

Nurses’ Health Study (NHS), NHS II and Health Professionals Follow‐Up Study participants free of venous thromboembolism (VTE) at baseline (n = 217 442) reported alcohol consumption by type, quantity and frequency, every 2–4 years. Incident PE cases were identified by self‐report and confirmed for participants without cancer. In this cohort study, we used Cox proportional hazards models to estimate multivariable‐adjusted hazard ratios (HRs) for PE associated with alcohol consumption amount and, separately, frequency. Secondary analyses evaluated alcohol type and heavy episodic drinking in relation to PE risk, and amount and frequency in relation to medical record‐confirmed idiopathic PE and any self‐reported VTE risk. Cohort‐specific analyses were pooled using random‐effects meta‐analysis.

Results

During ≥ 20 years of follow‐up, we identified 1939 PE events. We found no strong evidence of an association between PE risk and alcohol consumption amount (pooled HR_adj for 5.0–14.9 g day^?1 vs. abstention = 0.97 [95% CI, 0.79, 1.20]) or frequency (pooled HR_adj for 5–7 drinking days per week vs. abstention = 1.04 [95% CI, 0.88, 1.23]). Secondary analyses of type, heavy episodic drinking, idiopathic PE and VTE also yielded null findings.

Conclusions

Among three large prospective cohorts of US men and women, we found no evidence of an association between the amount or frequency of alcohol consumption and PE risk.

     

Reduction in physical function in women after venous thromboembolism

Essentials

• The association of venous thromboembolism (VTE) with subsequent physical function remains unclear.
• We prospectively evaluated this relationship among women from the Nurses’ Health Studies.
• We found a decline in physical function over four years in women with incident VTE.
• This decline was somewhat greater among women specifically reporting a pulmonary embolism.

Summary

Background

Physical function is integral to healthy aging; however, limited research has examined the association of venous thromboembolism(VTE) with subsequent physical function.

Objectives

To prospectively evaluate the relationship between VTE and decline in physical function among 80 836 women from the Nurses’ Health Study(NHS), ages 46–72 in 1992, and 84 304 women from the Nurses’ Health Study II(NHS II), ages 29–48 in 1993.

Methods

Physical function was measured by the Medical Outcomes Short Form‐36 physical function scale, administered every 4 years. We compared change in physical function for women with vs. without an incident VTE in each 4‐year follow‐up period using multivariable linear regression.

Results

We observed a decline in physical function over 4 years when comparing women with vs. those without incident VTE in both older (NHS) and younger (NHS II) women (multivariable‐adjusted mean difference NHS, ?6.5 points [95% CI ?7.4, ?5.6] per 4 years; NHS II, ?3.8 [95% CI ?5.6, ?2.0]). This difference appeared greater among women specifically reporting a pulmonary embolism (NHS, ?7.4 [95% CI ?8.7, ?6.1]; NHS II, ?4.8 [95% CI ?6.8, ?2.8]), and was equivalent to 6.2 years of aging. Whereas longer‐term slopes of physical function decline following a VTE were not different from the slopes of decline in women without a VTE, the absolute level of physical function of women with VTE was worse at the end of follow‐up compared to women without VTE.

Conclusions

In this prospective cohort, incident VTE was strongly associated with an acute decline in physical function. These results suggest it may be clinically important to consider approaches to ameliorating functional deficits shortly after VTE diagnosis.

     

Identification of major prognostic subgroups of patients with large-cell lymphoma treated with m-BACOD or M-BACOD

One hundred twenty-one patients with diffuse large-cell lymphoma treated with m- or M-BACOD (methotrexate, bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone) were evaluated for pretreatment characteristics predictive for response and survival. Two characteristics, poor performance status and massive bulky disease, were negatively associated with response rate in a multivariate analysis. These two characteristics were also negatively associated with survival in multivariate analysis, as was another factor, an increased number of extranodal sites of disease. These three pretreatment characteristics were used to construct a model containing 12 categories of patients at increasing risk for relapse and shortened survival. These categories divided naturally into three broad groups of patients with respective 5-year survival rates of 68%, 55%, and 24%.     

Human herpesvirus 6 and multiple sclerosis: systemic active infections in patients with early disease.

By means of immunohistochemical staining, cells actively infected with human herpesvirus 6 (HHV-6) were found in central nervous system tissues from 8 (73%) of 11 patients with definite multiple sclerosis (MS). Interestingly, 17 (90%) of 19 tissue sections showing active demyelination were positive for HHV-6-infected cells compared with only 3 (13%) of 23 tissue sections free of active disease (P<.0001). Central nervous system tissues from 2 of 28 normal persons and patients with other inflammatory demyelinative diseases were positive for HHV-6-infected cells (P<.0001), and the 2 positive cases were diagnosed as having HHV-6 leukoencephalitis. By use of a rapid culture assay, blood samples from 22 (54%) of 41 patients with definite MS were found to contain active HHV-6 infections, compared with 0 of 61 normal controls (P<.0001). No significant difference was found between HHV-6 viremia-positive and HHV-6 viremia-negative MS patients with respect to type of disease (relapsing/remitting or progressive). In contrast, patients with active HHV-6 viremia were significantly younger and had shorter durations of disease than did HHV-6 viremia-negative patients.     

Impact of Strain Typing Methods on Assessment of Relationship between Paired Nares and Wound Isolates of Methicillin-Resistant Staphylococcus aureus

The anterior nares are the site of choice for the Veterans Administration methicillin-resistant Staphylococcus aureus (MRSA) surveillance program; however, a correlation between nares colonization and concomitant wound infections has not been well established. The purpose of this study was 3-fold: to determine the relatedness of MRSA isolates from 40 paired wound and nares specimens by four different strain typing methods, to determine concordance of typing methods, and to establish a baseline of MRSA types at this medical center. Isolates were typed by repetitive PCR (rep-PCR) (DiversiLab System; DL) and SpectraCell Raman analysis (SCRA) (commercially available methods that can be performed within a clinical lab), pulsed-field gel electrophoresis (PFGE), and an antibiotic susceptibility profile (AB). Whole-genome optical mapping (WGM) (OpGen, Inc.) was performed on selected isolates. All methods agreed that 26 pairs were indistinguishable and four pairs were different. Discrepant results were as follows: 4 where only SCRA was discordant, 3 where only AB was discordant, 2 where both DL and AB were discordant, and 1 where both DL and SCRA were discordant. All WGM agreed with PFGE. After discrepancy resolution, 80% of the pairs were indistinguishable and 20% were different. A total of 56% of nares results were nonpredictive if negative nares and positive wound cultures are included. Methods agreed 85 to 93% of the time; however, congruence of isolates to a clade was lower. Baseline analysis of types showed that 15 pairs were unique to single patients (30 strains, 38%; 47% of the matching pairs). Twenty-five strains (30%) represented a single clade identical by PFGE, SCRA, and DL, decreasing specificity. Typing method and institutional type frequency are important in assessing MRSA strain relatedness.     

Appraisals of intentional actions from three perspectives: Do they relate to paranoia

Introduction. People often show a bias of attributing their own actions to more positive causes (e.g., generosity) than other persons’ actions. Models of paranoia suggest links between paranoia and negative construals of others’ intentions. Research on these biases has focused on causal attributions from two explainer perspectives, the agent (the person performing the action) and the object (the person being acted on), and has omitted the observer (third person) perspective.

Methods. This study investigated intention attributions from three perspectives (agent, object, observer). Students (n=149) took one of these perspectives and judged the intentionality, frequency, and positivity of 30 behaviours before completing the Paranoia Scale.

Results. Participants in agent and object perspectives rated positive behaviours more frequent and intentional than those in the observer perspective. Participants higher in paranoia distinguished less between positive and negative behaviours, and, in the object perspective, paranoia correlated with lower perceived intentionality of positive behaviours.

Conclusions. The use of three explainer perspectives and intention attributions clarifies how attributions for actions relate to paranoid beliefs. Results suggest that people higher in paranoia make more negative judgements about other person's positive and negative intentions, especially when they are the object of the action.