RESUMEN
BACKGROUND: Antidepressants (ADs) are commonly prescribed medications, but their long-term health effects are debated. ADs disrupt multiple adaptive processes regulated by evolutionarily ancient biochemicals, potentially increasing mortality. However, many ADs also have anticlotting properties that can be efficacious in treating cardiovascular disease. We conducted a meta-analysis assessing the effects of ADs on all-cause mortality and cardiovascular events in general-population and cardiovascular-patient samples. METHODS: Two reviewers independently assessed articles from PubMed, EMBASE, and Google Scholar for AD-related mortality controlling for depression and other comorbidities. From these articles, we extracted information about cardiovascular events, cardiovascular risk status, and AD class. We conducted mixed-effect meta-analyses testing sample type and AD class as moderators of all-cause mortality and new cardiovascular events. RESULTS: Seventeen studies met our search criteria. Sample type consistently moderated health risks. In general-population samples, AD use increased the risks of mortality (HR = 1.33, 95% CI: 1.14-1.55) and new cardiovascular events (HR = 1.14, 95% CI: 1.08-1.21). In cardiovascular patients, AD use did not significantly affect risks. AD class also moderated mortality, but the serotonin reuptake inhibitors were not significantly different from tricyclic ADs (TCAs) (HR = 1.10, 95% CI: 0.93-1.31, p = 0.27). Only "other ADs" were differentiable from TCAs (HR = 1.35, 95% CI: 1.08-1.69). Mortality risk estimates increased when we analyzed the subset of studies controlling for premedication depression, suggesting the absence of confounding by indication. CONCLUSIONS: The results support the hypothesis that ADs are harmful in the general population but less harmful in cardiovascular patients.
Asunto(s)
Antidepresivos Tricíclicos/uso terapéutico , Enfermedades Cardiovasculares , Trastorno Depresivo/tratamiento farmacológico , Mortalidad/tendencias , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Comorbilidad , Humanos , Factores de RiesgoRESUMEN
BACKGROUND: Inclusion of diverse groups of participants in cancer clinical trials is an important methodological and clinical issue. The quality of the science and generalizability of results depends on the inclusion of study participants who represent all populations among whom these treatment and prevention approaches will be used. METHODS: We conducted a systematic review using OVID as the primary source of reports included. Based on 304 peer-reviewed publications, diversity in the inclusion and reporting of study participants during a decade of cancer treatment and prevention trials (2001-2010) is summarized. Recommendations are made for improvements in the science and reporting of cancer clinical trials. RESULTS: Of the 277 treatment trials and 27 prevention trials included in this report, more than 80% of participants were white and 59.8% were male. In the recent decade, race and sex are rarely used as selection criteria unless the trial is focused on a sex-specific cancer. CONCLUSIONS: Women and racial/ethnic minorities remain severely underrepresented in cancer clinical trials, thus limiting the generalizability of cancer clinical research.
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Ensayos Clínicos como Asunto/métodos , Grupos Minoritarios , Neoplasias/terapia , Adulto , Femenino , Humanos , Persona de Mediana EdadRESUMEN
High-stress situations, such as combat deployments, are a potential risk factor for hypertension. Although stress is postulated to increase blood pressure, the underlying role of stress on hypertension is not well established. We sought to determine the relations between combat deployment-induced stress and hypertension. The Millennium Cohort baseline questionnaire (2001-2003) was completed by 77,047 US active-duty and Reserve/National Guard members. Follow-up was completed by 55,021 responders approximately 3 years later (2004-2006). Multivariable logistic regression was used to estimate the 3-year risk of newly reported hypertension, adjusting for general and mental health, demographics, and occupational and behavioral characteristics. After applying exclusion criteria, our analyses included 36 061 service members. Subanalyses of deployers included 8829 participants. Newly reported hypertension was identified in 6.9% of the cohort between baseline and follow-up, many of whom had deployed on military operations in support of the conflicts in Iraq and Afghanistan. After adjusting, deployers who experienced no combat exposures were less likely to report hypertension than nondeployers (odds ratio: 0.77; 95% CI: 0.67 to 0.89). Among deployers, those reporting multiple combat exposures were 1.33 times more likely to report hypertension compared with noncombat deployers (95% CI: 1.07 to 1.65). Although military deployers, in general, had a lower incidence of hypertension than nondeployers, deployment with multiple stressful combat exposures appeared to be a unique risk factor for newly reported hypertension.
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Trastornos de Combate/epidemiología , Hipertensión/epidemiología , Personal Militar/estadística & datos numéricos , Estrés Psicológico/epidemiología , Guerra , Adulto , Distribución por Edad , California/epidemiología , Estudios de Cohortes , Trastornos de Combate/diagnóstico , Trastornos de Combate/prevención & control , Intervalos de Confianza , Femenino , Humanos , Hipertensión/diagnóstico , Modelos Logísticos , Masculino , Personal Militar/psicología , Análisis Multivariante , Prevalencia , Probabilidad , Valores de Referencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/prevención & control , Encuestas y Cuestionarios , Factores de Tiempo , Estados Unidos , Adulto JovenRESUMEN
PURPOSE: The purpose of this study was to enhance adherence among older (aged 55 years and older) African American men enrolled in a cancer screening trial for prostate, lung, and colorectal cancer. For this study, we defined adherence as completing the trial screenings. DESIGN AND METHODS: We used a randomized trial design. Case managers contacted intervention group participants (n=352) at least monthly by telephone and provided information and referral services. The control group included 351 participants. RESULTS: Among participants with low income, those in the intervention group had higher screening adherence rates than did participants in the control group for (a) prostate-specific antigen test for prostate cancer (74.3% vs 53.0%, p=.001), (b) digital rectal exam for prostate cancer (66.2% vs 46.1%, p=.011), and (c) chest x-ray for lung cancer (70.9% vs 51.3%, p=.012). We found no statistically significant differences in adherence rates for flexible sigmoidoscopy screening for colorectal cancer. In contrast, among participants with moderate-to-high income, we found no statistically significant differences in adherence rates between intervention and control group participants for any of the screening tests. IMPLICATIONS: The case management intervention was effective in enhancing adherence among participants with the lowest income, who in many studies are the most difficult to retain.
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Negro o Afroamericano , Manejo de Caso , Ensayos Clínicos como Asunto , Tamizaje Masivo , Neoplasias/prevención & control , Cooperación del Paciente/psicología , Pacientes Desistentes del Tratamiento/psicología , Selección de Paciente , Anciano , Anciano de 80 o más Años , Cultura , Humanos , Masculino , Persona de Mediana Edad , Pobreza , Apoyo Social , Servicio Social , TeléfonoRESUMEN
PURPOSE: The purpose of this study was to enhance retention among African American men enrolled in a cancer screening trial. DESIGN: A telephone-based, randomized trial design was used. The intervention group included 352 African American men aged 55+. Case managers contacted participants at least monthly and provided information and referral services to participants and their relatives. RESULTS: The mean age of participants was 65.7 years. A total of 14,978 calls were made resulting in 780 referrals. The 10 most frequent referrals were for scheduling medical appointments, health information, insurance information, legal aid, transportation, cancer screening information, information technology/computer information, employment, housekeeping/chore services, and food programs. CONCLUSIONS: The case managers served as links between participants and community-based resources. The types of referrals made could be associated with the age-related needs of the participants.
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Negro o Afroamericano , Manejo de Caso , Ensayos Clínicos como Asunto , Tamizaje Masivo , Neoplasias/prevención & control , Selección de Paciente , Anciano , Cultura , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Pacientes Desistentes del Tratamiento , Apoyo Social , Servicio Social , TeléfonoRESUMEN
OBJECTIVES: This population-based case-control study examined the relationship between occupation, living or working on a farm, pesticide exposure, and the risk of multiple myeloma. METHODS: The study included 573 persons newly diagnosed with myeloma and 2131 controls. Information was obtained on sociodemographic factors, occupational history, and history of living and working on a farm. Occupational and industrial titles were coded by standardized classification systems. A job-exposure matrix was developed for occupational pesticide exposure. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated by unconditional logistic regression. RESULTS: Farmers and farm workers had odds ratios of 1.9 (95% CI 0.8-4.6) and 1.4 (95% CI 0.8-2.3), respectively. An odds ratio of 1.7 (95% CI 1.0-2.7) was observed for sheep farm residents or workers, whereas no increased risks were found for cattle, beef, pig, or chicken farm residents or workers. A modestly increased risk was observed for pesticides (OR 1.3, 95% CI 0.9-1.8). Significantly increased risks were found for pharmacists, dieticians and therapists (OR 6.1, 95% CI 1.7-22.5), service occupations (OR 1.3, 95% CI 1.02-1.7), roofers (OR 3.3, 95% CI 1.1-9.8), precision printing occupations (OR 10.1, 95% CI 1.03-99.8), heating equipment operators (OR 4.7, 95% CI 1.4-15.8), and hand molders and casters (OR 3.0, 95% CI 1.0-8.4). CONCLUSIONS: A modest increased risk of multiple myeloma is suggested for occupational pesticide exposure. The increased risk for sheep farm residents or workers indicates that certain animal viruses may be involved in myeloma risk.
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Enfermedades de los Trabajadores Agrícolas/inducido químicamente , Enfermedades de los Trabajadores Agrícolas/epidemiología , Mieloma Múltiple/inducido químicamente , Mieloma Múltiple/epidemiología , Exposición Profesional/efectos adversos , Plaguicidas/toxicidad , Adulto , Anciano , Enfermedades de los Trabajadores Agrícolas/etnología , Población Negra/estadística & datos numéricos , Estudios de Casos y Controles , Femenino , Georgia/epidemiología , Humanos , Masculino , Michigan/epidemiología , Persona de Mediana Edad , Mieloma Múltiple/etnología , New Jersey/epidemiología , Ocupaciones/clasificación , Oportunidad Relativa , Medición de Riesgo/métodos , Factores de Riesgo , Población Blanca/estadística & datos numéricosRESUMEN
BACKGROUND: For several decades, the incidence of pancreatic cancer has been 50% to 90% higher among blacks than among whites in the United States. The purpose of this study was to identify risk factors that may contribute to this racial disparity. METHODS: We conducted a population-based case-control study of pancreatic cancer diagnosed in Atlanta (GA), Detroit (MI), and 10 New Jersey counties from August 1986 through April 1989. In-person interviews were exclusively with subjects (526 cases and 2153 population controls), rather than with next of kin. RESULTS: The determinants of the higher incidence of pancreatic cancer among blacks than among whites differed by sex. Among men, established risk factors (, cigarette smoking, long-term diabetes mellitus, family history of pancreatic cancer) account for 46% of the disease in blacks and 37% in whites, potentially explaining all but 6% of the excess risk among blacks. Among women, however, other factors appear to contribute to the racial disparity, notably moderate/heavy alcohol consumption (>7 drinks per week) and elevated body mass index (above the first quartile). When these less accepted risk factors were combined with the established risk factors, 88% of the disease in black women and 47% in white women were explained, potentially accounting for all of the excess risk among blacks in our female study population. CONCLUSIONS: Among men, the established risk factors (mainly cigarette smoking and diabetes mellitus) explain almost the entire black/white disparity in incidence. Among women, however, other factors appear to contribute to the racial disparity, notably moderate/heavy alcohol consumption and elevated body mass index. In the absence of these factors, pancreatic cancer incidence rates among blacks probably would not exceed those among whites of either sex.
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Negro o Afroamericano , Neoplasias Pancreáticas/etnología , Población Blanca , Adulto , Índice de Masa Corporal , Estudios de Casos y Controles , Diabetes Mellitus/etnología , Femenino , Georgia/epidemiología , Humanos , Masculino , Michigan/epidemiología , Persona de Mediana Edad , New Jersey/epidemiología , Neoplasias Pancreáticas/genética , Vigilancia de la Población , Medición de Riesgo , Factores de Riesgo , Asunción de Riesgos , Factores Socioeconómicos , Salud UrbanaRESUMEN
Prostate cancer is the fourth most common cancer in men worldwide and the most common cancer in men in the United States, with reported incidence rates for U.S. blacks being the highest in the world. The etiology of prostate cancer and an explanation for the racial disparity in incidence in the United States remain elusive. Epidemiologic studies suggest that selenium, an essential trace element, may protect against the disease. To further explore this hypothesis, we measured serum selenium in 212 cases and 233 controls participating in a multicenter, population-based case-control study that included comparable numbers of U.S. black and white men aged 40-79 years. Serum selenium was inversely associated with risk of prostate cancer (comparing highest to lowest quartiles, OR = 0.71, 95% CI 0.39-1.28; p for trend = 0.11), with similar patterns seen in both blacks and whites. Cubic regression spline analysis of continuous serum selenium indicated a reduced risk of prostate cancer above concentrations of 0.135 microg/ml (median among controls) compared to a reference value set at the median of the lowest selenium quartile. Because both the selenoenzyme GPX and vitamin E can function as antioxidants, we also explored their joint effect. Consistent with other studies, the inverse association with selenium was strongest among men with low serum alpha-tocopherol concentrations. In conclusion, our results suggest a moderately reduced risk of prostate cancer at higher serum selenium concentrations, a finding that can now be extended to include U.S. blacks. Since selenium exposure varies widely throughout the world, further research on optimal concentrations for cancer prevention is justified.
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Estudios de Casos y Controles , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/epidemiología , Selenio/sangre , Población Blanca , Adulto , Anciano , Población Negra , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Factores de Riesgo , Estados Unidos/epidemiología , Vitamina E/sangreRESUMEN
BACKGROUND: The selection of clinical trials participants is a critical step in study design, because it affects the generalizability of recommendations made on the basis of trial results and public acceptance of medical research. The authors assessed the heterogeneity of subgroups in cancer treatment and prevention trials and the analysis of subgroups in the evaluation of trial outcomes. METHODS: The authors reviewed published reports (1990-2000) of cancer prevention and treatment trials from 11 journals. They report here on all Phase III cancer treatment and prevention trials that had at least 100 participants and were conducted among adults in the United States. A structured abstract was developed and used to extract data from the 261 published reports. Descriptive summaries of the abstracted data provided the information included in this systematic review. RESULTS: Age and gender of study participants were reported in more than 90% of these trials, whereas fewer than 30% of the trials reported race or ethnicity. Gender was reported as an explicit criterion for participant selection primarily in studies of gender specific malignancies. Race and ethnicity were reported as explicit selection criteria for participant selection for five of the prevention trials and for none of the cancer treatment trials. The 105 treatment trials that reported including both men and women had 42,355 participants, and 38.6% of those participants were women. The 26 prevention trials that reported including both men and women had 73,995 participants, and 34.7% of those participants were women. Fifty-seven treatment trials reported participant ethnic diversity: There were 45,815 participants, with 10.5% African-American participants and with less than 1% Hispanic, Asian, or Native American participants. Seventeen prevention trials reported participant ethnic diversity: There were 91,741 participants, with 5.5% African-American participants, 1.7% Hispanic participants, and less than 1% Asian or Native American participants. CONCLUSIONS: Cancer treatment and prevention trial reports provide scant information about participant race and ethnicity. Such studies use participant selection criteria that do not define diverse subgroups, and few subgroup analyses are conducted. Improvements in the selection, reporting, and analysis of clinical trials participants are needed.