Interaction between Tobacco and Alcohol Use and the Risk of Head and Neck Cancer: Pooled Analysis in the International Head and Neck Cancer Epidemiology Consortium

Background: The magnitude of risk conferred by the interaction between tobacco and alcohol use on the risk of head and neck cancers is not clear because studies have used various methods to quantify the excess head and neck cancer burden. Methods: We analyzed individual-level pooled data from 17 European and American case-control studies (11,221 cases and 16,168 controls) participating in the International Head and Neck Cancer Epidemiology consortium. We estimated the multiplicative interaction parameter (psi) and population attributable risks (PAR). Results: A greater than multiplicative joint effect between ever tobacco and alcohol use was observed for head and neck cancer risk (psi = 2.15; 95% confidence interval, 1.53-3.04). The PAR for tobacco or alcohol was 72% (95% confidence interval, 61-79%) for head and neck cancer, of which 4% was due to alcohol alone, 33% was due to tobacco alone, and 35% was due to tobacco and alcohol combined. The total PAR differed by subsite (64% for oral cavity cancer, 72% for pharyngeal cancer, 89% for laryngeal cancer), by sex (74% for men, 57% for women), by age (33% for cases < 45 years, 73% for cases > 60 years), and by region (84% in Europe, 51% in North America, 83% in Latin America). Conclusions: Our results confirm that the joint effect between tobacco and alcohol use is greater than multiplicative on head and neck cancer risk. However, a substantial proportion of head and neck cancers cannot be attributed to tobacco or alcohol use, particularly for oral cavity cancer and for head and neck cancer among women and among young-onset cases. (Cancer Epidemiol Biomarkers Prev 2009;18(2):541-50)

Family history of cancer: Pooled analysis in the International Head and Neck Cancer Epidemiology consortium

Alcohol and tobacco consumption are well-recognized risk factors for head and neck cancer (HNC). Evidence suggests that genetic predisposition may also play a role. Only a few epidemiologic studies, however, have considered the relation between HNC risk and family history of HNC and other cancers. We pooled individual-level data across 12 case-control studies including 8,967 HNC cases and 13,627 controls. We obtained pooled odds ratios (OR) using fixed and random effect models and adjusting for potential confounding factors. All statistical tests were two-sided. A family history of HNC in first-degree relatives increased the risk of HNC (OR = 1.7, 95% confidence interval, CI, 1.2-2.3). The risk was higher when the affected relative was a sibling (OR = 2.2, 95% CI 1.6-3.1) rather than a parent (OR = 1.5, 95% CI 1.1-1.8) and for more distal HNC anatomic sites (hypopharynx and larynx). The risk was also higher, or limited to, in subjects exposed to tobacco. The OR rose to 7.2 (95% CI 5.5-9.5) among subjects with family history, who were alcohol and tobacco users. A weak but significant association (OR = 1.1, 95% CI 1.0-1.2) emerged for family history of other tobacco-related neoplasms, particularly with laryngeal cancer (OR = 1.3, 95% CI 1.1-1.5). No association was observed for family history of nontobacco-related neoplasms and the risk of HNC (OR = 1.0, 95% CI 0.9-1.1). Familial factors play a role in the etiology of HNC. In both subjects with and without family history of HNC, avoidance of tobacco and alcohol exposure may be the best way to avoid HNC. (C) 2008 Wiley-Liss, Inc,

Air Pollution and Mortality in Latin America The Role of Education

Background: People with less education in Europe, Asia, and the United States are at higher risk of mortality associated with daily and longer-term air pollution exposure. We examined whether educational level modified associations between mortality and ambient particulate pollution (PM(10)) in Latin America, using several timescales. Methods: The study population included people who died during 1998-2002 in Mexico City, Mexico; Santiago, Chile; and Sao Paulo, Brazil. We fit city-specific robust Poisson regressions to daily deaths for nonexternal-cause mortality, and then stratified by age, sex, and educational attainment among adults older than age 21 years (none, some primary, some secondary, and high school degree or more). Predictor variables included a natural spline for temporal trend, linear PM(10) and apparent temperature at matching lags, and day-of-week indicators. We evaluated PM(10) for lags 0 and I day, and fit an unconstrained distributed lag model for cumulative 6-day effects. Results: The effects of a 10-mu g/m(3) increment in lag 1 PM(10) on all nonextemal-cause adult mortality were for Mexico City 0.39% (95% confidence interval = 0.131/-0.65%); Sao Paulo 1.04% (0.71%-1.38%); and for Santiago 0.61% (0.40%-0.83%. We found cumulative 6-day effects for adult mortality in Santiago (0.86% [0.48%-1.23%]) and Sao Paulo (1.38% [0.85%-1.91%]), but no consistent gradients by educational status. Conclusions: PM(10) had important short- and intermediate-term effects on mortality in these Latin American cities, but associations did not differ consistently by educational level.

Involuntary smoking and head and neck cancer risk: Pooled analysis in the International Head and Neck Cancer Epidemiology Consortium

Although active tobacco smoking has been identified as a major risk factor for head and neck cancer, involuntary smoking has not been adequately evaluated because of the relatively low statistical power in previous studies. We took advantage of data pooled in the International Head and Neck Cancer Epidemiology Consortium to evaluate the role of involuntary smoking in head and neck carcinogenesis. Involuntary smoking exposure data were pooled across six case-control studies in Central Europe, Latin America, and the United States. Adjusted odds ratios (OR) and 95% confidence interval (95% CI) were estimated for 542 cases and 2,197 controls who reported never using tobacco, and the heterogeneity among the study-specific ORs was assessed. In addition, stratified analyses were done by subsite. No effect of ever involuntary smoking exposure either at home or at work was observed for head and neck cancer overall. However, long duration of involuntary smoking exposure at home and at work was associated with an increased risk (OR for >15 years at home, 1.60; 95% CI, 1.12-2.28; P(trend) <0-01; OR for >15 years at work, 1.55; 95% CI, 1.04-2.30; P(trend) = 0.13). The effect of duration of involuntary smoking exposure at home was stronger for pharyngeal and laryngeal cancers than for other subsites. An association between involuntary smoking exposure and the risk of head and neck cancer, particularly pharyngeal and laryngeal cancers, was observed for long duration of exposure. These results are consistent with those for active smoking and suggest that elimination of involuntary smoking exposure might reduce head and neck cancer risk among never smokers.

Multiple ADH genes are associated with upper aerodigestive cancers

Alcohol is an important risk factor for upper aerodigestive cancers and is principally metabolized by alcohol dehydrogenase (ADH) enzymes. We have investigated six ADH genetic variants in over 3,800 aerodigestive cancer cases and 5,200 controls from three individual studies. Gene variants rs1229984 (ADH1B) and rs1573496 (ADH7) were significantly protective against aerodigestive cancer in each individual study and overall (P = 10(-10) and 10(-9), respectively). These effects became more apparent with increasing alcohol consumption (P for trend = 0.0002 and 0.065, respectively). Both gene effects were independent of each other, implying that multiple ADH genes may be involved in upper aerodigestive cancer etiology.

Low human papillomavirus prevalence in head and neck cancer: results from two large case-control studies in high-incidence regions

Background Recent studies support an important role for human papillomavirus (HPV) in a subgroup of head and neck squamous cell carcinomas (HNSCC). We have evaluated the HPV deoxyribonucleic acid (DNA) prevalence as well as the association between serological response to HPV infection and HNSCC in two distinct populations from Central Europe (CE) and Latin America (LA). Methods Cases (n = 2214) and controls (n = 3319) were recruited from 1998 to 2003, using a similar protocol including questionnaire and blood sample collection. Tumour DNA from 196 fresh tissue biopsies was analysed for multiple HPV types followed by an HPV type-specific polymerase chain reaction (PCR) protocol towards the E7 gene from HPV 16. Using multiplex serology, serum samples were analysed for antibodies to 17 HPV types. Statistical analysis included the estimation of adjusted odds ratios (ORs) and the respective 95% confidence intervals (CIs). Results HPV16 E7 DNA prevalence among cases was 3.1% (6/196), including 4.4% in the oropharynx (3/68), 3.8% in the hypopharynx/larynx (3/78) and 0% among 50 cases of oral cavity carcinomas. Positivity for both HPV16 E6 and E7 antibodies was associated with a very high risk of oropharyngeal cancer (OR = 179, 95% CI 35.8-899) and hypopharyngeal/laryngeal cancer (OR = 14.9, 95% CI 2.92-76.1). Conclusions A very low prevalence of HPV DNA and serum antibodies was observed among cases in both CE and LA. The proportion of head and neck cancer caused by HPV may vary substantially between different geographical regions and studies that are designed to evaluate the impact of HPV vaccination on HNSCC need to consider this heterogeneity.

Quantitative myocardial contrast echocardiography during pharmacological stress for diagnosis of coronary artery disease: a systematic review and meta-analysis of diagnostic accuracy studies

Aims We conducted a meta-analysis to evaluate the accuracy of quantitative stress myocardial contrast echocardiography (MCE) in coronary artery disease (CAD). Methods and results Database search was performed through January 2008. We included studies evaluating accuracy of quantitative stress MCE for detection of CAD compared with coronary angiography or single-photon emission computed tomography (SPECT) and measuring reserve parameters of A, beta, and A beta. Data from studies were verified and supplemented by the authors of each study. Using random effects meta-analysis, we estimated weighted mean difference (WMD), likelihood ratios (LRs), diagnostic odds ratios (DORs), and summary area under curve (AUC), all with 95% confidence interval (0). Of 1443 studies, 13 including 627 patients (age range, 38-75 years) and comparing MCE with angiography (n = 10), SPECT (n = 1), or both (n = 2) were eligible. WMD (95% CI) were significantly less in CAD group than no-CAD group: 0.12 (0.06-0.18) (P < 0.001), 1.38 (1.28-1.52) (P < 0.001), and 1.47 (1.18-1.76) (P < 0.001) for A, beta, and A beta reserves, respectively. Pooled LRs for positive test were 1.33 (1.13-1.57), 3.76 (2.43-5.80), and 3.64 (2.87-4.78) and LRs for negative test were 0.68 (0.55-0.83), 0.30 (0.24-0.38), and 0.27 (0.22-0.34) for A, beta, and A beta reserves, respectively. Pooled DORs were 2.09 (1.42-3.07), 15.11 (7.90-28.91), and 14.73 (9.61-22.57) and AUCs were 0.637 (0.594-0.677), 0.851 (0.828-0.872), and 0.859 (0.842-0.750) for A, beta, and A beta reserves, respectively. Conclusion Evidence supports the use of quantitative MCE as a non-invasive test for detection of CAD. Standardizing MCE quantification analysis and adherence to reporting standards for diagnostic tests could enhance the quality of evidence in this field.

Amygdala hyperactivation in untreated depressed individuals

The amygdala participates in the detection and control of affective states, and has been proposed to be a site of dysfunction in affective disorders. To assess amygdala processing in individuals with unipolar depression, we applied a functional MRI (fMRI) paradigm previously shown to be sensitive to amygdala function. Fourteen individuals with untreated DSM-IV major depression and 15 healthy subjects were studied using fMRI with a standardized emotion face recognition task. Voxel-level data sets were subjected to a multiple-regression analysis, and functionally defined regions of interest (ROI), including bilateral amygdala, were analyzed with MANOVA. Pearson correlation coefficients between amygdala activation and HAM-D score also were performed. While both depressed and healthy groups showed increased amygdala activity when viewing emotive faces compared to geometric shapes, patients with unipolar depression showed relatively more activity than healthy subjects, particularly on the left. Positive Pearson correlations between amygdala activation and HAM-D score were found for both left and right ROIs in the patient group. This study provides in vivo imaging evidence to support the hypothesis of abnormal amygdala functioning in depressed individuals. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

Olhares sobre Jongos e Caxambus: Processos educativos nas práticas religiosas afro-brasileiras

Este estudo foi elaborado a partir da proposta de fortalecimento das relações comunitárias entre a Universidade Federal do Espírito Santo e as comunidades jongueiras e caxambuzeiras. Destina-se a apresentar a pesquisa realizada em territórios negros sob a inspiração do Jongo e do Caxambu, reconhecidos como Patrimônio Imaterial do Brasil pelo Instituto do Patrimônio Histórico e Artístico Nacional (Iphan). A pesquisa foi desenvolvida no norte do Estado do Espírito Santo e tem como recurso analítico e conceitual estudos sobre etnicidade no campo da educação. Sua proposta é ampliar e constituir-se como base para a implementação da Lei nº. 10.639/2003, considerando a descrição das categorias religiosidade, territorialidade, memórias, cultura negra, cultura popular e tradição, com base nas narrativas dos sujeitos. Relaciona as práticas culturais do jongo e do caxambu como elementos importantes para a reconstrução da história do negro no Sudeste brasileiro. O tema de investigação foi construído sob a inspiração teórica dos estudos culturais referenciados em Stuart Hall (2008), Canclini (1997), Santos (2008, 2009), Certeau (2005) e na produção simbólica das interpretações sociais, das fronteiras étnicas para descrever as diferenças percebidas pelos sujeitos. Trabalhou-se basicamente propondo as múltiplas interpretações a partir do vivido. O estudo reforça a importância das africanidades na formação de professores e a discussão do Patrimônio Imaterial do Jongo como possibilidades de saberes-fazeres no campo do currículo escolar. Os caminhos da pesquisa partem de uma base etnográfica, conjugando a metodologia da história oral temática com a pesquisa participante e a pesquisa ação, interligando as memórias dos sujeitos, suas narrativas e vivências ao fazer pedagógico no cotidiano das comunidades. Ressalta a relação intercultural e territorial que identifica jongueiros e caxambuzeiros. Os resultados da pesquisa descrevem as condições dessas práticas, da visibilidade das políticas culturais, da produção das identidades jongueiras no norte do Estado do Espírito Santo, sob o ponto de vista dos sujeitos elencados.

Redes de saberesfazeres, complexidade e tensões : os cotidianos do ensino médio de uma escola pública do Espírito Santo

A ciência com suas verdades passou a ser um artefato essencial nos cotidianos escolares. Esses saberes se enredam com outros saberes que despotencializados e silenciados, permanecem nos interstícios do discurso hegemônico da modernidade na escola causando tensões. Potencializar a ocorrência dessas redes nesses cotidianos pode intensificar essas tensões e assim abalar esse domínio da ciência. Os muitos caminhos possíveis de serem percorridos nas tessituras desprivilegiam quaisquer saberes e fazeres que se pretendem exclusivos. Assumindo a metáfora das redes, os praticantes da escola podem potencializar as inter-relações que ocorrem na vida. A remoção de instâncias de poder hierárquico de saberes, enredando-os e o compartilhamento solidário das práticasteoriaspráticas, não significa a diluição da autoridade. Agora a autoridade cumpre um novo papel que é de constituir uma rede de relações de autoridade partilhada. Desejamos perceber esses múltiplos sentidos e problematizar o quão potentes são ou não para a vida. Participamos juntamente com os alunos e alunas das aulas e posteriormente, os convidamos para conversasentrevistas, gravando e fotografando esses momentos. Percorremos, nos turnos matutino e noturno, todos os seus espaçostempos, nos conectando nas redes que se tecem. Optamos por estar nas turmas de ensino médio de formação geral e nas turmas de ensino médio na modalidade Educação de Jovens e Adultos. As entrevistasconversas foram feitas com três alunos ao mesmo tempo, sempre de uma mesma turma, para que se estabelecesse uma conversa e para que a produção de sentidos dos cotidianos da escola pudesse ser mais potencializada. Dos alunos entrevistados, estão entre os seus desejos mais comuns para além dos saberes científicos, as atividades esportivas, artísticas, literárias, religiosas, cursos de formação profissional, dança, canto, campanhas educativas, passeios. As relações de amizade e outros modos relacionais como entre professores e alunos, têm sido citados com grande frequência, pelos estudantes, nas entrevistasconversas. Não tem se conseguido implantar na sua totalidade os preceitos da modernidade nos escola. Há, portanto, um visível esgotamento do monopólio do comportamento científico nos cotidianos da escola pública pesquisada. São nesses espaçostempos escolares nos quais pode se dar a experiência. Apesar do discurso moderno na escola produzir mecanismos que impedem a experiência, esse controle é acompanhado de diversos mecanismos de escapes. É pela “voz” dos alunos que se apresentam as ausências da escola. A “voz” dos estudantes é a grande presença na escola e sua grande potência. Talvez esse seja o maior desperdício no contexto educacional escolar.

Remoção do herbicida 2,4-D por meio do tratamento convencional da água e adsorção em carvão ativado granular em instalação piloto

O crescimento populacional empurra a produção agrícola em direção ao uso intensivo dos agrotóxicos que aumentam a produtividade. Porém, seu uso incorreto pode resultar em grave problema para as estações de tratamento da água e impactar negativamente na saúde pública. Segundo estudos em escala laboratorial, o tratamento convencional, um dos mais utilizados no Brasil, apresenta remoção insignificante do 2,4-D. A adsorção em carvão ativado tem se demonstrado como tecnologia eficiente na remoção de diversos contaminantes, dentre eles os agrotóxicos. Assim, foi avaliada a remoção dos herbicidas 2,4-D e 2,4,5-T e metabólito 2,4-DCP, utilizando o tratamento convencional e a adsorção em coluna de carvão ativado granular em instalação piloto. O carvão ativado granular empregado foi o derivado da casca de coco. A concentração dos herbicidas foi analisada por cromatografia líquida de alta eficiência com detector por arranjo de diodos e extração em fase sólida. A associação do tratamento convencional com a adsorção em carvão ativado granular apresentou elevada remoção do 2,4-D (99%) atingindo concentrações finais abaixo do limite da Portaria MS n° 2914/2011. O tratamento convencional, no entanto, também apresentou remoção do 2,4-D (35 a 59%), sendo o maior percentual obtido na decantação (30 a 52%), indicando que houve interação entre a matéria orgânica natural e o 2,4-D, contribuindo para sua remoção nessa etapa. O 2,4-DCP e 2,4,5-T apresentaram concentrações abaixo do limite de detecção.