A Study of the Teratogenic Potential of Oral Hormonal Pregnancy Tests in the White Rat

Submitted in partial fulfillment of the requirements for a Certificate in Orthodontics, Dept. of Orthodontics, University of Connecticut Health Center, 1976

Hormonal exposure and risk of pancreatic cancer in the United States

Background. In the United States, the incidence of pancreatic cancer has increased; more than 37,000 new cases of pancreatic cancer were diagnosed in the year 2007. Overall, the five-year survival rate is about 5% and pancreatic cancer ranks the fourth leading cause of cancer-related mortality among men and women. Despite the observed progress in cancer diagnosis and treatment, pancreatic cancer remains an unresolved significant public health problem in the United States. Familial pancreatic cancer has been confirmed to be responsible for approximately 10% of pancreatic cancer cases. However, 90% are still without known inherited predisposition. Until now, the role of oral contraceptive pills (OCPs) and hormonal replacement therapy (HRT) among women with pancreatic cancer remain unclear. We examined the association of exogenous hormonal uses in US women with risk of pancreatic cancer. ^ Methods. This was an active hospital-based case-control study which is conducted at the department of gastrointestinal medical oncology in The University of Texas M.D. Anderson Cancer Center. Between January 2005 and December 2007, a total of 287 women with pathologically confirmed pancreatic cancer (cases) and 287 healthy women (controls) were included in this investigation. Both cases and controls were frequency matched by age and race. Information about the use of hormonal contraceptives and hormonal replacement therapy (HRT) preparations as well as information about several risk factors of pancreatic cancer were collected by personal interview. Univariate and multivariate analyses were performed in this study to analyze the data. ^ Results. We found a statistical significant protective effect for use of exogenous hormone preparations on pancreatic cancer development (adjusted odds ratio [AOR], 0.4; 95% confidence interval [CI], 0.2–0.8). In addition, a 40% reduction in pancreatic cancer risk was observed among women who ever used any of the contraceptive methods including oral contraceptive pills (AOR, 6; 95% CI, 0.4–0.9). ^ Conclusions. Consistent with previous studies, the use of exogenous hormone preparations including oral contraceptive pills may confers a protective effect for pancreatic cancer development. More studies are warranted to explore for the underlying mechanism of such protection.^

Impact of hormonal therapy on survival and racial disparities in a large community-based cohort of older men with local/regional prostate cancer

Prostate cancer (CaP) is the most diagnosed non-cutaneous malignancy and the second leading cause of cancer mortality among United States males. Major racial disparities in incidence, survival, as well as treatment persist. The mortality is three times higher among African Americans (AAs) compared with Caucasians. Androgen carcinogenesis has been persistently implicated but results are inconsistent; and hormone manipulation has been the main stay of treatment for metastatic disease, supportive of the androgen carcinogenesis. The survival disadvantage of AAs has been attributed to the differences in socioeconomic factors (SES), tumor stage, and treatment. We hypostasized that HT prolongs survival in CaP and that the racial disparities in survival is influenced by variation in HT and primary therapies as well as SES. To address these overall hypothesis, we first utilized a random-effect meta-analytic design to examine evidence from randomized trials on the efficacy of androgen deprivation therapy in localized and metastatic disease, and assessed, using Cox proportional hazards models, the effectiveness of HT in prolonging survival in a large community-based cohort of older males diagnosed with local/regional CaP. Further we examined the role of HT and primary therapies on the racial disparities in CaP survival. The results indicated that adjuvant HT compared with standard care alone is efficacious in improving overall survival, whereas HT has no significant benefit in the real world experience in increasing the overall survival of older males in the community treated for local/regional disease. Further, racial differences in survival persist and were explained to some extent by the differences in the primary therapies (radical prostatectomy, radiation and watchful waiting) and largely by SES. Therefore, given the increased used of hormonal therapy and the cost-effectiveness today, more RCTs are needed to assess whether or not survival prolongation translates to improved quality of life, and to answer the research question on whether or not the decreased use of radical prostatectomy by AAs is driven by the Clinicians bias or AAs's preference of conservative therapy and to encourage AAs to seek curative therapies, thus narrowing to some degree the persistent mortality disparities between AAs and Caucasians. ^

Association of exogenous hormonal intake with the risk of development of hepatocellular carcinoma in women

Background. Primary liver cancer, the majority of which is hepatocellular carcinoma, is the third most common cause of mortality from cancer. It has one of the worst prognosis outcomes and an overall 5-year survival of only 5-6%. Hepatocellular carcinoma has been shown to have wide variations in geographic distribution and there is a marked difference in the incidence between different races and gender. Previously low-rate countries, including the US, have shown to have doubled the incidence of HCC during the past two decades. Even though the incidence of HCC is higher in males as compared to females, female hormones, especially estrogens have been postulated to have a role in the development of hepatocellular carcinoma on a molecular level. Despite the frequent usage of oral contraceptive pills (OCP) and previously, hormone replacement therapy (HRT), their role on HCC development has not been studied thoroughly. We aim to examine the association between exogenous hormone intake (oral contraceptives and post-menopausal hormone replacement therapy) and the development of HCC. Methods. This study is part of an ongoing hospital-based case-control study which is conducted at the Department of Gastrointestinal Oncology at The University of Texas M. D. Anderson Cancer Center. From January 2005 up to January 2008, a total of 77 women with pathologically confirmed hepatocellular carcinoma (cases) and 277 healthy women (controls) were included in the investigation. Information about the use of hormonal contraceptives, hormone replacement therapy and risk factors of hepatocellular cancer was collected by personal interview. Univariate and multivariate logistic regression analyses were done to estimate the crude odds ratios (OR) and adjusted odds ratios (AOR). Results. We found statistically significant protective effect for the use of HRT on the development of HCC, AOR=0.42 (95% CI, 0.21, 0.81). The significance was observed for estrogen replacement, AOR=0.43 (95% CI, 0.22, 0.83) and not for progesterone replacement, AOR=0.49 (95% CI, 0.10, 2.35). On the other hand, any hormonal contraceptive use, which encompasses oral contraceptive pills, implants and injections, did not show a statistical significance either in the crude OR=0.58 (95% CI, 0.33, 1.01) or AOR=0.56 (95% CI 0.26, 1.18). Conclusions. As corroborated by previous studies, HRT confers 58% HCC risk reduction among American women. The more important question of the association between hormonal contraceptives and HCC remains controversial. Further studies are warranted to explore the mechanism of the protective effect of HRT and the relationship between hormonal contraception and HCC.^

Bone metabolic and hormonal characteristics of Australian Antarctic expeditioners

Summary: Serum 25(OH)D levels decline without sunlight exposure. We studied 120 expeditioners to Antarctica to determine the skeletal and hormonal responses to sunlight deprivation. With emerging vitamin D insufficiency, serum calcium decreased, PTH increased, and bone loss at the proximal femur was observed. Baseline serum 25(OH)D levels >100 nmol/L prevented vitamin D insufficiency. Introduction: Vitamin D stores deplete without adequate sunlight exposure unless supplementation is provided. We studied 120 healthy adults who spent a year in Antarctica as a model for sunlight deprivation to define the timing and magnitude of the skeletal and hormonal responses to emerging vitamin D insufficiency. Methods: Fasting blood samples were assessed at baseline, 6 and 12 months for serum 25-hydroxyvitamin D (25(OH)D), osteocalcin (OC), bone formation (P1NP) and resorption (CTx), PTH and calcium. Lumbar spine and proximal femur BMD was measured using DXA. Differences over time were determined using repeated measures ANOVA. Percent changes were expressed as (Delta value/(value A +value B)/2)x100. Relationships between outcome measures were determined using Spearman's correlations. Results: Vitamin D insufficiency (<50 nmol/L) was observed in 85% of expeditioners by 6 months when serum calcium decreased and PTH increased (p<0.01). By 12 months, OC increased by 7.4±3.0% (p<0.05), and BMD decreased by 1.0±2.0% at the total proximal femur (p<0.05). For those with vitamin D sufficiency at baseline (>50 nmol/L), sunlight deprivation produced vitamin D insufficiency within 4 months unless baseline values were >100 nmol/L. Conclusion: Supplementation may be necessary for expeditioners with limited access to UV light.

Educação e inclusão: o ser professor ao educar alunos com deficiência numa escola confessional

O presente estudo tem por objetivo refletir o significado do ser professor ao educar alunos com deficiência e dificuldades de aprendizagem no contexto da confessionalidade Metodista . Para tanto contou com preciosas contribuições teóricas e relatos de experiências profissionais, com destaque às teorias de Paulo Freire, Merleau-Ponty. Hannah Arendt, Lino de Macedo. Maria Tereza Eglêr Mantoan. Joel Martins, Maria Aparecida Viggiani Bicudo, Leonardo Boff e Rui de Souza Josgrilberg. Para a coleta de dados necessários, foram utilizadas entrevistas orientadas pela pergunta da pesquisa - o que norteou toda a tragetória metodológica, contando com a participação de professores do Grupo Alternativo do Colégio Metodista. O método utilizado para a análise dos dados foi o fenomenólogo. Da análise empreendida ressalta, principalmente, a evidência de que no lócus alternativo de escolarização, o professor tem a condição de assumir uma nova atitude frente ao fenômeno da aprendizagem mediada pelo princípio da inclusão pautado em valores éticos e cristãos na formação do conhecimento e da cidadania. Da reflexão do que se desvelou, põe a descoberto o significado do ser professor. Surge a oportunidade dele repensar sua práxis, a concepção do ser professor que em relação de educabilidade, busca habitar o Lebenswelt. Abre-se, assim, uma possibilidade de compreender e intervir significativamente na relação com o aluno, que envolve uma atitude fenomenológica no compromisso com uma educação humana.(AU)

Educação e inclusão: o ser professor ao educar alunos com deficiência numa escola confessional

O presente estudo tem por objetivo refletir o significado do ser professor ao educar alunos com deficiência e dificuldades de aprendizagem no contexto da confessionalidade Metodista . Para tanto contou com preciosas contribuições teóricas e relatos de experiências profissionais, com destaque às teorias de Paulo Freire, Merleau-Ponty. Hannah Arendt, Lino de Macedo. Maria Tereza Eglêr Mantoan. Joel Martins, Maria Aparecida Viggiani Bicudo, Leonardo Boff e Rui de Souza Josgrilberg. Para a coleta de dados necessários, foram utilizadas entrevistas orientadas pela pergunta da pesquisa - o que norteou toda a tragetória metodológica, contando com a participação de professores do Grupo Alternativo do Colégio Metodista. O método utilizado para a análise dos dados foi o fenomenólogo. Da análise empreendida ressalta, principalmente, a evidência de que no lócus alternativo de escolarização, o professor tem a condição de assumir uma nova atitude frente ao fenômeno da aprendizagem mediada pelo princípio da inclusão pautado em valores éticos e cristãos na formação do conhecimento e da cidadania. Da reflexão do que se desvelou, põe a descoberto o significado do ser professor. Surge a oportunidade dele repensar sua práxis, a concepção do ser professor que em relação de educabilidade, busca habitar o Lebenswelt. Abre-se, assim, uma possibilidade de compreender e intervir significativamente na relação com o aluno, que envolve uma atitude fenomenológica no compromisso com uma educação humana.(AU)

ALUNOS COM DEFICIÊNCIA NO ENSINO REGULAR: E AGORA PROFESSOR, VAMOS FALAR DE INCLUSÃO?

A inclusão de alunos com deficiência em ensino regular no Brasil é um movimento que vem denotando constante crescimento nos últimos anos. Embora muitos avanços sejam observados, por ser um processo que suscita mudanças conceituais, legais e de prática, traz consigo dúvidas, decorrentes das contradições existentes entre os discursos que proclamam a inclusão e a realidade educacional brasileira. Sob o prisma da docência, no contexto da escola inclusiva, são inúmeras as dificuldades que os professores vêm enfrentando na prática com esse alunado. Considerando essa problemática, apesar da produção já existente, faz-se necessário o aprofundamento de estudos deste tema do ponto de vista do professor. Portanto, esta pesquisa investiga a voz e a ótica dos professores das classes regulares que possuem alunos em situação de inclusão, mais especificamente os que têm deficiência, e aborda os diferentes aspectos da inclusão no cotidiano escolar e o apoio ao professor como uma das ações necessárias para a prática pedagógica inclusiva à luz de teóricos que discutem o processo inclusivo. O estudo, de caráter qualitativo, foi realizado em quatro escolas do Ensino Fundamental (séries iniciais) da rede pública municipal de São Bernardo do Campo, e contou com a participação de nove professores, quatro diretores e quatro famílias de alunos com deficiência. Considerando a análise dos aspectos observados, pode-se inferir que os professores têm buscado a ressignificação de suas práticas, mas desvelam a necessidade de um apoio constante, que lhes dê sustentação para o atendimento à diversidade dos seus alunos.(AU)