Statin use and breast cancer survival: a nationwide cohort study in Scotland

Background: Preclinical evidence suggests that statins could delay cancer progression. Previous epidemiological findings have been inconsistent and some have been limited by small sample sizes, as well as certain time-related biases. This study aimed to investigate whether breast cancer patients who were exposed to statins had reduced breast cancer-specific mortality. Methods: We conducted a retrospective cohort study of 15,140 newly diagnosed invasive breast cancer patients diagnosed from 2009 to 2012 within the Scottish Cancer Registry. Dispensed medication usage was obtained from linkages to the Scottish Prescribing Information System and breast cancer-specific deaths were identified from National Records of Scotland Death Records. Using time-dependent Cox regression models, hazard ratios (HR) and 95 % confidence intervals (CI) were calculated for the association between post-diagnostic exposure to statins (including simvastatin) and breast cancer-specific mortality. Adjustments were made for a range of potential confounders including age at diagnosis, year of diagnosis, cancer stage, grade, cancer treatments received, comorbidities, socioeconomic status and use of aspirin. Results: A total of 1,190 breast cancer-specific deaths occurred up to January 2015. Overall, after adjustment for potential confounders, there was no evidence of an association between statin use and breast cancer-specific death (adjusted HR 0.93, 95 % CI 0.77, 1.12). No significant associations were observed in dose–response analyses or in analysis of all-cause mortality. For simvastatin use specifically, a weak non-significant reduction in breast cancer-specific mortality was observed compared to non-users (adjusted HR 0.89, 95 % CI 0.73, 1.08). Statin use before diagnosis was weakly associated with a reduction in breast cancer-specific mortality (adjusted HR 0.85, 95 % CI 0.74, 0.98). Conclusion: Overall, we found little evidence of a protective association between post-diagnostic statin use and cancer-specific mortality in a large nation-wide cohort of breast cancer patients. These findings will help inform the decision whether to conduct randomised controlled trials of statins as an adjuvant treatment in breast cancer.

Statin use and survival in colorectal cancer: Results from a population-based cohort study and an updated systematic review and meta-analysis

BACKGROUND: The aim of this study was to investigate the association between statin use and survival in a population-based colorectal cancer (CRC) cohort and perform an updated meta-analysis to quantify the magnitude of any association.

METHODS: A cohort of 8391 patients with newly diagnosed Dukes' A-C CRC (2009-2012) was identified from the Scottish Cancer Registry. This cohort was linked to the Prescribing Information System and the National Records of Scotland Death Records (until January 2015) to identify 1064 colorectal cancer-specific deaths. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer-specific mortality by statin use were calculated using time dependent Cox regression models. The systematic review included relevant studies published before January 2016. Meta-analysis techniques were used to derive combined HRs for associations between statin use and cancer-specific and overall mortality.

RESULTS: In the Scottish cohort, statin use before diagnosis (HR=0.84, 95% CI 0.75-0.94), but not after (HR=0.90, 95% CI 0.77-1.05), was associated with significantly improved cancer-specific mortality. The systematic review identified 15 relevant studies. In the meta-analysis, there was consistent (I(2)=0%,heterogeneity P=0.57) evidence of a reduction in cancer-specific mortality with statin use before diagnosis in 6 studies (n=86,622, pooled HR=0.82, 95% CI 0.79-0.86) but this association was less apparent and more heterogeneous (I(2)=67%,heterogeneity P=0.03) with statin use after diagnosis in 4 studies (n=19,152, pooled HR=0.84, 95% CI 0.68-1.04).

CONCLUSION: In a Scottish CRC cohort and updated meta-analysis there was some evidence that statin use was associated with improved survival. However, these associations were weak in magnitude and, particularly for post-diagnosis use, varied markedly between studies.

Calcium Channel Blocker Use and Risk of Prostate Cancer by TMPRSS2:ERG Gene Fusion Status

BACKGROUND: Calcium channel blockers (CCBs) may affect prostate cancer (PCa) growth by various mechanisms including those related to androgens. The fusion of the androgen-regulated gene TMPRSS2 and the oncogene ERG (TMPRSS2:ERG or T2E) is common in PCa, and prostate tumors that harbor the gene fusion are believed to represent a distinct disease subtype. We studied the association of CCB use with the risk of PCa, and molecular subtypes of PCa defined by T2E status.

METHODS: Participants were residents of King County, Washington, recruited for population-based case-control studies (1993-1996 or 2002-2005). Tumor T2E status was determined by fluorescence in situ hybridization using tumor tissue specimens from radical prostatectomy. Detailed information on use of CCBs and other variables was obtained through in-person interviews. Binomial and polytomous logistic regression were used to generate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS: The study included 1,747 PCa patients and 1,635 age-matched controls. A subset of 563 patients treated with radical prostatectomy had T2E status determined, of which 295 were T2E positive (52%). Use of CCBs (ever vs. never) was not associated with overall PCa risk. However, among European-American men, users had a reduced risk of higher-grade PCa (Gleason scores ≥7: adjusted OR = 0.64; 95% CI: 0.44-0.95). Further, use of CCBs was associated with a reduced risk of T2E positive PCa (adjusted OR = 0.38; 95% CI: 0.19-0.78), but was not associated with T2E negative PCa.

CONCLUSIONS: This study found suggestive evidence that use of CCBs is associated with reduced relative risks for higher Gleason score and T2E positive PCa. Future studies of PCa etiology should consider etiologic heterogeneity as PCa subtypes may develop through different causal pathways. 

Effects of time-controlled and continuous grazing on total herbage mass and ground cover

Grazing practices in rangelands are increasingly recognized as a management tool for environmental protection in addition to livestock production. Long term continuous grazing has been largely documented to reduce pasture productivity and decline the protective layer of soil surface affecting environmental protection. Time-controlled rotational grazing (TC grazing) as an alternative to continuous grazing is considered to reduce such negative effects and provides pasture with a higher amount of vegetation securing food for animals and conserving environment. To research on how the grazing system affects herbage and above ground organic materials compared with continuous grazing, the study was conducted in a sub-tropical region of Australia from 2001 to 2006. The overall results showed that herbage mass under TC grazing increased to 140% in 2006 compared with the first records taken in 2001. The outcomes were even higher (150%) when the soil is deeper and the slope is gentle. In line with the results of herbage mass, ground cover under TC grazing achieved significant higher percentages than continuous grazing in all the years of the study. Ground cover under TC grazing increased from 54% in 2003 to 73%, 82%, and 89% in 2004, 2005, and 2006, respectively, despite the fact that after the high yielding year of 2004 herbage mass declined to around 2.5 ton ha^(−1) in 2005 and 2006. Under continuous grazing however there was no significant increase over time comparable to TC grazing neither in herbage mass nor in ground cover. The successful outcome is largely attributed to the flexible nature of the management in which grazing frequency, durations and the rest periods were efficiently controlled. Such flexibility of animal presence on pastures could result in higher water retention and soil moisture condition promoting above ground organic material.

Parental alcohol use and resilience in young people: A study of family, peer and school processes

Funded by HSC R&D Division, Public Health Agency Parental alcohol misuse or ‘hidden harm’ presents a very significant challenge to public health policy and practice in the UK and internationally. A parent’s alcohol problems can have a profound impact on their children. Children depend on their family to meet their physical, psychological and social needs, their economic security and well-being, all of which can be jeopardised by parents misusing substances (NACD, 2011). The prevalence of parental alcohol misuse is extremely difficult to estimate, due to the ‘hidden’ nature of the problem within the family unit. Approximately 40,000 children in Northern Ireland are estimated to live with parental alcohol misuse (DHSSPS, 2008). In the UK, 30% of children (3.3 to 3.5 million) under 16 years, live with at least one binge drinking parent and 22% of children (2.6. million) with a hazardous drinker (Manning et al., 2009).  

New statin use and left ventricular structure: estimating long-term associations in the Multi-Ethnic Study of Atherosclerosis (MESA)

Thesis (Master's)--University of Washington, 2016-08

Native Women, Intimate Partner Violence, and Drug Use and Consequences: Prevalence and Associations Among Tribal College and University Students

Thesis (Ph.D.)--University of Washington, 2016-08

Changing use and hydromorphological adjustment in a coastal lagoon–estuarine system, the Ria de Aveiro, Portugal

Today the Ria de Aveiro of northern Portugal has a hydromorphological regime in which river influence is limited to periods of flood. For most of the annual cycle, tidal currents and wind waves are the major forcing agents in this complex coastal lagoon–estuarine system. The system has evolved over two centuries from one that was naturally fluvially dominant to one that is today tidally dominant. Human influence was a trigger for these changes, starting in 1808 when its natural evolution was halted by the construction of a new inlet/outlet channel through the mobile sand spit that isolates it from the Atlantic Ocean. In consequence, tidal ranges in the lagoon increased rapidly from ~0.1 m to >1 m and continued to increase, as a result of continued engineering works and dredging, today reaching ~3 m on spring tides. Hydromorphological adjustments that have taken place include the deepening of channels, an increase in the area of inter-tidal flats, regression of salt marsh, increased tidal propagation and increased saline intrusion. Loss of once abundant submerged aquatic vegetation (SAV), due to increased tidal flows, exacerbated by increased recreational activities, has been accompanied by a change from fine cohesive sediments to coarser, mobile sediments with reduced biological activity.

Language use and language attitudes in Malawian universities

This study aims to investigate patterns of language use and language attitudes amongst students in Malawian universities. This will highlight whether language issues affect Malawians’ ability to engage with tertiary education. It has been claimed that ineffective language policies in developing countries restrict people’s ability to access systems such as education. As a result, this has a negative impact on their own, and their country's, development. Specifically, Malawi frequently has the lowest rates of university enrolment worldwide and is consistently ranked amongst the world’s poorest countries. Recent language policy changes within Malawi have brought the issue of language use within education to the fore, with increased debate over whether English or indigenous languages are suitable for use in education. Through targeting university students across Malawi’s universities using semistructured interviews, data was collected to illustrate aspects of the sociolinguistic situation within Malawian universities. The results reveal that both English and indigenous languages are used within the university environment, while also suggesting that issues do arise from language use within university. While students recognise both positive and negative aspects of using each language, they are generally more favourable towards the use of English as a medium of instruction within university

Substance Use and Academic Outcomes among High School Seniors: Examining the Influence of Emotional Academic Engagement

Substance use is prevalent among adolescents, with two-thirds trying alcohol and half trying an illicit drug by twelfth grade (Miech et al., 2015). Substance use is known to affect academic performance. This study utilized nationally representative data from the 2013 Monitoring the Future twelfth grade survey to examine the relationships between substance use, skipping school, grades, and academic engagement. One-quarter of respondents (26%) had never used a substance. The majority (67%) had used at least one substance during the past year. Substance use during their lifetime but not during the past year was uncommon (7%). Lifetime non-users were less likely than past-year users to skip school during the past month and to have low grades. Lifetime non-users also had greater academic self-efficacy and emotional academic engagement relative to past-year users. These findings underscore the importance of screening and intervention for substance use to promote academic achievement and adolescent wellbeing.

The Relation between Substance Use and Medication Adherence among HIV Positive Substance Users in Residential Treatment

Poor medication adherence is problematic among HIV positive, low-income African-American substance users. Substance use has been shown to be associated with poor medication adherence, though we do not know the mechanism that underlies this relationship. Lack of positive environmental rewards and the propensity to discount delayed rewards may be possible mechanisms to explain this relationship. Using baseline data from a randomized controlled trial, we examined the relationships between substance use and medication adherence, testing both environmental rewards and delay discounting as independent mediators. There was a main effect of substance use on adherence, such that high frequency of substance use predicted poor adherence. There was also a main effect of environmental rewards on adherence, such that a lack of environmental reinforcement predicted poor adherence. This study shed light on the processes that contribute to low adherence, namely substance use and lack of environmental contingencies, and suggests important targets for intervention.

STUDY ON THE USE AND QUALITY OF INFORMATION BY INTERNET DOCUMENTARY OF STUDENTS OF THE UNIVERSITY, COSTA RICA: CASE LABORATORY LIBRARY ROOM Joaquin Garcia Monge

It is no secret that computer services came to revolutionize the world. More than a service, have since become an indispensable tool for humanity, because they simplify and make life easier in many of his orders, through its various support options. These advances are added Internet services, so that by the mid 1980's assessed the need for such a research tool in order to apply it in various fields of human knowledge.This research, based on the use and quality of documentary information from the Internet, with application to the students of the Universidad Nacional, Costa Rica, if the Library Board Laboratory Joaquin Garcia Monge, develops in the form of theses.

Determinants of alcohol use and khat chewing among Hawassa University students, Ethiopia: a cross sectional study.

Background: Students’ alcohol and khat use have been associated with various health related problems. However, its magnitude and associated factors among Ethiopian students are not yet well documented. Objective: The study aimed to assess the prevalence of alcohol use, khat chewing and its associated factors among Hawassa University students. Methods: A cross-sectional study was conducted from June to July 2011. Multistage stratified sampling technique was employed to select 590 students. Self administered questionnaires were used to collect data. Data was entered and analysed by SPSS version 20.0. Logistic regression analyses were used to identify the association of different variables. Results: The current prevalence of student’s alcohol and khat use were 29.5% (95% CI: 25.8-33.3) and 16.3% (95% CI: 13.7- 20.0) respectively. Being male (AOR 1.8; 95% CI 1.1-3.0) and living alone (AOR 20.1; 95% CI 2.5-166.7) had a higher odds of alcohol use. Similarly, family substance use history (AOR 4.8; 95% CI 2.5-9.3) and peer influence (AOR 4.6; 95% CI 2.3-9.0) had also higher odds of khat use. Conclusion and recommendation: The proportion of student’s khat chewing and alcohol use was significant. Hence, higher education in collaboration with other stakeholders should work on convincing students about the ill effects of these substances.

WATER USE AND SYSTEM RELIABILITY UNDER DIESELGENERATOR AND SOLAR PHOTOVOLTAIC POWERED PUMPING SYSTEMS: A CASE STUDY OF SOLLA TOGO

Access to improved potable water sources is recognized as one of the key factors in improving health and alleviating global poverty. In recently years, substantial investments have been made internationally in potable water infrastructure projects, allowing 2.3 billion people to gain access to potable water from 1990-2012. One such project was planned and installed in Solla, Togo, a rural village in the northern part of the country, from 2010-2012. Ethnographic studies revealed that, while the community has access to potable water, an estimated 45% of the village’s 1500 residents still rely on unprotected sources for drinking and cooking. Additionally, inequality in system use based on income level was revealed, with the higher income groups accessing the system more regularly than lower income groups. Cost, as well as the availability of cheaper sources, was identified as the main deterrent from using the new water distribution system. A new water-pricing scheme is investigated here with the intention of making the system accessible to a greater percentage of the population. Since 2012, a village-level water committee has been responsible for operations and maintenance (O&M), fulfilling the community management model that is recommended by many development theorists in order to create sustainable projects. The water committee received post-construction support, mostly in the form of technical support during system breakdowns, from the Togolese Ministry of Water and Sanitation (MWSVH). While this support has been valuable in maintaining a functional water supply system in Solla, the water committee still has managerial challenges, particularly with billing and fee collection. As a result, the water committee has only received 2% - 25% of the fees owed at each private connection and public tap stand, making their finances vulnerable when future repairs and capital replacements are necessary. A new management structure is proposed by the MWSVH that will pay utilities workers a wage and will hire an accountant in order to improve the local management and increase revenue. This proposal is analyzed under the new water pricing schemes that are presented. Initially, the rural water supply system was powered by a diesel-generator, but in 2013, a solar photo-voltaic power supply was installed. The new system proved a fiscal improvement for the village water committee, since it drastically reduced their annual O&M costs. However, the new system pumps a smaller volume of water on a daily basis and did not meet the community’s water needs during the dry season of 2014. A hydraulic network model was developed to investigate the system’s reliability under diesel-generator (DGPS) and solar photovoltaic (PVPS) power supplies. Additionally, a new system layout is proposed for the PVPS that allows pumping directly into the distribution line, circumventing the high head associated with pumping solely to the storage tank. It was determined that this new layout would allow for a greater volume of water to be provided to the demand points over the course of a day, meeting a greater fraction of the demand than with the current layout.