Metformin and the risk of head and neck cancer: a case-control analysis

AIMS Metformin use has been associated with a decreased risk of some cancers, although data on head and neck cancer (HNC) are scarce. We explored the relation between the use of antidiabetic drugs and the risk of HNC. METHODS We conducted a case-control analysis in the UK-based Clinical Practice Research Datalink (CPRD) of people with incident HNC between 1995 and 2013 below the age of 90 years. Six controls per case were matched on age, sex, calendar time, general practice and number of years of active history in the CPRD prior to the index date. Other potential confounders including body mass index (BMI), smoking, alcohol consumption and comorbidities were also evaluated. The final analyses were adjusted for BMI, smoking and diabetes mellitus (or diabetes duration in a sensitivity analysis). Results are presented as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS Use of metformin was neither associated with a statistically significant altered risk of HNC overall (1-29 prescriptions: adjusted OR 0.87, 95% CI 0.61-1.24 and ≥ 30 prescriptions adjusted OR 0.80, 95% CI 0.53-1.22), nor was long-term use of sulphonylureas (adjusted OR 0.87, 95% CI 0.59-1.30), or any insulin use (adjusted OR 0.92, 95% CI 0.63-1.35). However, we found a (statistically non-significant) decreased risk of laryngeal cancer associated with long-term metformin use (adjusted OR 0.41, 95% CI 0.17-1.03). CONCLUSIONS In this population-based study, the use of antidiabetic drugs was not associated with a materially altered risk of HNC. Our data suggest a protective effect of long-term metformin use for laryngeal cancer.

Use of diuretics and risk of incident gout: a population-based case-control study

OBJECTIVE Use of diuretics has been associated with an increased risk of gout. Data on different types of diuretics are scarce. We undertook this study to investigate the association between use of loop diuretics, thiazide or thiazide-like diuretics, and potassium-sparing agents and the risk of developing incident gout. METHODS We conducted a retrospective population-based case-control analysis using the General Practice Research Database established in the UK. We identified case patients who were diagnosed as having incident gout between 1990 and 2010. One control patient was matched to each case patient for age, sex, general practice, calendar time, and years of active history in the database. We used conditional logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs), and we adjusted for potential confounders. RESULTS We identified 91,530 incident cases of gout and the same number of matched controls. Compared to past use of diuretics from each respective drug class, adjusted ORs for current use of loop diuretics, thiazide diuretics, thiazide-like diuretics, and potassium-sparing diuretics were 2.64 (95% CI 2.47-2.83), 1.70 (95% CI 1.62-1.79), 2.30 (95% CI 1.95-2.70), and 1.06 (95% CI 0.91-1.23), respectively. Combined use of loop diuretics and thiazide diuretics was associated with the highest relative risk estimates of gout (adjusted OR 4.65 [95% CI 3.51-6.16]). Current use of calcium channel blockers or losartan slightly attenuated the risk of gout in patients who took diuretics. CONCLUSION Use of loop diuretics, thiazide diuretics, and thiazide-like diuretics was associated with an increased risk of incident gout, although use of potassium-sparing agents was not.

Association of hormone therapy and incident gout: population-based case-control study

OBJECTIVE This study aims to assess the odds of developing incident gout in association with the use of postmenopausal estrogen-progestogen therapy, according to type, timing, duration, and route of administration of estrogen-progestogen therapy. METHODS We conducted a retrospective population-based case-control analysis using the United Kingdom-based Clinical Practice Research Datalink. We identified women (aged 45 y or older) who had a first-time diagnosis of gout recorded between 1990 and 2010. We matched one female control with each case on age, general practice, calendar time, and years of active history in the database. We used multivariate conditional logistic regression to calculate odds ratios (ORs) with 95% CIs (adjusted for confounders). RESULTS The adjusted OR for gout with current use of oral formulations of opposed estrogens (estrogen-progestogen) was 0.69 (95% CI, 0.56-0.86) compared with never use. Current use was associated with a decreased OR for gout in women without renal failure (adjusted OR, 0.71; 95% CI, 0.57-0.87) and hypertension (adjusted OR, 0.62; 95% CI, 0.44-0.87) compared with never use. Tibolone was associated with a decreased OR for gout (adjusted OR, 0.77; 95% CI, 0.63-0.95) compared with never use. Estrogens alone did not alter the OR for gout. CONCLUSIONS Current use of oral opposed estrogens, but not unopposed estrogens, is associated with a decreased OR for incident gout in women without renal failure and is more pronounced in women with hypertension. Use of tibolone is associated with a decreased OR for incident gout. The decreased OR for gout may be related to the progestogen component rather than the estrogen component.

Diabetes, use of antidiabetic drugs, and the risk of glioma

BACKGROUND Prior epidemiologic studies suggest inverse relations between diabetes and glioma risk, but the underlying mechanisms, including use of antidiabetic drugs, are unknown. METHODS We therefore performed a matched case-control analysis using the Clinical Practice Research Datalink (CPRD). We identified incident glioma cases diagnosed between 1995 and 2012 and matched each case with 10 controls on age, gender, calendar time, general practice, and years of active history in the CPRD. We performed conditional logistic regression to estimate odds ratios (ORs) with 95% CIs, adjusted for body mass index and smoking. RESULTS We identified 2005 cases and 20 050 controls. Diabetes was associated with decreased risk of glioma (OR = 0.74; 95% CI = 0.60-0.93), particularly glioblastoma (OR = 0.69; 95% CI = 0.51-0.94). Glioblastoma risk reduction was markedly pronounced among diabetic men (OR = 0.60; 95% CI = 0.40-0.90), most apparently for those with diabetes of long-term duration (OR for >5 vs 0 y = 0.46; 95% CI = 0.26-0.82) or poor glycemic control (OR for HbA1c ≥8 vs <6.5% = 0.20; 95% CI = 0.06-0.70). In contrast, the effect of diabetes on glioblastoma risk was absent among women (OR = 0.85; 95% CI = 0.53-1.36). No significant associations with glioma were found for use of metformin (OR for ≥30 vs 0 prescriptions = 0.72; 95% CI = 0.38-1.39), sulfonylureas (OR = 0.71; 95% CI = 0.39-1.30), or insulin (OR = 0.79; 95% CI = 0.37-1.69). CONCLUSIONS Antidiabetic treatment appears to be unrelated to glioma, but long-term diabetes duration and increased HbA1c both show decreased glioma risk. Stronger findings in men than women suggest low androgen levels concurrent with diabetes as a biologic mechanism.

(Table 1) Species abundance at DSDP Hole 63-467

Neogene palynofloras of southern California have been all too infrequently studied. Previous investigations of Pacific Coast sediments have been largely restricted to Pacific Northwest locales. Some important studies include those by Gray (1964), Wolfe, Hopkins, and Leopold (1966), Wolfe and Leopold (1967), Hopkins (1968), Piel (1969, 1977), Ballog, Sparks, and Waloweek (1972), and Musich (1973). The only published study of southern California materials is that of Heusser (1978) on Holocene sediments of the Santa Barbara basin. Most of these studies are concerned with the microflora from a particular formation; thus they have limited stratigraphic value and in most cases involve nonmarine to marginal marine rocks where no planktonic zonation was available. Musich's (1973) study was the first attempt at tying pollen assemblages to a planktonic zonation over an extended stratigraphic interval (Miocene to Pleistocene).Its location in the southern California Borderland and the sedimentary sections sampled make Leg 63 extremely valuable in deciphering the palynologic history of the Pacific Coast Neogene. Site 467 was chosen for our initial detailed study, because the relatively slow sedimentation rate provides an almost complete Neogene sequence of mainly terrigenous sediments and reliable planktonic age control is available.The goals of this study were to: (1) establish a reference section of Neogene palynomorph assemblages; (2) develop biostratigraphic criteria for use in correlation with other localities; (3) correlate the palynologic assemblages with the planktonic zonations; and (4) study the paleoenvironmental history in the southern California Neogene.

Index properties, shear strenghts and consolidation characteristics of ODP Hole 164-995A sediments

Geotechnical properties of sediment from Ocean Drilling Program Leg 164 are presented as: (1) normalized shipboard strength ratios from the Cape Fear Diapir, the Blake Ridge Diapir, and the Blake Ridge; and (2) Atterberg limit, vane shear strength, pocket-penetrometer strength, and constant-rate-of-strain consolidation results from Hole 995A, located on the Blake Ridge. This study was conducted to understand the stress history in a region characterized by high sedimentation rates and the presence of gas hydrates. Collectively, the results indicate that sediment from the Blake Ridge exhibits significant underconsolidated behavior, except near the seafloor. At least 10 m of additional overburden was removed by erosion or mass wasting at Hole 993A on the Cape Fear Diapir, compared to nearby sites.

Ciudadanía femenina en El Salvador : Prudencia Ayala

El relato de la historia mundial, y de la historia de América Latina, ha sido escrito mayoritaria- mente por hombres. Por esa razón, este trabajo da cuenta de la participación y contribución del género masculino, con la excepción de contadas mujeres en el Salvador. Si bien es cierto que muchos campos estuvieron vedados a las mujeres por siglos, éstas no cesaron de defender la igualdad de derechos, constituyéndose en verdaderas protagonistas de nuestra historia en el campo de la política y la ciudadanía femenina. Por ello centramos el foco en el proceso de lucha de las mujeres salvadoreñas para ejercer este derecho, a través de la figura Prudencia Ayala, una mujer indígena y pobre, candidata a la presidencia en 1930.

La historia en los debates de la posmodernidad

Los modelos de comprensión de la realidad que han tomado los historiadores, elaborados por San Agustín en el siglo V (de la adaptación), por Maquiavelo en el siglo XVI (del conflicto) y por Leibniz en el siglo XVII (de la multiplicidad) –vistos en perspectiva de larga duración–, son los que, combinados de distinta manera, perviven hasta la actualidad en los historiadores que toman a la historia como una ciencia que intenta comprender el pasado. El debate con los pensadores posmodernos se da en términos de si la historia es ciencia o solamente discurso. Este escrito sostiene que la práctica de hacer historia, entendida como ciencia, no es compatible con los postulados posmodernos. Los que se dicen historiadores posmodernos no son historiadores, son posmodernos.

Derechos de autor y acceso al conocimiento : la educación pública en el medio

El presente proyecto se propone investigar la legislación de derechos de autor en relación con la universidad pública, su historia en el contexto nacional y educativo. Indagamos en torno de la normativa vigente, los aspectos facilitadores u obstaculizadores en la educación y las excepciones a las leyes con material de uso educativo en universidades públicas y las modalidades de implementación en el acceso al conocimiento libre. Asimismo, nos interesa conocer la diferencia entre bienes materiales e inmateriales, el estatuto del conocimiento humano como bien inmaterial y los impactos en el tratamiento de los bienes culturales y el conocimiento como bienes económicos susceptibles de apropiación privada.

Manejo del dolor en pacientes hospitalizados

Objetivos: Evaluar efectividad y adecuación de la terapia analgésica en pacientes internados con dolor. Materiales y Métodos: Estudio transversal, descriptivo y observacional, mediante revisión de historias clínicas y encuesta validada que incluye el Brief Pain Inventory (BPI). Consideramos respuesta analgésica adecuada un valor ≤ 3 (0-10). Criterio de inclusión: paciente internado con dolor. Análisis estadístico: medidas de tendencia central y dispersión, IC95%. Resultados: Se incluyeron 139 pacientes, distribuidos en clínica médica 13.67%, cardiología 2.88%, cirugía 38.13%, quemados 1.44%, ginecología 9.35%, maternidad 9.35%, traumatología 20.14%, neurología 0.72% y urología 2.16%. Edad media 43.40 años (DS±17.52); 41.73% hombres. Mediana de permanencia al momento de evaluación 3 días (1-60). Presentaron dolor somático 56.83% (IC95% 65.07-48.60), visceral 39.57% (IC95% 47.70-31.44) y neuropático 5.04% (IC95% 8.67-1.40). Las principales etiologías del dolor fueron patología quirúrgica aguda 31.65% (IC95% 39.39-23.92), traumatológica 20.14% (IC95% 26.81-13.48), postoperatorio 17.99% (IC95% 24.37-11.60) y neoplásico 10.07% (IC95% 15.08-5.07). El 82.73% (IC95% 89.02-76.45) tenía indicada analgesia, 47.48% endovenosa y en 3.60% participó especialista en dolor. La dosis fue adecuada en 65.47%; el analgésico más indicado diclofenac 36.69%, ketorolac 16.55%, tramadol 6.47%, paracetamol 5.76%, ibuprofeno 2.16%. Recibía morfina 3.60%, AINE combinado con opioide débil 11.51%, corticoides 3.60% y 0.72% anticonvulsivantes. El 3.60% reportó efectos colaterales atribuibles a la analgesia. Mediante BPI el 38% controló su peor dolor y 53% su valor promedio. Existió demora mayor a 24 hs en indicación de analgesia en 7.91%. La analgesia aplicada figuraba en historia clínica en 40.29%, en indicaciones para enfermería 82.73%. La valoración del dolor fue registrada en 46.76% de las evoluciones diarias.

Entre el pasado del futuro y el futuro del pasado

En toda representación del pasado se cruzan memorias que pugnan por su inscripción en la historia. Esta es una de las razones por la cuales memoria y olvido deben ser consideradas a la hora de estudiar las elaboraciones históricas. Estos aspectos protagonizan no solo debates públicos, sino también discusiones fundamentales en el marco de la filosofía de la historia. En este sentido, Walter Benjamin y Reinhart Koselleck ofrecen en el escenario alemán, reflexiones influyentes y cruciales para el abordaje de este tema. El presente escrito considerará los aspectos mencionados de la mano de sendos escritores, bajo tres ejes: experiencia, memoria y posibles usos del pasado.

Dimensiones horizontal y vertical de la Historia

El artículo examina una dimensión vertical de la historia diferente del desarrollo horizontal de los sucesos. Primero, analiza el trasfondo ofrecido por los fundadores de la fenomenología. E. Husserl, M. Scheler y M. Heidegger se refieren de diversas maneras a un desarrollo recíproco de Dios y hombre. Luego, se ocupa de la noción de la naturaleza como matriz de la historia según M. Merleau-Ponty. En tercer lugar, la atención recae en la concepción de E. Levinas sobre una cultura ética, que, sin comienzo histórico, se encuentra más allá de las culturas del saber y del arte. El cuarto apartado considera las raíces de la historia en el “yo puedo" individual tal como se funda, según M. Henry, en la Vida Absoluta. El apartado final del artículo se refiere a un reino inmemorial vinculado a la dimensión vertical y desarrollado en las tres esferas de la naturaleza, la intersubjetividad y la interioridad.

Mujeres y trabajo urbano : el caso de las mucamas de hotel (Mar Del Plata, 1960-1980)

A partir del análisis de un caso particular, como lo es el trabajo de las mucamas de hotel en la ciudad de Mar del Plata (entre las décadas de 1960 y 1980), el presente artículo se propone como una contribución al campo de estudios sobre el trabajo urbano femenino. En Mar del Plata, el impulso del turismo de masas a mediados del siglo XX fue acompañado por un importante desarrollo hotelero. Éste supuso una atractiva y amplia oferta de trabajo para hombres y mujeres que encontraron allí una forma de acceso al mercado laboral, principalmente durante la temporada estival. En este espacio, las mujeres se han concentrado en puestos de trabajo determinados. En el artículo observamos cómo las continuidades entre algunas de las labores desarrolladas en el hotel y el trabajo doméstico no remunerado contribuyeron a su feminización e indagamos en las implicancias que conllevó que un empleo presente importantes continuidades con dicho trabajo. El análisis de testimonios orales nos permitió un acercamiento a las experiencias de las trabajadoras y, junto a las sentencias de los Tribunales de Trabajo, contribuyeron a visibilizar los procesos (sociales, culturales y económicos) que intervienen en la generización del trabajo y en la segregación ocupacional que caracteriza al mercado de trabajo urbano.

Stable-isotope records from Dronning Maud Land, Antarctica

The European Project for Ice Coring in Antarctica (EPICA) includes a comprehensive pre-site survey on the inland ice plateau of Dronning Maud Land. This paper focuses on the investigation of the 18O content of shallow firn and ice cores. These cores were dated by profiles derived from dielectric-profiling and continuous flow analysis measurements. The individual records were stacked in order to obtain composite chronologies of 18O contents and accumulation rates with enhanced signal-to-noise variance ratios.These chronologies document variations in the last 200 and 1000 years.The 18O contents and accumulation rates decreased in the 19th century and increased during the 20th century.Using the empirical relationships between stable isotopes, accumulation rates and the 10m firn temperature, the variation of both parameters can be explained by the same temperature history.But other causes for these variations, such as the build-up of the snow cover, cannot be excluded. A marked feature of the 1000 year chronology occurs during the period AD 1180-1530 when the 18O contents remains below the long-term mean. Cross-correlation analyses between five cores from the Weddell Sea region and Dronning Maud Land show that 18O records can in some periods be positively correlated and in others negatively correlated, indicating a complex climatic history in time and space.

Geochemistry and physics on sediment cores from the Peru Basin

We studied preservation/dissolution cycles and paleoproductivity in eight sediment cores from the Peru Basin south of the highly productive surface waters of the eastern equatorial Pacific. Stratigraphy is based on stable oxygen isotopes and on combined magnetostratigraphy and biostratigraphy. Sediment cores which span the last 8 m.y., were retrieved during cruise 79 with RV SONNE close to the carbonate compensation depth (CCD). In general, sediments show Pacific-type carbonate cycles. We interpret a pronounced carbonate peak between 6 and 7 Ma as the result of a western and northern extension of the highly productive Peru Current. Decreased carbonate contents from the late Miocene to the late Pliocene might be associated with a slow contraction of the latitudinal extent of the high-productivity belt north of the study areas. During the Pliocene, carbonate variations showed 400 kyr cycles indicating the growth and decay of ice sheets, which should have been associated with pulsations of the Antarctic ice cap. An abrupt collapse of the carbonate system occurred at 2.4 Ma. Higher frequency variations of the carbonate record indicate the major increase of the northern hemisphere glaciation. During the Quaternary, carbonate fluxes are high during glacials and low during interglacials. Large amplitude variations with long broad minima and maxima, associated with small migrations of the lysocline and the CCD (< 200 m), are indicative of the preservation/dissolution history in the Peru Basin. During the early Pleistocene, climatic forcing by the 41 kyr obliquity cycle is not observed in the carbonate record. During the last 800 kyr, variability in the carbonate record was dominated by the 100 kyr eccentricity cycle. Fluxes of biogenic material (calcium carbonate, organic carbon, opal, and barium) were greatest during glacials, which imply higher productivity and export production of the Peru Current during cold climatic periods. Dissolution was greatest during interglacials as inferred from the relatively poor preservation of planktonic foraminifera and from the low accumulation rate of carbonate. After the Mid-Brunhes Event (400 ka), we observe a plateaulike shift to enhanced dissolution and to intensified productivity.