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. 

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

Environmental impacts of freshwater use and suspended solids in life cycle assessment

Perturbation of natural ecosystems, namely by increasing freshwater use and its degradative use, as well as topsoil erosion by water of land-use production systems, have been emerging as topics of high environmental concern. Freshwater use has become a focus of attention in the last few years for all stakeholders involved in the production of goods, mainly agro-industrial and forest-based products, which are freshwater-intensive consumers, requiring large inputs of green and blue water. This thesis presents a global review on the available Water Footprint Assessment and Life Cycle Assessment (LCA)-based methods for measuring and assessing the environmental relevance of freshwater resources use, based on a life cycle perspective. Using some of the available midpoint LCA-based methods, the freshwater use-related impacts of a Portuguese wine (white ‘vinho verde’) were assessed. However, the relevance of environmental green water has been neglected because of the absence of a comprehensive impact assessment method associated with green water flows. To overcome this constraint, this thesis helps to improve and enhance the LCA-based methods by providing a midpoint and spatially explicit Life Cycle Impact Assessment (LCIA) method for assessing impacts on terrestrial green water flow and addressing reductions in surface blue water production caused by reductions in surface runoff due to land-use production systems. The applicability of the proposed method is illustrated by a case study on Eucalyptus globulus conducted in Portugal, as the growth of short rotation forestry is largely dependent on local precipitation. Topsoil erosion by water has been characterised as one of the most upsetting problems for rivers. Because of this, this thesis also focuses on the ecosystem impacts caused by suspended solids (SS) from topsoil erosion that reach freshwater systems. A framework to conduct a spatially distributed SS delivery to freshwater streams and a fate and effect LCIA method to derive site-specific characterisation factors (CFs) for endpoint damage on aquatic ecosystem diversity, namely on algae, macrophyte, and macroinvertebrates organisms, were developed. The applicability of this framework, combined with the derived site-specific CFs, is shown by conducting a case study on E. globulus stands located in Portugal as an example of a land use based system. A spatially explicit LCA assessment was shown to be necessary, since the impacts associated with both green water flows and SS vary greatly as a function of spatial location.

Previous land use and climate influence differences in soil organic carbon following reforestation of agricultural land with mixed-species plantings

Reforestation of agricultural land with mixed-species environmental plantings (native trees and shrubs) can contribute to mitigation of climate change through sequestration of carbon. Although soil carbon sequestration following reforestation has been investigated at site- and regional-scales, there are few studies across regions where the impact of a broad range of site conditions and management practices can be assessed. We collated new and existing data on soil organic carbon (SOC, 0–30 cm depth, N = 117 sites) and litter (N = 106 sites) under mixed-species plantings and an agricultural pair or baseline across southern and eastern Australia. Sites covered a range of previous land uses, initial SOC stocks, climatic conditions and management types. Differences in total SOC stocks following reforestation were significant at 52% of sites, with a mean rate of increase of 0.57 ± 0.06 Mg C ha−1 y−1. Increases were largely in the particulate fraction, which increased significantly at 46% of sites compared with increases at 27% of sites for the humus fraction. Although relative increase was highest in the particulate fraction, the humus fraction was the largest proportion of total SOC and so absolute differences in both fractions were similar. Accumulation rates of carbon in litter were 0.39 ± 0.02 Mg C ha−1 y−1, increasing the total (soil + litter) annual rate of carbon sequestration by 68%. Previously-cropped sites accumulated more SOC than previously-grazed sites. The explained variance differed widely among empirical models of differences in SOC stocks following reforestation according to SOC fraction and depth for previously-grazed (R2 = 0.18–0.51) and previously-cropped (R2 = 0.14–0.60) sites. For previously-grazed sites, differences in SOC following reforestation were negatively related to total SOC in the pasture. By comparison, for previously-cropped sites, differences in SOC were positively related to mean annual rainfall. This improved broad-scale understanding of the magnitude and predictors of changes in stocks of soil and litter C following reforestation is valuable for the development of policy on carbon markets and the establishment of future mixed-species environmental plantings.

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.

PART STUDY OF PERCEPTION OF EDUCATIONAL PROGRAMS IN THE LIBRARY COMMUNITY: OPINION (AS) EMPLOYERS (AS) AND GRADUATES (AS) SCHOOL LIBRARY, DOCUMENTATION AND INFORMATION FOR THE NATIONAL UNIVERSITY

This article provides a brief description of some general aspects of self-evaluation process conducted in the School of Library, Documentation and Information from the National University of Costa Rica, to obtain accreditation from the career of Library and Documentation in 2005 and to achieve re-accreditation in 2009.The objective consists in a comparison between the two evaluation processes from the point of view of two specific sectors, employers and graduates, and presents the views provided by each of them as a partial analysis of the social impact assessment of educational programs in the community librarianship as a first input to raise awareness of the importance of these studies in the institutional and national level.

UPDATE NEEDS OF PROFESSIONAL LIBRARY: Diagnosis of teachers and graduate degree from the School of Library, Documentation and Information (EBDI), National University of Costa Rica

This project is a diagnosis of update needs and training for professionals in bibliotecology and its results will be used for the design of a Program of Permanent training in bibliotecology, which will be implemented in Bibliotecology School, Documentation and Information of the National University.The studied population is composed by all the teachers of Bibliotecology School, Documentation and Information of the National University, in October, 2007, and all the graduated students of licentiate of the EBDI from 2000 to 2007.The results of this investigation were obtained by means of a questionnaire that was filled by each one of the members of these two populations, who corresponded to 25 teachers of the EBDI and 18 graduates of licentiate. This one also presents the information that was obtained in interviews realized to the managers of the principal institutions who are professionals contracted in bibliotecology.The results obtained of this diagnosis will allow the elaboration of the Program of Permanent training in bibliotecology, considering the formative needs of the professionals in bibliotecology of the EBDI. This project includes the following products:a) Description of the social and demographic characteristics of teachers and of graduated of licentiate of the EBDI.b) Diagnosis of needs to update and training of bibliotecology professional teachers and of graduated of licentiate of the EBDI.c) Determination of the knowledge and skills that the needs to satisfy what big employers ask for.d) Recommendations for the program. Implementation.

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.

Resource use and greenhouse gas emissions from grain-finishing beef cattle in seven Australian feedlots: a life cycle assessment

Grain finishing of cattle has become increasingly common in Australia over the past 30 years. However, interest in the associated environmental impacts and resource use is increasing and requires detailed analysis. In this study we conducted a life cycle assessment (LCA) to investigate impacts of the grain-finishing stage for cattle in seven feedlots in eastern Australia, with a particular focus on the feedlot stage, including the impacts from producing the ration, feedlot operations, transport, and livestock emissions while cattle are in the feedlot (gate-to-gate). The functional unit was 1 kg of liveweight gain (LWG) for the feedlot stage and results are included for the full supply chain (cradle-to-gate), reported per kilogram of liveweight (LW) at the point of slaughter. Three classes of cattle produced for different markets were studied: short-fed domestic market (55–80 days on feed), mid-fed export (108–164 days on feed) and long-fed export (>300 days on feed). In the feedlot stage, mean fresh water consumption was found to vary from 171.9 to 672.6 L/kg LWG and mean stress-weighted water use ranged from 100.9 to 193.2 water stress index eq. L/kg LWG. Irrigation contributed 57–91% of total fresh water consumption with differences mainly related to the availability of irrigation water near the feedlot and the use of irrigated feed inputs in rations. Mean fossil energy demand ranged from 16.5 to 34.2 MJ lower heating values/kg LWG and arable land occupation from 18.7 to 40.5 m2/kg LWG in the feedlot stage. Mean greenhouse gas (GHG) emissions in the feedlot stage ranged from 4.6 to 9.5 kg CO2-e/kg LWG (excluding land use and direct land-use change emissions). Emissions were dominated by enteric methane and contributions from the production, transport and milling of feed inputs. Linear regression analysis showed that the feed conversion ratio was able to explain >86% of the variation in GHG intensity and energy demand. The feedlot stage contributed between 26% and 44% of total slaughter weight for the classes of cattle fed, whereas the contribution of this phase to resource use varied from 4% to 96% showing impacts from the finishing phase varied considerably, compared with the breeding and backgrounding. GHG emissions and total land occupation per kilogram of LWG during the grain finishing phase were lower than emissions from breeding and backgrounding, resulting in lower life-time emissions for grain-finished cattle compared with grass finishing.