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Biomedical subjects

S Dublin

Publications and source records attributed to S Dublin.

7 recordsLinked to original sources
PubMed2006

Diabetes and the risk of prostate cancer: the role of diabetes treatment and complications.

Epidemiologic evidence suggests diabetic men have a slightly lower prostate cancer risk than non-diabetic men. We examined this association in a prospective cohort study of 35 239 men, 50-76 years old, in Washington State who completed a baseline questionnaire between 2000 and 2002. Incident prostate cancers as of 31 December 2004 were identified through the SEER registry. Diabetic men had a slightly lower risk of prostate cancer than non-diabetic men (hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.64-1.07). Insulin users overall and insulin users with diabetic complications had decreased risks, compared to non-diabetic men (HR 0.49, 95% CI 0.26-0.92) and (HR 0.36, 95% CI 0.15-0.87), respectively. Oral medication use for diabetes was not associated with prostate cancer. Insulin is likely a marker of severity of diabetes. Future studies of this association should consider diabetes type, treatment, severity, complications and biomarkers.

Administration, Oral↗
PubMed2000

Maternal and neonatal outcomes after induction of labor without an identified indication.

OBJECTIVE: This study was undertaken to examine associations between induction of labor and maternal and neonatal outcomes among women without an identified indication for induction. STUDY DESIGN: This was a population-based cohort study of 2886 women with induced labor and 9648 women with spontaneous labor who were delivered at 37 to 41 weeks' gestation, all without identified medical and obstetric indications for induction. RESULTS: Among nulliparous women 19% of women with induced labor versus 10% of those with spontaneous labor underwent cesarean delivery (adjusted relative risk, 1.77; 95% confidence interval, 1.50-2.08). No association was seen in multiparous women (relative risk, 1.07; 95% confidence interval, 0. 81-1.39). Among all women induction was associated with modest increases in instrumental delivery (19% vs 15%; relative risk, 1.20; 95% confidence interval, 1.09-1.32) and shoulder dystocia (3.0% vs 1. 7%; relative risk, 1.32; 95% confidence interval, 1.02-1.69). CONCLUSION: Among women who lacked an identified indication for induction of labor, induction was associated with increased likelihood of cesarean delivery for nulliparous but not multiparous women and with modest increases in the risk of instrumental delivery and shoulder dystocia for all women.

Adult↗
PubMed1998

Accounting for time-dependent covariates whose levels are influenced by exposure status.

When measuring the association between an exposure and disease, one must decide whether to account for confounding or modifying variables whose levels are altered by the presence of the exposure. For example, to assess the impact of cessation of unopposed estrogen therapy on the occurrence of endometrial cancer, a researcher needs to consider the duration of the estrogen therapy, a strong risk factor for endometrial cancer, as a potential confounder or effect modifier. Duration of estrogen therapy, however, is itself influenced by the decision to stop the therapy (the "exposure" of interest). In such a case, two distinct approaches may be taken, depending upon the question being considered. One may wish to assess the degree to which the exposure predicts disease incidence, over and above the additional variable, at some later point in time. In this case, it is appropriate to consider the value of the other variable (for example, duration) at that later time. On the other hand, one may also wish to measure the rate of disease beginning at the time of cessation of the exposure, relative to the corresponding rate in persons with continuing exposure Here, the most appropriate analysis considers the level of the confounding variable (for example, duration) measured only until the time of exposure of interest occurs (for example, cessation of unopposed estrogen therapy). Examples are given to illustrate that the specific question being addressed dictates the handling of covariates of this type.

Confounding Factors, Epidemiologic↗
PubMed1995

Methods for rapid detection of a recurrent nonsense mutation and documentation of phenotypic features in neurofibromatosis type 1 patients.

We have developed a rapid screening method to detect a recurrent mutation in the neurofibromatosis type 1 gene. Using gene amplification and hybridization with allele-specific oligonucleotides, we screened 97 unrelated affected individuals for the recurrent C-->T substitution in codon 1947. The mutation was detected in 1 patient and found to cosegregate with the disease phenotype in the patient's family. Although the estimated prevalence of this mutation is low, rapid screening of different patient cohorts would identify multiple individuals carrying the same mutation. Such data would provide the first opportunity for examining correlations between phenotypic characteristics and molecular genotype and would allow clinicians to offer early diagnosis and prenatal screening to affected families. A format for the comparison of phenotypic features in other settings is presented.

Base Sequence↗
PubMed1994

Perinatal transmission of HIV type 1: associations with maternal anti-HIV serological reactivity. Mothers and Infants Cohort Study and the HIV-1 Perinatal Serology Working Group.

As a hypothesis-generating study of large regions of the human immunodeficiency virus type 1 (HIV-1) envelope, we collaborated with several laboratories to test sera from subgroups of 65 HIV-1-positive pregnant women, 18 (28%) of whom transmitted the virus to their infants. Assays included neutralizing antibodies to HIVLAI and reactivity to 102 HIV-1 Env peptides with sequences based on strains LAI, MN, SC, RF, and WMJ-2 as well as several clinical isolates, spanning about 65% of gp120 and about 80% of gp41. Results for the V3 loop and for neutralizing activity were conflicting and for the most part did not reach statistical significance. Transmission risk appeared lower with reactivity to a few gp41 epitopes (amino acids 571-585, 736-750, and perhaps 650-663), whereas risk appeared higher with reactivity to two gp120 epitopes (amino acids 466-480 and 475-486) and one gp41 epitope (amino acids 547-576). However, these associations could have occurred simply by chance because such a large number of peptides was tested. With independently synthesized peptides, results between laboratories often were inconsistent. However, reproducibility was good (rank correlation coefficient > or = 0.78) when the same protocols and peptides were used. Although this study could not identify a humoral immune response to linear Env peptides that consistently and broadly protected against perinatal transmission of HIV-1, there were regions of gp120 and gp41 that should be evaluated in larger cohorts and with techniques to investigate potential conformational epitopes and neutralization to autologous or clinical isolates of HIV-1 from the community.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Patterns and predictors of high-risk sexual behavior in female partners of HIV-infected men with hemophilia.

OBJECTIVE: To characterize and quantify high-risk heterosexual activity in HIV-discordant couples. DESIGN: Analysis of cross-sectional and longitudinal questionnaire data from 217 HIV-negative female sexual partners of HIV-infected hemophilic men. METHODS: Comparison of prevalence rates of anal sex, oral sex, vaginal intercourse with or without condoms, and use of other contraceptives between 1985 and 1991. Logistic regression analysis of demographic, sexual and clinical variables to predict unprotected vaginal sex. Actuarial estimates of semi-annual relapse rates to unsafe sex. RESULTS: The proportion of women at low risk increased from 7 to 69% between 1985 and 1991, mainly because more women were using condoms during all acts of vaginal intercourse. Other contraceptive practices did not change during this time. The proportion engaging in oral or anal sex decreased (from 26 to 13% and 13 to 4%, respectively). Unprotected vaginal sex was more common among women who enrolled earlier, had less education, engaged in oral or anal sex, and among those whose partners had not had AIDS. Unprotected vaginal sex before enrollment was the strongest predictor of this high-risk activity during follow-up. Two-year rates of relapse to high-risk behavior were significantly higher among women who enrolled at high risk compared with those who enrolled at low risk (39 versus 8%, P = 0.005). CONCLUSIONS: Although high-risk sexual behavior became much less prevalent in this population between 1985 and 1991, many continued to have unprotected vaginal sex occasionally. Counseling efforts should target couples who have been the most sexually active or have less education, and should emphasize not only initial risk reduction but also maintenance of low-risk behavior.

Adolescent↗