Correction to: Acetylcholinesterase inhibitors and the risk of osteoporotic fractures: nested case-control study.

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Acetylcholinesterase inhibitors and the risk of osteoporotic fractures: nested case-control study.

The objective of this study was to analyze the effect of acetylcholinesterase inhibitors (AChEIs) on the risk of osteoporotic fractures in Alzheimer patients. A nested case-control study was conducted on 1190 cases and 4760 controls. The use of AChEIs was found to decrease the risk of osteoporotic fractures in these patients. INTRODUCTION: The objective of this study is to estimate the extent to which the use of AChEIs is associated with a reduction in the risk of osteoporotic fractures. METHODS: A nested case-control study was conducted using data from the UK Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) database (1998-2013). The study cohort consisted of Alzheimer's Disease (AD) patients aged ≥ 65 years with no previous history of osteoporotic fractures at cohort baseline. Cases were individuals who suffered an osteoporotic fracture during the study period, whereas controls were subject who did not experience any osteoporotic fractures during the same period. Controls were drawn from the population time at risk while being matched to the cases in respect to age, sex, up-to-standard follow-up in the CPRD, calendar time, and duration of AD (control-to-case ratio: 4-to-1). Information on the use of AChEIs and the relevant potential confounders was ascertained from the CPRD database for all the cases and controls. RESULTS: We identified 1190 cases and 4760 controls. Compared to non-users, any use of AChEIs prior to the fracture was associated with a reduction in the fracture risk [adjusted odds ratio (OR) 0.80 (confidence interval (CI) 95%, 0.70-0.91)]. The use of AChEIs corresponding to a proportion of days covered of 0.8-1.0 was associated with a lower osteoporotic fracture risk compared to non-use [adjusted OR 0.76 (CI 95%, 0.66-0.87)]. CONCLUSIONS: In this study using large primary care databases, the use and treatment adherence to AChEIs were associated with a decreased risk of osteoporotic fractures in elderly AD patients.

Effect of acetylcholinesterase inhibitors on post-surgical complications and mortality following a hip fracture: a cohort study.

There is increasing evidence suggesting that the use of acetylcholinesterase inhibitors may have beneficial effects on bone. Data on the potential post-surgical effects of these medications on orthopedic interventions are very limited. This study was designed to determine whether the use of acetylcholinesterase inhibitors is associated with a decrease in post-surgical mortality and complications in hip fracture patients with Alzheimer's disease. To accomplish this objective, a retrospective cohort study was performed using data from the Clinical Practice Research Database, UK. The study included 532 Alzheimer's disease patients of age 65 years and older, who sustained a hip fracture between 1998 and 2012. During the follow-up period, 34% of the patients died (n=182), 22% sustained a second hip fracture (n=118) and 5% (n=29) required reintervention. The users of acetylcholinesterase inhibitors had a 56% reduction in all-cause mortality (HR= 0.44, 95% CI 0.30-0.63) and a 41% reduction in second hip fracture incidence during a year of post-surgical follow-up (HR= 0.59, 95% CI 0.38-0.94) after adjusting for potential confounders. Our results show that acetylcholinesterase inhibitors may have the potential to reduce all-cause mortality and the risk of suffering a second hip fracture during the first year after surgery.

[Association between oral conditions and colorectal cancer: A literature review and synthesis]. / Association entre les affections buccodentaires et le cancer colorectal: une revue et synthèse de la littérature.

BACKGROUND: Chronic periodontitis and tooth loss are chronic oral conditions that, in recent decades, have been implicated in the occurrence of certain types of cancer. In this review, we address the question of whether colorectal cancer is associated with these oral conditions. RESULTS: Epidemiological studies evaluating a potential association between periodontitis, tooth loss and colorectal cancer are scarce. However, several mechanisms argue in favor of this association, notably inflammation, nutrition and possibly infection by specific bacteria, as suggested by this literature review.

Risk factors for tobacco dependence in adolescent smokers.

OBJECTIVE: To study the incidence of conversion to tobacco dependence (TD) and the prevalence of the TD state in relation to several potential determinants in a sample of adolescent smokers. METHODS: Questionnaires were administered every 3-4 months to document TD symptoms, amount of cigarette consumption, and depression symptoms in a prospective cohort of 1293 grade 7 students in a convenience sample of 10 schools. RESULTS: Over 54 months of follow-up, 113 of 344 novice smokers converted to TD. The referent series for the analysis of incidence comprised 823 person-surveys. The prevalence series included 1673 person-surveys, contributed by 429 smokers. Conversion to TD and TD status were associated with the intensity of recent (that is, past 3-month) cigarette consumption (adjusted incidence rate ratio (aIRR) 1.63 (95% confidence interval (CI) 1.36 to 1.97) and adjusted prevalence odds ratio (aPOR) 1.35 (95% CI 1.23 to 2.48) per 100 cigarettes per month), slowest CYP2A6 activity (aIRR 4.19 (95% CI 1.38 to 12.76) and aPOR 2.30 (95% CI 1.29 to 4.09)), depression score (aIRR 1.61 (95% CI 1.17 to 2.21) and aPOR 1.47 (95% CI 1.22, 1.75) per 1-unit change). Additional determinants included, for conversion to TD, time since onset of cigarette use (aIRR 0.76 (95% CI 0.58 to 1.00) per year) and, for the TD state, positive TD status six months ago (aPOR 3.53 (95% CI 2.41 to 5.19)). CONCLUSIONS: TD risk in adolescents is associated with intensity of recent cigarette consumption, while the role of more distant cigarette consumption appears small; subjects with slow nicotine metabolism and those with more depression symptoms are at increased risk of becoming tobacco dependent. The risk of being tobacco dependent is considerably higher in subjects who had previously developed the TD state.

Deconstructing culture-bound syndromes.

Ethnopsychiatry comprises a large field of literature written from diverse perspectives, disciplines and orientations. Its status as an interdiscipLinary activity presents formidable obstacles to researchers interested in comparative problems and the development of generalizations. These difficulties can be demonstrated by even a cursory examination of the material written on what has come to be called 'culture-bound syndromes'. In spite of the considerable body of specific studies written about these 'ethnic psychoses', as Devereux termed them, debates continue to swirl over how to define them, whether they are manifestations of psychopathology, and, by implication, the degree to which the categories of Western psychiatric nosology are readily transferable to other cultural and historical settings. This paper does not attempt to play the role of broker between universalists and particularists. If anything I favor the particularist position with respect to the impossibility of directly applying diagnostic categories across cultural boundaries. On the other hand I would not deny that there are universal processes which take their form through complex interaction with particular cultural, historical and social settings. The goal of showing how general forms can only be realized in particular settings is a vital one for anthropology, and the literature on culture-bound syndromes illustrates the problems involved. The problems can be severe, but no more so than those facing any observer of an exotic cultural setting. Because I perceive parallels between problems of translation in social and anthropology in general and the issues that have emerged in discussions of culture-bound syndromes, I seek to return to basic issues in this essay to examine some aspects of culture-bound syndromes that should be examined before assertions about pathology are made.

Physical activity fluctuations and body fat during adolescence.

OBJECTIVE: The objective of the study was to test the hypothesis that greater fluctuations in physical activity lead to greater increases in body fat during adolescence. METHODS: Seven hundred fifty-six adolescents in Montreal, Canada, aged 12-13 years at baseline, completed a 7-d physical activity recall questionnaire every 3 months over 5 years. Body mass index (BMI), waist circumference, and triceps and subscapular skinfold thickness were measured at baseline and at the end of follow-up. Subject-specific linear regressions, expressing physical activity as a function of time, were fitted and physical activity fluctuation scores were obtained by averaging the absolute values of regression residuals. The association between body fat after 5 years and the physical activity fluctuation score was assessed in linear regressions adjusting for baseline body fat, average number of physical activity sessions per week, diet and sociodemographic variables. RESULTS: Among boys, there were statistically significant positive associations between physical activity fluctuation and BMI (ß, 95% confidence interval: 0.12, 0.02-0.21) and triceps skinfold (0.40, 0.17-0.63). The associations with waist circumference or subscapular skinfold were not statistically significant (0.22, -0.04-0.49; 0.13, -0.05-0.32, respectively). In girls, there were statistically significant negative associations between physical activity fluctuation and BMI (-0.12, -0.20 to -0.03), waist circumference (-0.54, -0.91 to -0.17), subscapular skinfold (-0.41, -0.56 to -0.26) and triceps skinfold (-0.22, -0.38 to -0.05). CONCLUSION: Physical activity fluctuations appear to affect body fat during adolescence. Sex-specific interventions may be needed given that greater physical activity fluctuations seem unfavourable for boys and beneficial for girls.

A comparison of damage accrual across different calendar periods in systemic lupus erythematosus patients.

Therapeutic approaches in systemic lupus erythematosus (SLE) have evolved over the last few decades, but their impact on prevention of organ damage is unknown. The objective of this study was to compare new cumulative damage in SLE patients across different calendar periods. Patients from a large SLE cohort were divided into two subcohorts; the first diagnosed and followed between 1978 and 1988 (cohort #1, n=100) and the second between 1989 and 1999 (cohort #2, n=51). Initial Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI) scores, and changes in scores over the observation intervals, were compared for the two groups. Logistic regression estimated adjusted odds ratios (OR) comparing damage accrual between the two cohorts. Medication exposures were noted. Baseline characteristics were similar between the two groups. At first assessment, the adjusted OR for a SLICC/ACR DI score > or =1 was 1.79 (95% CI 0.82, 3.88) for cohort #1 versus cohort #2. At the end of the observation interval, the adjusted OR for a SLICC/ACR DI score > or =1 was 1.22 (0.58, 2.55) for cohort #1 versus cohort #2. The adjusted OR for accruing damage over the observation interval in cohort #1 versus cohort #2 was 0.94 (0.39, 2.44). Increased medication exposure was evident for cohort #2 compared to cohort #1. Despite increased therapeutic measures used for patients in more recent periods, our data do not establish a clear difference in damage accrual. This emphasizes the need for strategies to effectively treat lupus-specific manifestations, while minimizing side effects and comorbidities.