Statin use and risk of prostate cancer in the prospective Osteoporotic Fractures in Men (MrOS) Study.

BACKGROUND: Statins are a common medication for cholesterol control that may also have effects on cancer-related pathways. The evidence of an association between statins and prostate cancer risk remains ambiguous. METHODS: We examined statin use in a prospective cohort of 5,069 elderly U.S. men and the risk of incident total, low/high stage, and low/high grade prostate cancer diagnosed between 2000 and 2008. We used multivariate logistic regression models to estimate relative risks and 95% confidence intervals, adjusting for demographic and lifestyle characteristics. RESULTS: There was no evidence of an association between statin use and any of the prostate cancer endpoints (total, low/high stage, low/high grade prostate cancer), adjusting for age, study site, race, body mass index, marital status, family history of prostate cancer, number of comorbidities, physical activity, and smoking history. CONCLUSIONS AND IMPACT: In this study of elderly U.S. men, we observed a null association between statin use and risk of prostate cancer.

Prostate specific antigen screening for prostate cancer: knowledge of, attitudes towards, and utilization among primary care physicians.

OBJECTIVE: Prostate specific antigen (PSA) screening for prostate cancer screening is not uniformly recommended by national organizations or primary care physicians (PCPs). Given this lack of consensus, we sought to identify patterns in physician knowledge of and attitudes towards PSA screening and to determine how these patterns along with patient and provider demographics influence PSA screening practices. METHODS: A self-administered questionnaire, which assessed provider's knowledge of prostate cancer, confidence in his/her knowledge, and PSA screening practices, was mailed to PCPs at an academic medical center. Frequencies of responses were summarized and 3 outcome variables (knowledge, confidence, and propensity to screen) were derived. Association of covariates with the outcome variables was determined using multivariable logistic regression. RESULTS: Eight-two (30.4%) physicians completed the survey; 98% identified African-American race as a prostate cancer risk factor, 42% identified digital rectal exam and PSA as the accepted screening method, and 59% underestimated the likelihood of prostate cancer in a man with a PSA level > 4 ng/ml; 19% were confident in their knowledge of prostate cancer; 86% screened fewer than 60% of their male patients over 50. A knowledge score above the median was not associated with a higher propensity to screen (r = 0.06, P = 0.61). Confidence in one's knowledge was correlated with ordering PSA testing (r = 0.33, P < 0.01). Physician (e.g., ethnicity) and patient (e.g., request for PSA testing) related factors, as well as practice guidelines, particularly those of the US Preventative Services Task Force, influenced providers' decision to offer PSA screening. CONCLUSIONS: Respondents correctly identified prostate cancer risk factors but were less knowledgeable about prostate cancer screening tests and overall prostate cancer risk. Most respondents were not confident in their knowledge and did not screen men over 50. Multiple patient- and provider-specific factors influence the decision to offer or not offer PSA screening.

Vibrio vulnificus oysters: pearls and perils.

Vibrio vulnificus is a naturally occurring bacterium found ubiquitously in coastal waters. Infection with this organism, which is often associated with eating raw oysters, is the leading cause of seafood-related deaths in the United States. This article reviews the current scientific literature on this potentially lethal pathogen and discusses the prognosis, treatment, and prevention of V. vulnificus infections.

Sex hormones and the risk of incident prostate cancer.

OBJECTIVE: To assess whether sex hormone levels are associated with subsequent development of prostate cancer. METHODS: A case-cohort study was conducted within the ongoing Osteoporotic Fractures in Men cohort study of community-dwelling men ≥ 65 years old recruited at 6 US clinical sites. After a mean follow-up of 4.7 years, all men with incident-confirmed prostate cancer and a random sample of the full cohort (subcohort) were selected for analysis: after excluding men with a history of prostate cancer and those who reported androgen or antiandrogen therapy at baseline, the resulting analytic sample comprised 275 cases and 1652 noncases with complete sex hormone measurements. Serum testosterone, estradiol, estrone, and sex hormone-binding globulin were assayed at baseline (prediagnosis) by gas chromatography combined with mass spectrometry. Associations between incident prostate cancer and each sex hormone were evaluated using Cox proportional hazards regression models adjusted for age, race, study site, body mass index, and person-time. RESULTS: In the subcohort, the mean age was 73 years. Higher serum estrone was strongly related to an increased risk of prostate cancer: compared with men in the lower quartile, the risk of prostate cancer among those in the highest 3 quartiles (> 24.9 pg/dL) was nearly 4-fold higher (adjusted heart rate = 3.93, CI: 1.61-9.57). Other sex hormones were not associated with the risk of prostate cancer. CONCLUSIONS: In this cohort of older men, higher estrone levels were strongly associated with an increased risk of incident prostate cancer. This association between estrone and prostate cancer risk needs to be clarified by further study.

Influenza and pneumococcal vaccination rates among Vietnamese, Asian, and non-Hispanic white Americans.

BACKGROUND: Vaccination data for Asian Americans are comparable to those for whites, possibly because they are reported in aggregate rather than for subgroups. We compared influenza and pneumococcal vaccination rates among eligible Asian Americans and white Americans, and for Vietnamese Americans as a subgroup, and assessed factors associated with these vaccinations. METHODS: Cross-sectional study of data collected from three ethnic groups over 4 years by telephone survey. Data were weighted for selection probability and population estimates and analyzed by multivariate logistic regression. RESULTS: Vietnamese Americans had a higher rate of influenza vaccination (61%) than Asian Americans (45%) and white Americans (52%), and lower rate of pneumococcal vaccination (41%) than Asian Americans (56%), both lower than white Americans (67%). CONCLUSION: When analyzed as a subgroup, Vietnamese Americans had a higher influenza vaccination rate, but a lower pneumococcal vaccination rate, compared to Asian Americans and white Americans, which may indicate that health behaviors and outcomes can differ widely among Asian subgroups. Analyses of preventive care measures in Asian Americans should focus on subgroups to ensure accuracy and quality of assessments.

Antibiotic and anti-inflammatory use and the risk of prostate cancer.

BACKGROUND: Prostate inflammation or infection may increase the risk of prostate cancer. Antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat prostatitis and urinary tract infections (UTIs). The objective of our study was to assess whether their use decreases the risk of prostate cancer. METHODS: We conducted a case-control study among men with incident prostate cancer (N = 65 cases) and without prostate cancer (N = 195 controls) at the San Francisco Veteran Affairs medical center (VAMC) between June 1996 and June 2006. Cases were all patients who had prostate biopsies positive for cancer. We matched controls to cases on age group and race at a 3:1 ratio, and each matched pair was given an identical index date. Total antibiotic, aspirin, and NSAID use (number of prescriptions) was computed for each participant by drug type and was restricted to a fill date at least 1 year before the index date. Logistic regression was used for analysis. We adjusted for the matching variables (age group and race) and potential confounders (years of VAMC enrollment and number of clinic visits). RESULTS: Neither total antibiotic use nor total anti-inflammatory use reduces the risk of prostate cancer (P > 0.05). CONCLUSION: Our analysis did not reveal a relation between use of antibiotics, aspirin, or NSAIDs and the risk of prostate cancer.

Effectiveness of adult vaccination programs in faith-based organizations.

Elderly persons of African American and Latino descent have lower rates of immunizations after adjustment for insurance and education. Interventions that use faith-based organizations (FBOs) are promising but have not been well evaluated. We examined the effectiveness of an FBO adult vaccination program in minority communities. From December 2003 through January 2004 and November 2005 through February 2006, 15 churches were randomized to intervention with onsite adult vaccinations or to comparison with no vaccinations. Participants were eligible if they had not been previously vaccinated with pneumococcal vaccine, did not regularly receive influenza vaccine, were aged > or =65 years, and had a clinical indication for vaccination. Baseline and follow-up surveys were conducted. Primary outcome was rates of influenza and pneumococcal vaccinations. The study sample (N=186) was 44% African American, 43% Latino, 8% White, and 3% Asian. Of those eligible, 90 of 112 (80%) in the intervention group used the influenza vaccine compared to 32 of 70 (46%) in the comparison group (P < .001). Of those eligible, 58 of 88 (66%) in the experimental group used the pneumococcal vaccine compared to 20 of 57 (35%) in the comparison group (P < .001). Participants in the intervention group were significantly more likely to receive influenza vaccinations (odds ratio [OR] 4.8, 95% confidence interval [CI] 2.5-9.4) and pneumococcal vaccination (OR 3.6, 95% CI 1.8-7.2). More than ninety percent of all participants reported willingness to participate in FBO education and promotion programs. This onsite, FBO adult vaccination program was effective in increasing vaccination rates and may be promising for decreasing raciallethnic disparities in vaccination rates.

Association between past urinary tract infections and current symptoms suggestive of chronic prostatitis/chronic pelvic pain syndrome.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a major cause of illness, and its association with history of past urinary tract infections is unclear. We surveyed a racially, ethnically and socioeconomically diverse, community-based sample of adults aged 30-79 years in Boston, MA. This report gives estimates from the 2,301 men in the BACH survey: 700 black, 766 Hispanic and 835 white. Symptoms of chronic prostatitis--any perineal and/or ejaculatory pain and a pain score of > or =4--were derived from the NIH Chronic Prostatitis Symptom Index and were used to identify men with symptoms suggesting CP/CPPS. The overall prevalence of symptoms suggestive of CP/CPPS is 6.3%. The number of urinary tract infections, particularly >3, was associated with symptoms suggestive of CP/CPPS (P < 0.01). There is a strong association between current symptoms of CP/CPPS and a history of urinary tract infections, particularly of multiple infections. The causality between chronic UTIs and CP/CPPS needs to be clarified by further study.

Ethnicity, language, specialty care, and quality of diabetes care.

OBJECTIVE: To investigate ethnicity, language, specialty care, and quality of diabetes care in one medical center. METHODS: Retrospective review of computerized records of patients with diabetes age > or = 50 years who were regularly cared for in general medicine, family practice, or diabetes clinics from 1997 to 2000. Measures of processes of care were tests for creatinine, cholesterol, hemoglobin A1C (HbA1C), and microalbumin; ophthalmologic care; and total visits. Intermediate outcomes were average systolic blood pressure (SBP) < 140 mm Hg and HbA1C < 8%. RESULTS: Among 1323 patients, test rates for creatinine, cholesterol, microalbuminuria, and HbA1C were 76.6%, 54.7%, 17.2%, 78.8%, respectively. Only 31.0% had ophthalmology visits, 57.4% had SBP < 140 mm Hg, and 62.0% had HbA1C < 8%. In multivariate analyses, African Americans, Asians, and Latinos received more tests and had more total visits than Whites. Intermediate outcomes were similar except that Asians were more likely (odds ratio [OR] = 1.78, 95% confidence interval [CI] 1.26-2.50) to have SBP < 140 mm Hg. Limited English proficient patients had more total visits (7.0) than English speakers (6.5) (P = .01). Compared to patients with only primary care, patients with a diabetes specialist had more microalbuminuria (OR 3.04, 95% CI 1.87-4.95) and HbA1C (OR 1.91, 1.12-3.26) tests, while those with both types of care were more likely to have each of the five process measures but less likely to have HbA1C < 8%. CONCLUSIONS: Quality of diabetes care was suboptimal for most patients. No ethnic disparity was seen in intermediate outcomes, which may have been achieved through more tests and visits. Combined care by primary and diabetes clinicians may be optimal.

Acceptance of pneumococcal vaccine under standing orders by race and ethnicity.

PURPOSE: To assess whether and how pneumococcal vaccine acceptance occurs after nurse recommendation varies by race/ethnicity. METHODS: We prospectively evaluated nurses' standing orders to assess and vaccinate high-risk patients in a general medicine practice. RESULTS: Of 370 adult patients surveyed (60% nonwhite), 78 (21%) declined vaccination following nurse recommendation, and 43 (12%) persisted in declining after physician consultation. Three-hundred-twenty-seven (88%) patients accepted vaccination: 292 (79%) accepted following nurse recommendation and 35 (9%) following physician consultation. African Americans (19%) were significantly more likely to decline compared with whites (8%) and Asians (5%) (P= 0.01). Reasons for refusal included believing vaccination was unnecessary (32%), fearing shots in general (21%), fearing vaccine-induced illness (26%) and wanting more informotion regarding the vaccine (9%). CONCLUSION: Standing orders, physicians' firm recommendations and addressing patients' vaccine-related concerns may reduce racial/ethnic disparities in vaccination.

Correlates and prevalence of prostatitis in a large community-based cohort of older men.

OBJECTIVES: To describe the prevalence and correlates of self-reported history of prostatitis in terms of lower urinary tract symptoms and associated dissatisfaction in community-dwelling older men. METHODS: We performed a cross-sectional analysis from a prospective cohort study of 5821 men aged 65 years and older recruited from six clinical centers. RESULTS: Overall, 1439 men (25%) self-reported a history of prostatitis. Men with a history of prostatitis were more likely to self-report a history of prostate cancer (26% versus 7%; P < 0.0001) and a history of benign prostatic hyperplasia (83% versus 38%; P < 0.0001) within a lifetime compared with men without a history of prostatitis. Men with a history of prostatitis also had a greater mean American Urological Association symptom score (mean +/- SD, 10.1 +/- 7.1 versus 7.7 +/- 5.9; P < 0.0001) than men without a history of prostatitis. Also, a greater percentage of men with a history of prostatitis reported being dissatisfied with their present urinary condition than did men without a history of prostatitis (21% versus 11%; P < 0.0001). We found positive associations for a history of prostatitis with a history of benign prostatic hyperplasia (odds ratio 8.0, 95% confidence interval 6.8 to 9.5), a history of prostate cancer (odds ratio 5.4, 95% confidence interval 4.4 to 6.6), and dissatisfaction with current urinary condition (odds ratio 1.2, 95% confidence interval 1.01 to 1.5). CONCLUSIONS: A self-reported history of prostatitis is common in older men and was associated with self-reported prostate cancer and benign prostatic hyperplasia and increased severity of lower urinary tract symptoms and associated dissatisfaction. Because of the potential detection bias, recall bias, and the cross-sectional nature of the study, limiting causal inference, the associations among these urologic conditions require additional study.

Focus group interviews on racial and ethnic attitudes regarding adult vaccinations.

UNLABELLED: Adult immunizations have dramatically improved the health of many Americans. In the United States, researchers have documented disparities in the utilization of adult vaccinations between whites and racial and ethnic minority populations. This article examines racial and ethnic attitudes regarding recommended adult vaccinations. METHODS: Four adult focus groups (N=22) were conducted in community churches in San Francisco, CA. Participants were either age-appropriate or had clinical indications to receive a strong recommendation for influenza and pneumococcal immunizations but had not been routinely immunized against influenza and had never been vaccinated against pneumococcal disease. Content analysis was used to analyze narrative data and identify emerging themes. RESULTS: Participants reported that they lacked information about the benefits or potential side effects of influenza and pneumococcal vaccinations and that their physicians were not routinely informing them of, or recommending, these vaccinations. Meanwhile, most participants expressed a willingness to be vaccinated against pneumococcal infection and influenza. All focus group participants felt that community churches were a potential venue for delivery of adult vaccines. CONCLUSIONS: Many adult racial and ethnic minorities have basic information regarding the influenza vaccine but lack sufficient information regarding the benefits of pneumococcal vaccinations. Physicians should provide information regarding adult vaccinations to all patients. On-site vaccination and vaccine education programs in community churches may be successful in increasing the utilization of adult vaccinations in unvaccinated church populations.

Adult immunization in university-based primary care and specialty practices.

The purpose of this study was to assess vaccination status of adults in primary and specialty care practices in a retrospective review of medical records from 1997 to 2000 at one university medical center. Eligible patients were aged 50 and older and had two or more visits to primary and specialty care practices (N=14,556). Outcomes were receipt of pneumococcal vaccine once, tetanus booster within 10 years, and influenza vaccine in 2 of the 3 years. Vaccination rates for patients aged 65 and older were 59% for pneumococcal, 51% for tetanus, and 32% for influenza. Asians, Latinos, and African Americans were more likely than whites to have received influenza, pneumococcal, or tetanus vaccinations. Patients seen in primary care (41%) or in both primary care and specialty practices (42%) were more likely to receive adequate vaccination than those in specialty practices (17%) (P<.001). For pneumococcal vaccinations, relative to patients receiving specialty care only, patients receiving primary care only had an adjusted odds ratios (OR) of 6.6 (95% confidence interval (CI)=5.6-7.7) and patients in both primary care and specialty care had an OR of 7.2 (95% CI=6.2-8.3). For influenza, the corresponding ORs were 3.9 and 4.8, respectively, and for tetanus, 4.6 and 5.2. Patients who received care only from specialty practices were less likely than those with some primary care to receive adequate adult vaccinations. With the exception of Russian immigrants, the study did not find that racial and ethnic minorities had lower rates of vaccination than whites.

Foodborne disease outbreaks in United States schools.

BACKGROUND: The objective of this study was to describe the epidemiology of foodborne disease outbreaks in schools and to identify where preventive measures could be targeted. METHODS: Reports by state and local health departments of foodborne disease outbreaks occurring in primary and secondary schools, colleges and universities from January 1, 1973, through December 31, 1997, were reviewed. Data from ill persons identified through foodborne outbreak investigations and subsequently reported to the Centers for Disease Control and Prevention in the Foodborne Outbreak Surveillance System were examined. The number and size of foodborne disease outbreaks, as well as the etiologic agents, food vehicles of transmission, site of food preparation and contributing factors associated with outbreaks were also examined. RESULTS: From 1973 through 1997, states and local health departments reported 604 outbreaks of foodborne disease in schools. The median number of school outbreaks annually was 25 (range, 9 to 44). In 60% of the outbreaks an etiology was not determined, and in 45% a specific food vehicle of transmission was not determined. Salmonella was the most commonly identified pathogen, accounting for 36% of outbreak reports with a known etiology. Specific food vehicles of transmission were epidemiologically identified in 333 (55%) of the 604 outbreaks. The most commonly implicated vehicles were foods containing poultry (18.6%), salads (6.0%), Mexican-style food (6.0%), beef (5.7%) and dairy products excluding ice cream (5.0%). The most commonly reported food preparation practices that contributed to these school-related outbreaks were improper food storage and holding temperatures and food contaminated by a food handler. CONCLUSIONS: Strengthening food safety measures in schools would better protect students and school staff from outbreaks of foodborne illness. Infection control policies, such as training and certification of food handlers in the proper storage and cooking of foods, meticulous hand washing and paid sick leave for food handlers with gastroenteritis, could make meals safer for American students.