Previous epidemiologic studies suggest that the major histologic subtypes of epithelial ovarian cancer may have different risk factor profiles; however, no known prospective study has systematically examined differences in risk by subtype. The authors used Cox proportional hazards regression, stratified by histologic subtype and time period, to examine the association between ovarian cancer risk factors and incidence of serous invasive, endometrioid, and mucinous ovarian cancers in the US Nurses' Health Study (1976-2006) and Nurses' Health Study II (1989-2005). For each exposure, they calculated P-heterogeneity using a likelihood ratio test comparing models with separate estimates for the 3 subtypes versus a single estimate across subtypes. Analysis included 221,866 women and 721 cases with the histologies of interest (496 serous invasive, 139 endometrioid, 86 mucinous). In analyses of reproductive/hormonal exposures, the associations with age, duration of breastfeeding, age at natural menopause, and duration of estrogen use differed significantly by subtype (all P-heterogeneity < or =0.05). The associations with several nonreproductive exposures also appeared to vary by subtype, but only the association with smoking differed significantly (P-heterogeneity = 0.03). Results suggest that associations with several ovarian cancer risk factors vary by subtype, and these differences are consistent with known similarities between each major histologic subtype and its normal tissue counterpart.

Flavonoids are antioxidant compounds found in plants, including fruits, vegetables and tea. No prior prospective studies have examined the association between intake of flavonoids in the flavonol and flavone subclasses and ovarian cancer risk. We analyzed the association between intake of 5 common dietary flavonoids and incidence of epithelial ovarian cancer among 66,940 women in the Nurses' Health Study. We calculated each participant's intake of myricetin, kaempferol, quercetin, luteolin and apigenin from dietary data collected at multiple time points, and used Cox proportional hazards regression to model the incidence rate ratio (RR) of ovarian cancer for each quintile of intake. Our analysis included 347 cases diagnosed between 1984 and 2002, and 950,347 personyears of follow-up. There was no clear association between total intake of the 5 flavonoids examined and incidence of ovarian cancer (RR 5 0.75 for the highest versus lowest quintile, 95% confidence interval [CI] 5 0.51-1.09). However, there was a significant 40% decrease in ovarian cancer incidence for the highest versus lowest quintile of kaempferol intake (RR 5 0.60, 95% CI 5 0.42-0.87; p-trend 5 0.002), and a significant 34% decrease in incidence for the highest versus lowest quintile of luteolin intake (RR 5 0.66, 95% CI 5 0.49-0.91; p-trend 5 0.01). There was evidence of an inverse association with consumption of tea (nonherbal) and broccoli, the primary contributors to kaempferol intake in our population. These data suggest that dietary intake of certain flavonoids may reduce ovarian cancer risk, although additional prospective studies are needed to further evaluate this association. If confirmed, these results would provide an important target for ovarian cancer prevention. ' 2007 Wiley-Liss, Inc.Key words: flavonoids; flavonols; flavones; diet; ovarian cancer There are few lifestyle factors known to reduce ovarian cancer risk, and no dietary exposure, with the possible exception of lactose, 1 has been clearly associated with risk. Flavonoids are polyphenol chemicals found naturally in fruits, vegetables, tea and other plant-derived foods and beverages. Experimental evidence suggests that flavonoids have several potential anticarcinogenic characteristics, including antioxidant, antiestrogenic, antiproliferative and antiinflammatory properties. [2][3][4][5] Flavonoids are defined by their chemical structure, which includes 2 aromatic rings (the ''A'' and ''B'' rings) linked by a three-carbon bridge that comprises part of a third six-member ''C'' ring. 6 There are over 5,000 individual flavonoid compounds and at least 10 subclasses of flavonoids, which are characterized further by the structure of the C ring and the connection of the B and C rings. 2,6,7 Flavonoids from 6 of these subclasses-flavones, flavonols, flavanols (catechins), flavanones, isoflavones and anthocyanidins-are common in the human diet. 2,7 Three studies have previously evaluated the association between dietary flavonoid intake and ovarian cancer risk. [8][9][10] However, only...

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that affects 7-8% of the general U.S. population at some point during their lifetime; however, the prevalence is much higher among certain subgroups, including active duty military personnel and veterans. In this article, we review the empirical literature on the epidemiology and screening of PTSD in military and veteran populations, including the availability of sensitive and reliable screening tools. Although estimates vary across studies, evidence suggests that the prevalence of PTSD in deployed U.S. military personnel may be as high as 14-16%. Prior studies have identified trauma characteristics and pre- and posttrauma factors that increase risk of PTSD among veterans and military personnel. This information may help to inform prevention and screening efforts, as screening programs could be targeted to high-risk populations. Large-scale screening efforts have recently been implemented by the U.S. Departments of Defense and Veterans Affairs. Given the prevalence and potential consequences of PTSD among veterans and active duty military personnel, development and continued evaluation of effective screening methods is an important public health need.

Previous studies have observed an association between ABO blood group and risk of certain malignancies, including ovarian cancer; however, no prospective studies of the association with ovarian cancer risk are available. Using data from 49,153 women in the Nurses' Health Study, we examined the association between ABO blood group and incidence of epithelial ovarian cancer. Study participants reported their blood type and Rh factor in 1996, and 234 women were diagnosed with incident ovarian cancer during 10 years of follow-up. We used Cox proportional hazards regression to model the incidence rate ratios (RR) and 95% confidence intervals (CI) of ovarian cancer for each blood group category. Compared to women with blood group O, women with blood group AB or B had a nonsignificant 38% increase in ovarian cancer incidence (95% CI 5 0.88-2.16 for blood group AB and 0.96-1.99 for blood group B), whereas blood group A was not associated with risk (RR 5 0.95, 95% CI 5 0.70-1.30). Combining blood groups AB and B, we observed a statistically significant positive association with presence versus absence of the B antigen overall (RR 5 1.41, 95% CI 5 1.06-1.88) and for the serous invasive subtype (RR 5 1.53, 95% CI 5 1.08-2.17). In this large, prospective cohort of women, presence of the B antigen was positively associated with ovarian cancer incidence, whereas blood group A was not associated with risk. Additional studies are needed to confirm this association and to explore the mechanisms through which blood group may influence ovarian cancer risk.Previous studies suggest a possible association between ABO blood group and risk of certain malignancies, 1 including an increased risk of ovarian cancer for blood group A versus O 1-4 ; however, no prospective studies of the blood group/ ovarian cancer association have been published. In a recent analysis of 107,503 men and women in 2 prospective cohorts, individuals with blood group A, AB or B had an increased incidence of pancreatic cancer compared to those with blood group O, with the highest risk among those with blood group B.5 Although the mechanisms for this association are unclear, blood group antigens are expressed on the surface of gastrointestinal, bronchopulmonary, skin and urogenital epithelial cells, 6 suggesting that blood group may influence carcinogenesis at multiple sites. We therefore examined the association between ABO blood group and incidence of ovarian cancer over 10 years among 49,153 women in the Nurses' Health Study (NHS). Material and Methods Study populationThe NHS began in 1976 when 121,700 US female registered nurses aged 30-55 completed a mailed questionnaire about known and suspected risk factors for cancer and cardiovascular disease. Participants completed follow-up questionnaires every 2 years, providing updated information on lifestyle factors and disease diagnoses. The Committee on the Use of Human Subjects in Research at Brigham and Women's Hospital, Boston, MA, approved this analysis and all participants provided implied consent by completin...

Patients with ITP may have severe thrombocytopenia, putting them at risk for serious bleeding. ITP trials of new treatments must allow use of standard‐of‐care therapies to prevent serious bleeding. Thrombopoietin mimetic trials used platelet counts and rescue/concomitant medication use as endpoints. These trials were of insufficient size and duration to measure mortality or serious bleeding, which are infrequent with appropriate treatment. A recent Cochrane review criticized the thrombopoietin mimetic registrational trials for inadequately assessing bleeding and survival. We discuss how these endpoints are difficult to measure in clinical trials designed to improve platelet counts and minimize bleeding, in accordance with ethical trial design. Am. J. Hematol. 2012. © 2012 Wiley Periodicals, Inc.

Several recent studies have evaluated the association between dietary flavonoid intake and ovarian cancer risk, and all reported significant or suggestive inverse associations with certain flavonoids or flavonoid subclasses; however, most of these studies were small to moderate in size. We, therefore, examined this association in a large, population-based case-control study. We calculated intake of 5 common dietary flavonoids (myricetin, kaempferol, quercetin, luteolin, and apigenin), as well as total intake of these flavonoids, for 1,141 cases and 1,183 frequency-matched controls. We used unconditional logistic regression to estimate the relative risk (RR) of ovarian cancer for each quintile of flavonoid intake when compared with the lowest quintile. We did not observe an association between total flavonoid intake and ovarian cancer risk. The multivariable-adjusted RR for the highest versus lowest quintile of total flavonoid intake was 1.06 (95% confidence interval [CI] 5 0.78-1.45). In analyses of each individual flavonoid, only intake of apigenin was associated with a borderline significant decrease in risk (RR, highest vs. lowest quintile 5 0.79, 95% CI 5 0.59-1.06; ptrend 5 0.26), and this association was significant after adjustment for intake of the other 4 individual flavonoids (comparable RR 5 0.72, 95% CI 5 0.53-0.98; p-trend 5 0.09). These results provide limited support for an association between flavonoid intake and ovarian cancer risk. However, given the findings of previous studies and the biologic plausibility of this association, additional studies are warranted. ' 2008 Wiley-Liss, Inc.Key words: flavonoids; flavonols; flavones; diet; ovarian cancer; epidemiology Ovarian cancer is the fifth leading cause of cancer death among women in the United States, accounting for an estimated 15,520 deaths per year.1 Although few modifiable risk factors for ovarian cancer have been firmly established, several recent studies have reported inverse associations with dietary intake of flavonoids. [2][3][4][5][6] Flavonoids are phytochemicals found in fruits, vegetables, tea, wine, and other foods and beverages derived from plant sources. The flavonoid chemical structure consists of 2 aromatic rings connected by a 3-carbon bridge contained within a third 6-member ring; individual flavonoid compounds are grouped into classes based on further similarities in their structure. 7,8 Six flavonoid subclasses are common in the human diet, 7,8 and 3-the isoflavone, flavonol, and flavone subclasses-have been associated with a decrease in ovarian cancer risk in previous studies.2-6 Flavonoids exhibit several anticarcinogenic properties in vitro, and specific flavonoids may decrease ovarian cancer risk by altering levels of estrogen and other sex steroid hormones, inhibiting oxidation or inflammation, decreasing angiogenesis or cell proliferation, or inducing apoptosis. 7,[9][10][11] Three prior case-control studies 2,3,6 and 2 cohort studies 4,5 have evaluated the association between flavonoid intake and ovarian cancer ri...

ABO blood type has been associated with risk and survival for several malignancies; however, data for an association with breast cancer are inconsistent. Our study population consisted of Nurses’ Health Study participants with self-reported serologic blood type and/or ABO genotype. Using Cox proportional hazards regression, we examined the association between serologic blood type and incident breast cancer among 67,697 women, including 3,107 cases. In addition, we examined the association with ABO genotype in a nested case-control study of 1,138 invasive breast cancer cases and 1,090 matched controls. Finally, we evaluated the association between serologic blood type and survival among 2,036 participants with breast cancer. No clear association was seen between serologic blood type or ABO genotype and risk of total breast cancer, invasive breast cancer, or breast cancer subtypes. Compared to women with blood type O, the age-adjusted incidence rate ratios for serologic blood type and total breast cancer were 1.06 (95% CI, 0.98–1.15) for type A, 1.06 (95% CI, 0.93–1.22) for AB, and 1.08 (95% CI, 0.96–1.20) for B. In genetic analyses, odds ratios for invasive breast cancer were 1.05 (95% CI, 0.87–1.27) for A/O, 1.21 (95% CI, 0.86–1.69) for A/A, 0.84 (95% CI, 0.56–1.26) for A/B, 0.84 (95% CI, 0.63–1.13) for B/O, and 1.17 (95% CI, 0.35–3.86) for B/B, compared to O/O. No significant association was noted between blood type and overall or breast cancer-specific mortality. Our results suggest no association between ABO blood group and breast cancer risk or survival.

We observed significant cross-sectional associations between hormone levels, including E2, T, and E2/T, and body composition measures in men. Longitudinal analyses showing no influence of baseline hormone levels on change in anthropometric measures imply that body composition affects hormone levels and not the reverse.