Human papillomaviruses (HPV) are double-stranded, DNA, epitheliotropic viruses that infect skin and mucosal membranes. Over 200 types of HPV have been identified and classified into alpha (α), beta (β), gamma (γ), mu (µ), and nu (ν) genera. HPV in the genus α mainly infect mucosal membranes, cause the majority of the ano-genital cancers, and are widely studied. However, epidemiology of HPV in the other genera, which mainly infect skin, is poorly understood. Few studies have reported the seroprevalence of cutaneous HPV among healthy individuals, and to date, no study has prospectively examined the association between cutaneous HPV seropositivity and development of external genital lesions (EGLs) in men. The objectives of this study were to estimate the seroprevalence of cutaneous HPV types and investigate factors associated with the seropositivity, and evaluate the association between seropositivity to cutaneous HPV types and the risk of development of EGLs. Several studies have reported the seroprevalence of mucosal HPV types (6, 11, 16 and 18) in the 4-valent HPV vaccine among men. However, few studies have reported the seroprevalence of the five additional HPV types (31, 33, 45, 52 and 58) in the recently approved 9-valent HPV (9vHPV) vaccine specifically among men across a broad age range. Baseline data on seroprevalence prior to vaccine introduction and dissemination are needed to establish the effectiveness of vaccines over time. Also, this study estimated the seroprevalence of 9vHPV vaccine types and investigated factors associated with the seropositivity among men residing in Brazil, Mexico, and the United States (U.S.). To estimate the seroprevalence of cutaneous HPV types and 9vHPV vaccine types, 600 men were randomly selected from the HPV Infection in Men (HIM) Study. To examine the association between seropositivity to cutaneous HPV types and development of EGLs, a case-control study of 163 incident EGL cases and 352 EGL-free controls nested in the HIM cohort was conducted. Cases were ascertained through visual inspection at each of up to 10 biannual clinical visits, confirmed through biopsy, and categorized into condyloma, suggestive of condyloma, penile intraepithelial neoplasia (PeIN) and other EGLs. Archived serum specimens were tested for antibodies against 14 cutaneous HPV types, β types (5, 8, 12, 14, 17, 22, 23, 24, 38 and 47), α type 27, γ type 4, µ type1 and ν type 41, and 9vHP types (6, 11, 16, 18, 31, 33, 45, 52 and 58) using a glutathione S-transferase (GST) L1-based multiplex serology assay. Socio-demographic and sexual behavior data were collected through a questionnaire. Binomial proportions were used to estimate seroprevalence, and logistic regression was used to examine factors associated with seropositivity. Overall, seroprevalence of ≥1 cutaneous HPV types was 65.4%, 1≥ β-HPV types was 39.0%, α-HPV 27 was 8.9%, γ-HPV 4 was 30.9%, µ-HPV 1 was 28.6%, and ν-HPV 41was 9.4%. Higher educational attainment was significantly associated with seropositivity to ≥1 cutaneous HPV types (adjusted odds ratio [AOR] 1.75 for ≥16 years of education vs. ≤12 years of education, 95% confidence interval [CI] 1.08-2.83), and seropositivity of ≥1 β-HPV types was significantly associated with increasing age (AOR 1.72 for men aged 31-44 years vs. men aged 18-30 years, 95% CI: 1.12–2.63,). Country of residence, circumcision status, and lifetime number of male anal sex partners were other factors significantly associated with various type-specific cutaneous HPV seropositivity. No statistically significant association was observed between grouped or individual cutaneous HPV seropositivity and the risk of development of EGLs across all pathological diagnoses. The seroprevalence of grouped and individual cutaneous HPV types was similar across different EGL categories and controls, with the most frequent types being ɤ-HPV 4, µ-HPV 1, and β-HPV 8. The seroprevalence of ≥1 9vHPV vaccine types was 28.3%, ≥1 high-risk types was 14.0%, five additional high-risk types was 11.2%, and low-risk types (6/11) was 17.4%. Compared to men with no male anal sex partners, men with ≥2 partners were two times more likely to be seropositive for grouped 9vHPV vaccine types, ≥1 high-risk types and ≥1 low-risk types, in addition to individual HPV types 6, 16, 33, and 58, with AORs ranging from 2.19 to 7.36. Older age, current smoking, and being single were other factors significantly positively associated with different grouped and type-specific seropositivity. In conclusion, our data show that exposure to cutaneous HPV was common in men although different risk factors were independently associated with grouped and type-specific cutaneous HPV seropositivity. It appears that exposure to cutaneous HPV is not likely to increase the risk of EGLs among men. Similarly, exposure to 9vHPV vaccine types was also common in men and seropositivity to 9vHPV vaccine types was positively associated with older age and lifetime number male anal sex partners.

Orientador: Neury Jose Botega / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T12:49:11Z (GMT). No. of bitstreams: 1 Silva_VivianeFrancoda_M.pdf: 6466226 bytes, checksum: 36ac15a4814199af198ed6685086f549 (MD5) Previous issue date: 2006 / Resumo: Este estudo tem como objetivo identificar variáveis associadas à Ideação Suicida ao Longo dos Últimos Doze Meses, na cidade de Campinas. Através de um estudo de caso-controle investigou-se fatores associados a ideação suicida mediante análise de variáveis independentes relacionadas ao indivíduo, à família e à saúde. Foram entrevistados 29 casos de ideação e 166 controles. Os casos foram identificados através de um inquérito de prevalência e os controles, selecionados aleatoriamente da mesma base populacional, entre os que não relataram ideação suicida nos últimos 12 meses. Modelos de análise de regressão foram propostos para controlar a ação dos fatores de confusão ou modificadores de efeito. Nos resultados obtidos, as variáveis sociodemográficas não estiveram associadas à ideação suicida. Na análise final, permaneceram com significância estatística as variáveis falta de energia e humor deprimido, derivadas do SRQ-20, dificuldades emocionais relatadas, vizinhança não solidária e menor freqüência à igreja. Ideação suicida mostrou-se consistentemente associada a fatores relacionados a sintomas depressivos, principalmente falta de energia e humor deprimido / Abstract: The aim of this investigation was to identify associated variables related to suicide ideation along the last twelve months, in the city of Campinas, São Paulo, Brazil. Through a study of a case-control design, risk factors for suicidal ideation was investigated through independent variables analysis of individual, familiar and health behavior; 29 cases of ideation and 166 controls were interviewed. The cases were identified by a former cross-sectional study and the controls selected at random from the same population bases among those without ideation in the last 12 months. Regression models were proposed to control confounding factors or effect modifiers. Demographic variables were not associated with suicidal ideation, in the obtained results. At the final model the variables remained with statistic significance were those regarding with depressive features, related emotional difficulties, lack of neighborhood¿support and less frequency to the church. Suicidal ideation is consistently associated with factors related to depressive features, specially energy loss and depressive humor / Mestrado / Saude Mental / Mestre em Ciências Médicas

Contexte : Bien que le tabagisme soit de loin le facteur de risque majeur de cancer de poumon, les expositions professionnelles, qui représentent la 2eme étiologie majeure de ces cancers, méritent un intérêt particulier. Peu d'information existe actuellement sur le risque de cancer du poumon associé aux expositions professionnelles aux solvants. Ces substances sont largement utilisées dans différentes industries et certaines professions comme les peintres par exemple, particulièrement exposés aux solvants, sont reconnues à risque de cancer du poumon, sans identification de l'agent cancérogène en cause.Objectifs : L'objectif de mon travail de thèse est l'évaluation du rôle de l'exposition à différents solvants organiques (groupés en solvants chlorés, carburants et solvants pétroliers, solvants oxygénés) sur le risque du cancer du poumon. Dans un premier temps nous avons étudié l'effet de l'exposition professionnelle aux solvants chlorés; ensuite l'analyse a intégré l'exposition aux deux autres familles de solvants, toujours en tenant en compte des principaux facteurs de risque de cancer du poumon, y compris le tabac et l'exposition professionnelle à l'amiante.Population et méthode: Ce travail est basé sur les données d'une large étude de type cas-témoins en population générale, ICARE. Des données détaillées sur l'activité professionnelle vie entière ont été recueillis. Au total, 2,926 cas de cancer de poumon (2,276 hommes et 650 femmes) et 3,555 témoins (2,780 hommes et 775 femmes) ont été inclus. L'exposition aux solvants a été évaluée par des matrices emplois-expositions, élaborés séparément par chaque substance par des hygiénistes industriels. En outre, l'exposition à certains solvants était directement déclarée par les sujets dans le questionnaire. Nous avons d'abord suivi une approche d'analyse statistique classique par régression afin d'étudier le rôle des solvants chlorés. Lors de l'analyse qui intégrait les trois familles des solvants, nous avons suivi une approche méthodologique complexe multidimensionnelle. La méthode bayésienne profil regression nous a permis de contourner les limites de l'analyse classique, dues à la forte multicollinéarité qui existe entre les solvants.Résultats et conclusions: L'analyse focalisée sur les solvants chlorés a suggéré une association entre le cancer du poumon et l'exposition professionnelle au perchloroethylene (PCE), en particulier chez les femmes. En revanche, aucune association avec le risque de cancer du poumon n'a pu être mise en évidence par la seconde analyse intégrant les trois familles de solvants (chlorés, pétroliers et oxygénés). Cependant, parce que nous avons augmenté la spécificité de la définition de l'exposition le PCE n'était pas inclus dans les solvants étudiés, nous empêchant de confirmer ou infirmer l'association mise en évidence précédemment. Bien que les solvants ne soient pas associés au cancer du poumon, nous avons identifié deux groupes de sujets avec un risque de cancer du poumon supérieur à la moyenne. L'un de ces groupes incluait notamment une forte concentration de peintres. Notre analyse ne plaide pas en faveur du rôle des solvants pour expliquer cet excès. Malgré l'absence d'association entre l'exposition aux solvants et le risque de cancer du poumon l'approche Bayésienne utilisée nous a permis d'analyser l'exposition conjointe à un nombre relativement important de substances, ce qui est une situation assez courante en matière d'expositions professionnelles. Notre souhait est maintenant grâce à cette nouvelle méthodologie de nous pencher sur l'étude du rôle des expositions conjointes de substances reconnues cancérigènes pour le poumon comme l'amiante, la poussière de silice et les gaz d'échappement du moteur diesel, toutes trois retrouvés très fréquemment dans l'industrie de la construction par exemple. / Context: The principal risk factor for lung cancer is by far tobacco smoke, however occupational exposures deserve a special interest because they are the 2nd main etiology of this cancer. Little information is currently available on the relationship between lung cancer risk and occupational exposure to solvents that are widely used in several industries. Certain jobs such as painters, who are particularly exposed to solvents, are known to be at increased risk of lung cancer, but the causative agent is still unknown or unproven.Objectives: The aim of the present work was the evaluation of the role of occupational exposure to different organic solvents on lung cancer risk. Initially we studied the effect of occupational exposure to chlorinated solvents; then the analysis integrated exposure to two other solvent families, namely fuels and petroleum solvents and oxygenated solvents, always taking into account the main risk factors for lung cancer, including cigarette smoking and occupational exposure to asbestos.Population and methods: This work was based on a large population-based case-control study, ICARE. Detailed data on the lifelong occupation was collected. A total of 2,926 cases of lung cancer (2,276 men and 650 women) and 3,555 controls (2,780 men and 775 women) were included. Exposure to solvents was assessed by job exposure matrices, developed separately for each substance by industrial hygienists. In addition, exposure to certain solvents was directly reported by subjects in the questionnaire. First we followed a classical statistical regression analysis approach to investigate the role of chlorinated solvents. In the analysis that included three families of solvents, we followed a multidimensional complex methodological approach. Bayesian profile regression method enabled us to overcome traditional analysis limits due to high multicollinearity between solvents.Results and conclusions: The analysis focused on chlorinated solvents suggested an association between lung cancer and occupational exposure to perchloroethylene (PCE), especially in women. While, no association with lung cancer risk could be demonstrated in the second analysis, incorporating the three families of solvents (chlorinated, petroleum and oxygenated). However, as we had increased the specificity of exposure definition, PCE was not included in the studied solvents anymore, preventing us from confirming or denying the association suggested above. Although solvents were not associated with lung cancer, we identified two groups of subjects whose risk of lung cancer was higher than the average. In particular, one of these groups included a high concentration of painters, however our analysis does not advocate the role of solvents to explain this excess. Despite the lack of association between solvent exposure and risk of lung cancer, the Bayesian approach allowed us to analyze the effect of joint exposure to a relatively large number of substances, which is a fairly common situation in occupational exposures. Thanks to this innovative method, our intention is now to look at the role of joint exposure to substances recognized as carcinogenic for the lung such as asbestos, silica dust and diesel engine exhaust, that are frequently found for instance in construction industry.

No description available.

Nosocomial outbreaks of infection due to non-typeable Haemophilus influenzae (NTHi) are rarely described. There are a few published reports that suggest that elderly patients with underlying pulmonary disease are at risk and that person-to-person spread is key to disease transmission. During the summer months of 2005, we documented an outbreak of NTHi infections in a Veterans Affairs nursing home. Thirteen patients developed conjunctivitis or lower respiratory infection involving a β-lactamase-negative biotype III NTHi isolate, with an indistinguishable SmaI macrorestriction pattern. Patients were elderly males usually with underlying cardiac and pulmonary disease. A case-control study failed to demonstrate any specific significant risk factor for NTHi infection and there was no evidence of spatial clustering of cases within the nursing home. A random throat culture survey involving nursing home patients during the outbreak showed that only one of 19 persons was colonized with NTHi. The outbreak concluded following appropriate treatment and an emphasis on universal and respiratory droplet precautions. All patients recovered and a specific inciting event for the outbreak was never defined. Literature review revealed a spectrum of responses to nosocomial NTHi infections and a lack of consensus regarding the infection control approach towards NTHi outbreaks.

An inverse association between estrogen therapy (ET) and Alzheimer disease (AD) has been reported in some, but not in all studies. We investigated the association between ET and AD in postmenopausal women using a population-based case-control design. Women who developed AD from 1985 through 1989 in Rochester, MN (cases, n=264) were individually matched by age (±1 y) to control women free of dementia from the same population (controls, n=264). ET exposure (≥6 mo after menopause) was ascertained by abstracting the complete medical records archived in the records-linkage system of the Rochester Epidemiology Project. The frequency of ET use was similar in cases (11.4%) and controls [10.6%; odds ratio=1.10; 95% confidence interval (CI)=0.63-1.93]. However, cases who used ET had a suggestive trend for an earlier age at start of ET compared with controls (median, 49.0 vs. 50.5 y; P=0.06). Although smoking (ever vs. never) was not associated with AD overall, we observed an interaction between smoking and ET. The odds ratio of AD in ET users was 4.55 (95% CI=1.33-15.53) among smokers, but was 0.68 (95% CI=0.35-1.32) among never-smokers (P for interaction=0.01). Our findings do not confirm a significant association between ET and AD overall; however, the possible interaction with smoking deserves further study.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18888号 / 医博第3999号 / 新制||医||1009(附属図書館) / 31839 / 京都大学大学院医学研究科医学専攻 / (主査)教授 中川 一路, 教授 木原 正博, 教授 西渕 光昭 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13126号 / 論医博第2135号 / 新制||医||1024(附属図書館) / (主査)教授 湊谷 謙司, 教授 椛島 健治, 教授 岩井 一宏 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24478号 / 医博第4920号 / 新制||医||1062(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 山本 洋介, 教授 近藤 尚己, 教授 柳田 素子 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Quinolones are a group of antibiotics that have gained significant popularity on a global scale since the end of the last century. This popularity was predominantly based on their proven potency, broad coverage against a wide range of bacteria, in addition to possessing a favorable pharmacologic profile. Whereas quinolone-associated adverse reactions are generally tolerable and self-limiting, some reactions have generated heightened concerns due to their serious nature, which have resulted in label changes or even market withdrawal in some instances. This thesis investigates the association between quinolone antibiotics and two adverse reactions of an acute and serious nature: acute liver failure and retinal detachment. Each adverse reaction is investigated through integrating evidence from three studies utilizing different designs based on data from different sources, with each source offering a unique perspective on this issue. The first study type (chapter 2 for acute liver failure ‘ALF’ and Chapter 5 for retinal detachment ‘RD’) analyzes spontaneous reports submitted to the US Food & Drug Administration (FDA) adverse event reporting system database. Chapters 3 and 6 systematically identified all relevant (published and unpublished) clinical trials for occurrences of ALF and RD, respectively, among trial participants. Finally, chapters 4 (ALF) and 7 (RD) involved case-control analysis of a major US database of electronic health records for nearly 70 million inpatients admitted to more than 500 hospitals between 2000 and 2016. The FAERS analysis revealed a positive ALF signal with ciprofloxacin and a marginal signal for RD with moxifloxacin. Examination of the evidence from clinical trials revealed only two cases of ALF, one associated with gemifloxacin and one with moxifloxacin. No cases of RD were reported in any of the identified clinical trials. Primary analyses of the Health Facts® data revealed no overall association between quinolones and the risk of ALF or RD. However, elevated risk was identified in some subgroups, including African Americans (ALF, RD), Caucasians (ALF), women (ALF, RD), men (ALF), those ≤60 years of age (ALF) or 56-70 years of age (RD), and those with no or few comorbidities (ALF). Evidence from analyses of data from spontaneous reports and clinical trials provided some evidence for an elevated risk of ALF or RD following the systemic administration of quinolone antibiotics. Some evidence of elevated risk was also identified in the case-control analyses of inpatient EHR records. Findings from our six epidemiologic studies are in line with current advisories by FDA and Health Canada.