Résumé : Depuis 2002, une augmentation des taux d’issues défavorables de l’infection à Clostridium difficile (ICD) a été attribuable à l’émergence de la souche NAP1/BI/R027. Il est indispensable d’identifier les facteurs de risque de développer des complications (ICDc) et des récidives (ICDr), et de pouvoir les prédire lors du diagnostic afin d’optimiser le traitement. Le projet de recherche a comme objectifs: i) l’identification des facteurs de risque pour le développement d’ICDc et ICDr et ii) le développement et la validation d’un outil de prédiction à partir de variables mesurées dans les 48h du diagnostic d’une ICD. Méthode: Une cohorte multicentrique prospective de patients adultes hospitalisés pour une ICD. Les données suivantes ont été recueillies: i) démographiques; ii) comorbidités; iii) traitements et procédures reçus dans les 2 mois avant le diagnostic; iv) paramètres cliniques, vi) biochimiques, hématologiques et vii) microbiologiques (ribotypage). Un suivi à 30 et 90 jours a été effectué. Les facteurs de risque ont été identifiés par des modèles multivariés de régression logistique et d'analyse de survie. La méthode de validation croisée a été utilisée pour la dérivation et la validation interne. Différents modèles ont été comparés selon l’aire sous la courbe ROC (ASC), l’erreur de prédiction (EP) et les paramètres de performance. Un score prédictif a été dérivé à partir du modèle optimal. Résultats: Au total, 1380 patients ont été inclus dont 96% suivis 90 jours. Une ICDc a été observée chez 8% et une ICDr chez 26%. La souche R027 représentait 52% des souches caractérisées. Les ICDc sont associées à un âge ≥80 ans, un rythme cardiaque >90/min, un rythme respiratoire >20/min, globules blancs (GB) <4 et ≥20×10[indice supérieur 9]/L, albumine sérique <25 g/L, urée sérique >7 mmol/L, et CRP ≥150 mg/L. Les ICDr sont associés à l'âge ≥ 65 ans, à l’exposition à des macrolides et/ou clindamycine, CRP ≥150 mg/L, R027, et une hospitalisation ≥14 jours suivant l'ICD. Un sous-groupe de 1038 cas complets a été utilisé pour la modélisation prédictive. Le modèle optimal contenait l’âge ≥80 ans, GB ≥12×10[indice supérieur 9]/L, albumine sérique <26 g/L et urée sérique >7 mmol/L, avec une ASC de 0,84 et une EP de 6%. Un score variant entre 0 et 17 points a été construit. En validation, un score >10 points présentait une sensibilité de 50% (IC[indice inférieur 95]% = 28-72), une spécificité de 85% (81-89), une valeur prédictive positive de 17% (7-27) et une valeur prédictive négative de 96% (94-99). Conclusions: En utilisant une large cohorte prospective multicentrique et plusieurs étapes de modélisation prédictive et de validation interne, nous avons identifié les facteurs associés aux ICDc et ICDr et dérivé un score prédictif des ICDc ayant une performance acceptable. Au moment du diagnostic de l’ICD, ces facteurs sont à considérer pour envisager le traitement le plus optimal afin de prévenir ces issues. / Abstract : A significant increase in Clostridium difficile infection (CDI) unfavourable outcomes was observed since 2002 and was associated with the emergence of the strain NAP1/BI/R027. Identifying patients at high risk of developing complications (cCDI) and recurrences (rCDI), and predicting these outcomes early in the course of illness could improve clinical decision-making. The main objectives of this research were to: i) identify risk factors for cCDI and rCDI, and ii) develop and validate a clinical prediction rule for cCDI using predictors measured within 48h of CDI diagnosis. Methods: Adult in patients with confirmed CDI diagnosis in 10 acute care hospitals, were enrolled in a prospective cohort. Data at enrolment were collected : demographics, underlying illnesses, past medical and drug history (two months prior to CDI), clinical signs, blood tests, and C. difficile strain type. A follow-up was completed on day 30 and 90 after enrolment. Risk factors were identified by multivariate logistic regression and survival analyses. Split-sample technique was used for training and validation sets. Several predictive models were derived and assessed in both sets by AUC/ROC, prediction error (PE), and performance parameters. A predictive score was built using the optimal predictive model. Results: A total of 1380 patients were enrolled and 96% had 90 days follow -up. cCDI was observed in 8% and rCDI in 26%. R027 was identified in 52% of patients. Age ≥80 years, heart rate >90/min, respiratory rate >20/ min, white cell count <4 or ≥20 × 109/L, albumin <25 g/L, blood urea nitrogen >7 mmol/L, and C-reactive protein (CRP) ≥150 mg/L were independently associated with cCDI. Age ≥65 years, increased CRP, expos ure to macrolides/clindamycin, R 027, and prolonged hospital stay were associated with rCDI. A sub-group of 1038 complete cases was used for predictive modelling. In the training set, the optimal model with 6% PE and AUC 0.84 included age≥80, WBC≥12x10 [superscript 9]/L, BUN>7 mmol/L, and serum albumin <26 g/L. A predictive score was built with minimum 0 and maximum 17 points. A score >10 points showed 50% sensitivity (95%CI, 28-72), 85% specificity (81-89), 17% (7-27) positive predictive value, and 96% (94-99) negative predictive value. Conclusion: Through a large multicenter prospective cohort and multiple modelling approached, independent risk factors of complications and recurrence of CDI were identified. We derived a predictive score that included easily available meas ures at the bedside and showed acceptable performance. At time of CDI diagnosis, these predictors could be used by clinicians to identify patients at higher risk and adjust for the most optimal treatment that could prevent unfavourable outcomes.

<p>Uvod: Osteoporoza je sistemsko oboljenje skeleta koje se karakteri&scaron;e smanjenjem mase kosti i promenama u ko&scaron;tanoj strukturi, &scaron;to sve ima za posledicu povećanu sklonost ko&scaron;tanog tkiva ka prelomima. Prema preporuci Svetske zdravstvene organizacije, dijagnoza osteoporoze postavlja se ukoliko je T-score -2,5 SD i ispod te vrednosti, a normalan nalaz ako je vrednost T-score -1,0 SD i iznad te vrednosti. Danas se smatra da je zlatni standard u dijagnostici osteoporoze primena dvostruke X apsorpcione denzitometrije lumbalne kičme i kuka putem koje se dobiju vrednosti ko&scaron;tane mase Bone mineral density i T-score. Međutim, poznato je da postoje faktori rizika koji utiču na redukciju mase kosti na taj način &scaron;to smanjuju maksimum mase kosti koji se stiče do 35. godine života i / ili ubrzavaju inače normalan proces postepenog i blagog smanjenja mase kosti koji počinje posle 35. godine života i na taj način povećavaju rizik za frakture. Takođe, poznato je da neki od faktora rizika i njihova udruženost može dovesti do povećanog rizika za frakture i nezavisno od ko&scaron;tane mase i T-score. Ciljevi istraživanja : 1. Utvrditi ko&scaron;tanu masu u postmenopauznih žena primenom dvostruke X apsorpcione denzitometrije. 2. Analizirati distribuciju faktora rizika u pacijentkinja sa T-score ispod -2.5 SD u poređenju sa pacijentkinjama sa T-score iznad -1.0 SD. 3. Utvrditi odnos između statističkog prostora koji čine pojedinačni i udruženi faktori rizika (sa karakteristikama svakih od njih) i mase kosti određene denzitometrijski. Materijal i metode rada: Istraživanje je koncipirano delom kao prospektivna, a delom kao retrospektivna studija koja je sprovedena kod pacijentkinja u postmenopauznom periodu života, životne dobi od 50 do 80 godina. Nakon urađene dvostruke X apsorpcione denzitometrije lumbalne kičme i kuka ispitivane pacijentkinje su same popunjavale upitnik uz pomoć medicinske sestre ili lekara. Nakon dobijenih podataka pacijentkinje su podeljene u dve grupe: sa osteoporozom i bez osteoporoze. U grupi sa osteoporozom je bilo 270 pacijentkinja, a u grupi bez osteoporoze 250 pacijentkinja. Potom je sprovedena statistička obrada podataka. Nakon sveobuhvatne analize dobijenih rezultata istraživanja izvedeni su sledeći zaključci: 1.Ustanovljeno je da 60% postmenopauznih žena prosečne životne dobi od 67.0 &plusmn; 7.0 godina ima osteoporozu odnosno vrednost T-score &le; -2.5 SD. 2. Postoji statistička značajna povezanost između ko&scaron;tane mase i sledećih faktora rizika: pozitivna porodična anamneza na osteoporozu i frakture, telesna težina, telesna visina, ranije frakture, česti padovi i smanjenje u visini vi&scaron;e od 3 cm. 3. Analizom faktora rizika se dobijaju karakteristike osoba sa osteoporozom: pozitivna porodična anamneza na osteoporozu i frakture, manja telesna težina i telesna visina, smanjenje u visini vi&scaron;e od 3 cm, česti padovi i ranije frakture. 4. Hipertireoidizam i hiperparatireoidizam, reumatoidni artritis, primena kortikosteroidne terapije su faktori rizika koji su vi&scaron;e zastupljeni kod ispitivanih pacijentkinja sa osteoporozom. 5. Pu&scaron;enje, rana menopauza, alergija na mleko bez adekvatne supstitucije sa kalcijumom i nedovoljan boravak na suncu bez adekvatne supstitucije sa vitaminom D su faktori rizika koji su vi&scaron;e zastupljeni kod ispitivanih pacijentkinja sa osteoporozom. 6. Najveći doprinos celini daje pozitivna porodična anamneza na osteoporozu i frakture (20.99%), zatim slede telesna težina, telesna visina, Index telesne mase (19.03%), ranije frakture, česti padovi, smanjenje u visini vi&scaron;e od 3 cm (18.41%), pu&scaron;enje i nedovoljna fizička aktivnost (12.75%), alergija na mleko i nedovoljan boravak na suncu (12.14%), rana menopauza (8.72%), hipertireoidizam, hiperparatireoidizam, reumatoidni artritis (7.93%). 7. Analizom tri grupe obeležja koja daju najveći doprinos celini ustanovljeno je da pozitivna porodična anamneza na frakture (37.7%) i telesna težina (31.3%) predstavljaju major faktore rizika za osteoporozu. 8. Matematičkom obradom dolazi se do formule pomoću koje bi sa verovatnoćom od 64.0 % mogla predvideti osteoporoza, a sa verovatnoćom 73.2 % odsustvo osteoporoze, čime se između ostalog u na&scaron;em istraživanju donekle relativizuje neophodnost određivanja ko&scaron;tane mase u proceni rizika za prelome i u proceni potrebe za uvođenje antiosteoporotične terapije. Formula je +.214 O +.562 F +.202 R +.223 P +.335 S +.493 T +.057 V +.020 9. Potrebno je testirati dobijenu formulu na ispitivanim pacijentkinjama i nastaviti istraživanje na većem uzorku na faktore rizika koji nisu pokazali statističku značajnost.</p> / <p>Introduction: Osteoporosis is a systematic disease of skeleton characterized by the reduction of bone mass and changes in bone structure which result in the increased aptitude of bone tissue to fractures. According to the suggestion of the World Health Organization, the diagnosis for osteoporosis is set if the T-score is -2.5 SD and below it and the normal report if the value of T-score is -1.0 SD and above it. Nowadays, it is considered that the golden standard in osteoporosis diagnostic is the use of double X absorption densitometry of lumbal spine and hipe which provides the values of bone mass Bone mineral density as well as T-score. However, it has been known that there are risk factors whish influence the reduction of bone mass by reducing maximum bone mass gained by the age of 35 and/or by quckening, the normal process of gradual and mild reduction of bone mass starting after 35 and in that way increase the risk toward fractures. It mas also been known that some of the risk factors and their correlation may cause the increasement of the risk factor toward fractures not having the connection with the bone mass and T-score. Researchment aims: 1. Determine bone mass in postmenopausal women using double X absorption densitometry. 2. Analyse distribution of risk factors in patients whith the T-score below -2.5 SD comparing to the patients with T-score above -1.0SD. 3. Determine the relation between statistical space made by individual and associated risk factors (with the characteristics of each of them) and the bone mass specified by densitometry. Material and methods of working: Researchment is outlined partly as prospective and partly as retrospective study which was carried out in patients in postmenopausal life period, aged 50-80. After applying double X absorption densitometry of lumbal spine and hip the examined patients did the questionnaire by themselves whith the help of nurses and doctors. After obtaining the data, patients were divided into two groups: with and without osteoporosis. There were 270 patients in the group with osteoporosis and 250 of them without it. Thereafter, the statistic data processing was carried out. After the overall analysis of obtained results of researchment, following conclusions were conducted: 1. It has been determined that 60 % of postmenopausal women of average age 67.0&plusmn;7.0 have osteoporosis, in other words, their T-score is &le; -2.5 SD. 2. There is statistically important relationship between the bone mass and following risk factors: positive family anamnesis to osteoporosis and fractures, body weight, height, previos fractures, frequent falls and reduction of height for more than 3 cm. 3. Analysing the risk factors, characteristics of persons with osteoporosis have been obtained: positive family anamnesis to osteoporosis and fractures, smaller body weight and height, the reduction in height for more than 3 cm, frequent falls and previous fractures. 4. Hyperthyroidism and hyperparathyroidism, rheumatoid arthritis and the usage of corticosteroid therapy are the risk factors more incident in the examined patients with osteoporosis. 5. Smoking, early menopause, allergy to milk with no adequate substitution of calcium and insufficient exposition to sun rays with no adequate substitution of vitamine D are the risk factors more incident in patients with osteoporosis. 6. The largest contribution to the total makes positive family anamnesis to osteoporosis and fractures (20.99%), followed by body weight, height, Body mass index (19.03%), previos fractures, frequent falls and reduction in height for more than 3 cm (18.41%), smoking and insufficient physical activity (12.75%), allergy to milk and insufficient exposition to the sun (12.14%), early menopause (8.72%), hyperthyroidism and hyperparathyroidism, rheumatoid arthritis (7.93%). 7. By the analysis of all three goups of features giving the largest cintribution to the total, it has been determined that positive family anamnesis to fractures (37.7%), and body weight (31.3%), present the major risk factors for osteoporosis. 8. By mathematical processing we obtain the formula which can with the probability of 64.0% predict osteoporosis, and with the probability of 73.2% the absence of osteoporosis, which can, among other things in our research to some extent, require relative necessity for introduction of antiosteoporotic therapy. The formula is +.214 O +.562 F +.202 R +.223 P +.335 S +.493 T +.057 V +.020. 9. It is necessary to test the formula obtained in examined patients and continue the reseachment, on larger sample, of risk factors which have not shown statistic importance.</p>

Objetivo: Identificar los factores asociados al abandono del tratamiento antituberculoso en un centro de salud de atención primaria del distrito de Chorrillos, Lima, Perú. Materiales y métodos: Estudio de casos y controles retrospectivo no pareado. Se definió como caso a los pacientes que abandonaron el tratamiento por un periodo de 30 días consecutivos o más y como controles a los pacientes que terminaron el tratamiento antituberculoso. Se evaluó el puntaje de riesgo de abandono que se realiza en el centro de salud (≥22), así como variables demográficas. Se calculó el odds ratio (OR) e intervalos de confianza al 95% (IC95%) usando regresión logística. Resultados: Se incluyó 34 controles y 102 casos. En el análisis multivariado se encontró que quienes cursaron menos de seis años de educación (OR: 22,2; IC95%: 1,9-256,1) así como quienes tenían un puntaje ≥ a 22 puntos en la prueba de riesgo de abandono (OR= 21,4; IC95%: 6,3-72,4) tenían mayor probabilidad de abandonar el tratamiento antituberculoso. Conclusión: El abandono del tratamiento antituberculoso está asociado con tener menos de seis años de educación y un score mayor a 22 puntos en la prueba de abandono de tratamiento antituberculoso.

The Health Belief Model was used to study HIV/AIDS beliefs of 419, 18 to 24 year old, never married, sexually active, heterosexual college students and predict their AIDS preventive behaviors from a larger sample of 662 college students. The structural properties of the scales used were evaluated using confirmatory factor analysis. Recent preventive behaviors were predicted in a LISREL Structural Equation Modeling analysis.

This dissertation breaks new ground. It examines the perceptions of older adults towards AIDS prevention. Using the National Health Interview Survey, 1988: AIDS Knowledge and Attitudes Supplement, a modified Health Belief Model is developed. Despite the low number of older adults 55+ with AIDS, some extenuating circumstances increase their risk of AIDS contraction. Older adults have lower levels of knowledge about AIDS, weaker immune systems and receive more blood transfusions. Societal influences include educational neglect at the hands of physicians, healthcare workers and social service personnel. The first stage of the dissertation involved establishing older adults as an at-risk population through an extensive literature review. Next, the data was described utilizing frequencies, correlations and factor analysis. Frequencies clearly indicated that older adults in the data set had low levels of AIDS knowledge and did not view themselves at risk for AIDS contraction. Correlations between the variables were minimal. A modified Health Belief Model was developed and tested. Multiple regression determined that minimal variation in the two dependent variables, "Perceived Effectiveness of Effective Methods to Prevent AIDS Contraction" and "Perceived Effectiveness of Ineffective Methods to Prevent AIDS Contraction" was accounted for by the independent variables. Although F ratios allowed rejection of the two null hypotheses, beta weights were low. Adjusted R^2's accounted for only 21% and 16% respectively of the variation in the dependent variables. Finally, discrepancies in the model were determined and recommendations made for further research. Most health belief models concentrate on individual social-psychological variables. Due to AIDS' societal consequences, it is proposed that societal providers of education: physicians, social service workers and healthcare personnel need to be included in the model. Recommendations were made for additional research into sexual behavior of older adults and exploration of available training of physicians, healthcare and social service professionals. Finally, recommendations were made to provide training and education for both professionals as well as the elderly to prevent their growth into an at-risk population.

Alcohol use disorders are a public health issue related to adverse effects for individuals and society. A low level of response, or decreased sensitivity, to alcohol has been identified as a heritable risk factor for development of alcohol use disorders. One method for researching level of response to alcohol is through the use of rodent models, which are developed to mimic human conditions while eliminating barriers to conducting research with people. Current rodent models used to evaluate effects of ethanol on motor performance have been criticized for not being well matched to human tasks that measure level of change in body sway after alcohol consumption. This study looks at oromotor behavior as a potential alternative to gross motor performance in hopes of increasing correspondence between human and rodent measures of intoxication. To evaluate rodent oromotor performance a force transducer lickometer is used to measure several dimensions of licking behavior after administration of different concentrations of ethanol solution via gavage. Results show that force of licking is not sensitive to dose of ethanol. The total number of licks per session show dose related decreases and licking rhythm, evaluated by the length and distribution of interlick intervals, either increased or decreased for three of the four subjects. Recommendations are made for procedural modifications in order to reduce variability in data and further investigate oromotor performance and level of response to alcohol.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Sensory Modulation Disorder (SMD) reduces a child’s ability to respond to sensory stimuli in the environment in a manner that corresponds to the nature or intensity of the stimulus; this disorder therefore significantly can impact participation in developmentally appropriate play and functional activities. More studies are needed to enhance research in the field of SMD and aid the general community in understanding the disorder and its causes. The purpose of this study was to characterize the prevalence of SMD among Puerto Rican preschoolers and examine the relationship between specific risk factors (socioeconomic status, pre-natal alcohol exposure, low birth weight, preterm delivery, and lead exposure) and SMD in this population. The sample consisted of 141 caregivers of preschool children; 78 were from Head Start programs and 63 were from private preschools. The Short Sensory Profile was used to determine the presence of SMD. A Demographic and Risk Factors Data Sheet was used to obtain information about the risk factors, except for lead exposure, which was measured using results of blood lead levels tests available in the records of Head Start preschoolers. Prevalence of SMD among the total sample, calculated through descriptive statistics, was 19.9%, which is higher than previously reported estimates of studies with children on the US mainland. According to an Analysis of Variance test, no differences were found in the prevalence of SMD based on parents’ education and/or household income. Diverse multivariate analyses, including structural equation modeling, were used to determine the relevance of risk factors used to explain variance in SMD scores. Due to limitations of the data collected, it was not possible to provide a definite conclusion about the most relevant risk factors identified in this study. In general, when compared to the other risk factors included, findings point to household income and low birth weight as relevant variables to explain scores on the SSP for the total sample. For the Head Start sample, lead exposure and low birth weight, followed by household income, achieved the better relative relevance to explain scores in the SSP (when compared to the other risk factors considered). However, due to the low effect sizes and low percentage of shared variance found among the variables, findings from this study do not support strong associations between risk factors and SMD as suggested in previous literature. More research is required to further understand SMD and the complex interaction among potential risk factors that might be associated with its prevalence.

In this study, the researcher explored high school English language learners’ perceptions of risk factors and protective factors present in their academic and social lives. The researcher also explored how these students negotiated risk factors and used protective factors to be academically resilient. Therefore, the study was designed to examine academic resilience from the students’ perspectives, allowing them to share their story about their success in high school. The following research questions guided this study: (1) What risk factors are present in high school English language learners’ academic and social lives? and (2) Which protective factors do high school English language learners use to be academically resilient? The researcher collected and analyzed qualitative data using key characteristics of focus group analysis. Nine students voluntarily participated in three different semi-structured focus group meetings. The findings revealed that risk factors such as lack of English language ability, low expectations of teachers, inability to form new relationships, stress, and inattentiveness prevented students from being successful. In addition, the students discussed how several protective factors like learning English, establishing and maintaining positive relationships, establishing and implementing good study habits, and possessing certain inner qualities helped them be academically resilient. Two themes that emerged were students (1) choosing to be academically resilient and (2) actively seeking sources of help. Based on this study, suggestions for educators are as follows: (1) consider providing more language support for newcomers; (2) include and build upon parent-school and teacher-student relationships; (3) encourage and provide ways for students to form relationships with others through school-based programs; (4) foster and continue to support the growth of the students’ academic skills; (5) find ways for students to become more involved with community-based services and programs; and (6) stress the importance of holding all students to high standards, regardless of students’ English language proficiency levels.

This is a compilation of 3 abstracts for the three manuscripts included in this dissertation. I. Meta-Analysis: Racial Disparities in Prostate Cancer Survival: Prostate cancer is the second leading cause of cancer-related mortality in men. Previous studies have drawn inconsistent conclusions on racial differences in prostate cancer survival. This meta-analysis was conducted to investigate the relationship between race and survival from prostate cancer. A systematic review of published articles from 1968 to 2007 assessing survival from prostate cancer among African American and White men was conducted. The search yielded 20 eligible published manuscripts. Analysis of unadjusted studies showed African American men have an increased risk of all-cause mortality (Hazard ratio (HR) = 1.47, 95% confidence interval (CI): 1.31, 1.65, P < 0.001). However, examination of adjusted studies showed no difference (HR = 1.07, 95% CI: 0.94, 1.22, P = 0.308). No statistically significant difference was observed in prostate cancer-specific survival in both analyses using unadjusted (HR = 1.11, 95% CI: 0.94, 1.31, P = 0.209) and adjusted studies (HR = 1.15, 95% CI: 0.95, 1.41, P = 0.157). There was evidence of heterogeneity that was unexplained by factors analyzed in overall survival but explained by stage in prostate cancer-specific survival. This meta-analysis concludes that there are no racial differences in the overall and prostate cancer-specific survival between African American and White men. II. Case-Control study: Association between Family History of Cancers and Prostate Cancer: Family history of prostate cancer is an established risk factor for prostate cancer. However, the relationship between family history of cancers other than prostate cancer and prostate cancer risk is inconclusive. This study sought to examine the association between family history of cancers and prostate cancer. A case-control study was conducted in which cases and controls were randomly selected from a large urology clinic in Central Virginia. Cases were 600 histologically confirmed prostate cancer patients who were diagnosed between January 2000 and December 2005, and controls were 686 patients who visited the clinic during the same period and diagnosed with urological illnesses other than cancers and prostate-related problems. Data on family history of cancers, lifestyle and demographic factors were collected. Unconditional logistic regression analysis was used to estimate the odds ratios and the corresponding 95% confidence intervals after adjustment for potential confounding factors. Multiple comparisons adjustments were made using Bonferroni adjustment. Men with family history of any cancer in first-degree relatives including parents (OR=2.42, 95% CI: 1.53, 3.84) and parents only (OR=1.90, 95% CI: 1.23, 2.94) were at increased risk of developing prostate cancer compared to men with no such family history of cancer. Significant increased risk was also observed with family history of prostate cancer in first-degree relatives (OR=2.68, 95% CI: 1.53, 4.69) and parents only (OR=3.26, 95% CI: 1.71, 6.24) compared to men with no family history of prostate cancer. Even after adjustments for multiple comparisons, the significance persisted both in first-degree relatives (OR=2.68, 95% CI: 1.16, 6.21) and parents alone (OR=3.26, 95% CI: 1.24, 8.63). No association was found with family history of other cancers including breast, colon, lung, skin, digestive tract, stomach, liver, pancreas, female cancers, urogenital, urinary bladder, brain, blood and lymph node and other cancers and risk of prostate cancer. This study demonstrated an increased prostate cancer risk for men with a family history of any cancer or prostate cancer in first-degree relatives including parents and parents alone. Health care providers need to be aware of the potential risk of family history of cancers on prostate cancer. III. Case-Control study: Association between Obesity and Prostate Cancer: Obesity is a major public health problem in the United States. Several studies have investigated the association between obesity and prostate cancer risk. However the impact of early-adult obesity on prostate cancer is not well studied. This study proposes to investigate the relationship between prostate cancer and early-onset obesity and current obesity. A case-control study was conducted to investigate the relationship between obesity and prostate cancer in a large urology clinic population in Central Virginia. Cases included histologically confirmed prostate cancer patients of all stages and grades diagnosed from January 2000 to December 2005. Controls were patients who were diagnosed with urological illness other than cancers and prostate-related problems. Self-reported data was collected on anthropometric, lifestyle and demographic factors through a mail survey. Unconditional logistic regression analysis was conducted to investigate the association between prostate cancer and early-onset obesity (BMI at age 18) and current obesity. Odds ratios and corresponding 95% confidence intervals were calculated after accounting for significant interaction terms and adjusting for potential confounding variables. This study showed statistically significant association between BMI at age 18 and prostate cancer risk in the multivariate analysis when BMI was evaluated as a continuous variable. There was a 7% decrease in the odds of prostate cancer risk for every 1 kg/m(2) increment in BMI at age 18 (OR=0.93, 95% CI: 0.87, 0.98). Analysis of BMI at age 18 as a categorical variable also showed reduced risk though statistically non-significant. Obese men (OR=0.62, 95% CI: 0.12, 3.08) and overweight men (OR=0.60, 95% CI: 0.35, 1.05) had a non-significant decreased risk of developing prostate cancer compared to normal weight men at age 18. Examination of current BMI showed a non-statistically significant decreased risk of prostate cancer when examined as a continuous variable. However, there was significant interaction between current BMI treated categorically and age. This study concludes that there is decreased prostate cancer risk associated with increasing BMI at age 18. Future large prospective studies are needed to better understand the association between early-onset obesity and risk of prostate cancer and explore the biological factors associated especially in the early ages. This document was created in Microsoft Word 2003.