The purpose of this study was to resolve a critical gap in depression literature through assessment of the temporal relationship between depression and low LDL. A systematic review and meta-analysis was conducted to investigate the overall cross-sectional association between serum LDL and depression. Inconsistent findings suggest that more work must be done to clarify the link between LDL and depression. Next, Cox regression was used to explore the association between LDL and the subsequent onset of depressive symptoms within a subset of the Women’s Health Initiative cohort and evaluate the potential for effect modification by lipid-lowering medication use. This study provides evidence toward an association between low LDL and the subsequent onset of depressive symptoms, with increased risk confined to LDL below 100 mg/dL. Elevated risk was not associated with lipid-lowering medication use. The final study examined the differences in the magnitude and direction of change in serum LDL levels among individuals experiencing new-onset depression, and examines the potential for physical activity, energy intake, and total body weight to mediate the depression-LDL relationship. This study provides no evidence of an association between depression and subsequent serum LDL changes. Altogether, this data suggests that LDL that is below 100 mg/dL without the use of lipid-lowering medication may predispose individuals to a greater risk of depression, and also suggests that low LDL is not likely a state brought about by physiological or behavioral changes following the onset of depression.

Cutaneous melanoma accounts for less than 5% of all skin cancers but over 75% of skin cancer related deaths. Prior biologic research suggests caffeine may arrest cancer cell formation and metastasis in vivo. Additionally, certain tea components exhibit anti-inflammatory, anti-oxidant, and other anti-carcinogenic effects. Prior epidemiologic studies show possible protective effect of both coffee and tea on risk of melanoma, but results remain inconsistent. We examined the association between coffee and tea intake and risk of cutaneous melanoma using the Women’s Health Initiative Observational Study. Coffee and tea intake were measured through self-administered questionnaires. Melanomas were self-reported and physician adjudicated. Cox proportional hazards models were used to evaluate associations. Of the 66,484 white post-menopausal women with no prior history of cancer (average follow up=7.8 years), 73% reported daily intake of coffee, 26% reported daily tea intake, and 398 cases of melanoma were adjudicated. Daily coffee intake (HR=0.84 95% CI=0.66-1.08) and daily tea intake (HR=1.00, 95% CI=0.78-1.29) were not significantly associated with increased risk of cutaneous melanoma compared to non-daily intake. No significant trend was observed with increased daily coffee (p-trend=0.22) or tea intake (p-trend=0.28). In conclusion, we observed insignificant inverse associations between coffee intake and cutaneous melanoma among post-menopausal Caucasian women.

Results from prospective studies examining associations between sleep duration and weight gain have been mixed. Melatonin has been hypothesized to mediate the association between sleep duration and weight/body composition. In cross-sectional studies, aMT6s has been shown to be inversely associated with weight/body fat percentage. We examined associations between baseline sleep duration, insomnia status, aMT6s levels with weight/body fat percentage through 6 years, utilizing a subset 690 women who participated in a breast cancer case-control study nested within the WHI-OS. Multi-variable and mixed-effects regression was used to calculate beta-coefficients and 95% confidence intervals. Cross-sectional analyses showed urinary aMT6s levels were inversely associated with BMI and body fat percentage. No associations were observed between sleep patterns and measures of adiposity. The prospective relationship between urinary aMT6 levels and weight/body fat percentage was complex. Age-adjusted mixed models show an association in the interaction term between year and aMT6s with body fat percentage (βinteraction:0.09, pinteraction:0.16, p=0.07), demonstrating the influence of baseline aMT6s and time on changes in outcome. Women with higher baseline aMT6s had a trajectory of increased body fat percentage and weight gain steepest between baseline and year 3, whereas women with lower baseline aMT6 levels had a trajectory of decreased body fat percent and weight between year 3 and year 6. The prospective association between melatonin levels and adiposity measures was unexpected. Future studies with objective measures of sleep and repeated measures of melatonin may shed light of possible explanations for our findings.

Breast cancer is the most prevalent form of cancer and the second leading cause of mortality, affecting 1 in 9 women in the United States. Recent studies have shown that antipsychotic drug use is associated with increased prolactin levels, which, in turn, is associated with increased risk of breast cancer. However, studies of the association between antipsychotic drug use and the risk of breast cancer are sparse and have largely been conducted in homogenous populations. Therefore, we evaluated this relationship in postmenopausal women (N = 119 524) in a diverse population of the Women’s Health Initiative (WHI) cohort. Antipsychotic drug use was self-reported and in situ and invasive breast cancer cases were confirmed by medical records for the WHI clinical trial (CT) and the WHI observational study (OS), from 1993 through 2018. We used Cox proportional hazards regression to model breast cancer risk against antipsychotic drug use while adjusting for dietary and lifestyle factors. Overall, antipsychotic users made up 0.41% of this population. There was no overall association between antipsychotic drug use and postmenopausal breast cancer risk (HR = 1.01, 95% CI = 0.73 – 1.40). Among typical antipsychotic drug users, there was a suggested two-fold increased risk in developing in situ breast cancer (HR = 2.02, 95% CI = 0.84, 4.86). Thus, antipsychotic drug use does not appear to increase breast cancer risk overall, but the potential association between antipsychotics and in situ breast cancer merits further study.

Autoimmune and thyroid conditions account for a substantial proportion of the morbidity and mortality experienced in the United States, affecting >40 million Americans combined. Co-occurrence of both an autoimmune and thyroid condition is also likely, particularly among women. Epidemiologic studies on both sets of conditions have examined many risk factors, including demographic, lifestyle, genetic, and environmental risk factors. However, one area which has been neglected is the effect of early life exposures on the development of autoimmune and thyroid conditions. To investigate the potential association between an individual’s birth weight (by category;in uteroand early childhood, extending the hypothesis to include thyroid conditions.

Orientador: Lucia Helena Simões da Costa Paiva / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-06T03:23:51Z (GMT). No. of bitstreams: 1 LazarJunior_Felipe_D.pdf: 154939 bytes, checksum: 9790b7b84c0e5eb21859931d78316ca3 (MD5) Previous issue date: 2006 / Resumo: O objetivo deste estudo foi avaliar o conhecimento e as repercussões sobre a atitude e prática dos médicos ginecologistas três anos após a publicação dos resultados do estudo Women¿s Health Initiative. Sujeitos e Método: Um questionário auto-administrado e anônimo com 19 questões foi enviado aos 6000 ginecologistas da Associação de Obstetrícia e Ginecologia do Estado de São Paulo (SOGESP). Os questionários foram postados em novembro de 2005 com recepção concluída em dezembro de 2005. Resultados: O índice de resposta foi de 24,2% (1453 questionários preenchidos) com erro amostral de 2,23% e intervalo de confiança de 95%. Apesar de 95,9% dos ginecologistas referirem conhecer o estudo WHI, apenas 24,4% tinham conhecimento dos outros estudos (HERS I, HERS II, e Million Women Study) além do WHI. Apesar de 84,6% referirem que os resultados obtidos no estudo WHI não poderiam ser extrapolados para outros tipos de TH, 23,1% e 25,2% abandonaram o uso de EEC ou AMP, 63,7% diminuíram a dose, 55,2% passaram a prescrever drogas como bifosfonatos, tibolona e serms, e 46,3% passaram a utilizar calmantes, isoflavonas e drogas naturais. Além disso, 59,2% concordaram que o tempo ideal de TH deveria ser diminuído para 4-5 anos. Houve queda significativa nas prescrições para todas as indicações de TH (p<0.0001). Para os médicos, a causa mais importante de descontinuação da TH foi o maior risco de câncer de mama (62,3%), no entanto, segundo os médicos, o fator mais importante para as pacientes foi o medo da TH (80,3%) Conclusão: Os ginecologistas têm elevado conhecimento do estudo WHI e seguiram suas recomendações com relação à prevenção de doença cardiovascular, consequentemente, mudaram sua forma de abordar o tratamento das mulheres na pós-menopausa, restringindo as indicações, tempo de uso e dose da TH / Abstract: The objective of this study was to evaluate gynecologists¿ knowledge of the Women¿s Health Initiative study, and its repercussions on their attitudes and practice three years after publication. Design: A self-administered, anonymous questionnaire containing 19 questions was sent to 6000 gynecologists, members of the São Paulo Society of Obstetrics and Gynecology. Results: The response rate was 24.2% (1453 completed questionnaires) with a sample error of 2.23% and confidence level of 95%. Although 95.9% of gynecologists were aware of the WHI study, only 24.4% had knowledge of all the other studies mentioned (HERS I, HERS II and Million Women Study). Although 84.6% stated that the results of the WHI study could not be extrapolated to other forms of HT, 23.1% and 25.2%, respectively, stopped prescribing CEE or MPA, 63.7% decreased the dose, 55.2% opted for drugs such as bisphosphonates, tibolone and SERMS, and 46.3% began to prescribe tranquilizers, isoflavone and other natural medications. Moreover, 59.2% agreed that HT should be used for only 4-5 years. Prescriptions decreased significantly for all indications (p<0.0001). The principal reason for physicians to discontinue HT in a patient was increased risk of breast cancer (62.3%), whereas, according to the physicians, the most important factor for the patients was fear of HT (80.3%). Conclusion: A high percentage of gynecologists in this study knew of the WHI study and followed its recommendations concerning cardiovascular prevention; consequently they changed their management of the treatment of postmenopausal women by restricting indications for HT and decreasing its duration of use and dose / Doutorado / Tocoginecologia / Doutor em Tocoginecologia

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In the tradition of previous studies of threatened species, this thesis was undertaken with the aim of improving our understanding of the ecology of the White-winged Nightjar Caprimulgus candicans, and providing the information necessary to facilitate conservation efforts on its behalf. In 1998-2001, I studied a population of White-winged Nightjars at Aguará Ñu, an area of cerrado habitats within the Reserva Natural del Bosque Mbaracayù, eastern Paraguay. Over the course of three fieldwork seasons, I captured and ringed a total of 49 nightjars (34 adults and 15 young birds). Young females first bred at approximately one year old, while still in pre-definitive plumage. Young males exhibited a form of delayed plumage maturation, whereby they only attained definitive plumage following a prolonged moult spanning much of their first potential breeding season. No evidence was obtained to suggest that they succeeded in breeding while in this conspicuously intermediate state of moult. Considerable variation was noted in the plumage whiteness of definitive males, but no clear evidence was found for consistent age-related increases in white. During the breeding season, males defended small aggregated display territories, at which they conducted nuptial display flights between late August and early January. Female nightjars were responsible for all the parental care, and apparently visited male display arenas solely to obtain copulations. Chick paternity data confirmed that the study population was polygynous, with patterns of male aggregation suggestive of an exploded lek or 'landmark' mating system. Radio-telemetry studies showed that nightjars utilised home ranges of at least 20 to 40 hectares during the eight to ten months for which they were monitored. Home ranges contained a disproportionately large amount of young campo cerrado vegetation, but no forest or old campo cerrado habitats. When selecting foraging sites within their ranges, nightjars preferred younger and avoided older campo cerrado vegetation; wet grassland was utilised roughly in proportion to its availability. Observed patterns of habitat selection were potentially explained by the greater abundance of insect prey in younger habitats. When selecting daytime roost sites, nightjars preferred vegetation of intermediate age, reflecting their need for a balance between cover and ease of access. A more general analysis of patterns of sexual dimorphism within the Caprimulgidae showed that, although almost 80% of nightjar species exhibit some dimorphism of plumage whiteness, the study species was by far the most extreme case. The striking plumage of the male was partly explained by a strong positive relationship between wing white and openness of breeding habitats within the family. However, this failed to explain the complete absence of white in the female plumage, or the extent of white dimorphism shown by the species. The most likely explanation would appear to be that extreme plumage dimorphism occurred in conjunction with the evolution of polygyny and female-only care in this open-country species. The implications of these findings for the conservation of the White-winged Nightjar are highlighted, and recommendations are proposed for future work and conservation action.