Investigation into Levels of Pain, Quality of Life, and Depression by Stage of Endometriosis

Objective: Despite the high prevalence of endometriosis, controversy exists surrounding the association between the stage of endometriosis and long-term treatment outcomes. The objective of the present study was to investigate the postsurgical long-term pain, quality-of-life, and psychological distress among women with differing stages of endometriosis. Methods: This cross-sectional study was conducted between 2008 and 2009. Women who had undergone surgery for pelvic pain at UNC Hospitals from 2003 to 2006 were mailed questionnaires to collect information on demographics, pain, sexual dysfunction, quality of life, and depression. Descriptive statistics and ANOVAs were used to examine the distribution of these variables by stage of endometriosis. Results: The study population included women aged 22 to 50 years old (mean age 36 years). Of the 82 women, 38 (46%) were classified as having stage 1 endometriosis, 26 (32%) having stage 2 endometriosis, 13 (16%) having stage 3 endometriosis, and 5 (6%) having stage 4 endometriosis. Across the four stages, there was no pattern of increased overall pain, pelvic pain, quality-of-life, or depression with increasing stage of endometriosis. The mean scores (standard deviation) on an adapted version of the McGill Pain Questionnaire for total pain were 8.0 (7.8), 10.4 (10.8), 4.6 (7.5), and 9.4 (13.4) for stages 1, 2, 3, and 4, respectively (ANOVA p-value 0.34). The mean scores for intensity of pelvic pain (possible score range of 0-5) were 1.5 (1.4), 1.7 (1.4), 1.0 (1.6), and 1.6 (0.9), respectively (ANOVA p-value 0.56). Using the SF12 quality-of-life measure the mean (standard deviation) mental and physical component standardized scores were 43.2 (10.3) and 45.6 (11.7) for stage 1, 45.5 (11.4) and 44.1 (10.2) for stage 2, 47.3 (12.8) and 50.4 (9.4) for stage 3, and 36.0 (14.8) and 43.3 (8.7) for stage 4 (ANOVA p-values 0.30 and 0.39 for the mental and physical components, respectively). Finally, scores on the Beck Depression Inventory were also similar by stage, although women with stage 4 endometriosis did score higher than the other three stages [stage 1: 9.2 (7.9), stage 2: 10.9 (7.5), stage 3: 8.3 (8.4) and stage 4: 16.2 (12.3)] (ANOVA p-value 0.26). Conclusions: These results indicate that long-term treatment outcomes in women undergoing laparoscopic surgery for pelvic pain may not be related to the stage of endometriosis. Regardless of endometriosis stage, most women were found to have residual pain symptoms. Further research to understand chronic pain, quality-of-life, and psychological distress and endometriosis is warranted. Summary: This study has shown that among women who underwent surgery for pelvic pain at UNC Hospitals, level of pain, quality-of-life, and depression do not increase with increasing stage of endometriosis

Cholecystectomy and the Risk of Colorectal Adenomas

Cholecystectomy has been identified as a risk factor for colorectal cancer, yet little attention has been given to the association between cholecystectomy and colorectal adenomas

Reliability of variables on the North Carolina birth certificate: a comparison with directly queried values from a cohort study

Birth records are an important source of data for examining population-level birth outcomes, but questions about the reliability of these vital records exist. We sought to assess the reliability of birth certificate data by comparing them with data from a large prospective cohort. Pregnancy, Infection, and Nutrition cohort study participants were matched with their birth certificates to assess agreement for maternal demographics, health behaviours, previous pregnancies and major pregnancy events. Agreement among categorical variables was assessed using percentage agreement and kappa statistics; for continuous variables, Spearman’s correlations and concordance correlation coefficients were used

An Ecologic Analysis of County-Level PM2.5 Concentrations and Lung Cancer Incidence and Mortality

Few studies have explored the relationship between PM2.5 and lung cancer incidence. Although results are mixed, some studies have demonstrated a positive relationship between PM2.5 and lung cancer mortality. Using an ecologic study design, we examined the county-level associations between PM2.5 concentrations (2002–2005) and lung cancer incidence and mortality in North Carolina (2002–2006). Positive trends were observed between PM2.5 concentrations and lung cancer incidence and mortality; however, the R2 for both were <0.10. The slopes for the relationship between PM2.5 and lung cancer incidence and mortality were 1.26 (95% CI 0.31, 2.21, p-value 0.01) and 0.73 (95% CI 0.09, 1.36, p-value 0.03) per 1 μg/m3 PM2.5, respectively. These associations were slightly strengthened with the inclusion of variables representing socioeconomic status and smoking. Although variability is high, thus reflecting the importance of tobacco smoking and other etiologic agents that influence lung cancer incidence and mortality besides PM2.5, a positive trend is observed between PM2.5 and lung cancer incidence and mortality. This suggests the possibility of an association between PM2.5 concentrations and lung cancer incidence and mortality

trans-Fatty acid consumption and its association with distal colorectal cancer in the North Carolina Colon Cancer Study II

Recently, the potential health effects of trans-fatty acid consumption have raised concerns. A few studies have examined the risk of colorectal cancer with increasing consumption of trans-fatty acids, but none investigated the risk of rectal cancer, which may have different risk factors than colon cancer. Our objective was to explore the relationship between trans-fatty acid consumption and distal colorectal (sigmoid, rectosigmoid, and rectal) cancer using a case-control study of Whites (n=1516) and African Americans (n=392) in North Carolina from 2001–2006. Matched cases and controls were interviewed about demographic information, lifestyle factors, and diet. White cases reported higher mean consumption of trans-fatty acid than White controls, but mean consumption was similar for African American cases and controls. Relative to the lowest quartile, the highest quartiles of energy-adjusted trans-fatty acid consumption were positively associated with distal colorectal cancer for Whites [adjusted ORs for the third and fourth quartiles, respectively: 1.54 (95%CI: 1.12, 2.13) and 1.45 (95%CI: 1.04, 2.03)]. Consumption was not associated with distal colorectal cancer in African Americans [adjusted ORs for the third and fourth quartiles: 0.98 (95%CI: 0.47, 2.05) and 0.87 (95%CI 0.42, 1.81)]. In conclusion, high consumption of trans-fatty acids was positively associated with distal colorectal cancer among Whites

Associations Between Trans Fatty Acid Consumption and Colon Cancer Among Whites and African Americans in the North Carolina Colon Cancer Study I

Disparities in incidence and mortality rates of colon cancer exist between Whites and African Americans. Prior studies examined the association between trans fatty acid consumption and colorectal cancer, but none assessed this possible relationship within a large study population of African Americans and Whites. Using data from a population-based case-control study in North Carolina, we investigated this association with attention to possible racial differences. Cases and matched controls were queried on demographic characteristics, lifestyle factors, medical history, and diet. Cases reported higher daily consumption (grams/day) of trans fatty acids [mean 5.9 (SD 2.9) and median 5.5 (IQR 3.8-7.5)] compared to controls [mean 5.2 (SD 2.4) and median 4.7 (IQR 3.5-6.4)]. Energy-adjusted trans fatty acid consumption was not associated with colon cancer. Compared to participants in the lowest quartile of consumption, those in the highest quartile had an adjusted odds ratio of 1.01 (95% confidence interval 0.69, 1.49) for Whites and 0.99 (95% confidence interval 0.61, 1.62) for African Americans. No association was found between increased consumption of trans fatty acid and specific tumor location (proximal or distal colon). In conclusion, trans fatty acid consumption is not associated with colon cancer and does not contribute to disparities in colon cancer rates

The Association between Diabetes, Insulin Use, and Colorectal Cancer among Whites and African Americans

Colorectal cancer and diabetes are common diseases that share many risk factors. It has been hypothesized that diabetes is a risk factor for colorectal cancer. We used two large population-based case-control studies from North Carolina to determine whether diabetes and/or insulin therapy were associated with colon cancer and/or rectal cancer (defined as cancer of the sigmoid colon, rectosigmoid, or rectum) and whether this association differed by race. Cases and matched controls from the North Carolina Colon Cancer Studies I and II were interviewed about demographics, dietary factors, diagnosis of diabetes, and use of medications to treat diabetes. Odds ratios and 95% confidence intervals were estimated using unconditional logistic regression. Colon and rectal cancer cases reported a higher prevalence of diabetes than their respective control groups. Compared to Whites without diabetes, Whites with diabetes had an adjusted odds ratio of 1.40 (95%CI 0.93, 2.12) for colon cancer and 1.38 (95%CI 1.00, 1.90) for rectal cancer. Diabetes was not associated with colon or rectal cancer among African Americans [OR 1.17 (95%CI 0.81, 1.70) and OR 0.75 (95%CI 0.44, 1.28), respectively]. Among Whites with diabetes, insulin use was positively associated with rectal cancer. The same association was not seen for African American diabetics using insulin however the number of African Americans using insulin was small. In sum, diabetes was positively associated with rectal cancer and approached a positive association with colon cancer among Whites. No association was present among African Americans. Insulin use was also positively associated with rectal cancer among Whites

Conceptualizing Neighborhood Space: Consistency and Variation of Associations for Neighborhood Factors and Pregnancy Health Across Multiple Neighborhood Units

The purpose of this research was to assess the consistency of associations between neighborhood characteristics and pregnancy-related behaviors and outcomes across four nested neighborhood boundaries using race-stratified fixed-slope random-intercept multilevel logistic models. High incivilities was associated with increased smoking, inadequate weight gain and pregnancy-induced hypertension (PIH), while walkability was associated with decreased smoking and PIH for white women across all neighborhood definitions. For African American women, high incivilities was associated with increased smoking and inadequate gestational weight gain, while more walkable neighborhoods appeared protective against smoking and inadequate weight gain in all but the smallest neighborhoods. Associations with neighborhood attributes were similar in effect size across geographies, but less precise as neighborhoods became smaller

Associations between prenatal exposure to air pollution, small for gestation alage,and term low birthweight in a state-widebirth cohort

A range of health effects, including adverse pregnancy outcomes, have been associated with exposure to ambient concentrations of particulate matter (PM) and ozone(O3). The objective of this study was to determine whether maternal exposure to fine particulate matter (PM2.5) andO3 during pregnancy is associated with the risk of term low birth weight and small for gestational age infants in both single and co-pollutant models. Term low birth weight and small for gestational age were determined using all birth certificates from North Carolina from 2003 to 2005. Ambient air concentrations of PM2.5 and O3 were predicted using a hierarchical Bayesian model of air pollution that combined modeled air pollution estimates from the EPA\u27s Community Multi-Scale Air Quality (CMAQ) model with air monitor data measured by the EPA\u27s Air Quality System. Binomial regression, adjusted for multiple potential confounders, was performed. In adjusted single-pollutant models for the third trimester, O3 concentration was positively associated with small for gestational age and term low birth weight births [risk ratios for an interquartile range increase inO3: 1.16(95%CI1.11,1.22)for small for gestational age and2.03(95% CI 1.80,2.30)for term low birth weight]; however, inverse or null associations were observed forPM2.5 [risk ratios for an interquartile range increase inPM2.5: 0.97(95%CI0.95,0.99) for small for gestational age and 1.01(95%CI0.97,1.06)for term low birth weight]. Findings were similar in co-pollutant models and linear models of birth weight. These results suggest thatO3 concentrations in both urban and rural areas may be associated with an increased risk of term low birth weight and small for gestational age births