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Introduction Nonarteritic anterior ischemic optic neuropathy ( NAION), a rare visual disorder, has been reported in men using phosphodiesterase type 5 inhibitors ( PDE5i) for erectile dysfunction. Aim We examined whether intermittent use of PDE5i is associated with acute NAION onset within approximately five half-lives following drug ingestion. Methods One hundred two ophthalmology centers in the United States and Europe identified potential cases of NAION. An expert adjudication committee conducted a blind review of the records of those with recent PDE5i use to classify cases as Definite, Possible, or not NAION. Subjects provided information on PDEi use via telephone interview. Each NAION case's PDE5i exposure immediately prior to onset was compared against his recent patterns of use in an observational case-crossover design. A sample size of 40 cases with intermittent PDE5i exposure in the 30 days prior to NAION onset was needed to detect an odds ratio ( OR) of 3.0 with 80% power. Main Outcome Measures The daily relative risk for acute NAION on days within five half-lives of PDE5i use vs. other days was estimated via an OR obtained from conditional logistic regression. Results Among 43 Definite NAION cases with PDE5i exposure in the prior 30 days, the OR was 2.15 (95% confidence interval [ CI]: 1.06, 4.34). When 21 Possible NAION cases were included (n = 64), the OR was 2.36 (95% CI: 1.33, 4.19). Conclusions We found an approximately twofold increased risk of acute NAION within five half-lives of PDE5i use compared with use in a more prior time period. Bias from inaccurate recall of exposure was unlikely to have substantially affected the results. Based on our results, we estimate that weekly use of PDE5i adds three NAION cases per 100,000 men 50 years and older annually. Campbell UB, Walker AM, Gaffney M, Petronis KR, Creanga D, Quinn S, Klein BEK, Laties AM, Lewis M, Sharlip ID, Kolitsopoulos F, Klee BJ, Mo J, and Reynolds RF. Acute nonarteritic anterior ischemic optic neuropathy and exposure to phosphodiesterase type 5 inhibitors. J Sex Med 2015;12:139-151. [ABSTRACT FROM AUTHOR]

We have explored the use of data from the Commission on Professional and Hospital Activities-Professional Activity Study (CPHA-PAS) for ascertaining information on cancer incidence, with regional breakdowns. Extirpative surgical procedures were linked with discharge diagnoses to provide estimates of numbers of incident cases. We calculated incidence rates for four cancers: breast, colon, ovary, and testis. CPHA-PAS inferred rates corresponded closely to those of other reporting systems for breast cancer in most age groups, and for colonic and testicular cancer in some age groups. Ovarian cancer rates were consistently underestimated. We conclude that a cancer incidence reporting scheme based on hospital discharge data can work for certain cancers, and be very inexpensive and efficient. It must, however, be used with care. [ABSTRACT FROM AUTHOR]

Vital stalistics show that a rise in incidence of endometrial cancer began in the mid-1960s on the West Coast of the United States. This rise was continuous and reached a peak in 1975. Elsewhere, incidence rates for endometrial cancer rose during the 1970s. It now seems evident that much of the rise in all areas of the Country was due to replacement estrogen treatment. We estimated from data obtained from the Commission on Professional and Hospital Activities Professional Activity Study of Ann Arbor. Michigan, that over 15,000 cases of endometrial cancer were caused by replacement estrogens during the five-year period 1971–1975 alone. This represents one of the largest epidemics of serious latrogenic disease that has ever occurred in Ibis country. With the substantial fall in estrogen sales starting in January 1976. there has been an associated decline in the incidence rates of endometrial cancer nationwide. [ABSTRACT FROM AUTHOR]

The article focuses on the condition of public health in various countries. In the United States there is now 99% survival of infants, with life expectancy of 70-00 years and more, a far cry from the figure of 50 years in 1900. Funds for health have reached a high of 16% in the United States. The chief "killers", coronary heart disease (CHD) and stroke, have had their mortality rates almost halved, yet CHD incidence rate has not changed. Total mortality rate from cancer is stationary, or falling only slightly. The prevalence of obesity in women, and of hypertension and diabetes, already exceeds that in the white population. In most countries there is a tremendous health burden from infections, not only from malaria, but also from tuberculosis, and, more recently, from HIV infection. Rates of HIV infection in South Africa are the highest in the world; in parts, nearly 50% of antenatal African women are infected. In Spain, although mean serum cholesterol is rising, CHD mortality is falling. In Japan, although some risk factors are rising, inexplicably, mortality rates for breast and colon cancers are falling.

The Portland Metropolitan region, a single economic and ecological region with a bifurcated state and local governance structure, provides an opportunity to compare governance models and state policy environments in a single region. Using stakeholder interviews and secondary sources, we examine the role of state government policy in shaping and supporting different regimes. We find that Portland exhibits a stable, “smart-growth” regime that we characterized as a metropolitan eco-regime whereas Vancouver is in a period of fragmentation without a stable metropolitan regime. This is best explained by the differing state-level regulatory contexts and the different forms of polycentricity influenced by state action. Differences in regime and governance structure result in differently drawn and expanded urban growth boundaries with subsequent differences in land-use outcomes. We conclude with observations about state-level action and subsequent forms of polycentricity to support metropolitan eco-regimes. [ABSTRACT FROM AUTHOR]

Background: Although echinocandins are generally well tolerated, there is little information on the frequency with which renal and hepatic adverse effects occur during use of micafungin or other parenteral antifungal (PAF) agents in clinical practice.Methods: MYCOS is a multicentre cohort study of adult and paediatric patients who received micafungin or other PAFs between 2005 and 2012 at seven tertiary care hospitals from six centres in the USA. PAF cohort controls were selected through propensity score (PS) matching to micafungin recipients using clinical characteristics, other treatments, procedures and hospital service where PAF treatment was initiated. Analysis was restricted to patients without chronic liver and kidney conditions at the time of cohort entry. Treatment-emergent hepatic and renal injury was documented by changes in liver enzymes or estimated glomerular filtration rate through 30 days following completion of PAF treatment. Comparisons were quantified using the HR from a proportional hazards analysis.Results: There were 2970 micafungin recipients PS matched to 6726 recipients of comparator PAFs. Balance was achieved in all baseline covariates between treatment groups. There were similar rates of hepatic injury (micafungin, 13 events per 100 patients and other PAF, 12 per 100; HR = 0.99; 95% CI 0.86-1.14) and lower rates of renal injury (micafungin, 63 events per 100 patients and other PAF, 65 per 100; HR = 0.93; 95% CI 0.87-0.99) for micafungin recipients versus PAF comparators.Conclusion: For a wide spectrum of underlying conditions, we observed no increase in liver injury by micafungin and possibly a reduced risk of renal dysfunction in comparison with other PAF medications. [ABSTRACT FROM AUTHOR]

Objective: To examine nonvertebral fracture risk in relation to inhaled corticosteroid (ICS) exposure among adults with respiratory disease. Design and patients: Nested case-control study within a cohort of 89,877 UnitedHealthcare members aged ≥ 40 years with physician insurance claims for COPD or asthma, enrolled for ≥ 1 year from January 1, 1997 to June 30, 2001. Methods: Cases (n = 1,722) represented patients with a first treated nonvertebral fracture (the index date is the first fracture claim). Control subjects (n = 17,220) were randomly selected from the person-time and assigned a random index date. ICS exposure was ascertained 1 month, 3 months, 6 months, and 12 months before the index date, with estimated cumulative dose through 0 to 6 months, 7 to 12 months, and 0 to 12 months. Covariates included demographics, oral corticosteroid and other medication exposure, comorbidities, and indicators of respiratory disease severity. Odds ratios (ORs) adjusted for all covariates were estimated by logistic regression. Results: No increased fracture risk with ICS exposure as a class or with fluticasone propionate alone was detected. ORs for exposure in the preceding 30 days were 1.05 (95% confidence interval [CI], 0.89 to 1.24), 1.13 (95% CI, 0.90 to 1.40), and 0.97 (95% CI, 0.78 to 1.21) for all ICS, fluticasone propionate, and other ICS, respectively. No dose-response effect was present. Among patients with COPD only (n = 6,932), no increased risk was found for recent ICS exposure (OR, 0.86; 95% CI, 0.59 to 1.25). Conclusions: Concern about nonvertebral fracture risk should not strongly influence the decision to use recommended doses of ICS for adult patients with asthma or COPD in managed-care settings in the United States. This study could not evaluate very-high ICS dose, long-term ICS exposure, or vertebral fracture risk. [ABSTRACT FROM AUTHOR]

Presents commentaries on issues related to pediatric care and health. Contraindications of birth control pills; Information on the billings method of contraception in adolescents; Age of onset of lactose intolerance in children; Blood pressure of children in the United States.