Social isolation is associated with higher mortality in studies comprising mostly white adults, yet associations among black adults are unclear. In this prospective cohort study, we evaluated whether associations of social isolation with allcause, cardiovascular disease, and cancer mortality differed by race and sex. Adults enrolled in Cancer Prevention Study II in 1982/1983 were followed for mortality through 2012 (n = 580,182). Sex-and race-specific multivariableadjusted hazard ratios and 95% confidence intervals were estimated for associations of a 5-point social isolation score with risk of death. Social isolation was associated with all-cause mortality in all subgroups (P for trend ≤ 0.005); for the most isolated versus the least isolated, the hazard ratios were 2.34 (95% confidence interval (CI): 1.58, 3.46) and 1.60 (95% CI: 1.41, 1.82) among black men and white men, respectively (P for interaction = 0.40) and 2.13 (95% CI: 1.44, 3.15) and 1.84 (95% CI: 1.68, 2.01) among black women and white women, respectively (P for interaction = 0.89). The association did not differ between black men and black women (P for interaction = 0.33) but was slightly stronger in white women than in white men (P for interaction = 0.01). Social isolation was associated with cardiovascular disease mortality in each subgroup (P for trend < 0.03) but with cancer mortality only among whites (P for trend < 0.0001). Subgroup differences in the influence of specific social isolation components were identified. Identifying and intervening with socially isolated adults could improve health outcomes.

Epstein-Barr virus (EBV) causes rare, malignant lymphomas. The role of EBV in other non-Hodgkin lymphomas (NHLs) remains unclear, but mildly reduced immune function could lead to reactivation of EBV and subsequent NHL. We examined the association between prospectively-collected plasma EBV antibodies and NHL risk in the Cancer Prevention Study-II (CPS-II) Nutrition Cohort and conducted a meta-analysis of our and published results. The CPS-II study included 225 NHL cases and 2:1 matched controls. No associations were observed between EBV serostatus or antibody levels and risk of NHL overall. However, when including only the three most common types of NHL (diffuse large B-cell lymphoma, follicular lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma), high compared to low early antigen (EA-D) diffuse and BZLF1-encoded replication activator antibodies were associated with approximately 60% higher risk of NHL. Odds ratios (ORs) for EBV nuclear antigen-1 and viral capsid antigen (VCA)-p18 were elevated but not statistically significant. In the meta-analysis, both EA (summary OR 5 1.52, 95% confidence interval (CI): 1.16-2.00) and VCA (summary OR 5 1.20, 95% CI: 1.00-1.44) were positively associated with NHL risk. These results suggest EBV may be associated with a wider spectrum of NHL subtypes, but further study is needed to confirm and fully understand these associations.Epstein-Barr virus (EBV) is a known carcinogen and has been causally linked to some rare types of non-Hodgkin lymphoma (NHL) and NHL in immunosuppressed individuals. 1In particular, the 2009 IARC Working Group on the carcinogenicity of biologic agents found sufficient evidence to conclude causality for EBV's role in Burkitt lymphoma, immunosuppression-related NHL, extranodal NK/T-cell lymphoma (nasal type), Hodgkin lymphoma and cancer of the nasopharynx. The role of EBV in more common types of NHL and in seemingly immunocompetent individuals is less clear, particularly since EBV prevalence in adult humans is >90%, and EBV establishes lifelong latent infection in memory B-cells. The mechanism by which HIV-1 positive, immunocompromised individuals are at higher risk of NHL is thought to be mostly due to immunosuppression leading to increased replication of EBV and other carcinogenic viruses. 2It is possible that more mild forms of reduced immune function may lead to reactivation and replication of EBV. For example, psychological stress and aging can dysregulate immune function 3 and have been implicated in subclinical reactivation of EBV.4,5 EBV reactivation itself may be a risk factor for NHL, alternatively the external factor responsible for reducing immune function may cause both EBV reactivation and an increase in risk of NHL. Either way, we would expect the higher antibody levels that accompany reactivation (rather than seropositivity) to be associated with subsequent risk of NHL. Results of serologic studies of EBV antibodies and NHL risk published to date are inconsistent. [6][7][8][9][10][11] This inconsistency might be due, in par...

The results of our study do not support an association between H. pylori infection and colorectal cancer risk in this elderly, mostly Caucasian population.

OBJECTIVE To summarize the approaches used to manage exposure of patients to inadequately sterilized neurosurgical instruments contaminated as a result of Creutzfeldt-Jakob disease (CJD). METHODS Information on past CJD exposure incidents reported to the Centers for Disease Control and Prevention (CDC) was aggregated and summarized. In addition, inactivation studies were reviewed, and data from selected publications were provided for reference. RESULTS Nineteen incidents of patient exposure to potentially CJD-contaminated instruments were reported to the CDC, including 17 that involved intracranial procedures and 2 that involved ophthalmologic procedures. In more than 50% of incidents, the neurosurgical procedures were performed for diagnostic work up of the index patients. At least 12 of the hospitals had multiple neurosurgical sets, and the CJD-contaminated instruments could not be identified in 11 of 19 hospitals. In 12 of 15 hospitals with neurosurgical incidents, a decision was made to notify patients of their potential exposure. CONCLUSIONS Neurosurgical instruments used for treatment of patients with suspected or diagnosed CJD or patients whose diagnosis is unclear should be promptiy identified and sterilized using recommended CJD decontamination protocols. Inability to trace instruments complicates appropriate management of exposure incidents. The feasibility of instituting instrument tracking procedures should be considered.