Is there a reduced risk of breast cancer among women with hip fractures?

To test the hypothesis that osteoporosis, which results partly from long-term estrogen deficiency, is associated with a lowered risk of breast cancer, a population-based cohort study was performed in Amiens. To ascertain the incidence of breast cancer, 1300 women were followed through after a first hip fracture. Overall, 18 cases of cancer were observed cf. 21.8 expected (standardized incidence ratio (SIR): 0.82; 95% confidence interval (CI): 0.5–1.3). The results are consistent with previous studies which concluded that long-term estrogen deficiency is associated with a reduced risk of developing breast cancer.     

脆性髋部骨折手术与非手术治疗的临床疗效分析

目的通过随访脆性髋部骨折不同治疗方法的临床疗效,为髋部脆性骨折的治疗提供指导。方法收集2010—2012年入住我院且获得随访的286例50岁以上脆性髋部骨折患者的住院及随访资料,统计分析手术与非手术组患者恢复优良率、死亡率。结果 2010—2012年我院共收住脆性髋部骨折患者560例,获得随访286例,其中采用手术治疗的250例,非手术治疗的36例,手术组病人功能恢复优良率达85.60%,非手术组病人功能恢复优良率仅为22.22%,2者差异有统计学意义（χ2=81.815,P〈0.01）。手术组病人随访期死亡率10.00%,非手术组随访期病人随访期死亡率高达69.44%,2者差异有统计学意义（χ2=77.081,P〈0.01）。结论脆性髋部骨折致残率及死亡率高,条件允许的情况下采用手术治疗可以显著降低患者的病死率,促进髋部功能的恢复,提高患者的生活质量。     

Health status and health resource use among long-term survivors of breast,colorectal and prostate cancer

Introduction

The growing number of long-term cancer survivors poses a new challenge to health care systems. In Spain, follow-up is usually carried out in oncology services, but knowledge of cancer survivors’ health care needs in this context is limited. The purpose of this study was to ascertain the health status of long-term survivors of breast, prostate, and colorectal cancer and to characterize their use of health care services.

Methods

Retrospective multicenter cohort study. We collected data from patients’ clinical histories and through telephone interviews, using a specially designed questionnaire that included the SF-36v2 Quality of Life and Nottingham Health Profile scales.

Results

The questionnaire was completed by 51.2% (n= 583) of the potential sample. No significant differences were observed between 5-year and 10-year survivors. Overall, more than 80% of respondents were undergoing drug treatment for morbidity related to advanced age. Quality of life was good in most patients, and cancer-related morbidity was low and of little complexity. For the most part, participants reported using primary care services for care of chronic diseases and opportunistic treatment of sequelae related to the cancer treatment. Oncological follow-up was centralized at the hospital.

Conclusions

Survivors of breast, prostate and colorectal cancer with tumoral detection at an early stage and without recurrences or second neoplasms experienced little morbidity and enjoyed good quality of life. This study proposes exploration of a follow-up model in the Spanish health system in which primary care plays a more important role than is customary in cancer survivors in Spain.     

膳食因素与乳腺癌患病风险的病例对照研究

目的探讨青岛地区膳食因素与乳腺癌患病风险的关系,为乳腺癌的病因研究及一级预防提供科学的理论依据。方法采用病例对照研究设计,通过半定量食物频率表法,对200例乳腺癌患者和200例对照进行问卷调查,调查内容包括基本情况和膳食情况两大部分。结果经单因素和多因素非条件logistic回归分析,结果显示,食物种类中,与低水平蔬菜摄入量相比,较高水平的蔬菜摄入量可能降低乳腺癌的患病风险（OR=0．429,95％CI：0．223～0．827,P=0．012）;与低水平红肉摄入量相比,较高水平的红肉摄入量可能增加乳腺癌的患病风险（OR=2．185,95％CI：1．077～4．431,P=0．030）。膳食营养素中,与低水平脂肪摄入量相比,中、高及较高水平的脂肪摄入量均可能增加乳腺癌的患病风险,且随着脂肪摄入量增多,其OR值也递增,且差异均有统计学意义（OR值分别为2．478、2．533、2．799,95％CI分别为1．245～4．933、1．130～5．675、1．449～5．470,P〈0．05,P〈0．01）;与低水平蛋白质摄入量相比,中、高及较高水平的蛋白质摄入量均可能增加乳腺癌的患病风险（OR值分别为3．484、3．860、3．467,95％CI分别为1．872～6．848、1．972～7．554、1．778～6．762,P〈0．01）;而与低水平铁摄入量相比,中、高及较高水平的铁则可能降低乳腺癌的患病风险（OR值分别为0．528、0．479、0．340,95％CI分别为0．297～0．939、0．241～0．953、0．153～0．758,P〈0．05,P〈0．01）;与低水平视黄醇当量相比,中、高及较高水平视黄醇当量则可能降低乳腺癌的患病风险（OR值分别为0．428、0．409、0．175,95％CI分别为0．227～0．806、0．217～0．769、0．080。0．385,P〈0．01）。结论建议调整饮食结构,增加蔬菜类摄入量,减少肉类摄入量。     

Association of clinical experiences with patient-reported outcomes among breast cancer surgery patients: breast cancer quality care study

Background We aimed to clarify the association of breast cancer patients’ clinical experiences with patient-reported outcomes (PRO) of satisfaction with care, choice of the same type of surgery again, and health-related quality of life (HRQOL). Methods There were 2,403 (25.9%) of 9,283 eligible women who had undergone primary curative surgery for breast cancer in one of five selected hospitals between 1993 and 2002 who responded to a survey questionnaire including information about care experiences, satisfaction with care, and HRQOL. Results Treatment satisfaction was independently associated with cancer recurrence, problems obtaining surgery, receiving adjuvant hormonal therapy, being involved in treatment decisions, having opinions reflected in treatment decisions, experiencing treatment toxicity, or being hospitalized for treatment toxicity (P <0.01). Breast-conserving surgery with radiotherapy, receiving adjuvant hormone therapy, being involved in treatment decisions, having opinion reflected in treatment decisions, having no treatment toxicity, and receiving regular follow-up care were associated with choosing the same treatment over again (P < 0.01). Good care experiences, except for regular follow-ups, were significantly associated with good HRQOL in most functioning subscales (P < 0.01). Conclusions Our findings suggest that timely referral for treatment, reflection of the patient’s opinions in treatment decisions, and prevention of treatment toxicity might be important to HRQOL. Dong Young Noh and Seok Jin Nam contributed equally to this work as first authors.     

北京市城区中老年人髋部骨折的病例对照研究

目的 探索北京市中老年人髋部骨髂发生的危险因素,为今后开展髋部骨折的病因学研究提供线索。方法对北京市城区２０１例５０岁以上髋部骨折病例和４０２名对照进行了１：２配比的病例对照研究。结果 与髋部骨折危险性增另有关的危险因素有低钙饮食、３０年前不上立活动、未服用钙剂、体质指数低目前不经常体育锻炼、未曾在农村居住、工作性质为脑力劳动、髋部骨折阳性家族史和糖尿病。对于女性,绝经提前和哺乳时间和时间短也是髋     

Screening of women at high risk for breast cancer

A woman may be at high risk of breast cancer because of a strong family history of breast cancer or because she carries a mutation in the BRCA1 or BRCA2 gene. The annual risk for women in this category is between 1% and 2% and the lifetime risk of breast cancer among gene carriers may approach 80%. Several recent trials have reported that the sensitivity of MRI for imaging breast cancer greatly exceeds that of conventional mammography, but no study has yet determined that annual MRI reduces breast cancer-specific mortality. Women with breast cancer and a BRCA1 mutation typically develop aggressive breast cancers and the prognosis is relatively poor for women with small node-negative breast cancers (compared to non-carriers) in particular, if chemotherapy is not given. It is hoped that annual MRI screening combined with appropriate treatment will result in decreased mortality for this and other groups of high-risk women. MRI-based screening for women at moderate risk is a topic of great interest—MRI has not yet been endorsed in moderate risk women because of the high cost of screening and because the specificity of the screening test is not yet determined in this subgroup.     

人工髋关节置换在老年股骨颈骨折治疗中的作用

目的 探讨人工髋关节置换在治疗老年股骨颈骨折中的作用.方法 比较内固定术组与人工髋关节置换组老年股骨颈骨折治疗效果、并发症发生率、功能情况来评价两种治疗方式的优劣.结果 人工髋关节置换组术后卧床时间为(20.4±3.8)d,内固定组术后卧床时间为(60.0±13.5)d.两组患者均有并发症发生:内固定组出现股骨头坏死、骨折不愈合等并发症,发生率为19.11％(13/68);人工髋关节置换组并发症发生率为7.78％ (7/90);内固定组和人工髋关节置换组功能评估优良率分别为69.12％和93.0％.结论 人工髋关节置换术治疗老年股骨颈骨折效果较好.在符合人工髋关节置换术手术条件的情况下,要优先选用人工髋关节置换术来治疗老年患者股骨颈骨折.     

Computed tomography-based finite element analysis to assess fracture risk and osteoporosis treatment

Finite element analysis(FEA) is a computer technique of structural stress analysis and developed in engineering mechanics. FEA has developed to investigate structural behavior of human bones over the past 40 years. When the faster computers have acquired, better FEA, using 3-dimensional computed tomography(CT) has been developed. This CT-based finite element analysis(CT/FEA) has provided clinicians with useful data. In this review, the mechanism of CT/FEA, validation studies of CT/FEA to evaluate accuracy and reliability in human bones, and clinical application studies to assess fracture risk and effects of osteoporosis medication are overviewed.     

老年髋部骨折患者术后感染的预防与控制

目的 探索老年髋部骨折患者术后感染的预防和控制措施,以预防与控制其术后感染,提高治愈率.方法 对医院2008年1月-2010年12月手术治疗的223例＞65岁髋部骨折患者进行回顾性调查分析.结果 223例髋部骨折患者中,167例合并有≥1种其他科疾病,以心血管疾病、糖尿病和呼吸系统疾病为主;入院后平均手术时间(4.29±2.45)d;手术方式为内固定或髋关节置换;术后感染共6例占2.7％,其中手术部位感染2例占0.9％,呼吸道感染1例占0.45％,尿路感染3例占1.35％.结论 对老年髋部骨折患者术后感染的预防和控制,除预防性应用抗菌药物外,应尽早请相关科室会诊,共同评估患者病情及制定围手术期治疗方案,重视围手术期镇痛和早期功能锻炼、离床活动.     

Personal accounts of exercise and quality of life from the perspective of breast cancer survivors

Objectives The purpose of the study was to examine breast cancer survivors’ perceptions of exercise and their quality of life (QoL). Methods About 289 breast cancer survivors completed a survey addressing exercise attitudes, behaviour and perceived QoL. In addition, the breast cancer survivors completed two open-ended questions designed to explore perceptions of exercise and QoL throughout their cancer experience. Inductive and deductive content analyses were used to analyse responses. Results About 19 first-order themes were identified, which were clustered into five second-order themes that included; Exercise behaviour, Lifestyle, Limitations and barriers, Growth and priorities, and Personal beliefs and values. The findings identified a framework of multifaceted views held by breast cancer survivors in relation to their QoL and outlook on their disease. Conclusions Given that cancer survivors are faced with a number of treatment related morbidities 2 years post-diagnosis, there is a need for health professionals to carefully address a cancer survivor’s exercise needs in an attempt to help improve their future QoL.     

骨质疏松性髋部骨折的直接经济负担及其影响因素分析

目的分析骨质疏松性髋部骨折患者的直接经济负担及其影响因素。方法对北京协和医院1998年1月至2002年12月骨质疏松性髋部骨折出院患者采用回顾性问卷调查方式进行直接经济负担数据采集,并对影响因素进行单因素方差分析及多因素logistic回归分析。结果平均每例髋部骨折患者直接经济负担为32776元／年,影响直接经济负担总费用的因素有住院时间、结局、患者工作状态;住院期间费用影响因素有住院时间、患者骨折类型及患者工作状态;影响患者康复期费用的因素有患者住院及康复时间、结局。年龄、治疗方式及医疗负担方式对费用无显著性影响。结论骨质疏松性髋部骨折直接经济负担重,强调从经济学角度论证重视骨质疏松防治的重要性。     

Low bone mass and postfall fracture risk among elderly nursing home men

OBJECTIVE: To study postfall fracture risk in relation to bone mineral density. SETTING: The study was conducted in men residing in nursing homes. PARTICIPANTS: A total of 212 men above the age of 65 years were recruited, and of these, 172 satisfied the inclusion criteria of the study. Among them, 82 were less than 85 years old, and 90 were at least 85 years old. INTERVENTION: Bone mineral density (BMD) of the calcaneus was measured, using the Lunar PIXI Bone Densitometer (version 1.43) and charts were reviewed for age, falls, and fractures. MEASUREMENTS: The values of BMD were expressed as T-scores, and the Lunar criteria equivalents of T-scores were used (T-scores more than -0.6 for normal BMD, -0.6 to -1.6 for osteopenia, and below -1.6 for osteoporosis). RESULTS: The median age of all participants was 84 years (range 65 to 102 years), and their mean T-score at the calcaneus was -1.51. In about 51% of them, the T-score was in the osteoporotic range. For subjects less than 85 years old, the mean T-score was -1.19, and for those 85 years and older, the mean T-score was -1.81; the mean bone density of those in the older old group was significantly lower than those in the younger old group if there was a history of a fracture. Analysis by age quartiles showed a progressive decline in BMD with advancing age. About 53% of the subjects who fell (37.2%) sustained a nontraumatic fracture. Among them, 67.6% had osteoporosis. CONCLUSION: At any given age after age 65, men who sustained a postfall fracture had a significantly lower BMD than those who did not sustain a postfall fracture.     

老年骨折伴心血管疾病患者手术危险因素分析

目的探讨分析合并心血管疾病老年骨折患者的手术风险及其影响因素。方法回顾性分析192例合并心血管疾病的老年骨折患者的临床资料,采用微机多因素分析处理。结果老年骨折伴心血管疾病病人手术危险性大,有显著影响的因素依次为手术时间长、心血管病种类、心功能差和手术部位。结论对围手术期危险性作充分评估,严格掌握手术适应证,选择适当的手术时机,对心血管疾病作相应处理,能降低手术风险。     

Embodying risk,embodying political rationality: Women's accounts of risks for breast cancer

'Risk' has become one of the defining cultural characteristics of Western society at the end of the twentieth century. As in other areas of life, 'risk' has become central to discourses related to individual health; that is, risk has become a common construct around which health in Western society is described, organised, and practised, both personally and professionally. The purpose of this paper is to explore the notion of a 'phenomenology of risk' by considering the results of a preliminary study undertaken to explore the themes which emerge in women's accounts of their own individual risks for breast cancer. A second purpose is to move towards situating the phenomenology of risk within the social and political context within which individual experience occurs. To that end, this study was framed theoretically within the emerging social science literature which examines the broader social and political meanings and implications of health risk discourses. This paper demonstrates that by embodying prevailing discourses on health risks in general, and on breast cancer risk in particular, the women in this study have embodied a political rationality, which, among other things, reconstitutes them as autonomous, responsible 'entrepreneurial subjects'. The phenomenological and political implications of the findings of this study are considered.     

中国女性乳腺癌危险因素的Meta分析

目的:评价中国女性乳腺癌部分危险因素的作用,探索乳腺癌的病因。方法:运用Meta分析方法对我国1996～2006年间公开发表的有关乳腺癌危险因素病例对照研究的12篇文献资料进行定量综合分析。结果:各因素合并OR值分别为:初潮年龄(年)OR=1.54(95%CI:1.3437～1.7654);哺乳OR=0.68(95%CI:0.4779～0.9782);口服避孕药OR=1.33(95%CI:1.0627～1.6589);良性乳腺疾病史OR=2.62(95%CI:2.0275～3.3804);吸烟OR=1.86(95%CI:1.5394～2.2415);饮酒OR=0.81(95%CI:0.6196～1.0686);饮茶OR=0.86(95%CI:0.7646～0.9728)。结论:初潮年龄、口服避孕药、良性乳腺疾病史及吸烟是乳腺癌发生的危险因素,哺乳及饮茶则是乳腺癌的保护因素。     

中国城市居民乳腺癌危险因素的研究

目的 乳腺癌是全世界妇女中最多发的肿瘤。我国城市女性乳腺癌危险因素的筛查及其探索监测方法研究（并有相关的论文陆续发表）,对乳腺癌的预防和控制十分重要。方法 在我国选择北京、天津、上海、重庆、武汉、广州六大城市作为监测地区,采用以人群为基础的１：１配对的病例对照研究方法,共抽取２１００对病例与对照,进行问卷调查。应用ＳＡＳ６．１２软件进行单因素、多因素条件ｌｏｇｉｓｔｉｃ回归分析,并对六城市分别做指     

Factors influencing quality of life in breast cancer survivors

Longitudinal data from 195 breast cancer survivors were used to identify factors affecting the level and rate of change in quality of life after completion of treatment. Women were interviewed up to four times at approximately yearly intervals using Kaplan and Bush's Quality of Well Being instrument (QWB). Random coefficient regression analysis was used to model QWB as a function of time since diagnosis and personal characteristics. QWB scores decreased over time and the rate of decline increased with age (p = 0.032). This was similar to declines in women with benign breast biopsies, but overall QWB levels were lower in women with breast cancer. Having a spouse tended to slow the rate of decline in breast cancer survivors (p = 0.004). The presence of comorbidity was associated with significantly lower QWB levels (p = 0.037) but did not affect the rate of change over time. Education, family history of breast cancer, cancer stage and treatment modalities were not significantly related to QWB levels or rates of change. Breast cancer survivors experience a reduction in quality of life that persists for years after treatment and is similar in magnitude to that associated with other health problems.