Smoking duration before first childbirth: an emerging risk factor for breast cancer? Results from 302,865 Norwegian women

Purpose

Recently, The International Agency for Research on Cancer classified cigarette smoking as possibly carcinogenic to the human breast. Since some new cohort studies have suggested that this risk is confined to women who started to smoke before first childbirth, we wanted to examine the association between smoking and breast cancer, with a focus on time of smoking initiation in relation to the first childbirth.

Methods

We followed 302,865 Norwegian women born between 1899 and 1975, recruited from 1974 to 2003, by linkage to national registries through December 2007. We used Cox proportional hazard models to estimate hazard ratios (HR) and 95 % confidence intervals (CI).

Results

During more than 4.1 million person-years of follow-up, we ascertained 7,490 cases of primary invasive breast cancer. Compared with never smokers, ever smokers had a 15 % (HR = 1.15, 95 % CI 1.10–1.21) increased risk of breast cancer overall and also a significantly increased risk of breast cancer in the three most exposed categories of age at smoking initiation (parous women), number of cigarettes smoked per day, years of smoking duration and number of pack-years. Ever smokers who started to smoke more than 1 year after the first childbirth had not an increased risk (HR = 0.93, 95 % CI 0.86–1.02), while those who initiated smoking more than 10 years before their first childbirth had a 60 % (HR = 1.60, 95 % CI 1.42–1.80) increased risk of breast cancer, compared with never smokers.

Conclusion

Smoking initiation before the first childbirth increases the risk of breast cancer.     

Lifeworld perspectives on assistive devices: Lived experiences of spouses of persons with stroke

The purpose of this study was to explore how spouses of persons with a disability following stroke describe their lived experiences regarding assistive devices in everyday life. A phenomenological lifeworld approach was used and conversational interviews were conducted with 12 spouses. Their lived experiences of assistive devices were explored in relation to four lifeworld existentials intertwined in everyday life. The results showed that lived body concerns aspects of feelings, habits, and incorporation of the devices with one's own body. The devices are, from the spouses’ perspective, a prerequisite for their partner with stroke living at home. Successively the devices are incorporated into the couples’ homes, and they provide a new view of the environment, aspects related to lived space. The devices bring about a changed relation to lived time, related to past, present, and future. Further, lived human relation concerns changed relationships to husbands/wives with stroke, including a great responsibility due to the devices and their usage. The results also included stigmatizing aspects and a twofold relationship to health professionals regarding participation in decisions about prescribing assistive devices. Understanding the unique meaning of assistive devices from the spouses’ perspective is vital for occupational therapists prescribing such devices.     

In situ phosphorylation of Akt and ERK1/2 in rat mammary gland, colon, and liver following treatment with human insulin and IGF-1

High doses of insulin and the insulin analog AspB10 have been reported to increase mammary tumor incidence in female rats likely via receptor-mediated mechanisms, possibly involving enhanced IGF-1 receptor activation. However, insulin and IGF-1 receptor functionality and intracellular signaling in the rat mammary gland in vivo is essentially unexplored. The authors investigated the effect of a single subcutaneous dose of 600 nmol/kg human insulin or IGF-1 on Akt and ERK1/2 phosphorylation in rat liver, colon, and mammary gland. Rat tissues were examined by Western blotting and immunohistochemistry by phosphorylation-specific antibodies. Insulin as well as IGF-1 caused Akt phosphorylation in mammary epithelial cells, with myoepithelial and basal epithelial cells being most sensitive. IGF-1 caused stronger Akt phosphorylation than insulin in mammary gland epithelial cells. Phosphorylation of ERK1/2 was not influenced by insulin or IGF-1. Rather, in liver and mammary gland P-ERK1/2 appeared to correlate with estrous cycling, supporting that ERK1/2 has important physiological roles in these two organs. In short, these findings supported that the rat mammary gland epithelium expresses functional insulin and IGF-1 receptors and that phosphorylation of Akt as well as ERK1/2 may be of value in understanding the effects of exogenous insulin in the rat mammary gland and colon.     

Current methods of diagnosis and treatment of scaphoid fractures

Fractures of the scaphoid bone mainly occur in young adults and constitute 2-7% of all fractures. The specific blood supply in combination with the demanding functional requirements can easily lead to disturbed fracture healing. Displaced scaphoid fractures are seen on radiographs. The diagnostic strategy of suspected scaphoid fractures, however, is surrounded by controversy. Bone scintigraphy, magnetic resonance imaging and computed tomography have their shortcomings. Early treatment leads to a better outcome. Scaphoid fractures can be treated conservatively and operatively. Proximal scaphoid fractures and displaced scaphoid fractures have a worse outcome and might be better off with an open or closed reduction and internal fixation. The incidence of scaphoid non-unions has been reported to be between 5 and 15%. Non-unions are mostly treated operatively by restoring the anatomy to avoid degenerative wrist arthritis.     

Medication adherence: a call for action

Poor adherence to efficacious cardiovascular-related medications has led to considerable morbidity, mortality, and avoidable health care costs. This article provides results of a recent think-tank meeting in which various stakeholder groups representing key experts from consumers, community health providers, the academic community, decision-making government officials (Food and Drug Administration, National Institutes of Health, etc), and industry scientists met to evaluate the current status of medication adherence and provide recommendations for improving outcomes. Below, we review the magnitude of the problem of medication adherence, prevalence, impact, and cost. We then summarize proven effective approaches and conclude with a discussion of recommendations to address this growing and significant public health issue of medication nonadherence.     

Craniofacial morphology in patients with hypophosphatemic rickets: a cephalometric study focusing on differences between bone of cartilaginous and intramembranous origin

Hypophosphatemic rickets (HR) are diseases characterized by deficient mineralization of bone due to abnormal renal wasting of phosphate. Deformation of bony structures of cartilaginous origin has been described as a major characteristic in patients with HR, but little is known about the impact on bony structures of intramembranous origin. The aim of the present study was to describe the osseous morphology of the craniofacial structures in patients with HR compared to healthy controls, and to investigate the impact of different bone origin on the osseous morphology. Fifty-three patients with HR (17 males, 36 females), aged 3-74 yrs, were included. Fifty HR patients had dominant X-linked disease, and in three patients no mutations were identified. A total of 79 healthy individuals (37 males, 42 females), aged 6-79 yrs, with normal occlusion served as controls. Significant cephalometric differences were found between HR patients and controls. In HR patients, the cranial base was flattened and the depth of the posterior cranial fossa was decreased. The anterior height of the cranium, the angle nasion-sella-frontale, and the thickness of theca were increased. The length of the nasal bone and the height of the maxilla were reduced. In contrast, the vertical as well as the sagittal relation between the jaws were unaffected in HR patients compared to controls. In conclusion, we found that the cranial structures of cartilaginous origin as well as the structures of intramembraneous origin were affected in patients with HR.     

How well does social variation mirror secular change in prevalence of cardiovascular risk factors in a country in transition?

Objectives: The social and cultural transition among the Inuit in Greenland over the last generations has in ecological studies been linked to changes in cardiovascular risk factors. To permit analyses at the individual level, we propose a categorization of participants in a cross‐sectional study according to their relative position in the process of social change. Methods : Data was included from two cross‐sectional population surveys in 1993–1994 (N = 1,580) and 2005–2009 (N = 2,834). Socioeconomic factors, mental health, health behavior, obesity, blood lipids, blood pressure, and prevalence of diabetes were compared between the surveys and among groups at various degree of social change defined from current residence, job, and education. General linear models and logistic regression analysis were applied. Results : Most outcome variables showed statistically significant difference between the two studies indicating secular change, and for most the gradient in the ranked social groups was in agreement with the observed secular change. This included housing conditions, wealth, diet, smoking, alcohol, physical activity, obesity, and for women also non‐HDL cholesterol and hypertension. Anxiety and depression increased over time but decreased with social group for women. Prevalence of type 2 diabetes has increased, but we found no differences among social groups. Serum triglyceride and for men non‐HDL cholesterol and hypertension showed inconsistent results. Conclusions : For a majority of the examined cardiovascular risk factors, social population groups defined from cross‐sectional data adequately mirror secular change. Am. J. Hum. Biol., 2011. © 2011 Wiley‐Liss, Inc.     

Enzyme-linked immunosorbent assay (ELISAs) for metalloproteinase derived type II collagen neoepitope, CIIM--increased serum CIIM in subjects with severe radiographic osteoarthritis

ObjectivesIn joint degenerative diseases, the collagens are degraded by matrix metalloproteinases and protein fragments are released to serum as potential biomarkers.MethodsA collagen type II specific neoepitope, CIIM, was identified (…RDGAAG¹⁰⁵³) by mass spectrometry. Two ELISAs against the neoepitope were developed. CIIM was measured in cartilage explants in the presence or absence of protease inhibitors. CIIM was measured in OA synovial fluid (n = 51) and serum (n = 156). Knee OA was graded by standard Kellgren–Lawrence (KL) score.ResultsThe ELISAs showed good technical performance; CV%, < 13%. CIIM release from cartilage explants was blocked by the MMP inhibitor. CIIM was detected in synovial fluid. Furthermore, serum CIIM levels were significantly higher (P < 0.05) in those individuals with mild or severe OA than in those with no OA.ConclusionWe developed a new biomarker for joint degenerative diseases, which we demonstrated was derived from MMP-degraded type II collagen.     

Impaired fasting glucose is associated with renal hyperfiltration in the general population

OBJECTIVE

Increased glomerular filtration rate (GFR), also called hyperfiltration, is a proposed mechanism for renal injury in diabetes. The causes of hyperfiltration in individuals without diabetes are largely unknown, including the possible role of borderline hyperglycemia. We assessed whether impaired fasting glucose (IFG; 5.6–6.9 mmol/L), elevated HbA_1c, or hyperinsulinemia are associated with hyperfiltration in the general middle-aged population.

RESEARCH DESIGN AND METHODS

A total of 1,560 individuals, aged 50–62 years without diabetes, were included in the Renal Iohexol Clearance Survey in Tromsø 6 (RENIS-T6). GFR was measured as single-sample plasma iohexol clearance. Hyperfiltration was defined as GFR >90th percentile, adjusted for sex, age, weight, height, and use of renin-angiotensin system inhibitors.

RESULTS

Participants with IFG had a multivariable-adjusted odds ratio of 1.56 (95% CI 1.07–2.25) for hyperfiltration compared with individuals with normal fasting glucose. Odds ratios (95% CI) of hyperfiltration calculated for a 1-unit increase in fasting plasma glucose (FPG) and HbA_1c, after multivariable-adjustment, were 1.97 (1.36–2.85) and 2.23 (1.30–3.86). There was no association between fasting insulin levels and hyperfiltration. A nonlinear association between FPG and GFR was observed (df = 3, P < 0.0001). GFR increased with higher glucose levels, with a steeper slope beginning at FPG ≥5.4 mmol/L.

CONCLUSIONS

Borderline hyperglycemia was associated with hyperfiltration, whereas hyperinsulinemia was not. Longitudinal studies are needed to investigate whether the hyperfiltration associated with IFG is a risk factor for renal injury in the general population.Chronic kidney disease (CKD) is recognized as a global health problem. The prevalence of CKD is estimated to exceed 10% in Western societies and in many Asian countries (1). Concurrently, the incidence of obesity and prediabetes, defined as impaired fasting glucose (IFG) or impaired glucose tolerance, has reached epidemic proportions worldwide (2). Growing evidence links prediabetes and insulin resistance to microalbuminuria and CKD, but the pathophysiologic mechanisms for renal injury have not been elucidated (3,4). However, studies in animals and humans indicate that an abnormally elevated glomerular filtration rate (GFR), or hyperfiltration, may increase the susceptibility to renal injury in obesity and in diabetes (5,6).At the single-nephron level, hyperfiltration is hypothesized to be an early link in the chain of events that lead from intraglomerular hypertension to albuminuria and, subsequently, to reduced GFR (7). This paradigm has received attention in experimental research, but is difficult to study at the population level because obtaining accurate measurements of GFR is complicated and time-consuming. GFR estimated from creatinine or cystatin C levels is imprecise in the normal or upper range of GFR and is biased in individuals with atypical body composition or creatinine production (8). Accordingly, although hyperglycemia is known to mediate hyperfiltration in diabetes, the causes of hyperfiltration in the general population are largely unknown; particularly, whether prediabetes or insulin resistance is associated with hyperfiltration is unknown.The current study investigated whether IFG, elevated HbA_1c, hyperinsulinemia, or insulin resistance are associated with hyperfiltration in a general middle-aged population. To avoid the problems of estimating GFR from creatinine or cystatin C values, we measured GFR as iohexol clearance, which is recognized as an accurate method (9).     

The characterisation of workloads and nursing staff allocation in intensive care units: A descriptive study using the Nursing Activities Score for the first time in Norway

Objective

This study compares the Nine Equivalents of Nursing Manpower Use Score (NEMS) to the Nursing Activities Score (NAS) in terms of characterising the nursing workload by examining and calculating the per-nurse NAS% over a 24-h period.

Method

The sample consisted of 235 patients from four volunteered for the study multidisciplinary ICUs in Norway. The daily NEMS, NAS and number of nurses who were involved in patient care per ICU were measured over one month from 2008 to 2009.

Results

The average length of stay for the included patients was 5 days, and the mean patient age was 52.8 years. The mean NEMS was 32.7 points (S.D., 8.98 points), and the mean NAS was 96.24% (S.D., 22.35%). Several nurses exhibited mean NEMS points that ranged from 16 to 39.7 per ICU per day. The correlation between the NEMS and NAS could only be separately determined for each ICU. The correlation was r = 0.16–0.40 [significant at the 0.01 level (2-tailed)] per unit. Depending on which unit was investigated, each nurse was observed to perform of capacity with a NAS as high as 75–90%.

Conclusion

The study suggests that the actual numbers of nurses might explain the calculated NAS of 75–90% per nurse.