Understanding income inequalities in health among men and women in Britain and Finland.

The aims of this study were to investigate whether the relationship between income and self-perceived health is similar for men and women in two contrasting welfare states, Britain and Finland; whether the relationship between income and health is accounted for by employment status, education, and occupational social class; and whether the association differs when using alternative ways of measuring income: gross individual and net household equivalent income. Among British and Finnish men, low household and low individual income were related to poor health, even after adjusting for employment status, education, and social class. The adjusted relationship between individual income and health was stronger for British than Finnish men. Among British and Finnish women, net household equivalent income was strongly related to health, but after adjusting for employment status, education, and social class this relationship became weaker for British women and practically disappeared for Finnish women. For British women the association between income and health differed strongly depending on the income measure used; gross individual income had almost no effect on health. These results indicate that the association between health and income has no threshold in the sense that only people in poverty have poorer health than others. In further studies of income and health, household equivalent income should be used as the principal measure of income with adjustments for employment status, and men and women should be studied separately.     

Dexamethasone-Induced Enhancement of Resistance to Ionizing Radiation and Chemotherapeutic Agents in Human Tumor Cells

Background: Dexamethasone-induced changes in radioresistance have previously been observed by several authors. Here, we examined effects of dexamethasone on resistance to ionizing radiation in 10 additional human cell lines and strains, and on resistance to carboplatin and paclitaxel in 13 fresh tumor samples. Material and Methods: Eight human carcinoma cell lines, a glioblastoma cell line and a strain of normal human diploid fibroblasts were arbitrarily chosen for these in-vitro studies. Effects on radiosensitivity were assessed using a conventional colony formation assay. Effects on resistance to the drugs were investigated prospectively (ATP cell viability assay) using 13 fresh tumor samples from consecutive patients operated for ovarian cancer within the context of a Swiss nation-wide randomized prospective clinical trial (SAKK 45/94) Results: Dexamethasone promoted proliferation of 1 of the cell lines without affecting radiosensitivity, while it completely inhibited proliferation of another cell line (effects on radiosensitivity could thus not be examined). Furthermore, dexamethasone induced enhanced radioresistance in 1 of the 8 carcinoma cell lines examined. In the glioblastoma cell line, there was no effect on growth or radioresistance in 1 of the 8 carcinoma cell lines examined. In the glioblastoma cell line, there was no effect on growth or radioresistance, nor in the fibroblasts. Treatment with dexamethasone enhanced resistance of the malignant cells to carboplatin in 4 of the 13 fresh tumor samples examined, while no enhancement in resistance to paclitaxel was observed. Conclusions: In agreement with previous reports, we found that dexamethasone may induce radioresistance in human carcinoma cells. Including the published data from the literature, dexamethasone induced enhancement in radioresistance in 4 of 12 carcinoma cell lines (33%), but not in 3 glioblastoma cell lines, nor in 3 fibroblast strains. Dexamethasone also induced enhanced resistance to carboplatin with a similar probability in fresh samples of ovarian cancer evaluated prospectively (in 4 of 13 samples; 31%). We worry that induction of resistance by corticosteroids given to patients undergoing either radiotherapy or chemotherapy with agents causing DNA damage might be associated with a reduced clinical responsiveness in a significant fraction of patients with a carcinoma. Hintergrund: In der Literatur gibt es verschiedene Berichte über eine dexamethasoninduzierte Erhöhung der Strahlenresistenz. Wir untersuchten deshalb weitere menschliche Tumorzellinien und Fibroblasten auf induzierbare Veränderungen der Wachstumsfähigkeit und der Strahlenempfindlichkeit. Außerdem prüften wir die Wirkung von Dexamethason auf die Sensibilität von Ovarialkarzinomproben gegenüber Carboplatin und Paclitaxel. Material und Methode: Wir untersuchten acht Karzinomzellinien, eine Glioblastomzellinie sowie Hautfibroblasten in Kultur. Die Wirkung auf die Wachstumsfähigkeit der Zellen und auf die Strahlenwirkung wurde unter Verwendung des üblichen Koloniebildungstests bestimmt. Die Wirkung von Dexamethason auf die Effekte der Chemotherapeutika Carboplatin und Paclitaxel wurde an Proben von 13 konsekutiven Ovarialkarzinomen im Rahmen einer klinischen Studie (SAKK 45/94) prospektiv untersucht (ATP cell viability assay). Ergebnisse: Dexamethason stimulierte das Wachstum einer Karzinomzellinie, ohne die Strahlenresistenz zu beeinflussen. Außerdem wurde das Wachstum einer anderen Zellinie vollständig gehemmt, so daß die Wirkung auf die Strahlenempfindlichkeit nicht untersucht werden konnte. Dexamethason bewirkte in einer der übrigen Karzinomzellinien eine erhöhte Resistenz gegenüber Bestrahlung. Wachstumsfähigkeit und Strahlenempfindlichkeit von Glioblastomzellen und Fibroblasten wurden nicht beeinflußt. Außerdem induzierte Dexamethason eine erhöhte Resistenz gegenüber Carboplatin in vier der 13 Ovarialkarzinomproben. Eine erhöhte Resistenz gegenüber Paclitaxel wurde hingegen nicht beobachtet. Schlußfolgerungen: Diese Ergebnisse bestätigen frühere Berichte über dexamethasoninduzierte Resistenz gegenüber Bestrahlung. Einschließlich der in der Literatur publizierten Daten findet sich eine dexamethasoninduzierte Erhöhung der Resistenz in vier von zwölf evaluierbaren Karzinomzellinien (33%), nicht jedoch in den drei Glioblastomzellinien oder in Fibroblasten. Dexamethason erzeugte ähnlich häfuig, nämlich in vier von 13 Proben (31%), eine erhöhte Resistenz gegenüber Carboplatin. Dexamethasongabe könnte sich deshalb negativ auswirken.     

Efficacy of cefuroxime axetil suspension compared with that of penicillin V suspension in children with group A streptococcal pharyngitis.

The bacteriological and clinical efficacies of cefuroxime axetil suspension (20 mg/kg of body weight per day in two divided doses) were compared with those of penicillin V suspension (50 mg/kg/day in three divided doses) in a multicenter, randomized, evaluator-blinded study. Children aged 2 to 13 years with clinical signs and symptoms of acute pharyngitis and a positive throat culture for group A beta-hemolytic streptococci (GABHS) were eligible. Patients were assessed and samples from the throat for culture were obtained at the time of diagnosis, 3 to 7 days after the initiation of treatment, and 4 to 8 days and 19 to 25 days after the completion of 10 days of therapy. Of the 385 evaluable patients, GABHS were eradicated from 244 of 259 (94.2%) cefuroxime-treated patients and 106 of 126 (84.1%) penicillin-treated patients (P = 0.001). Complete resolution of the signs and symptoms present at the time of diagnosis was achieved in 238 of 259 (91.9%) cefuroxime-treated patients and 102 of 126 (81.0%) penicillin-treated patients (P = 0.001). Potential drug-related adverse events were reported in 7.0 and 3.2% of the cefuroxime- and penicillin-treated patients, respectively (P = 0.078). In the present study, cefuroxime axetil suspension given twice daily resulted in significantly greater bacteriological and clinical efficacies than those of penicillin V suspension given three times daily to pediatric patients with acute pharyngitis and a positive throat culture for GABHS.     

Association of the Presence of Bone Marrow Micrometastases with the Sentinel Lymph Node Status in 410 Early Stage Breast Cancer Patients: Results of the Swiss Multicenter Study

Background The sentinel lymph node (SLN) status has proven to accurately reflect the remaining axillary lymph nodes and represents the most important prognostic factor. It is unknown whether an association exists between the SLN status and the presence of bone marrow (BM) micrometastases. The objective of the present investigation was to evaluate whether or not such an association exists. Methods In the present investigation 410 patients with early stage breast cancer (pT1 and pT2 ≤3cm, cN0) were prospectively enrolled between 1/2000 and 12/2003. All patients underwent SLN biopsy and bone marrow aspiration. The histological examination of the SLN consisted of step sectioning, H&E, and immunohistochemistry (Lu-5, CK 22) staining. Cancer cells in the BM were stained with monoclonal antibodies A45-B/B3 against cytokeratin and counted by an automated computerized digital microscope. Results BM micrometastases were detected in 28.8% (118/410) of all patients. The SLN contained metastases in 32.4% (133/410). Overall 51.2% of the patients (210/410) were SLN negative/BM negative and 12.4% (51/410) SLN positive/BM positive. Of all patients, 16.4% (67/410) were SLN negative/BM positive and 20.0% (82/410) SLN positive/BM negative. There was a statistically significant association between the SLN and BM status, both in unadjusted (Fisher’s exact test: P = .004) and multiple logistic regression analysis (P = .007). Conclusions In the present investigation a significant association was found between a positive SLN status and the presence of BM micrometastases. Nonetheless, the percentage of non-concordance (SLN negative/BM positive and SLN positive/BM negative) was considerable. The prognostic impact of BM micrometastases in our patient sample remains to be evaluated. Presented at the 2006 Annual Meeting of the Society of Surgical Oncology in San Diego/USA.     

The effects of childhood circumstances, adult socioeconomic status, and material circumstances on physical and mental functioning: a structural equation modelling approach

PURPOSE: We sought to examine the importance of childhood circumstances, adult socioeconomic status, and material circumstances to physical and mental functioning among middle-aged women and men. METHODS: The data were collected among the employees of the City of Helsinki by mailed questionnaires from 2000 to 2002 (7148 women and 1799 men, response rate 67%). Three latent variables covering childhood circumstances, adult socioeconomic status, and material circumstances were constructed from 10 observed socioeconomic indicators. Direct and indirect effects of the latent variables on physical and mental functioning, measured by the SF-36 component summaries, were examined using structural equation modelling. RESULTS: Childhood circumstances were not directly associated with either physical or mental functioning but had some effect through socioeconomic status. Low socioeconomic status was associated with poor physical functioning, but mental functioning was poorer among those in higher positions. Material circumstances were associated with physical and especially with mental functioning. CONCLUSIONS: Low socioeconomic status and material circumstances are both important for physical functioning. However, mental functioning does not necessarily follow a similar socioeconomic pattern and the results are heavily influenced by how socioeconomic position is measured.     

Changes in leisure-time physical activity and subsequent sickness absence: A prospective cohort study among middle-aged employees

ObjectiveThe aim of this study was to examine how changes over time in leisure-time physical activity are associated with subsequent sickness absence.MethodsHelsinki Health Study cohort baseline questionnaire survey data were collected in 2000–2002 among 40–60-year-old employees of the City of Helsinki, Finland. A follow-up survey was conducted in 2007. 4182 (83% women) respondents were available for the analyses. Leisure-time physical activity was asked using identical questions in both surveys. Sickness absence data were derived from the employer's registers (mean follow-up time 2.8 years). Associations of changes over time in leisure-time physical activity with self-certified (≤ 3 days) and medically certified (> 3 days) sickness absence spells were examined, using Poisson regression analysis.ResultsInactive women and men who increased their physical activity to vigorously active had a significantly lower risk of both self-certified (RR = 0.80, 95% CI 0.65–0.97) and medically certified (RR = 0.63, 95% CI 0.49–0.83) subsequent sickness absence spells compared with the persistently inactive. The persistently active with vigorous intensity had the lowest risk of sickness absence. Adjusting for changes in physical health functioning attenuated but did not abolish the lowered risk found.ConclusionsFor reducing sickness absence more emphasis should be given to the potential contribution of vigorous physical activity.