Pregnancy weight gain and premenopausal breast cancer risk

OBJECTIVE: To investigate whether excessive weight gain during pregnancy alters a woman's risk of developing premenopausal breast cancer. STUDY DESIGN: We conducted a nested case-control study within a cohort composed of 22,610 Finnish women (mean age, 40; SD 6.4) who responded to a questionnaire requesting information on breast cancer diagnosis and on adult and pregnancy weight gain as part of a study of a hormone-releasing intrauterine device. One hundred fourteen of these women reported having been diagnosed with breast cancer, and 98 were eligible for analysis. Four matched controls were selected for each case (n = 392). Mean age at the time the women were diagnosed with breast cancer was 41.3 years (SD 5.46) and at the time they returned the questionnaire, 46.7 years (SD 5.55). RESULTS: We found no evidence that pregnancy weight gain, unadjusted or adjusted for prepregnancy body weight or other covariates (educational status, age at menarche and first pregnancy, and family history of breast cancer), had an effect on breast cancer risk. However, pregnancy weight gain was linked to an inverse association between change in body mass index (BMI) during adult life and premenopausal breast cancer. Women who gained an excessive amount of weight during pregnancy (> 16 kg) were at a significantly reduced risk of developing premenopausal breast cancer (p = 0.043, OR 0.28, 95% CI 0.08-0.96) if their BMI increased > 7 m/kg(-2) after age 20. BMI increase was not associated with breast cancer risk in women whose pregnancy weight gain remained within the recommended range (< 16 kg). CONCLUSION: Since our previous findings show that women who gain an excessive amount of weight during pregnancy are at an increased breast cancer risk after menopause, regardless of adult BMI, an excessive pregnancy weight gain may provide a short-term protective but cause a long-term breast cancer-promoting effect. It remains to be determined why BMI and pregnancy weight gain differently affect premenopausal and postmenopausal breast cancer risk.     

Impact of childhood obesity treatment on body composition and metabolic profile

Background  

Childhood obesity is associated with adverse changes in cardiometabolic risk factors. A family-oriented group program stressing a health-promoting lifestyle has been more effective than routine counselling in the treatment of obesity in school children. The aim of the present study was to compare the impact of group program and routine councelling on body composition and metabolic profile, and to evaluate the associations of changes in adiposity with levels of cardiometabolic risk factors.     

Lifestyle counseling during pregnancy and offspring weight development until four years of age: follow-up study of a controlled trial

Background

Fetal conditions are known to be partly responsible for the child??s risk for obesity. Our pilot study aimed to determine the effect of gestational lifestyle counseling on the offspring weight gain until 4?years of age and to estimate power for future studies.

Design and methods

First-time pregnant mothers participated in a controlled trial conducted in maternity health clinics during 2004 ?C 2006. The intervention included individual counseling on physical activity and diet, and an option to attend supervised group exercise sessions. The participant mothers (N?=?109) received a follow-up questionnaire concerning 13 repeated growth measurements of their offspring. Response rate to the follow-up questionnaire was 66.1% (N?=?72/109).

Results

The increase of BMI z-score between 24?C48?months was not significantly slower among the intervention group offspring (95% CI ?0.025 to 0.009, p?=?0.34) compared to control group. Z-scores for weight-for-length/height did not differ between groups when the period 0?C48?months was analyzed (95% CI ?0.010 to 0.014, p?=?0.75).

Conclusions

In this pilot study gestational lifestyle counseling did not significantly slow the weight gain of the offspring. Gestational intervention studies with at least 300 mothers per group are needed to confirm the possible effect on offspring??s risk for obesity.

Trial registration

Current Controlled Trials ISRCTN21512277.     

Short-term prognosis of occupational asthma in a Finnish population

Background: Causative agents of occupational asthma (OA) are well described in literature but far less is known about factors affecting the outcome of OA. Short duration of exposure, early diagnosis when symptoms appear and further avoidance of exposure have been suggested as good prognostic factors. This study was designed to investigate a short‐term outcome of OA. Methods: The medical records of 47 Caucasian patients from a Finnish population diagnosed with OA in year 2003 were reviewed retrospectively. Employment status at 6‐month follow‐up of all patients was determined. We assessed the following potential predictors of unemployment at follow‐up: the causative agents of OA, asthma medication, spirometry results, smoking status, gender, age, occupation, atopy status, bronchial hyperresponsiveness and time to diagnosis. We calculated odd ratios (ORs) to predict employment status at follow‐up. Results: At the follow‐up examination, 23 persons (49%) were not working. At the time of follow‐up there were no significant differences in pulmonary function between those employed and those who discontinued to work. Atopy at baseline predicted diminished lung function at the 6‐month follow‐up. In addition, atopy was the only prognostic factor and was inversely related to the work discontinuation at the follow‐up [OR 0.18, 95% confidence interval (CI) 0.04–0.79]. Work continuation as an OA outcome at 6 months could not be predicted by gender, age, occupational status, exposure antigen, smoking habits or duration of symptoms before diagnosis. Conclusions: The socio‐economic short‐term prognosis of OA was relatively poor since half of the patients were not at work at the 6 months follow‐up. Please cite this paper as: Kauppi P, Hannu T, Helaskoski E, Toivio P and Sauni R. Short‐term prognosis of occupational asthma in a Finnish population. Clin Respir J 2011; 5: 143–149.     

Predictive value of health-related fitness tests for self-reported mobility difficulties among high-functioning elderly men and women

BACKGROUND AND AIMS: The functional independence of elderly populations deteriorates with age. Several tests of physical performance have been developed for screening elderly persons who are at risk of losing their functional independence. The purpose of the present study was to investigate whether several components of health-related fitness (HRF) are valid in predicting the occurrence of self-reported mobility difficulties (MD) among high-functioning older adults. METHODS: Subjects were community-dwelling men and women, born 1917-1941, who participated in the assessment of HRF [6.1-m (20-ft) walk, one-leg stand, backwards walk, trunk side-bending, dynamic back extension, one-leg squat, 1-km walk] and who were free of MD in 1996 (no difficulties in walking 2- km, n=788; no difficulties in climbing stairs, n=647). Postal questionnaires were used to assess the prevalence of MD in 1996 and the occurrence of new MD in 2002. Logistic regression analysis was used as the statistical method. RESULTS: Both inability to perform the backwards walk and a poorer result in it were associated with risk of walking difficulties in the logistic model, with all the statistically significant single test items included. Results of 1-km walk time and one-leg squat strength test were also associated with risk, although the squat was statistically significant only in two older birth cohorts. Regarding stair-climbing difficulties, poorer results in the 1-km walk, dynamic back extension and one-leg squat tests were associated with increased risk of MD. CONCLUSIONS: The backwards walk, one-leg squat, dynamic back extension and 1-km walk tests were the best predictors of MD. These tests are recommended for use in screening high-functioning older people at risk of MD, as well as to target physical activity counseling to those components of HRF that are important for functional independence.     

Screening of Urine Samples by Flow Cytometry Reduces the Need for Culture

Urine samples constitute a large proportion of samples tested in clinical microbiology laboratories. Culturing of the samples is fairly time- and labor-consuming, and most of the samples will yield no growth or insignificant growth. We analyzed the feasibility of the flow cytometry-based UF-500i instrument (Sysmex, Japan) to screen out urine samples with no growth or insignificant growth and reduce the number of samples to be cultured. A total of 1,094 urine specimens sent to our laboratory for culture during 4 months in the spring of 2009 in Lahti, Finland, were included in the study. After culture, all samples were analyzed with the Sysmex UF-500i for bacterial and leukocyte (white blood cell [WBC]) counts. Youden index and closest (0,1) methods were used to determine the cutoff values for bacterial and WBC counts in culture-positive and -negative groups. By flow cytometry, samples considered positive for UTI in culture had bacterial and WBC values that were significantly higher than those for samples considered negative. The flow cytometric screening worked best when both bacterial counts and WBC counts were used with age- and gender-specific cutoff values for all patient groups, excluding patients with urological disease or anomaly. By use of these cutoff values, 5/167 (3.0%) of culture-positive samples were missed by UF-500i and the percentage of samples that did not need to be cultured was 64.5%. Use of the UF-500i instrument is a reliable method for screening out a major part of the UTI-negative samples, significantly diminishing the amount of work required in the microbiology laboratory.Urinary tract infections (UTIs) are among the most common infections treated by community health care centers and hospitals (5, 6, 13, 19, 24). In Finland, urinary tract infections account for approximately 6% of all infectious disease diagnoses in primary care (20) and urine samples constitute a large proportion of the samples tested in clinical microbiology laboratories (13, 18, 24). The gold standard for UTI diagnosis is bacterial culture, which is based on bacterial counts and identification. Culturing of the samples is fairly time- and labor-consuming, and most of the samples yield no growth or insignificant growth (10, 15, 22, 24). In order to improve the efficiency of handling of the urine samples, methods for screening out the culture-negative samples from the culture-positive samples have been developed. Chemical screening with strips for nitrite, pH, leukocytes, erythrocytes, albumin, and glucose is widely used (17, 18, 22, 23), but a meta-analysis of the literature (4) has shown that the method is insensitive and is suitable as a rule-out test only when both nitrite and leukocyte-esterase are negative. Cells, particles, and microorganisms in urine can be examined by microscopic-urine-sediment analysis, but this method is time-consuming, labor-intensive, and sensitive to interobserver variability (2, 7, 8, 10, 12, 21).Pyuria with bacteria predicts bladder infection better than the presence of bacteria alone, and therefore, a screening method that detects both leukocytes and bacteria is favorable for the identification of patients with urinary tract infections (18). During the last 10 years, the use of flow cytometry-based analyzers that measure quantitatively both leukocytes and bacteria has been evaluated (2, 6, 8, 10-16, 21, 25). The studies done with the first-generation Sysmex instruments, UF-50 and UF-100, showed variable results concerning the suitability of this technology for screening purposes (3, 6, 15, 25). The second-generation Sysmex analyzers, UF-500i and UF-1000i, have a separate measurement channel for bacteria which improves the specificity for counting of bacterial organisms.The aim of this study was to evaluate the feasibility of flow cytometry using a UF-500i instrument (Sysmex Corporation, Japan) in routine diagnosis of UTI. We sought to develop a screening strategy in which as few samples as possible needed to be cultured, while maintaining a low level of false negatives and a high negative predictive value.     

Evaluation of an organizational stress management program in a municipal public works organization

The aim of this study was to investigate the effects of employee participation in an organizational stress management program consisting of several interventions aiming to improve psychosocial work environment and well-being. Pre- and postintervention questionnaires were used to measure the outcomes with a 2-year interval. This article describes the background of the program, results of previously published effect studies, and a qualitative evaluation of the program. The authors also tested the effects of level of participation in all interventions among the employees of the service production units by 2 (time) x 3 (group) repeated measures ANOVAs (n = 625). "Active participation" (more than 5.5 days) had a positive effect on feedback from supervisor and flow of information. Work climate remained on a permanent level while it decreased in the categories of moderate and nonparticipation. The level of participation did not improve individual well-being or other aspects of psychosocial work environment as postulated by the work stress models. The qualitative evaluation and practical conclusions drawn by the management of the Organization provided a positive impression of the impact of the program.