Obesity may be associated with increased risk of pneumonia, but available data on this relationship are sparse and inconsistent. We followed a prospective cohort of 22,578 males and 25,973 females ...from the Danish Diet, Cancer and Health Study, aged 50-64 yrs and free from major chronic diseases at baseline (1993-1997), for first-time hospitalisation with pneumonia (median follow-up 12 yrs). Compared with males of normal weight, adjusted hazard ratios (HRs) for pneumonia were 1.4 (95% CI 1.2-1.7) for males with moderate obesity (body mass index (BMI) 30.0-34.9 kg·m⁻²), and 2.0 (95% CI 1.4-2.8) for males with severe obesity (BMI ≥ 35.0 kg·m⁻²), controlling for lifestyle and educational variables. Among females the associations were weaker, with adjusted HRs of 0.8 (95% CI 0.6-1.0) for moderate obesity, and 1.2 (95% CI 0.8-1.6) for severe obesity. Adjustment for major chronic diseases diagnosed during follow-up eliminated the associations between obesity and pneumonia risk. Obesity is associated with higher risk of hospitalisation with pneumonia among males but not among females, which is apparently explained by occurrence of other chronic diseases.
Background: Large‐scale prospective studies are needed to assess whether smoking is associated with venous thromboembolism (VTE) (i.e. deep venous thrombosis and pulmonary embolism) independently of ...established risk factors. Objective: To investigate the association between smoking and the risk of VTE among middle‐aged men and women. Methods: From 1993 to 1997, 27 178 men and 29 875 women, aged 50–64 years and born in Denmark, were recruited into the Danish prospective study ‘Diet, Cancer and Health’. During follow‐up, VTE cases were identified in the Danish National Patient Registry. Medical records were reviewed and only verified VTE cases were included in the study. Baseline data on smoking and potential confounders were included in gender stratified Cox proportional hazard models to asses the association between smoking and the risk of VTE. The analyses were adjusted for alcohol intake, body mass index, physical activity, and in women also for use of hormone replacement therapy. Results: During follow‐up, 641 incident cases of VTE were verified. We found a positive association between current smoking and VTE, with a hazard ratio of 1.52 (95% CI, 1.15–2.00) for smoking women and 1.32 (95% CI, 1.00–1.74) for smoking men, and a positive dose‐response relationship. Former smokers had the same hazard as never smokers. Conclusions: Smoking was an independent risk factor for VTE among middle‐aged men and women. Former smokers have the same risk of VTE as never smokers, indicating acute effects of smoking, and underscoring the potential benefits of smoking cessation.
Background
Previous research has shown that the use of the bispectral index (BIS) monitor to measure the depth of anaesthesia reduces the amount of anaesthetics administered and the recovery time ...from general anaesthesia. The effect of BIS on recovery from anaesthesia and consumption of anaesthetics in a paediatric population receiving total intravenous anaesthesia (TIVA) with propofol and remifentanil has not been studied.
Methods
A single‐blind, single‐centre clinical trial. One hundred fifty‐seven patients were enrolled. They were scheduled for ear, nose, and throat surgery and stratified according to age groups (1–3 years, 4–11 years, 12–17 years, 18–65 years) and type of operation, yielding a total of nine subgroups. Patients were randomly allocated to receive either a TIVA with propofol and remifentanil according to conventional clinical practice (control) or guided by BIS. Normalised propofol (μg/kg/min) and remifentanil (μg/kg/min) consumption and time to extubation (s) were the outcome measures.
Results
Children aged 1–3 years in the BIS group had a longer time to extubation compared with controls (P: 0.04). Patients aged 12–17 years in the BIS group received higher maintenance infusion rates of propofol compared with controls (P = 0.02). No significant difference for the outcome variables was evidenced in the other age groups.
Conclusion
BIS monitoring for guidance of propofol‐remifentanil anaesthesia does not result in reduced consumption of anaesthetics and does not reduce time to extubation in adult and children compared with conventional practice. (Clinicaltrials.gov identifier: NCT01043952; http://clinicaltrials.gov/ct2/show/NCT01043952)
Regular exercise reduces the risk of cancer and disease recurrence. Yet the mechanisms behind this protection remain to be elucidated. In this study, tumor-bearing mice randomized to voluntary wheel ...running showed over 60% reduction in tumor incidence and growth across five different tumor models. Microarray analysis revealed training-induced upregulation of pathways associated with immune function. NK cell infiltration was significantly increased in tumors from running mice, whereas depletion of NK cells enhanced tumor growth and blunted the beneficial effects of exercise. Mechanistic analyses showed that NK cells were mobilized by epinephrine, and blockade of β-adrenergic signaling blunted training-dependent tumor inhibition. Moreover, epinephrine induced a selective mobilization of IL-6-sensitive NK cells, and IL-6-blocking antibodies blunted training-induced tumor suppression, intratumoral NK cell infiltration, and NK cell activation. Together, these results link exercise, epinephrine, and IL-6 to NK cell mobilization and redistribution, and ultimately to control of tumor growth.
Display omitted
•Exercise reduces tumor incidence and growth in several mouse models•Exercise increases NK cell infiltration, thereby controlling tumor growth•Epinephrine mobilizes NK cells and β-blockade blunts the tumor suppression•Exercise-induced muscle-derived IL-6 is involved in NK cell redistribution
The beneficial effects of exercise are countless. Pedersen et al. now link exercise, cancer, and immunity and reveal that exercise decreases tumor incidence and growth by over 60% across several mouse tumor models through a direct regulation of NK cell mobilization and trafficking in an epinephrine- and IL-6-dependent manner.
Abstract Introduction Several statistical methods of assessing seasonal variation are available. Brookhart and Rothman 3 proposed a second-order moment-based estimator based on the geometrical model ...derived by Edwards 1 , and reported that this estimator is superior in estimating the peak-to-trough ratio of seasonal variation compared with Edwards’ estimator with respect to bias and mean squared error. Alternatively, seasonal variation may be modelled using a Poisson regression model, which provides flexibility in modelling the pattern of seasonal variation and adjustments for covariates. Method Based on a Monte Carlo simulation study three estimators, one based on the geometrical model, and two based on log-linear Poisson regression models, were evaluated in regards to bias and standard deviation (SD). We evaluated the estimators on data simulated according to schemes varying in seasonal variation and presence of a secular trend. All methods and analyses in this paper are available in the R package Peak2Trough 13. Results Applying a Poisson regression model resulted in lower absolute bias and SD for data simulated according to the corresponding model assumptions. Poisson regression models had lower bias and SD for data simulated to deviate from the corresponding model assumptions than the geometrical model. Conclusion This simulation study encourages the use of Poisson regression models in estimating the peak-to-trough ratio of seasonal variation as opposed to the geometrical model.
L’étude ONSET 1 est une étude randomisée de 26 semaines ayant évalué l’efficacité et la tolérance de l’insuline Faster Aspart (FIA) vs l’insuline Aspart (ASP) chez des patients diabétiques de type 1, ...randomisés selon un schéma 1 :1 :1 : FIA (n=381) et IASP (n=380) au moment du repas en double aveugle ou FIA en ouvert après le repas (n=382) associés à l’insuline detemir. Cette analyse post-hoc a évalué l’impact de l’IMC et du taux d’HbA1c initiaux sur le contrôle glycémique obtenu par FIA ou IASP au moment du repas.
L’analyse a été réalisée sur trois sous-groupes d’IMC ( : <25, 25–30, ≥30kg/m2) et d’HbA1c (≤7,5 %, 7,5–8,0 %, ≥8,0 %).
Sur la totalité de la population de l’étude, la non-infériorité (seuil : 0,4 %) sur la variation de l’HbA1c a été confirmée (différence estimée entre les traitements DET : −0,15 % −0,23 ;−0,07). Il en est de même pour les sous-groupes d’IMC (DET : −0,16 ; −0,15 et −0,12, respectivement) et d’HbA1c (DET :−0,15 ; −0,23 ; −0,08, respectivement) analysés. Aucune différence n’a été observée pour les épisodes d’hypoglycémie sévère ou confirmée. La dose journalière totale d’insuline était comparable pour les différents sous-groupes d’HbA1c et d’IMC (excepté en cas d’IMC initial>30kg/m2 où la dose était significativement plus faible avec FIA).
La différence entre les traitements par FIA ou IASP en termes de contrôle glycémique chez les diabétiques de type 1 n’est pas impactée par le niveau initial d’IMC ou d’HbA1c.
The evidence regarding fatty acids and breast cancer risk is inconclusive. Adipose tissue fatty acids can be used as biomarkers of fatty acid intake and of endogenous fatty acid exposure. Fatty acids ...in adipose tissue are correlated owing to common dietary sources and shared metabolic pathways, which group fatty acids into naturally occurring patterns. We aimed to prospectively investigate associations between adipose tissue fatty acid patterns and long-term risk of total breast cancer and breast cancer subtypes characterised by oestrogen and progesterone receptor status (ER and PR).
This case-cohort study was based on data from the Danish cohort Diet, Cancer and Health. At baseline, a fat biopsy and information on lifestyle and reproductive factors were collected. From the 31 original fatty acids measured, patterns of fatty acids were identified using the treelet transform. During a median follow-up of 5.3 years, 474 breast cancer cases were identified. Hazard ratios and 95% confidence intervals of risk of total breast cancer and of subtypes according to quintiles of factor score were determined by weighted Cox proportional hazards regression.
After adjustment for potential confounders, factor scores for the seven patterns identified by the treelet transform were not associated with risk of total breast cancer, nor with risk of ER+, ER-, PR+ or PR- tumours.
No clear associations between the patterns of fatty acids at baseline and long-term risk of total breast cancer or ER+, ER-, PR+ or PR- tumours were observed.
Given the importance of nutrition therapy in diabetes management, we hypothesized that food intake differs between individuals with and without diabetes. We investigated this hypothesis in two large ...prospective studies including different countries and ethnic groups.
Study populations were the European Prospective Investigation into Cancer and Nutrition Study (EPIC) and the Multiethnic Cohort Study (MEC). Dietary intake was assessed by food frequency questionnaires, and calibrated using 24h-recall information for the EPIC Study. Only confirmed self-reports of diabetes at cohort entry were included: 6192 diabetes patients in EPIC and 13 776 in the MEC. For the cross-sectional comparison of food intake and lifestyle variables at baseline, individuals with and without diabetes were matched 1:1 on sex, age in 5-year categories, body mass index in 2.5 kg/m(2) categories and country.
Higher intake of soft drinks (by 13 and 44% in the EPIC and MEC), and lower consumption of sweets, juice, wine and beer (>10% difference) were observed in participants with diabetes compared with those without. Consumption of vegetables, fish and meat was slightly higher in individuals with diabetes in both studies, but the differences were <10%. Findings were more consistent across different ethnic groups than countries, but generally showed largely similar patterns.
Although diabetes patients are expected to undergo nutritional education, we found only small differences in dietary behavior in comparison with cohort members without diabetes. These findings suggest that emphasis on education is needed to improve the current behaviors to assist in the prevention of complications.
Background. Little is known about temporal trends in the incidence and mortality associated with bacteremia in the general population. Methods. We conducted a population-based cohort study in ...Northern Denmark to examine changes in bacteremia occurrence and 30-day mortality from 1992 through 2006. All patients who received a diagnosis of bacteremia were identified in a population-based bacteremia database and followed up for mortality through the Danish Civil Registry System. We determined the overall annual age- and sex-standardized rates of bacteremia episodes, the incidence of first-time episodes, and the adjusted 30-day mortality by place of acquisition and study period. Results. We identified 14,303 bacteremia episodes, 11,703 (81.8%) of which were incident. The age- and sex-standardized overall rate of bacteremia increased by 68% from 1992 through 2006, and the incidence increased by 46% (from 114 to 166 episodes per 100,000 person-years). Community-acquired and nosocomial bacteremia incidence rates peaked at 92.1 and 77.2 episodes per 100,000 person-years in 2004 and 2002, respectively, whereas the incidence of health care-associated bacteremia increased steadily from 2.9 to 39.8 episodes per 100,000 person-years. Total number of deaths increased from 742 during 1992—1996 to 926 during 2002—2006. The 30-day mortality decreased in patients with community-acquired bacteremia (19.0% during 1992—1996 vs 15.4% during 2002—2006) but remained nearly unchanged for health care—associated (23.4% and 22.0%, respectively) and nosocomial bacteremia (27.9% and 27.7%, respectively). Conclusions. The occurrence of bacteremia in Northern Denmark, regardless of the place of acquisition, increased considerably in the past 15 years, and bacteremia was associated with persistently high 30-day mortality. Thus, bacteremia remains a clinical and public health concern.
PDF
