The aim of this study was to describe breast tumor subtypes by common breast cancer risk factors and to determine correlates of subtypes using baseline data from two pooled prospective breast cancer ...studies within a large health maintenance organization.
Tumor data on 2544 invasive breast cancer cases subtyped by estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (Her2) status were obtained (1868 luminal A tumors, 294 luminal B tumors, 288 triple-negative tumors and 94 Her2-overexpressing tumors). Demographic, reproductive and lifestyle information was collected either in person or by mailed questionnaires. Case-only odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression, adjusting for age at diagnosis, race/ethnicity, and study origin.
Compared with luminal A cases, luminal B cases were more likely to be younger at diagnosis (P = 0.0001) and were less likely to consume alcohol (OR = 0.74, 95% CI = 0.56 to 0.98), use hormone replacement therapy (HRT) (OR = 0.66, 95% CI = 0.46 to 0.94), and oral contraceptives (OR = 0.73, 95% CI = 0.55 to 0.96). Compared with luminal A cases, triple-negative cases tended to be younger at diagnosis (P < or = 0.0001) and African American (OR = 3.14, 95% CI = 2.12 to 4.16), were more likely to have not breastfed if they had parity greater than or equal to three (OR = 1.68, 95% CI = 1.00 to 2.81), and were more likely to be overweight (OR = 1.82, 95% CI = 1.03 to 3.24) or obese (OR = 1.97, 95% CI = 1.03 to 3.77) if premenopausal. Her2-overexpressing cases were more likely to be younger at diagnosis (P = 0.03) and Hispanic (OR = 2.19, 95% CI = 1.16 to 4.13) or Asian (OR = 2.02, 95% CI = 1.05 to 3.88), and less likely to use HRT (OR = 0.45, 95% CI = 0.26 to 0.79).
These observations suggest that investigators should consider tumor heterogeneity in associations with traditional breast cancer risk factors. Important modifiable lifestyle factors that may be related to the development of a specific tumor subtype, but not all subtypes, include obesity, breastfeeding, and alcohol consumption. Future work that will further categorize triple-negative cases into basal and non-basal tumors may help to elucidate these associations further.
Background/AimsEarly childhood adiposity may have significant later health effects, highlighting the importance of early recognition in young children. This study examines the prevalence and ...recognition of obesity and severe obesity in preschool-aged children.MethodsThe electronic medical record was used to examine body mass index (BMI), height, sex, and race/ ethnicity in 42,559 children aged 3-5 years 2007-2010 within Kaiser Permanente Northern California. Normal BMI (BMI <85th percentile); overweight (BMI 85th-94th percentile); obesity (BMI greater than or equal to 95th percentile); and extreme obesity (BMI greater than or equal to 99th percentile or BMI greater than or equal to 1.295th BMI percentile) were classified using the 2000 Center for Disease Control and Prevention growth charts. Provider recognition of elevated BMI was examined for obese children aged 5 years.ResultsAmong 42,559 children, 12.4% (2,698 of 21,720) of boys and 10.0% (2,077 of 20,839) of girls had BMI greater than or equal to 95th percentile. The prevalence was highest among Hispanics (18.2%, 982 of 5,397 boys and 15.2%, 760 of 4,988 girls), followed by blacks (12.4%, 161 of 1,138 boys and 12.7%, 154 of 1,216 girls). A positive trend existed between BMI category and median height percentile, with obesity rates highest in the highest height quintile. The proportion with BMI greater than or equal to 99th percentile was 3.9% (1,670 of 42,559), nearly two-fold higher for boys (66.8%, 1,116 of 1,670) versus girls (33.2%, 554 of 1,670), and identified a larger proportion of children compared to BMI greater than or equal to 1.2 95th BMI percentile (1.6%, P <0.001). Among those aged 5 years, 77.9% of obese children (1082 of 1389) had provider diagnosis of obesity or elevated BMI, increasing to 84.5% (424 of 502) among the subset with severe obesity.ConclusionsObesity and severe obesity are evident as early as age 3-5 years, with race/ ethnic trends similar to older children. This study underscores the need for continued recognition and contextualization of early childhood obesity in order to develop effective strategies for early weight management.
Background/AimsThe aim of the study was to examine the prevalence of obesity and extreme obesity in school-aged children using three classifications based on body mass index (BMI): BMI percentile, ...percentage above the 95th percentile and Z score, and the association of BMI stratification with elevated blood pressure.MethodsThis was a retrospective study of 117,618 children aged 6-17 years receiving well-child care in Kaiser Permanente Northern California between July 2007 and December 2010. Blood pressure, BMI and other data were extracted from electronic records.ResultsThe prevalence of BMI >95th percentile ranged from 14.5% (4,395 of 30,235) in whites and 14.3% (2,287 of 16,033) in Asians to 22.3% (1,809 of 8,124) in blacks and 25.8% (5,734 of 22,187) in Hispanics. For boys, the highest prevalence was in Hispanics (29.2%, 3,346 of 11,452), followed by blacks (21.0%, 879 of 4,193); for girls, the highest prevalence was in blacks (23.7%, 930 of 3,931) and then Hispanics (22.2%, 2,388 of 10,735). For extreme obesity, a threshold of BMI greater than or equal to 120% of the 95th BMI percentile identified the largest proportion of children (5.6%, 6,532 of 117,618) compared to BMI greater than or equal to 99th percentile (3.8%, 4,488 of 117,618) and BMI Z score greater than or equal to 3.0 (0.1%, 83 of 117,618). Stratification of BMI by percentage above the 95th percentile demonstrated a graded relationship between obesity severity and risk of elevated blood pressure.ConclusionsThe prevalence of obesity and extreme obesity in children varied by age, gender and race/ethnicity, with the highest prevalence among Hispanics followed by black children. Compared to BMI thresholds based on the 99th BMI percentile or BMI Z score of 3, classification by BMI greater than or equal to 120% of the 95th BMI percentile identified a greater percentage of severely obese children in whom additional health risk-stratification was achieved by further categorizing based on percentage above the 95th BMI percentile. This classification approach may be useful for obesity management in clinical practice, public health surveillance, and research.
Summary
Background
Although paediatric growth charts are recommended for weight assessment prior to age 20, many teenagers transition earlier to adult care where absolute body mass index (BMI) is ...used. This study examines concordance of weight classification in older teenagers using paediatric percentiles and adult thresholds.
Methods
BMI from 23 640 US teens ages 18–19 years were classified using paediatric BMI percentile criteria for underweight (< 5th), normal (5th to < 85th), overweight (85th to < 95th), obesity (≥ 95th) and severe obesity (≥ 120% × 95th percentile) and adult BMI (kg m−2) criteria for underweight (< 18.5), normal (18.5–24.9), overweight (25–29.9) and obesity: class I (30–34.9), class II (35–39.9) and class III (≥ 40). Concordance was examined using the kappa (κ) statistic. Blood pressure (BP) from the same visit was classified hypertensive for BP ≥ 140/90.
Results
The majority of visits (72.8%) occurred in adult primary care. Using paediatric/adult criteria, 3.4%/5.2% were underweight, 66.6%/58.8% normal weight, 15.7%/21.7% overweight, 14.3%/14.3% obese and 4.9%/6.0% severely/class II–III obese, respectively. Paediatric and adult classification for underweight, normal, overweight and obesity were concordant for 90.3% (weighted κ 0.87 95% confidence interval, 0.87–0.88). For severe obesity, BMI ≥ 120% × 95th percentile showed high agreement with BMI ≥ 35 kg m−2 (κ 0.89 0.88–0.91). Normal‐weight males and moderately obese females by paediatric BMI percentile criteria who were discordantly classified into higher adult weight strata had a greater proportion with hypertensive BP compared with concordantly classified counterparts.
Conclusions
Strong agreement exists between US paediatric BMI percentile and adult BMI classification for older teenagers. Adult BMI classification may optimize BMI tracking and risk stratification during transition from paediatric to adult care.
Newer approaches for classifying gradations of pediatric obesity by level of body mass index (BMI) percentage above the 95th percentile have recently been recommended in the management and tracking ...of obese children. Examining the prevalence and persistence of severe obesity using such methods along with the associations with other cardiovascular risk factors such as hypertension is important for characterizing the clinical significance of severe obesity classification methods.
This retrospective study was conducted in an integrated healthcare delivery system to characterize obesity and obesity severity in children and adolescents by level of body mass index (BMI) percentage above the 95th BMI percentile, to examine tracking of obesity status over 2-3 years, and to examine associations with blood pressure. Moderate obesity was defined by BMI 100-119% of the 95th percentile and severe obesity by BMI ≥120% × 95th percentile. Hypertension was defined by 3 consecutive blood pressures ≥95th percentile (for age, sex and height) on separate days and was examined in association with obesity severity.
Among 117,618 children aged 6-17 years with measured blood pressure and BMI at a well-child visit during 2007-2010, the prevalence of obesity was 17.9% overall and was highest among Hispanics (28.9%) and blacks (20.5%) for boys, and blacks (23.3%) and Hispanics (21.5%) for girls. Severe obesity prevalence was 5.6% overall and was highest in 12-17 year old Hispanic boys (10.6%) and black girls (9.5%). Subsequent BMI obtained 2-3 years later also demonstrated strong tracking of severe obesity. Stratification of BMI by percentage above the 95th BMI percentile was associated with a graded increase in the risk of hypertension, with severe obesity contributing to a 2.7-fold greater odds of hypertension compared to moderate obesity.
Severe obesity was found in 5.6% of this community-based pediatric population, varied by gender and race/ethnicity (highest among Hispanics and blacks) and showed strong evidence for persistence over several years. Increasing gradation of obesity was associated with higher risk for hypertension, with a nearly three-fold increased risk when comparing severe to moderate obesity, underscoring the heightened health risk associated with severe obesity in children and adolescents.
Acellular extracellular matrix preparations are useful for studying cell-matrix interactions and facilitate regenerative cell therapy applications. Several commercial extracellular matrix products ...are available as hydrogels or membranes, but these do not possess tissue-specific biological activity. Because perfusion decellularization is usually not possible with human heart tissue, we developed a 3-step immersion decellularization process. Human myocardial slices procured during surgery are first treated with detergent-free hyperosmolar lysis buffer, followed by incubation with the ionic detergent, sodium dodecyl sulfate, and the process is completed by exploiting the intrinsic DNase activity of fetal bovine serum. This technique results in cell-free sheets of cardiac extracellular matrix with largely preserved fibrous tissue architecture and biopolymer composition, which were shown to provide specific environmental cues to cardiac cell populations and pluripotent stem cells. Cardiac extracellular matrix sheets can then be further processed into a microparticle powder without further chemical modification, or, via short-term pepsin digestion, into a self-assembling cardiac extracellular matrix hydrogel with preserved bioactivity.
Little evidence exists to support the value of reflection in the clinical setting.
To determine whether reflecting and revisiting the "patient" during a standardized patient (SP) examination improves ...junior medical students' performance and to analyze students' perceptions of its value.
Students completed a six-encounter clinical skills examination, writing a guided assessment after each encounter to trigger reflection. SPs evaluated the students with Medical Skills and Patient Satisfaction checklists. During the last three encounters, students could opt to revisit the SP and be reevaluated with identical checklists.
One hundred and forty-nine third year medical students.
Changes in scores in the Medical Skills and Patient Satisfaction checklists between first visit and revisit were tested separately per case as well as across cases.
On the medical skills and patient satisfaction checklists, mean revisit scores across cases were significantly higher than mean first visit scores 12.6 vs 12.2 (pooled SD = 2.4), P = .0001; 31.2 vs 31.0 (pooled SD = 3.5), P = .0001). Sixty-five percent of the time, students rated "reflect-revisit" positively, 34% neutrally, and 0.4% negatively. Five themes were identified in the positive comments: enhancement of (1) medical decision making, (2) patient education/counseling, (3) student satisfaction/confidence, (4) patient satisfaction/confidence, and (5) clinical realism.
Offering third year medical students the option to reflect and revisit an SP during a clinical skills examination produced a small but nontrivial increase in clinical performance. Students perceived the reflect-revisit experience as enhancing patient-centered practices (counseling, education) as well as their own medical decision making and clinical confidence.
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