Obesity is not associated with disease-free interval, melanoma-specific survival, or overall survival in patients with clinical stage IB-II melanoma after SLNB

BACKGROUND AND OBJECTIVES: Clinicopathologic characteristics have prognostic value in clinical stage IB‐II patients with melanoma. Little is known about the prognostic value of obesity that has been associated with an increased risk for several cancer types and worsened prognosis after diagnosis. This study aims to examine effects of obesity on outcome in patients with clinical stage IB‐II melanoma. METHODS: Prospectively recorded data of patients with clinical stage IB‐II melanoma who underwent sentinel lymph node biopsy (SLNB) between 1995 and 2018 at the University Medical Center of Groningen were collected from medical files and retrospectively analyzed. Cox‐regression analyses were used to determine associations between obesity (body mass index> 30), tumor (location, histology, Breslow‐thickness, ulceration, mitotic rate, SLN‐status) and patient‐related variables (gender, age, and social‐economic‐status [SES]) and disease‐free interval (DFI), melanoma‐specific survival (MSS), and overall survival (OS). RESULTS: Of the 715 patients, 355 (49.7%) were women, median age was 55 (range 18.6‐89) years, 149 (20.8%) were obese. Obesity did not significantly affect DFI (adjusted hazard ratio [HR] = 1.40; 95% confidence interval [CI] = 0.98–2.00; p = 0.06), MSS (adjusted HR = 1.48;95%CI = 0.97–2.25; p = 0.07), and OS (adjusted HR = 1.25; 95% CI = 0.85–1.85; p = 0.25). Increased age, arm location, increased Breslow‐thickness, ulceration, increased mitotic rate, and positive SLN‐status were significantly associated with decreased DFI, MSS, and OS. Histology, sex, and SES were not associated. CONCLUSION: Obesity was not associated with DFI, MSS, or OS in patients with clinical stage IB‐II melanoma who underwent SLNB

Sustainable prevention of obesity through integrated strategies: The SPOTLIGHT project's conceptual framework and design

<p>Abstract</p> <p>Background</p> <p>The prevalence of overweight and obesity in Europe is high. It is a major cause of the overall rates of many of the main chronic (or non communicable) diseases in this region and is characterized by an unequal socio-economic distribution within the population. Obesity is largely determined by modifiable lifestyle behaviours such as low physical activity levels, sedentary behaviour and consumption of energy dense diets. It is increasingly being recognised that effective responses must go beyond interventions that only focus on a specific individual, social or environmental level and instead embrace system-based multi-level intervention approaches that address both the individual and environment. The EU-funded project “sustainable prevention of obesity through integrated strategies” (SPOTLIGHT) aims to increase and combine knowledge on the wide range of determinants of obesity in a systematic way, and to identify multi-level intervention approaches that are strong in terms of Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM).</p> <p>Methods/Design</p> <p>SPOTLIGHT comprises a series of systematic reviews on: individual-level predictors of success in behaviour change obesity interventions; social and physical environmental determinants of obesity; and on the RE-AIM of multi-level interventions. An interactive web-atlas of currently running multi-level interventions will be developed, and enhancing and impeding factors for implementation will be described. At the neighbourhood level, these elements will inform the development of methods to assess obesogenicity of diverse environments, using remote imaging techniques linked to geographic information systems. The validity of these methods will be evaluated using data from surveys of health and lifestyles of adults residing in the neighbourhoods surveyed. At both the micro- and macro-levels (national and international) the different physical, economical, political and socio-cultural elements will be assessed.</p> <p>Discussion</p> <p>SPOTLIGHT offers the potential to develop approaches that combine an understanding of the obesogenicity of environments in Europe, and thus how they can be improved, with an appreciation of the individual factors that explain why people respond differently to such environments. Its findings will inform governmental authorities and professionals, academics, NGOs and private sector stakeholders engaged in the development and implementation of policies to tackle the obesity epidemic in Europe.</p

Health status of those affected by the firework disaster in Enschede, four years later

Health status of those affected by the firework disaster in Enschede, four years later.Among the group of affected residents with severe damage to their homes, recovery from health problems did not continue in the period from 18 months to four years after the disaster. The current health problems are of a chronic nature. Affected rescue workers four years after the disaster did not unambiguously report more health or work-related problems than unaffected rescue workers.The presence of chronic health problems in particular groups of affected residents is of importance to the health care providers in Enschede. They can direct their follow-up care toward these specific groups.Native Dutch residents with severe damage to their homes reported health problems 1.5 to 2 times more often than unaffected native Dutch residents of Tilburg. Native Dutch residents without severely damaged homes had scarcely more health problems than the native Dutch in Tilburg. Affected (first- and second-generation) immigrant residents, independent of whether their homes sustained serious damage, reported 1.5 to 3 times more health problems than the unaffected immigrants in Tilburg. Among 80-90% of all affected residents with health problems, the complaints appeared to be chronic: residents had reported the same health problems in earlier surveys.While some groups of affected residents still reported work-related problems four years after the disaster, residents of Enschede were not more likely to be receiving disability benefits than the unaffected residents of Tilburg.Among affected residents with psychological symptoms, 70-83% have had contact with mental health care professionals at some point in the past four years; a minority (25-40%) has ongoing contact.Gezondheid getroffenen vier jaar na de vuurwerkramp Enschede.Bij de groep getroffen bewoners met zware schade aan het huis zet het herstel van de gezondheidsklachten niet door in de periode van 18 maanden tot 4 jaar na de ramp. De aanwezige gezondheidsklachten zijn chronisch van aard. Getroffen reddingswerkers rapporteerden vier jaar na de ramp niet eenduidig meer gezondheidsklachten of problemen op het werk dan niet-getroffen reddingswerkers.De aanwezigheid van chronische klachten bij bepaalde groepen getroffen bewoners is van belang voor de zorgverleners in Enschede. Zij kunnen hun nazorgactiviteiten specifiek op deze groepen richten.Autochtone bewoners met zware schade aan het huis rapporteerden 1,5 tot 2 keer zo vaak gezondheidsklachten als de niet-getroffen autochtonen uit Tilburg. Autochtone getroffenen zonder zware schade aan het huis hadden nauwelijks meer klachten dan de autochtonen uit Tilburg. Allochtone getroffenen rapporteerden 1,5 tot 3 keer meer gezondheidsklachten dan de niet-getroffen allochtonen uit Tilburg, ongeacht of ze wel of geen zware schade aan het huis hadden.In 80-90% van alle getroffen bewoners met gezondheidsklachten vier jaar na de ramp bleken deze klachten chronisch te zijn; zij rapporteerden deze klachten ook al op eerdere onderzoeken. Alhoewel sommige getroffen groepen bewoners nog problemen op het werk hadden, zaten getroffen bewoners vier jaar na de ramp niet vaker in de WAO dan de niet-getroffenen uit Tilburg. Van de getroffen bewoners met psychische klachten heeft 70-83% contact gehad met de GGZ in de afgelopen vier jaar. Een minderheid van 25-40% heeft nu nog contact

Health status of those affected by the firework disaster in Enschede, four years later

zie ook RIVM rapport 630930004, 630930003, 630930002/IVP9920012Gezondheid getroffenen vier jaar na de vuurwerkramp Enschede.Bij de groep getroffen bewoners met zware schade aan het huis zet het herstel van de gezondheidsklachten niet door in de periode van 18 maanden tot 4 jaar na de ramp. De aanwezige gezondheidsklachten zijn chronisch van aard. Getroffen reddingswerkers rapporteerden vier jaar na de ramp niet eenduidig meer gezondheidsklachten of problemen op het werk dan niet-getroffen reddingswerkers.De aanwezigheid van chronische klachten bij bepaalde groepen getroffen bewoners is van belang voor de zorgverleners in Enschede. Zij kunnen hun nazorgactiviteiten specifiek op deze groepen richten.Autochtone bewoners met zware schade aan het huis rapporteerden 1,5 tot 2 keer zo vaak gezondheidsklachten als de niet-getroffen autochtonen uit Tilburg. Autochtone getroffenen zonder zware schade aan het huis hadden nauwelijks meer klachten dan de autochtonen uit Tilburg. Allochtone getroffenen rapporteerden 1,5 tot 3 keer meer gezondheidsklachten dan de niet-getroffen allochtonen uit Tilburg, ongeacht of ze wel of geen zware schade aan het huis hadden.In 80-90% van alle getroffen bewoners met gezondheidsklachten vier jaar na de ramp bleken deze klachten chronisch te zijn; zij rapporteerden deze klachten ook al op eerdere onderzoeken. Alhoewel sommige getroffen groepen bewoners nog problemen op het werk hadden, zaten getroffen bewoners vier jaar na de ramp niet vaker in de WAO dan de niet-getroffenen uit Tilburg. Van de getroffen bewoners met psychische klachten heeft 70-83% contact gehad met de GGZ in de afgelopen vier jaar. Een minderheid van 25-40% heeft nu nog contact.Health status of those affected by the firework disaster in Enschede, four years later.Among the group of affected residents with severe damage to their homes, recovery from health problems did not continue in the period from 18 months to four years after the disaster. The current health problems are of a chronic nature. Affected rescue workers four years after the disaster did not unambiguously report more health or work-related problems than unaffected rescue workers.The presence of chronic health problems in particular groups of affected residents is of importance to the health care providers in Enschede. They can direct their follow-up care toward these specific groups.Native Dutch residents with severe damage to their homes reported health problems 1.5 to 2 times more often than unaffected native Dutch residents of Tilburg. Native Dutch residents without severely damaged homes had scarcely more health problems than the native Dutch in Tilburg. Affected (first- and second-generation) immigrant residents, independent of whether their homes sustained serious damage, reported 1.5 to 3 times more health problems than the unaffected immigrants in Tilburg. Among 80-90% of all affected residents with health problems, the complaints appeared to be chronic: residents had reported the same health problems in earlier surveys.While some groups of affected residents still reported work-related problems four years after the disaster, residents of Enschede were not more likely to be receiving disability benefits than the unaffected residents of Tilburg.Among affected residents with psychological symptoms, 70-83% have had contact with mental health care professionals at some point in the past four years; a minority (25-40%) has ongoing contact.VW

Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century

Aims/hypothesis The aim of this study was to determine and quantify socioeconomic position (SEP) inequalities in diabetes mellitus in different areas of Europe, at the turn of the century, for men and women. Methods We analysed data from ten representative national health surveys and 13 mortality registers. For national health surveys the dependent variable was the presence of diabetes by self-report and for mortality registers it was death from diabetes. Educational level (SEP), age and sex were independent variables, and age-adjusted prevalence ratios (PRs) and risk ratios (RRs) were calculated. Results In the overall study population, low SEP was related to a higher prevalence of diabetes, for example men who attained a level of education equivalent to lower secondary school or less had a PR of 1.6 (95% CI 1.4-1.9) compared with those who attained tertiary level education, whereas the corresponding value in women was 2.2 (95% CI 1.9-2.7). Moreover, in all countries, having a disadvantaged SEP is related to a higher rate of mortality from diabetes and a linear relationship is observed. Eastern European countries have higher relative inequalities in mortality by SEP. According to our data, the RR of dying from diabetes for women with low a SEP is 3.4 (95% CI 2.6-4.6), while in men it is 2.0 (95% CI 1.7-2.4). In Europe, educational attainment and diabetes are inversely related, in terms of both morbidity and mortality rates. This underlines the importance of targeting interventions towards low SEP groups. Access and use of healthcare services by people with diabetes also need to be improved