Alcohol consumption and risk of common cancers: evidence from a cohort of adults from the United Kingdom

Background: Recent guidelines from the United Kingdom recommend that men and women should drink no more than 14 units of alcohol per week. This recommendation takes into account the link between alcohol and several cancers; however, there is a dearth of high quality evidence from the UK to support this. Methods: Alcohol consumption using a detailed diary was obtained from 8,670 adults representative of the UK population in 1984/5, with follow-up data from cancer registries until 2009. Hazard ratios (HR) adjusted for several variables including cigarette smoking were calculated for cancers of the breast, lung, colorectum and prostate separately using Cox regression. Results: Units per week on a typical basis, fitted as a linear term, was associated with breast cancer in women (HR=1.27 per 10 units/week; 95% CI 1.03-1.58) and lung cancer in men (HR=1.16; 1.06-1.27). Increased risks of lung (HR=2.23; 1.18-4.24) and colorectal (HR = 2.28; 1.13-4.57) cancer were seen in men at 15-28 units/week along with higher levels of consumption. Some findings differed by alcohol type. Conclusions: Overall, alcohol consumption of 15-28 units/week may be harmful in men with respect to common cancers. A linear association between alcohol consumption and risk of breast cancer was observed in women

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Biodiversity, climate change, and ecosystem services

The capacity of ecosystems to deliver essential services to society is already under stress. The additional stresses imposed by climate change in the coming years will require extraordinary adaptation. We need to track the changing status of ecosystems, deepen our understanding of the biological underpinnings for ecosystem service delivery and develop new tools and techniques for maintaining and restoring resilient biological and social systems. We will be building on an ecosystem foundation that has been radically compromised during the past half century. Most rivers have been totally restructured, oceans have been severely altered and depleted, coral reefs are near the tipping point of disappearing as functional ecosystems, over half of the land surface is devoted to livestock and crop agriculture, with little consideration for the ecosystemservices that are being lost as a consequence, some irrevocably so. We have already seen many regime shifts, or tipping points, due to human activity, even before the onset of measurable climate change impacts on ecosystems. Climate change, caused mainly by anthropogenic greenhouse gas emissions, will disrupt our ecosystem base in new ways. Already we are seeing widespread signs of change. Species behaviors are altering and disrupting mutualisms of long standing. We are seeing extinctions within vulnerable habitats and conditions where migrations are necessary for survival but where often there are no pathways available for successful movement in the fragmented world of today. These challenges represent an extraordinary threat to society and a call for urgent attention by the scientific community

Ecosystem Impacts of Geoengineering: A Review for Developing a Science Plan

Geoengineering methods are intended to reduce climate change, which is already having demonstrable effects on ecosystem structure and functioning in some regions. Two types of geoengineering activities that have been proposed are: carbon dioxide (CO2) removal (CDR), which removes CO2 from the atmosphere, and solar radiation management (SRM, or sunlight reflection methods), which reflects a small percentage of sunlight back into space to offset warming from greenhouse gases (GHGs). Current research suggests that SRM or CDR might diminish the impacts of climate change on ecosystems by reducing changes in temperature and precipitation. However, sudden cessation of SRM would exacerbate the climate effects on ecosystems, and some CDR might interfere with oceanic and terrestrial ecosystem processes. The many risks and uncertainties associated with these new kinds of purposeful perturbations to the Earth system are not well understood and require cautious and comprehensive research

Students' participation in collaborative research should be recognised

Letter to the editor