Cancer and work in Canada with particular reference to occupational risk factors in breast cancer patients in one community and related selected research methods used to investigate those factors

Cancer represents a major cause of human morbidity and mortality. There is no scientific consensus regarding cancer causality or prevention. Occupational exposure potentially remains a major contributor to the incidence of this group of diseases, but the data to assess its impact continues to elude researchers and public health advocates. Among women in industrialised countries, breast cancer is the most prevalent cancer. The known or suspected risk factors, including family history and lifetime oestrogen load, can account for less than 50 percent of the cases. New hypotheses about the role of xenoestrogens and endocrine disrupting compounds are challenging the previous scientific precepts regarding cancer causality. Within this context, the extent to which a community-based occupational history data collection initiative can contribute to advancing our scientific understanding of associations between cancer and work is explored. The possibility that occupational histories data can find associations missed in conventional breast cancer research that ignore occupation is also explored. More specifically, the extent to which data derived from an occupational history questionnaire can provide insight into the potential association between breast cancer risk and farming is examined. Occupational histories of cancer patients contain data that could help to elucidate and inform our understanding of cancer aetiology and prevention. In the community of Windsor, Ontario, Canada a local cancer treatment centre responded to community concerns by cooperating in a collaborative research project to collect the occupational histories of cancer patients. 'Computerised Record of Occupation Made Easy' (CROME) was an innovative method that allowed individual patients to document their lifetime work histories. This data collection process represented the first time a local Canadian cancer treatment center had undertaken such an initiative. Based on the hypothesis generated by CROME, a new research study was launched - Lifetime Occupational History Record (LOHR). Over a two-and-a-half year period, all female patients at the Windsor Regional Cancer Centre with new incident breast cancer were invited to participate in a population-based case-control study along with an equivalent number of randomly selected community controls. A comprehensive lifetime history questionnaire was administered to subjects by interview. Data gathered included known or suspected risk factors along with a complete occupational history of all jobs ever worked. An occupational history of farming alone produced an Odds Ratio (OR) = 2.8 (Cl, 95%, 1.6-4.8). These findings are important for our understanding of cancer causality with implications for resolving the current scientific conflict regarding the role of occupationally caused carcinogenesis. Such collaborative, community-based studies also demonstrate the importance of community participation in the scientific research process

Impact of school closures on the health and well-being of primary school children in Wales UK: a routine data linkage study using the HAPPEN Survey (2018–2020)

Objectives: This study aimed to explore the relationship between initial school closures and children’s health by comparing health and well-being outcomes collected during school closures (April–June 2020) via HAPPEN (the Health and Attainment of Pupils in a Primary Education Network) with data from the same period in 2019 and 2018 via the HAPPEN Survey. Setting: The study was conducted online with 161 primary schools across Wales involved in the ‘HAPPEN At Home’ Survey. Participants: Data were collected via the ‘HAPPEN At Home’ Survey capturing the typical health behaviours of children aged 8–11 years from 1333 participants across Wales. These data were compared with data in 2018 and 2019 also collected between April and June, from HAPPEN (2019 (n=1150) and 2018 (n=475)). Primary and secondary outcome measures: Primary outcomes included validated measures of physical activity, screen time, diet and dental health, as well as well-being, competency and autonomy. Free school meal (FSM) status was used as a proxy for socioeconomic deprivation. Analyses were repeated stratifying by FSM. Results: Comparing responses between April–June in 2020 (n=1068), 2019 (n=1150) and 2018 (n=475), there were improvements in physical activity levels, sleep time, happiness and general well-being for children during school closures compared with previous years. However, children on FSM ate fewer fruits and vegetables (21% less at five or more portions of fruits and vegetables (95% CI: 5.7% to 37%)) and had lower self-assessed school competence compared with 2019. Compared with those not on FSM, they also spent less time doing physical activity (13.03%, 95% CI: 3.3% to 21.7%) and consumed more takeaways (16.3%, 95% CI: 2% to 30%) during school closures. Conclusions: This study suggests that schools are important in reducing inequalities in physical health. The physical health (eg, physical activity and diet) of children eligible for FSM may be affected by prolonged school closures

The potential interaction between clopidogrel and proton pump inhibitors: a systematic review

<p>Abstract</p> <p>Background</p> <p>Recently, several publications have investigated a possible drug interaction between clopidogrel and proton pump inhibitors (PPIs), and regulatory agencies have issued warnings despite discordant study results. In an attempt to clarify the situation, we performed a systematic review with a critical analysis of study methodologies to determine whether varying study quality (that is, bias) could explain the discordant results.</p> <p>Methods</p> <p>A systematic review of all studies reporting clinical outcomes was performed using an electronic literature search of the MEDLINE and EMBASE databases, abstracts from the major cardiology conferences and a hand-search of bibliographies from identified articles. Each study was evaluated for its risk of bias according to a prespecified quality measure scale.</p> <p>Results</p> <p>A total of 18 studies were identified. Ten of 13 studies judged to be of low scientific quality reported a statistically positive interaction between clopidogrel and the general class of PPIs, and each concluded this was likely a clinically meaningful effect. None of the five studies judged to be of moderate or high quality reported a statistically significant association. Multiple sources of heterogeneity (that is, different populations, outcomes assessed, drug exposure methods and study quality) prevented a formal quantitative analysis of all studies. An increased risk of bias was observed in the positive studies, resulting in an inverse correlation between study quality and a reported statistically positive interaction (10/13 versus 0/5; <it>P </it>= p = 0.007). There was also no clinical evidence for a positive interaction according to specific PPIs.</p> <p>Conclusion</p> <p>The observed association between clopidogrel and PPIs is found uniquely in studies judged to be of low quality and with an increased risk of bias. High-quality evidence supporting a clinically significant clopidogrel/PPI interaction is presently lacking.</p

Factors influencing wellbeing in young people during COVID-19: A survey with 6291 young people in Wales

COVID-19 infection and the resultant restrictions has impacted all aspects of life across the world. This study explores factors that promote or support wellbeing for young people during the pandemic, how they differ by age, using a self-reported online survey with those aged 8–25 in Wales between September 2020 and February 2021. Open-ended responses were analysed via thematic analysis to provide further context. A total of 6,291 responses were obtained from 81 education settings across Wales (including primary and secondary schools as well as sixth form, colleges and universities). Wellbeing was highest in primary school children and boys and lowest in those who were at secondary school children, who were girls and, those who preferred not to give a gender. Among primary school children, higher wellbeing was seen for those who played with lots of others (rather than alone), were of Asian ethnicity (OR 2.17, 95% CI: 1.26 to 4.3), had a safe play area (OR: 2.4, 95% CI: 1.67 to 2.56) and had more sleep. To support their wellbeing young people reported they would like to be able to play with their friends more. Among secondary school children those who were of mixed ethnicity reported lower wellbeing (OR: 5.14, 95% CI: 1.68 to 15.79). To support their wellbeing they reported they would like more support with mental health (due to anxiety and pressure to achieve when learning online). This study found self-reported wellbeing differed by gender, ethnicity and deprivation and found younger children report the need for play and to see friends to support wellbeing but older children/young people wanted more support with anxiety and educational pressures

Capitalism, politics, and railroads in Prussia, 1830-1870

(print) xi, 273 p. ; 24 cmPreface -- Capital and political authority in German history. p.1 -- Private or state owned? The railroad question, 1830-1848. p.22 -- The search for mutual accommodation, 1848-1857. p.53 -- The conflict over night trains. p.75 -- Banking and the business class. p.87 -- The Railroad Fund, 1842-1859. p.107 -- The juste milieu, 1857-1870. p.135 -- Conclusion. p.165 -- List of abbreviations. p.177 -- Notes. p.179 -- Bibliography. p.247 -- Index. p.26

The Effect COVID Has Had on the Wants and Needs of Children in Terms of Play: Text Mining the Qualitative Response of the Happen Primary School Survey with 20,000 Children in Wales, UK between 2016 and 2021

Play is central to children’s physical and social development. This study examines changes in children’s response to questions on play opportunities between 2016 and 2021. Primary school children aged 8–11 in Wales participated in the HAPPEN survey between 2016 and 2021. The survey captures a range of information about children’s health and wellbeing, including open-ended questions about what could make them happier. Text mining methods were used to examine how open-ended responses have changed over time in relation to play, before and, after the COVID enforced school closures. A total of 20,488 participant responses were analysed, 14,200 pre-school closures (2016 to pre-March 2020) and 6248 after initial school closures (September 2020–December 2021). Five themes were identified based on children’s open-ended responses; (a) space to play (35%), (b) their recommendations on play (31%), (c) having permission to play (20%), (d) their feelings on health and wellbeing and play (10%) and (e) having time to play (4%). Despite differences due to mitigation measures, the predominant recommendation from children after COVID is that they would like more space to play (outside homes, including gardens), more time with friends and protected time to play with friends in school and at home

Primary school staff perspectives of school closures due to COVID-19, experiences of schools reopening and recommendations for the future: A qualitative survey in Wales

School closures due to the COVID-19 global pandemic are likely to have a range of negative consequences spanning the domains of child development, education and health, in addition to the widening of inequalities and inequities. Research is required to improve understanding of the impact of school closures on the education, health and wellbeing of pupils and school staff, the challenges posed during face-to-face reopening and importantly to identify how the impacts of these challenges can be addressed going forward to inform emerging policy and practice. This qualitative study aimed to reflect on the perspectives and experiences of primary school staff (pupils aged 3–11) in Wales regarding school closures and the initial face-to-face reopening of schools and to identify recommendations for the future. A total of 208 school staff completed a national online survey through the HAPPEN primary school network, consisting of questions about school closures (March to June 2020), the phased face-to-face reopening of schools (June to July 2020) and a return to face-to-face education. Thematic analysis of survey responses highlighted that primary school staff perceive that gaps in learning, health and wellbeing have increased and inequalities have widened during school closures. Findings from this study identified five recommendations; (i) prioritise the health and wellbeing of pupils and staff; (ii) focus on enabling parental engagement and support; (iii) improve digital competence amongst pupils, teachers and parents; (iv) consider opportunities for smaller class sizes and additional staffing; and (v) improve the mechanism of communication between schools and families, and between government and schools

A Breakthrough Propulsion Architecture for Interstellar Precursor Missions: Phase I Final Report

Our breakthrough propulsion architecture is an innovative way to take advantage of kilometer-scale, multi-hundred megawatt, space-based, phased-array lasers to enable rapid transportation throughout the solar system. In this architecture, the laser would beam power over distances of up to 40 AU increasing the available power density relative to solar insolation by two orders of magnitude. The receiving vehicle would have a photovoltaic array with cells tuned to the laser frequency that outputs a voltage of 6 kV to directly-drive a lithium-fueled gridded ion thruster system at an ultra-high specific impulse of 40,000 s. Such a system could enable final spacecraft speeds of greater than 40 AU/year, potentially enabling missions to the solar gravity lens focus at 550 AU in less than 15 years. This is the propulsion architecture of the 22nd century