Higher incidence of premenopausal breast cancer in less developed countries; myth or truth?

Background: Fundamental etiologic differences have been suggested to cause earlier onset of breast cancer in less developed countries (LDCs) than in more developed countries (MDCs). We explored this hypothesis using world-wide breast cancer incidence data. Methods: We compared international age-standardized incidence rates (ASR) of pre- (<50 years) and postmenopausal (≥50 years) breast cancers as well as temporal trends in ASRs of pre-and postmenopausal breast cancer among selected countries during 1975–2008. We used joinpoint log-linear regression analysis to estimate annual percent changes (APC) for premenopausal and postmenopausal breast cancer in the northern Europe and in Black and White women population in the US. Results: Premenopausal breast cancers comprised a substantially higher proportion of all incident breast cancers in LDCs (average 47.3%) compared to MDCs (average 18.5%). However, the ASR of premenopausal breast cancer was consistently higher in MDCs (29.4/100,000) than LDCs (12.8/100,000). The ASR of postmenopausal cancer was about five-fold higher in the MDCs (307.6/100,000) than the LDCs (65.4/100,000). The APC of breast cancer in Denmark was substantially higher in postmenopausal (1.33%) than premenopausal cancer (0.98%). Higher incidence of breast cancer among the white than black women in the US was pertained only to the postmenopausal cancer. Conclusion: The substantial and consistent lower age-specific incidence of breast cancer in LDCs than in MDCs contradicts the theory of earlier onset. Demographic differences with fewer old women in LDCs and lower prevalence of risk factors of postmenopausal cancer are the most likely explanation to the lower mean age at diagnosis in these countries

An empirical derivation of the optimal time interval for defining ICU readmissions

BACKGROUND:: Intensive care unit (ICU) readmission rates are commonly viewed as indicators of ICU quality. However, definitions of ICU readmissions vary, and it is unknown which, if any, readmissions are associated with ICU quality. OBJECTIVE:: Empirically derive the optimal interval between ICU discharge and readmission for purposes of considering ICU readmission as an ICU quality indicator. RESEARCH DESIGN:: Retrospective cohort study. SUBJECTS:: A total of 214,692 patients discharged from 157 US ICUs participating in the Project IMPACT database, 2001-2008. MEASURES:: We graphically examined how patient characteristics and ICU discharge circumstances (eg, ICU census) were related to the odds of ICU readmissions as the allowable interval between ICU discharge and readmission was lengthened. We defined the optimal interval by identifying inflection points where these relationships changed significantly and permanently. RESULTS:: A total of 2242 patients (1.0%) were readmitted to the ICU within 24 hours; 9062 (4.2%) within 7 days. Patient characteristics exhibited stronger associations with readmissions after intervals >48-60 hours. By contrast, ICU discharge circumstances and ICU interventions (eg, mechanical ventilation) exhibited weaker relationships as intervals lengthened, with inflection points at 30-48 hours. Because of the predominance of afternoon readmissions regardless of time of discharge, using intervals defined by full calendar days rather than fixed numbers of hours produced more valid results. DISCUSSION:: It remains uncertain whether ICU readmission is a valid quality indicator. However, having established 2 full calendar days (not 48 h) after ICU discharge as the optimal interval for measuring ICU readmissions, this study will facilitate future research designed to determine its validity. Copyright © 2013 by Lippincott Williams & Wilkins.http://deepblue.lib.umich.edu/bitstream/2027.42/175339/2/ICU readm time.pdfPublished versionDescription of ICU readm time.pdf : Published versio

Performance as Intersectional Resistance: Power, Polyphony and Processes of Abolition

Australia’s brutal carceral-border regime is a colonial system of intertwining systems of oppression that combine the prison-industrial complex and the border-industrial complex. It is a violent and multidimensional regime that includes an expanding prison industry and onshore and offshore immigration detention centres; locations of cruelty, and violent sites for staging contemporary politics and coloniality. This article shares insights into the making of a radical intersectional dance theatre work titled Jurrungu Ngan-ga by Marrugeku, Australia’s leading Indigenous and intercultural dance theatre company. The production, created between 2019–2021, brings together collaborations through and across Indigenous Australian, Kurdish, Iranian, Palestinian, Filipino, Filipinx, and Anglo settler performance, activism and knowledge production. The artistic, political and intellectual dimensions of the show reinforce each other to interrogate Australia’s brutal carceral regime and the concept of the border itself. The article is presented in a polyphonic structure of expanded interviews with the cast and descriptions of the resulting live performance. It identifies radical ways that intersectional and trans-disciplinary performances can, as an ‘act of liberation’, be applied to make visible, embody, address, and help dismantle systems of oppression, control and subjugation