Adipose Tissue Distribution and Survival Among Women with Nonmetastatic Breast Cancer.

ObjectivePrevious studies of breast cancer survival have not considered specific depots of adipose tissue such as subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT).MethodsThis study assessed these relationships among 3,235 women with stage II and III breast cancer diagnosed between 2005 and 2013 at Kaiser Permanente Northern California and between 2000 and 2012 at Dana Farber Cancer Institute. SAT and VAT areas (in centimeters squared) were calculated from routine computed tomography scans within 6 (median: 1.2) months of diagnosis, covariates were collected from electronic health records, and vital status was assessed by death records. Hazard ratios (HRs) and 95% CIs were estimated using Cox regression.ResultsSAT and VAT ranged from 19.0 to 891 cm2 and from 0.484 to 454 cm2 , respectively. SAT was related to increased risk of death (127-cm2 increase; HR [95% CI]: 1.13 [1.02-1.26]), but no relationship was found with VAT (78.18-cm2 increase; HR [95% CI]: 1.02 [0.91-1.14]). An association with VAT was noted among women with stage II cancer (stage II: HR: 1.17 [95% CI: 0.99-1.39]; stage III: HR: 0.90 [95% CI: 0.76-1.07]; P interaction < 0.01). Joint increases in SAT and VAT were associated with mortality above either alone (simultaneous 1-SD increase: HR 1.19 [95% CI: 1.05-1.34]).ConclusionsSAT may be an underappreciated risk factor for breast cancer-related death

Gender, economics and culture: diversity and the international evolution of smoking prevalence

Aims: To examine whether the observed diversity between national patterns of smoking prevalence could require modification of the World Health Organization (WHO) linear model for an international `smoking pandemic' (a worldwide epidemic) to address data from non-western countries. Method: We conducted secondary research using current measures in three publicly available databases: Globalink, the International Labour Organization and the World Bank (all internetaccessible). The measures we used are the separate percentage data for men and women on: smoking and employment and national income per capita (US$) and percentage growth per annum. Results: Regression analysis showed that women smokers were more frequent in countries with higher national income, but women were less likely to smoke in countries of rapid growth. Men were less likely to smoke in countries with higher national income, but more likely to smoke in countries of rapid growth. Two principle components together explained 62% of all the variance in the international data. The largest factor was positively correlated with the percentage of employed females, the percentage of female smokers and national income per capita, but negatively correlated with the percentage of male smokers and percentage annual growth. The effect of female employment was not continuous, but above a threshold of 51%, was associated with a higher prevalence of female smoking. The smaller, second factor was only weakly correlated with any smoking variables. Conclusions: In his 1994 model (subsequently adopted by the WHO) Lopez looked at historical trends in `stages' of smoking prevalence. These have been associated with `stages' of economic development. We extended this analysis to look at a dynamic change (% annual growth) and a social indicator (employment). Male and female smoking is affected differentially by economic change and by level of income. These are also strongly related to the percentage of women in employment. This has implications for workplace policies on smoking

Changing population characteristics, effect-measure modification, and cancer risk factor identification

Epidemiologic studies have identified a number of lifestyle factors, e.g. diet, obesity, and use of certain medications, which affect risk of colon cancer. However, the magnitude and significance of risk factor-disease associations differ among studies. We propose that population trends of changing prevalence of risk factors explains some of the variability between studies when factors that change prevalence also modify the effect of other risk factors. We used data collected from population-based control who were selected as study participants for two time periods, 1991–1994 and 1997–2000, along with data from the literature, to examine changes in the population prevalence of aspirin and non-steroidal anti-inflammatory medication (NSAID) use, obesity, and hormone replacement therapy (HRT) over time. Data from a population-based colon cancer case-control study were used to estimate effect-measurement modification among these factors. Sizeable changes in aspirin use, HRT use, and the proportion of the population that is obese were observed between the 1980s and 2000. Use of NSAIDs interacted with BMI and HRT; HRT use interacted with body mass index (BMI). We estimate that as the prevalence of NSAIDs use changed from 10% to almost 50%, the colon cancer relative risk associated with BMI >30 would change from 1.3 to 1.9 because of the modifying effect of NSAIDs. Similarly, the relative risk estimated for BMI would increase as the prevalence of use of HRT among post-menopausal women increased. In conclusion, as population characteristics change over time, these changes may have an influence on relative risk estimates for colon cancer for other exposures because of effect-measure modification. The impact of population changes on comparability between epidemiologic studies can be kept to a minimum if investigators assess exposure-disease associations within strata of other exposures, and present results in a manner that allows comparisons across studies. Effect-measure modification is an important component of data analysis that should be evaluated to obtain a complete understanding of disease etiology

Interplays of psychometric abilities on learning gross anatomy

In recent years, there has been international debate concerning how students learn anatomy. The rapid increase in scientific knowledge has put pressure on the place of anatomy within the medical and allied health professional curricula, as well as the design and structure of anatomy courses. In this regard, relatively little is known about what medical and allied health professions students want from an anatomy course or how they learn it. To assess students’ learning approaches and perceptions of anatomy, a series of psychometric tests were administered to Medical (n=82), Podiatry (n=21), and Pharmacy (n=74) students in the United Kingdom. Analysis of the Anatomy Learning Experience (ALE) questionnaire revealed a predominantly positive attitude towards anatomy and the dissection room, with most valuing cadaveric dissection and not regarding it as a daunting environment. Further to this, analysis of the Approaches to Studying Inventory for Students (ASSIST) revealed predominant preferences for strategic and deep approaches. Personality traits were associated with certain learning approaches; neuroticism with surface (p=0.038), conscientiousness with both a deep and strategic approach (p=0.000 and p=0.060 respectively). Certain personality traits were also found to be associated with anatomy experience e.g. neuroticism and achievement striving felt the most effective way to learn was to get their hands in and feel for structures (p=0.044 and p=0.012 respectively). This study concludes that undergraduate students of medicine, podiatry and pharmacy learn anatomy in slightly different ways. Preparation for classroom activities should centre on the promotion of an optimum learning environment and teaching strategies which promote a deep approach to learning. Understanding students’ personality and learning experiences should help teachers improve the students’ learning of anatomy for effective application to clinical practice

Study on Solar KANG Heating System for Cold Areas

AbstractThe current rural traditional heated kang cannot meet people's increasing requirements of comfort and environmental protection. This paper propose solar kang heating system in cold regions. System performance and heating effect were analyzed. We selected two typical rooms. One was set in traditional kang, and the other one was solar Kang type. Using temperature recording instrument and 64 roads inspection instrument and other instruments, we test the indoor temperature and the kang surface temperature of two rooms. Solar kang thermal resistance, heat storage, heat dissipation and heating effect were analyzed and compared. The results of the study show this system have the smaller fluctuation, more comfort while alleviating the kang surface overheat or super-cooling problem. It satisfied the requirements of indoor thermal comfort. The warming rate is 5.17°C/h, and the cooling rate is 3.01°C/h. These are slower than traditional Huokang speed. It improved the heat storage capacity of kang body with surface heat dissipation 1237W. Average temperature of the solar kang heating room was improved 3.28°C. It gets the smaller indoor temperature fluctuation. PMV values are concentrated about -0.5, and this basically meet the requirements of the user comfort