Oral Bisphosphonate Exposure and the Risk of Upper Gastrointestinal Cancers

The association between oral bisphosphonate use and upper gastrointestinal cancer has been controversial. Therefore, we examined the association with esophageal and gastric cancer within the Kaiser Permanente, Northern California population. A total of 1,011 cases of esophageal (squamous cell carcinoma and adenocarcinoma) and 1,923 cases of gastric adenocarcinoma (cardia, non-cardia and other) diagnosed between 1997 and 2011 from the Kaiser Permanente, Northern California cancer registry were matched to 49,886 and 93,747 controls, respectively. Oral bisphosphonate prescription fills at least one year prior to the index date were extracted. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between prospectively evaluated oral bisphosphonate use with incident esophageal and gastric cancer diagnoses with adjustment for potential confounders. After adjustment for potential confounders, no significant associations were found for esophageal squamous cell carcinoma (OR 0.88; 95% CI: 0.51, 1.52), esophageal adenocarcinoma (OR 0.68; 95% CI: 0.37, 1.24), or gastric non-cardia adenocarcinoma (OR 0.83, 95% CI: 0.59, 1.18), but we observed an adverse association with gastric cardia adenocarcinoma (OR 1.64; 95% CI: 1.07, 2.50). In conclusion, we observed no association between oral bisphosphonate use and esophageal cancer risk within a large community-based population. A significant association was detected with gastric cardia and other adenocarcinoma risk, although this needs to be replicated

Planned repeat cesarean section at term and adverse childhood health outcomes: a record-linkage study

Global cesarean section (CS) rates range from 1% to 52%, with a previous CS being the commonest indication. Labour following a previous CS carries risk of scar rupture, with potential for offspring hypoxic brain injury, leading to high rates of repeat elective CS. However, the effect of delivery by CS on long-term outcomes in children is unclear. Increasing evidence suggests that in avoiding exposure to maternal bowel flora during labour or vaginal birth, offspring delivered by CS may be adversely affected in terms of energy uptake from the gut and immune development, increasing obesity and asthma risks, respectively. This study aimed to address the evidence gap on long-term childhood outcomes following repeat CS by comparing adverse childhood health outcomes after (1) planned repeat CS and (2) unscheduled repeat CS with those that follow vaginal birth after CS (VBAC).A data-linkage cohort study was performed. All second-born, term, singleton offspring delivered between 1 January 1993 and 31 December 2007 in Scotland, UK, to women with a history of CS (n = 40,145) were followed up until 31 January 2015. Outcomes assessed included obesity at age 5 y, hospitalisation with asthma, learning disability, cerebral palsy, and death. Cox regression and binary logistic regression were used as appropriate to compare outcomes following planned repeat CS (n = 17,919) and unscheduled repeat CS (n = 8,847) with those following VBAC (n = 13,379). Risk of hospitalisation with asthma was greater following both unscheduled repeat CS (3.7% versus 3.3%, adjusted hazard ratio [HR] 1.18, 95% CI 1.05-1.33) and planned repeat CS (3.6% versus 3.3%, adjusted HR 1.24, 95% CI 1.09-1.42) compared with VBAC. Learning disability and death were more common following unscheduled repeat CS compared with VBAC (3.7% versus 2.3%, adjusted odds ratio 1.64, 95% CI 1.17-2.29, and 0.5% versus 0.4%, adjusted HR 1.50, 95% CI 1.00-2.25, respectively). Risk of obesity at age 5 y and risk of cerebral palsy were similar between planned repeat CS or unscheduled repeat CS and VBAC. Study limitations include the risk that women undergoing an unscheduled CS had intended to have a planned CS, and lack of data on indication for CS, which may confound the findings.Birth by repeat CS, whether planned or unscheduled, was associated with an increased risk of hospitalisation with asthma but no difference in risk of obesity at age 5 y. Greater risk of death and learning disability following unscheduled repeat CS compared to VBAC may reflect complications during labour. Further research, including meta-analyses of studies of rarer outcomes (e.g., cerebral palsy), are needed to confirm whether such risks are similar between delivery groups

‘Understanding the whole person’: the first in a series of literature reviews on severe and multiple disadvantage.

Because many people experience multiple and complex needs, it is important to understand the cross-cutting and distinct themes across the journeys of recovery from mental illness, recovery from substance misuse, and desistance from crime. The key themes highlighted in our paper are based on a review of the literature within three separate disciplinary fields: mental health, criminology and substance misuse. Common themes emerging from the literature • The three areas are processes, not events, involving setbacks, lapses, and trying again. While they are difficult many people eventually achieve lasting success - we should all be optimistic about people’s potential. • These journeys are about moving towards something positive: this is as if not more important than rejecting or moving away from bad experiences. These are inherently hopeful journeys looking towards the future. • The journeys are highly subjective and about the reality of people’s lives, not top-down interventions or treatments. A person must perceive an opportunity or event as meaningful for it to make a positive impact. • Success is associated with developing a strong, positive identity. This means overcoming labels like ‘offender’ and ‘patient’ and believing in one’s own agency and capability. • Healthy relationships are crucial. They give emotional and practical support as well as providing meaningful roles and opportunities to give back. But social networks are unhelpful in some cases, and often positive relationships are rare for certain groups such as drug-using offenders and other people facing multiple needs. • It is key to believe in one’s role in the wider community and society, and internalised stigma can be a big barrier to recovery and desistance. Distinctive themes: • Recovery in mental health focuses on recovery from institutions and the effects of being a mental health patient; whereas the other two domains focus more on processes of behaviour and motivational change taking place in a social context. • Recovery in mental health also emphasises the need for socially inclusive policies and adaptations that allow people with an ongoing severe mental illness to still participate on their own terms. • Some of the variation in themes is partly due to the particular research methods used by each domain. The review concludes that some of the themes distinctive to mental health recovery have potential relevance to all three domains. It also highlights the literature’s relevance to multiple needs policy and reiterates that there are many ways to support people on their complex but often successful journeys towards change

Integrated care pathways

Health delivery systems globally are under increasing pressure to provide effective services to meet the increasing needs of society, whilst working with finite resources in aiming to do so. Whilst family-centred care has developed within the field of children's nursing and is utilised alongside the nursing process to organise and aid care delivery, there is an increasing acknowledgement and development of integrated care pathways (ICP). This chapter discusses the origin and elements of ICPs and gives consideration to the development of ICPs for specific patient groups within a clinical environment. To illustrate and appreciate the structure and support ICPs offer in delivering care to children and their families, an ICP for the management of bronchiolitis is utilised in this chapter to outline how these documents can support care planning and delivery.<br/

Oral bisphosphonates and colorectal cancer

Use of oral bisphosphonates has been associated with a decreased risk of colorectal cancer (CRC), but the association may be related to residual confounding by healthy lifestyle or body mass index (BMI). Therefore, we conducted a prospective nested case-control study within the Kaiser Permanente, Northern California health system cohort. In total, 12,505 CRC cases were individually matched to 599,534 controls. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using conditional logistic regression models with adjustment for important covariates extracted from the database. Participants who had ever used oral bisphosphonates were less likely than non-users to be diagnosed with CRC (OR 0.82; 95% CI: 0.74, 0.89). Colon and rectum site-specific associations were similar to the overall association. A stronger inverse association for ever use of bisphosphonates was observed for men (OR 0.63; 95% CI: 0.47, 0.85), however when stratified by previous lower endoscopy, the association was only observed in the participants who did not have a previous lower endoscopy (OR 0.73 (0.64, 0.83)). In conclusion, we found that oral bisphosphonate use was associated with a decreased odds of CRC, however this association may be due to residual confounding by BMI or another confounder

Descriptive characteristics of the esophageal and gastric cancer cases and controls from Kaiser Permanente, Northern California, 1997–2011.

<p>Abbreviations: Charlson Comorbidity Index (CCI), gastroesophageal reflux disease (GERD), proton pump inhibitors (PPIs), H2-receptor antagonists (H2-RAs), hormone replacement therapy (HRT), non-steroidal anti-inflammatory drugs (NSAIDs), squamous cell carcinoma (SCC)</p><p>Descriptive characteristics of the esophageal and gastric cancer cases and controls from Kaiser Permanente, Northern California, 1997–2011.</p