DDT exposure in early childhood and female breast cancer: Evidence from an ecological study in Taiwan

© 2018 Elsevier Ltd Researchers still lack consensus on the association between exposure to DDT and the risk of breast cancer. One reason could be that the measurements of DDT obtained during or near the time of diagnosis may not reflect exposure during the etiologically relevant time period in a woman's life. This study undertook an ecological analysis to investigate whether exposure to DDT among cohort born between 1951 and 1959 (i.e. age 0–5 years) and who reached the age 50–54 years during 2001–2013 had an increased risk of breast cancer in adulthood. To do this, we used the number of DDT sprays in each township during the anti-malaria campaign in Taiwan in the 1950s as a proxy for direct DDT exposure. The DDT sprays were then linked to the township female breast cancer incidence rate in the 2000s when the birth cohorts had reached age 50–54 years. Insurance claims data were used to identify breast cancer cases during 1996–2013. Zero-Inflated Poisson regression was performed to estimate the effect of DDT sprays on the breast cancer incidence rate. The analysis was based on a total of 9 birth cohorts (1951–1959) in 349 townships who had lived at least up to age 50. On average, one DDT spray experienced during age 0–5 years was associated with an increase of 8 more female breast cancer cases per 100,000 during age 50–54. The effect appears to increase with the number of sprays. Our finding suggests that DDT exposure in early childhood could raise the risk of breast cancer in adulthood

The impact of nurse staffing methodologies on nurse and patient outcomes: A systematic review

Aim Aim of this study is to systematically review and synthesize available evidence to identify the association between nurse staffing methodologies and nurse and patient outcomes. Design Systematic review and narrative synthesis. Data sources A search of MEDLINE (EBSCO), CINAHL (EBSCO) and Web of Science was conducted for studies published in English between January 2000 and January 2020. Review methods The reporting of this review and narrative synthesis was guided by the preferred reporting items for systematic and meta-analysis guidelines (PRISMA) statement and data synthesis guided by the Synthesis Without Meta-analysis (SWiM) guideline. The quality of each article was assessed using the Mixed Methods Appraisal Tool. Results Twenty-two studies met the inclusion criteria. Twenty-one used the mandated minimum nurse-to-patient ratio methodology and one study assessed the number of nurse hours per patient day staffing methodology. Both methodologies were mandated. All studies that reported on nurse outcomes demonstrated an improvement associated with the implementation of mandated minimum nurse-to-patient ratio, but findings related to patient outcomes were inconclusive. Conclusions Evidence on the impact of specific nurse staffing methodologies and patient and nurse outcomes remains highly limited. Future studies that examine the impact of specific staffing methodologies on outcomes are required to inform this fundamental area of management and practice

Are There Ethnic Disparities in Exposure to Workplace Hazards Among New Zealand Migrants to Australia?

Disparities in exposure to workplace hazards exist between Māori and non-Māori workers in New Zealand, with Māori workers generally incurring poorer conditions. This study aimed to determine if these ethnic disparities are similar after migration to Australia. A national cross-sectional telephone survey asked participants what tasks they undertook in their job to assess exposure to carcinogens as well as whether they experienced ethnic discrimination, bullying, job precariousness, or job strain. A total of 389 New Zealand Caucasians and 152 Māori/Pasifika workers were recruited. After adjustment, 79% of Māori/Pasifika compared with 67% of New Zealand Caucasian workers were assessed as being exposed to at least one carcinogen at work. Māori/Pasifika workers were also more likely to report ethnic discrimination and fair or poor current health than New Zealand Caucasians. Some ethnic disparities in exposure to workplace hazards in New Zealand are apparent after migration to Australia

Prevalence of exposure to multiple occupational carcinogens among exposed workers in Australia.

© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. OBJECTIVES: Workers can be exposed to a range of different carcinogenic agents in the workplace. However, previous studies have often focused on prevalence of exposure to a single carcinogen, resulting in substantial knowledge gaps regarding the extent of multiple exposures in the workplace. This study aims to investigate the current prevalence of occupational exposure to multiple carcinogens among exposed workers in Australia. METHODS: The data for this study come from the Australian Work Exposures Study, a nationwide cross-sectional telephone survey of Australian workers aged between 18 and 65. Information was collected about the respondents' current employment and numerous demographic factors using a web-based application (Occupational Integrated Database Exposure Assessment System) to conduct the interview, with predefined algorithms used to automatically assign exposures to carcinogens based on the respondents' job tasks. RESULTS: The majority (81%) of exposed respondents were assessed as being probably exposed to more than one carcinogen, and 26% reported exposure to five or more carcinogens. We found that after adjusting for occupation, exposure to multiple carcinogens was more likely among male respondents, while older workers (aged between 55 and 65) were less likely to be exposed to multiple carcinogens. CONCLUSIONS: This study provides information on the prevalence of exposure to multiple carcinogens in the general population that has not previously been reported. This information could be useful for the intervention and control of occupational exposures to the prioritised carcinogens identified in this study

Lifestyle and occupational factors associated with participation in breast mammography screening among Western Australian women

© The Author(s) 2019. Objectives: Various lifestyle and occupational factors have been associated with an increased risk of breast cancer, but there is limited research investigating the relationship between these factors and participation in breast cancer screening. This study explores the associations between lifestyle and occupational factors and participation in breast mammography screening among women living in Western Australia. Methods: This study involved 1705 women aged 40 and older who participated as controls in the Breast Cancer Environment and Employment Study conducted in Western Australia. Self-reported questionnaire data were collected on participation in mammography screening, demographic factors, and lifestyle and occupational variables (smoking, physical activity, alcohol consumption, body mass index, use of contraceptive pill and hormone replacement therapy, breastfeeding, occupation, and participation in shift work). Multivariate modified Poisson regression was used to identify variables associated with ever participation in breast mammography screening. Results: Just over 88% of women reported having ever had a mammogram. Likelihood of having ever had a mammogram was higher among women who had ever used hormone replacement therapy (adjusted prevalence ratio (aPR) = 1.05, 95% CI 1.02–1.07). Women who worked in clerical occupations (aPR = 1.06, 95% CI 1.01–1.11) or home duties (aPR = 1.05, 95% CI 1.00–1.11) were also more likely to report having ever had a mammogram compared with those in professional or technical occupations. Conclusions: Participation in mammography screening was found to differ by lifestyle and occupational factors. These results have important implications for public health strategies on improving screening participation

Qat Chewing and risk of potentially malignant and malignant oral disorders: A systematic review

© 2015, NIOC Health Organization. All right resurved. Background: Qat(also known as Khat, Kat andMiraa) is a green-leaved plant (Catha edulis). It is a shrub indigenous to Yemen and certain parts of eastern Africa. Chewing the leaves, which have sympathomimetic and euphoric effects, has been documented in many countries and increased with worldwide migration. The effect of long-term chewing Qaton the oral cavity is unknown. Objective:A systematic review was performed to identify any associations between Qat chewing and the occurrence of potentially malignant and malignant oral disorders. Methods:Medline and the Web of Science were searched for articles published before May 2014 without limits with regard to publication date and language. Results:From a total of 890 papers identified, 17 English papers reported potentially malignant or malignant oral disorders and Qat chewing. One additional paper in Arabic language was identified from reviewing the list of references of eligible papers. It was found that exposure to Qatmay be associated with potentially malignant and malignant oral disorders, but methodological issues, such as inadequate study design, sample size, selection of study subjects, clinical evaluations of outcome and limited adjustment for confounders, limit the strength of the evidence base in this area. Conclusion:The association between Qat chewing and potentially malignant and malignant oral disorders remains debatable and requires further investigations

Reflections from Women with an Interval Breast Cancer Diagnosis: A Qualitative Analysis of Open Disclosure in the BreastScreen Western Australia Program

Background: ‘Interval breast cancer’ describes a malignancy that is diagnosed after a negative screening mammogram. Open disclosure is a process of addressing a negative health outcome that includes an apology and an opportunity for the client to discuss concerns. BreastScreen Western Australia has implemented a policy of open disclosure. The purpose of this study was to gain an understanding of clients’ experience with interval cancer and their attitude towards the screening programme by conducting a thematic analysis of written responses from women participating in the open disclosure process. Methods: Women experiencing an interval cancer diagnosis between 2011 and 2020 were sent a questionnaire by mail. It included two broad questions with free-text responses. A qualitative analysis of the responses was conducted using an inductive approach. Responses were de-identified and data were thematically analysed and presented using verbatim quotations. Results: Five themes emerged in response to “what could we have done better?”: ‘nothing,’ ‘broaden scope,’ ‘service delivery,’ ‘breast density education’ and ‘more education’ generally. Six themes emerged in response to “what did we do well?”: ‘staffing,’ ‘overall satisfaction,’ ‘reminders,’ ‘follow-up after interval cancer,’ ‘efficiency’ and ‘information and education provision.’ An additional theme of ‘storytelling’ emerged from both questions: an opportunity for the woman to share her experience of cancer. Conclusion: Most women expressed positive attitudes towards the service and appreciated giving feedback in the open disclosure process. Several themes supporting the role of BreastScreen in education were identified, including providing information about breast density, breast health, and limitations of screening

Impact of the age expansion of breast screening on screening uptake and screening outcomes among older women in BreastScreen western

Objectives To assess the impact of age expansion of screening (EOS) of the target age group from 50 to 69 to 50–74 in Australia, which began mid-2013, by examining screening uptake and outcomes of older women, and by identifying factors associated with continuing screening after reaching the age of 75 years. Methods Retrospective study using data from women aged 65+ who attended BreastScreen Western Australia between 2010 and 2017 for free mammograms. Screening uptake and screening outcomes were calculated for the periods before (2010–2012) and after (2015–2017) the age EOS to women aged 70–74. Logistic regression was used to identify variables associated with continuing screening after reaching age 75 years, while controlling for possible confounding variables. Results Age EOS increased screening uptake amongst women aged 70–74 b y 36% and amongst women ≥75 years by 3% while screening uptake in women aged 65-69 decreased by 3%. Rate of invasive screened-detected cancers significantly decreased among women aged 70–74 from 11.4/1000 screens before to 8.1/1000 screens after age EOS. Likelihood of continuing screening into age ≥75 years was higher in women who had a personal history or a family history of breast cancer, or used hormone replacement therapy within six months of screening. Women who were born outside Australia were less likely to continue screening after reaching age 75 years. Conclusions Our study found that age EOS to women aged 70–74 was effective in increasing screening uptake in this age-group but was accompanied by a moderate increase in screening uptake amongst women ≥75 years via self-referral for whom potential benefit of screening may be limited

Does the Size of a Company Make a Difference in the Prevalence of Exposure to Asthmagens and in the Use of Respiratory Protective Equipment?

Introduction: About half of all workers in high-income countries work in small companies. However, regulatory bodies and researchers predominantly work with large companies because they are more convenient to study and easier to reach. We aimed to estimate the prevalence of exposure to asthmagens and the use of respiratory protective equipment (RPE) by company size. Methods: This analysis used data from the Australian Work Exposures Study-Asthma, a telephone survey which investigated exposure to 27 asthmagen groups. Results: Among 4844 respondents, 18.8, 19.9, 31.9, and 29.4% of workers reported working in micro (<5 employees), small (5-19 employees), medium (20-200 employees), and large (>200 employees) companies, respectively. Compared to workers in large companies, workers in micro, small, or medium companies had higher prevalence of exposure to most asthmagens and lesser use of RPE. Conclusion: Our results suggest that policy actions and regulatory measures should target micro/small companies in order to have the greatest effect