Alcohol and Cardiovascular Disease

The relationship between alcohol consumption and three cardiovascular diseases (ischemic stroke, hemorrhagic stroke, and heart failure) was examined in a population sample of middle-aged U.S. adults who were participants in the Atherosclerosis Risk in Communities (ARIC) cohort. Alcohol intake was selfreported at two time periods. Stroke events were ascertained by contacting study participants and reviewing hospitalization and death certificate data. Heart failure (HF) events were identified from hospital discharge diagnoses and death certificates. To assess the association between alcohol consumption and each cardiovascular disease outcome separately, age-adjusted incidence rates by level of alcohol intake were calculated. Alcohol intake was categorized based on American Heart Association guidelines. Poisson regression was used to estimate incidence rate ratios (RRs) comparing levels of alcohol intake with never drinkers. Results were stratified by race. The crude RRs for all stroke showed an inverse association for occasional drinkers (RR=0.57, 95%CI:0.42-0.77) and light/moderate drinkers (RR=0.74, 95%CI:0.59-0.94) as compared with never drinkers. After adjustment for age, race, sex, and socioeconomic status the RRs were attenuated (comparing occasional with never drinkers RR=0.91, 95%CI:0.67-1.25 and light/moderate with never drinkers iv (RR=0.99, 95%CI:0.77-1.28). Results for ischemic stroke were similar to those for all stroke. The crude RRs for hemorrhagic stroke were 1.16 (95%CI:0.51-2.63) for former drinkers, 1.13 (95%CI:0.48-2.69) for occasional drinkers, 0.74 (95%CI:0.32- 1.71) for light/moderate drinkers, and 1.67 (95%CI:0.66-4.25) for heavy drinkers, as compared with never drinkers. Adjustment for age, race, sex, and socioeconomic status resulted in an increase in RRs. The RRs comparing each level of alcohol intake with never drinkers for HF incidence were 1.12 (95%CI:0.95-1.31) for former drinkers, 0.67 (95%CI:0.54-0.82) for occasional drinkers, 0.65 (95%CI:0.54-0.78) for light/moderate drinkers, and 0.75 (95%CI:0.59-0.95) for heavy drinkers. Similar patterns were seen for blacks and whites. We found no compelling evidence that occasional or light/moderate alcohol intake reduces stroke incidence rates. Adjusted RRs suggest that any level of alcohol intake increases hemorrhagic stroke incidence rates. We found a positive association for former drinking and an inverse association for current drinking for HF incidence. While the association between former drinkers and HF incidence was evident for whites, the evidence among blacks was less strong

A Narrative Review of Specialist Parkinson’s Nurses:Evolution, Evidence and Expectation

Extended nursing roles have existed since the 1940s. The first specialist nurse for Parkinson’s disease, a complex neurodegenerative disease, was appointed in the United Kingdom (UK) in 1989. A review was undertaken using MEDLINE and Cumulative Index to the Nursing and Allied Health Literature (CINAHL), relating to the role and evidence for Parkinson’s disease nurse specialists (PDNSs). PDNSs fulfil many roles. Trials of their effectiveness have failed to show a positive benefit on health outcomes, but their input appears to improve the wellbeing of people with Parkinson’s. Now embedded in the UK Parkinson’s multidisciplinary team, this care model has since been adopted widely, including successful dissemination of training to countries in Sub-Saharan Africa. The lack of evidence to support the benefit of PDNSs may reflect an insufficient duration and intensity of the intervention, the outcome measures selected or the need to combine PDNS input with other evidence-based interventions. Whilst the current evidence base for their effectiveness is limited, their input appears to improve subjective patient wellbeing and they are considered a vital resource in management. Better evidence in the future will support the development of these roles and may facilitate the application of specialist nurses to other disease areas

Increased Risk of Developing Breast Cancer after a False-Positive Screening Mammogram

Women with a history of false-positive mammogram result may be at increased risk of developing subsequent breast cancer

Insurance-Based Differences in Time to Diagnostic Follow-up after Positive Screening Mammography

Insurance may lengthen or inhibit time to follow-up after positive screening mammography. We assessed the association between insurance status and time to initial diagnostic follow-up after a positive screening mammogram

Lung Cancer Screening Practices in North Carolina CT Facilities

The burden of lung cancer in the United States is staggering, with more Americans dying from lung cancer than the next four most common cancers combined. With endorsement of lung cancer screening by the United States Preventive Services Task Force and reimbursement by the Centers for Medicare and Medicaid Services (CMS), the number screened for lung cancer with low-dose computed tomography (LDCT) is anticipated to rise in the near future

Travel Burden to Breast MRI and Utilization: Are Risk and Sociodemographics Related?

Mammograms, unlike magnetic resonance imaging (MRI), are relatively geographically accessible. Additional travel time is often required to access breast MRI. However, the amount of additional travel time and whether it varies based on sociodemographic or breast cancer risk factors is unknown

National Performance Benchmarks for Modern Screening Digital Mammography: Update from the Breast Cancer Surveillance Consortium

Purpose To establish performance benchmarks for modern screening digital mammography and assess performance trends over time in U.S. community practice. Materials and Methods This HIPAA-compliant, institutional review board-approved study measured the performance of digital screening mammography interpreted by 359 radiologists across 95 facilities in six Breast Cancer Surveillance Consortium (BCSC) registries. The study included 1 682 504 digital screening mammograms performed between 2007 and 2013 in 792 808 women. Performance measures were calculated according to the American College of Radiology Breast Imaging Reporting and Data System, 5th edition, and were compared with published benchmarks by the BCSC, the National Mammography Database, and performance recommendations by expert opinion. Benchmarks were derived from the distribution of performance metrics across radiologists and were presented as 50th (median), 10th, 25th, 75th, and 90th percentiles, with graphic presentations using smoothed curves. Results Mean screening performance measures were as follows: abnormal interpretation rate (AIR), 11.6 (95% confidence interval [CI]: 11.5, 11.6); cancers detected per 1000 screens, or cancer detection rate (CDR), 5.1 (95% CI: 5.0, 5.2); sensitivity, 86.9% (95% CI: 86.3%, 87.6%); specificity, 88.9% (95% CI: 88.8%, 88.9%); false-negative rate per 1000 screens, 0.8 (95% CI: 0.7, 0.8); positive predictive value (PPV) 1, 4.4% (95% CI: 4.3%, 4.5%); PPV2, 25.6% (95% CI: 25.1%, 26.1%); PPV3, 28.6% (95% CI: 28.0%, 29.3%); cancers stage 0 or 1, 76.9%; minimal cancers, 57.7%; and node-negative invasive cancers, 79.4%. Recommended CDRs were achieved by 92.1% of radiologists in community practice, and 97.1% achieved recommended ranges for sensitivity. Only 59.0% of radiologists achieved recommended AIRs, and only 63.0% achieved recommended levels of specificity. Conclusion The majority of radiologists in the BCSC surpass cancer detection recommendations for screening mammography; however, AIRs continue to be higher than the recommended rate for almost half of radiologists interpreting screening mammograms. © RSNA, 2016 Online supplemental material is available for this article

Factors Associated with Preoperative Magnetic Resonance Imaging Use among Medicare Beneficiaries with Nonmetastatic Breast Cancer

Preoperative breast magnetic resonance imaging (MRI) use among Medicare beneficiaries with breast cancer has substantially increased from 2005 to 2009. We sought to identify factors associated with preoperative breast MRI use among women diagnosed with ductal carcinoma in situ (DCIS) or stage I-III invasive breast cancer (IBC)

Is the Closest Facility the One Actually Used? An Assessment of Travel Time Estimation Based on Mammography Facilities

Characterizing geographic access depends on a broad range of methods available to researchers and the healthcare context to which the method is applied. Globally, travel time is one frequently used measure of geographic access with known limitations associated with data availability. Specifically, due to lack of available utilization data, many travel time studies assume that patients use the closest facility. To examine this assumption, an example using mammography screening data, which is considered a geographically abundant health care service in the United States, is explored. This work makes an important methodological contribution to measuring access--which is a critical component of health care planning and equity almost everywhere. We analyzed one mammogram from each of 646,553 women participating in the US based Breast Cancer Surveillance Consortium for years 2005-2012. We geocoded each record to street level address data in order to calculate travel time to the closest and to the actually used mammography facility. Travel time between the closest and the actual facility used was explored by woman-level and facility characteristics

Effects of air pollution and the introduction of the London Low Emission Zone on the prevalence of respiratory and allergic symptoms in schoolchildren in East London: a sequential cross-sectional study

The adverse effects of traffic-related air pollution on children’s respiratory health have been widely reported, but few studies have evaluated the impact of traffic-control policies designed to reduce urban air pollution. We assessed associations between traffic-related air pollutants and respiratory/allergic symptoms amongst 8–9 year-old schoolchildren living within the London Low Emission Zone (LEZ). Information on respiratory/allergic symptoms was obtained using a parent-completed questionnaire and linked to modelled annual air pollutant concentrations based on the residential address of each child, using a multivariable mixed effects logistic regression analysis. Exposure to traffic-related air pollutants was associated with current rhinitis: NOx (OR 1.01, 95% CI 1.00–1.02), NO2 (1.03, 1.00–1.06), PM10 (1.16, 1.04–1.28) and PM2.5 (1.38, 1.08–1.78), all per μg/m3 of pollutant, but not with other respiratory/allergic symptoms. The LEZ did not reduce ambient air pollution levels, or affect the prevalence of respiratory/allergic symptoms over the period studied. These data confirm the previous association between traffic-related air pollutant exposures and symptoms of current rhinitis. Importantly, the London LEZ has not significantly improved air quality within the city, or the respiratory health of the resident population in its first three years of operation. This highlights the need for more robust measures to reduce traffic emissions