Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium

Objective - To investigate the impact of smoking and smoking cessation on cardiovascular mortality, acute coronary events, and stroke events in people aged 60 and older, and to calculate and report risk advancement periods for cardiovascular mortality in addition to traditional epidemiological relative risk measures. Design - Individual participant meta-analysis using data from 25 cohorts participating in the CHANCES consortium. Data were harmonised, analysed separately employing Cox proportional hazard regression models, and combined by meta-analysis. Results - Overall, 503¿905 participants aged 60 and older were included in this study, of whom 37¿952 died from cardiovascular disease. Random effects meta-analysis of the association of smoking status with cardiovascular mortality yielded a summary hazard ratio of 2.07 (95% CI 1.82 to 2.36) for current smokers and 1.37 (1.25 to 1.49) for former smokers compared with never smokers. Corresponding summary estimates for risk advancement periods were 5.50 years (4.25 to 6.75) for current smokers and 2.16 years (1.38 to 2.39) for former smokers. The excess risk in smokers increased with cigarette consumption in a dose-response manner, and decreased continuously with time since smoking cessation in former smokers. Relative risk estimates for acute coronary events and for stroke events were somewhat lower than for cardiovascular mortality, but patterns were similar. Conclusions - Our study corroborates and expands evidence from previous studies in showing that smoking is a strong independent risk factor of cardiovascular events and mortality even at older age, advancing cardiovascular mortality by more than five years, and demonstrating that smoking cessation in these age groups is still beneficial in reducing the excess risk

Aging Hallmarks: the benefits of physical exercise

World population has been continuously increasing and progressively aging. Aging is characterized by a complex and intraindividual process associated with nine major cellular and molecular hallmarks, namely, genomic instability, telomere attrition, epigenetic alterations, a loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication. This review exposes the positive antiaging impact of physical exercise at the cellular level, highlighting its specific role in attenuating the aging effects of each hallmark. Exercise should be seen as a polypill, which improves the health-related quality of life and functional capabilities while mitigating physiological changes and comorbidities associated with aging. To achieve a framework of effective physical exercise interventions on aging, further research on its benefits and the most effective strategies is encouraged

Investigation of experiences of women who developed lymph edema related to breast cancer treatment and their expectations from nurses

Amaç: Meme kanseri tedavisine bağlı lenf ödem gelişen kadınların deneyimlerini ve hemşirelerden beklentilerini açıklamaktır. Yöntem: Araştırma nitel bir çalışmadır. Ölçüt örneklem yöntemi kullanılmıştır. Primer meme kanseri tedavisine bağlı lenf ödem tanısı konulan 20 kadın araştırmanın örneklemini oluştumuştur. Veriler "yarı yapılandırılmış görüşme formu" kullanılarak, "derinlemesine görüşme" yöntemi ile toplanmıştır. Her kadın ile bir kez görüşülmüştür. Görüşmelerin tamamı kadınlardan izin alınarak ses kayıt cihazı ile kayıt edilmiştir. Verilerin analizinde "betimsel analiz" yöntemi kullanılmıştır. Bulgular: Meme kanseri tedavisine bağlı lenf ödem gelişen kadınların yaşadıkları deneyimler ve hemşirelerden beklentileri ile ilgili beş ana tema ve alt temalar saptanmıştır. Bu ana temalaræ lenf ödemi fark etme, fiziksel, duygusal, sosyal olarak yaşadıkları deneyimler ve hemşirelerden beklentileridir. Sonuç ve Öneriler: Bu araştırmada elde edilen sonuçlara göreæ kadınlar lenf ödem geliştikten sonra fiziksel olarak lenf ödem tedavisi, öz bakım, ev işleri, uyku, meslek ve yaz mevsimi ile ilgili, duygusal olarak gelecekle ilgili endişe ve kendisini engelli olarak görme, sosyal olarak yaşadıkları deneyimler eşi, çocukları ve diğer aile üyeleri, arkadaşları ve sosyal çevre, beden imajı ve hobileri olmak üzere günlük yaşamlarında bir çok konuda güçlük yaşadıklarını belirtmişlerdir. Kadınlar, hemşirelerden lenf ödemin önlenmesi, tedavisi ve bakımı hakkında bilgi vermelerini, tedavi sürecinde aynı hemşireden danışmanlık almak istediklerini ifade etmişlerdir. Aynı hemşirenin, meme kanseri tedavisi süresince (ameliyat, radyoterapi, kemoterapi, hormonterapi vb) kadınlara lenf ödemin önlenmesi, geliştikten sonra bakım ve yönetilmesi hakkında danışmanlık yapmaları önerilmektedir. Ayrıca hemşirelerin bu alanda yeterliliklerini artırmak için sertifika programlarının geliştirilmesi önerilmektedir. Anahtar Kelimeler: Lenf ödem, meme kanseri, hemşirelik, nitel çalışma Aim: It is to investigate experiences of women who developed lymph edema related to breast cancer treatment and their expectations from nurses. Method: Research is qualitative study. Sampling criteria method was used. The sample of research consists of 20 women with primer breast cancer diagnosed lymph edema related to breast cancer treatment. This study was carried out at their homes of women and in quite room. Data was collected with method of "in depth interview" by using "semi-structured interview form". We interviewed with each women once. All interviews were recorded with audio recorder by getting permission of women. Data were assessed with "descriptive analysis". Results: Five main themes and sub-themes have been determined concerning the expectations had from nurses and the experiences of the women who had advanced lymph edema due to breast cancer treatment. These main themesæ recognize of lymph edema, physical, emotional and social experiences and expectations from nurses. Conclusion and Suggestions: According to conclusions obtained from this researchæ the women who had advanced lymph edema have stated that they had some difficulties regarding their daily lives and had physical experiences such as lymph edema treatment, self care, houseworks, sleep, occupation, related to summer, had emotional experiences such as anxiety about future and seeing themselves as disabled, had social experiences such as body image, their husbands, children, family members, friends and social environment and hobbies. The women stated that they asked to the nurses that lymph edema to be prevented and be informed about the treatment and care and receive consultancy from the same nurse in the process of treatment. The same nurse is suggested that she prevents the lymph edema and gives consultancy about care and operation after lymph edema is advanced in the process of breast cancer treatment (surgical, radiotherapy, chemotherapy, hormonotherapy etc.). The nurses are also suggested to develop their certificate programs in order to increase their qualifications in this field. Keywords: Lymph edema, breast cancer, nursing, qualitative stud

Smoking and All-cause Mortality in Older Adults: Results From the CHANCES Consortium

Introduction Smoking is known to be a major cause of death among middle-aged adults, but evidence on its impact and the benefits of smoking cessation among older adults has remained limited. Therefore, we aimed to estimate the influence of smoking and smoking cessation on all-cause mortality in people aged ≥60 years. Methods Relative mortality and mortality rate advancement periods (RAPs) were estimated by Cox proportional hazards models for the population-based prospective cohort studies from Europe and the U.S. (CHANCES [Consortium on Health and Ageing: Network of Cohorts in Europe and the U.S.]), and subsequently pooled by individual participant meta-analysis. Statistical analyses were performed from June 2013 to March 2014. Results A total of 489,056 participants aged ≥60 years at baseline from 22 population-based cohort studies were included. Overall, 99,298 deaths were recorded. Current smokers had 2-fold and former smokers had 1.3-fold increased mortality compared with never smokers. These increases in mortality translated to RAPs of 6.4 (95% CI=4.8, 7.9) and 2.4 (95% CI=1.5, 3.4) years, respectively. A clear positive dose-response relationship was observed between number of currently smoked cigarettes and mortality. For former smokers, excess mortality and RAPs decreased with time since cessation, with RAPs of 3.9 (95% CI=3.0, 4.7), 2.7 (95% CI=1.8, 3.6), and 0.7 (95% CI=0.2, 1.1) for those who had quit <10, 10 to 19, and ≥20 years ago, respectively. Conclusions Smoking remains as a strong risk factor for premature mortality in older individuals and cessation remains beneficial even at advanced ages. Efforts to support smoking abstinence at all ages should be a public health priority. © 2015 American Journal of Preventive Medicine