The Cochrane 2018 review on brief interventions in primary care for hazardous and harmful alcohol consumption: a distillation for clinicians and policy makers

Aims An updated Cochrane systematic review assessed effectiveness of screening and brief intervention to reduce hazardous or harmful alcohol consumption in general practice or emergency care settings. This paper summarises the implications of the review for clinicians. Methods Cochrane methods were followed. Reporting accords with PRISMA guidance. We searched multiple resources to September 2017, seeking randomised controlled trials of brief interventions to reduce hazardous or harmful alcohol consumption in people attending general practice, emergency care or other primary care settings for reasons other than alcohol treatment. Brief intervention was defined as a conversation comprising five or fewer sessions of brief advice or brief lifestyle counselling and a total duration of less than 60 min. Our primary outcome was alcohol consumption, measured as or convertible to grams per week. We conducted meta-analyses to assess change in consumption, and subgroup analyses to explore the impact of participant and intervention characteristics. Results We included 69 studies, of which 42 were added for this update. Most studies (88%) compared brief intervention to control. The primary meta-analysis included 34 studies and provided moderate-quality evidence that brief intervention reduced consumption compared to control after one year (mean difference −20 g/wk, 95% confidence interval −28 to −12). Subgroup analysis showed a similar effect for men and women. Conclusions Brief interventions can reduce harmful and hazardous alcohol consumption in men and women. Short, advice-based interventions may be as effective as extended, counselling-based interventions for patients with harmful levels of alcohol use who are presenting for the first time in a primary care setting

Mortality and cancer incidence 1952-1998 in UK participants in the UK atmospheric nuclear weapons tests and experimental programmes

An updated analysis has been conducted of mortality and cancer incidence among men from the United Kingdom who took part in the UK atmospheric nuclear weapon tests and experimental programmes in Australia and the Pacific between 1952 and 1967. Rates of multiple myeloma, leukaemia, other cancers, and non-cancer causes of death were studied, as in previous analyses of these men. Based on a total of 21,357 test participants and 22,333 controls identified from the same Ministry of Defence (MOD) archives, information was obtained on deaths and cancer registrations up to the end of 1998. Compared with national mortality rates, rates of deaths from all causes increased to a similar extent in both test participants and controls with longer follow-up, with Standardised Mortality Ratios (SMRs) of 89 and 88 respectively over the full follow-up period and a relative risk of 1.01 (90% confidence interval (Cl) 0.98-1.05). For all cancers, the corresponding SMRs were 93 for test participants and 92 for controls, with a relative risk of 1.01 (90% Cl 0.96-1.08) for all cancers. Mortality from multiple myeloma was consistent with national rates both for test participants and controls, and the relative risk of myeloma incidence among test participants relative to controls was 1.14 (90% Cl 0.74-1.74) over the full follow up period and 0.79 (90% Cl 0.45-1.38) during the extended period of follow up (1991-98). Over the full follow-up period, leukaemia mortality among test participants was consistent with national rates, whilst rates among controls were significantly lower (SMR 68), and there was a suggestion of a raised risk among test participants relative to controls (relative risk 1.45 (0.96-2.17), one-sided p=0.07, two-sided p=0.14); the corresponding relative risk for leukaemia incidence was 1.33 (0.97-1.84), one-sided p==0.07, two-sided p=0.14. After excluding chronic lymphatic leukaemia (CLL), which is not thought to be radiation-inducible, the relative risk of leukaemia mortality increased to 1.83 (1.15-2.93, one-sided p=0.015, two-sided p==0.027), whilst that for incidence was little changed. Among other types of cancer, only for liver cancer incidence was there evidence of differences in rates between participants and controls in both the earlier period of follow-up and in the additional period. Mortality rates among test participants from causes other than cancer were generally similar to those among the controls. It is concluded that that overall levels of mortality and cancer incidence in UK nuclear weapons test participants have continued to be similar to those in a matched control group, and for overall mortality to be lower than expected from national rates. There was no evidence of an increased risk of multiple myeloma among test participants in recent years. The suggestion in the first analysis of this study of a raised risk of myeloma has not been confirmed in longer periods of follow-up and is likely to have been a chance finding. Analyses of subgroups with greater potential for exposure provided little evidence of increased risks, although the numbers of men involved were smaller and the statistical power was therefore less. In common with earlier analyses, there is some evidence of a raised risk of leukaemia among test participants relative to controls, particularly when focussing on leukaemia other than CLL. This could be a chance finding, in view of low leukaemia rates among the controls and the generally small radiation doses recorded for test participants. However, the possibility that test participation caused a small absolute risk of leukaemia other than CLL among men cannot be ruled out; the evidence for any increased risk appears to have been greatest in the early years after the tests, but a small risk may have persisted in more recent years. (author)Title from coverSIGLEAvailable from British Library Document Supply Centre- DSC:9091. 900(NRPB-W27) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Radiation cataractogenesis: A review of recent studies.

The lens of the eye is recognized as one of the most radiosensitive tissues in the human body, and it is known that cataracts can be induced by acute doses of less than 2 Gy of low-LET ionizing radiation and less than 5 Gy of protracted radiation. Although much work has been carried out in this area, the exact mechanisms of radiation cataractogenesis are still not fully understood. In particular, the question of the threshold dose for cataract development is not resolved. Cataracts have been classified as a deterministic effect of radiation exposure with a threshold of approximately 2 Gy. Here we review the combined results of recent mechanistic and human studies regarding induction of cataracts by ionizing radiation. These studies indicate that the threshold for cataract development is certainly less than was previously estimated, of the order of 0.5 Gy, or that radiation cataractogenesis may in fact be more accurately described by a linear, no-threshold model

Joint analysis of three European nested case-control studies of lung cancer among radon exposed miners Exposure restricted to below 300 WLM

International audienceAnalyses of lung cancer risk were carried out using restrictions to nested case-control data on uranium miners in the Czech Republic, France, and Germany. With the data restricted to cumulative exposures below 300 working-level-months (WLM) and adjustment for smoking status, the excess relative risk (ERR) per WLM was 0.0174 (95% CI 0.009-0.035), compared to the estimate of 0.008 (95% CI 0.004-0.014) using the unrestricted data. Analysis of both the restricted and unrestricted data showed that time since exposure windows had a major effect; the ERR/WLM was six times higher for more recent exposures (5-24 y) than for more distant exposures (25 y or more). Based on a linear model fitted to data on exposures <300 WLM, the ERR WLM of lung cancer at 30 y after exposure was estimated to be 0.021 (95% CI 0.011-0.040), and the risks decreased by 47% per decade increase in time since exposure. The results from analyzing the joint effects of radon and smoking were consistent with a sub-multiplicative interaction; the ERR WLM was greater for non-smokers compared with current or ex-smokers, although there was no statistically significant variation in the ERR WLM by smoking status. The patterns of risk with radon exposure from the combined European nested case-control miner analysis were generally consistent with those based on the BEIR VI Exposure-Age-Concentration model. Based on conversions from WLM to time weighted averaged radon concentration (expressed per 100 Bq m), the results from this analysis of miner data were in agreement with those from the joint analysis of the European residential radon studies. Copyright © 2013 Health Physics Society

Ionizing radiation and risk of chronic lymphocytic leukemia in the 15-country study of nuclear industry workers

In contrast to other types of leukemia, chronic lymphocytic leukemia (CLL) has long been regarded as non-radiogenic, i.e. not caused by ionizing radiation. However, the justification for this view has been challenged. We therefore report on the relationship between CLL mortality and external ionizing radiation dose within the 15-country nuclear workers cohort study. The analyses included, in seven countries with CLL deaths, a total of 295,963 workers with more than 4.5 million person-years of follow-up and an average cumulative bone marrow dose of 15 mSv; there were 65 CLL deaths in this cohort. The relative risk (RR) at an occupational dose of 100 mSv compared to 0 mSv was 0.84 (95% CI 0.39, 1.48) under the assumption of a 10-year exposure lag. Analyses of longer lag periods showed little variation in the RR, but they included very small numbers of cases with relatively high doses. In conclusion, the largest nuclear workers cohort study to date finds little evidence for an association between low doses of external ionizing radiation and CLL mortality. This study had little power due to low doses, short follow-up periods, and uncertainties in CLL ascertainment from death certificates; an extended follow-up of the cohorts is merited and would ideally include incident cancer cases. © 2008 by Radiation Research Society

On Some Tests of the Covariance Matrix Under General Conditions

Covariance matrix, Test statistic, Characteristic function, Canonical correlation, Multiple correlation coefficient,

Power and sample size calculations for multivariate linear models with random explanatory variables

MANCOVA, MANOVA, multivariate regression, noncentral F distribution.,