The cervical cancer epidemic that screening has prevented in the UK.

BACKGROUND: Recent reports suggest that the reduction in mortality achieved by the UK national cervical screening programme is too small to justify its financial and psychosocial costs, except perhaps in a few high-risk women. METHODS: We analysed trends in mortality before 1988, when the British national screening programme was launched, to estimate what future trends in cervical cancer mortality would have been without any screening. FINDINGS: Cervical cancer mortality in England and Wales in women younger than 35 years rose three-fold from 1967 to 1987. By 1988, incidence in this age-range was among the highest in the world despite substantial opportunistic screening. Since national screening was started in 1988, this rising trend has been reversed. INTERPRETATION: Cervical screening has prevented an epidemic that would have killed about one in 65 of all British women born since 1950 and culminated in about 6000 deaths per year in this country. However, these estimates are subject to substantial uncertainty, particularly in relation to the effects of oral contraceptives and changes in sexual behaviour. 80% or more of these deaths (up to 5000 deaths per year) are likely to be prevented by screening, which means that about 100000 (one in 80) of the 8 million British women born between 1951 and 1970 will be saved from premature death by the cervical screening programme at a cost per life saved of about pound 36000. The birth cohort trends also provide strong evidence that the death rate throughout life is substantially lower in women who were first screened when they were younger

Candidate gene-environment interactions in breast cancer.

Gene-environment interactions have the potential to shed light on biological processes leading to disease, identify individuals for whom risk factors are most relevant, and improve the accuracy of epidemiological risk models. We review the progress that has been made in investigating gene-environment interactions in the field of breast cancer. Although several large-scale analyses have been carried out, only a few significant interactions have been reported. One of these, an interaction between CASP8-rs1045485 and alcohol consumption has been replicated, but others have not, including LSP1- rs3817198 and parity, and 1p11.2-rs11249433 and ever being parous. False positive interactions may arise if the gene and environment are correlated and the causal variant is less frequent than the tag SNP. We conclude that while much progress has been made in this area it is still too soon to tell whether gene-environment interactions will fulfil their promise. Before we can make this assessment we will need to replicate (or refute) the reported interactions, identify the causal variants that underlie tag-SNP associations and validate the next generation of epidemiological risk models

Healthy lifestyles or ‘dangerous competition’? – self-tracking and the geographies of surveillance and materiality in the lives of young people.

Self-tracking technologies monitor and measure aspects of your body and life, such as your physical activity and diet, with a view to achieve a healthier lifestyle and self-optimisation. In recent years, there have been concerns around young people’s use of self-tracking technologies, particularly in relation to obsessive behaviours. Within academia, researchers have analysed how individuals undertake self-tracking to take responsibility for their health and research has also begun to recognise the sensory, embodied, affective experiences of self-tracking. However, there is limited scholarship on young people’s experiences of self-tracking technologies. In this research, I explore the factors that impact the relationship young people have with their self-tracking technologies. In doing so, I seek to better understand the different motivations for individuals to undertake self-tracking and the complex ways in which young people make sense of and relate to their data. Moreover, I seek to advance applications of feminist new materialism to self-tracking practices and synthesise this with Foucauldian theory, to explore the relationship between humans and nonhumans and the ways in which individuals engage in self-governance through self-tracking. I draw on 30 digital interviews (video, email, phone and instant messenger) with young people aged 18-26 in the UK, alongside an auto-netnography of my own self-tracking experiences. I focus on the ways in which self-tracking impacts experiences and understandings of health and body perceptions, the ways in which self-tracking technologies become a part of young people’s embodied, sensory and everyday experiences and the ways in which other people impact experiences of self-tracking and understandings of health. I argue that young people’s experiences of self-tracking are extremely individualistic and argue that the ways in which individuals engage in self-tracking and the reasons for doing so change over space and time due to the dynamic, fluid nature of the human-technology assemblage. I conclude this thesis with a discussion of the possibilities for future research. I argue that future research should focus on a more diverse range of experiences, whilst questioning who does not have access to self-tracking technologies. I also discuss the opportunities for future research to work collaboratively with participants to understand how self-tracking technologies can be designed in more qualitative, individualist ways that account for the diverse ways in which individuals may use them

CYP3A variation, premenopausal estrone levels, and breast cancer risk.

BACKGROUND: Epidemiological studies have provided strong evidence for a role of endogenous sex steroids in the etiology of breast cancer. Our aim was to identify common variants in genes involved in sex steroid synthesis or metabolism that are associated with hormone levels and the risk of breast cancer in premenopausal women. METHODS: We measured urinary levels of estrone glucuronide (E1G) using a protocol specifically developed to account for cyclic variation in hormone levels during the menstrual cycle in 729 healthy premenopausal women. We genotyped 642 single-nucleotide polymorphisms (SNPs) in these women; a single SNP, rs10273424, was further tested for association with the risk of breast cancer using data from 10 551 breast cancer case patients and 17 535 control subjects. All statistical tests were two-sided. RESULTS: rs10273424, which maps approximately 50 kb centromeric to the cytochrome P450 3A (CYP3A) gene cluster at chromosome 7q22.1, was associated with a 21.8% reduction in E1G levels (95% confidence interval [CI] = 27.8% to 15.3% reduction; P = 2.7 × 10(-9)) and a modest reduction in the risk of breast cancer in case patients who were diagnosed at or before age 50 years (odds ratio [OR] = 0.91, 95% CI = 0.83 to 0.99; P = .03) but not in those diagnosed after age 50 years (OR = 1.01, 95% CI = 0.93 to 1.10; P = .82). CONCLUSIONS: Genetic variation in noncoding sequences flanking the CYP3A locus contributes to variance in premenopausal E1G levels and is associated with the risk of breast cancer in younger patients. This association may have wider implications given that the most predominantly expressed CYP3A gene, CYP3A4, is responsible for metabolism of endogenous and exogenous hormones and hormonal agents used in the treatment of breast cancer

Income and Its Effects On Health Literacy: A Study Between a Student-Run Free Clinic and a Family Medicine Office

More than 1/3 of people nationwide (80+ million) have limited health literacy, which contributes to poor health outcomes and lifestyle choices. Health literacy is defined as the understanding and application of words, numbers & documents (i.e., medication labels, medical forms). The Rowan Community Health Center (RCHC), located in Lindenwold NJ, is a student-run clinic that wanted to assess the health literacy of our patients in order to further provide better care. RCHC provides cost-free primary care services regardless of income, insurance, or legal status. To assess health literacy, RCHC used the New Vital Signs (NVS) literacy assessment tool to investigate if there is a difference in health literacy between non-insured patients at RCHC and insured patients a Rowan Family Medicine (FM) office in Hammonton, NJ. The NVS tool, which was a score ranging from 0 to 6, was administered to 45 participants. Data was stored in Qualtrics and analyzed in SPSS. Data showed a significantly higher prevalence of limited literacy (NVS score ≤3) compared to adequate literacy (score ≤4) among male patients (p=0.046) and patients below the poverty line (p=0.036). This showed that both gender and socioeconomic factors correlate with health literacy in our patient populations at RCHC and Family Medicine office. Health literacy extends universally and should not be neglected when interacting with patients. RCHC plans to use this data to mend the health literacy gap by creating a future literacy course as a potential intervention for basic health literacy

Straight-sided beer and cider glasses to reduce alcohol sales for on-site consumption: A randomised crossover trial in bars.

BackgroundStraight-sided glasses can slow the rate of lager consumption in a laboratory setting compared with curved glasses. Slower drinking rates may lower overall alcohol consumption. Glass shape is therefore a potential target for intervention. The aim of this randomised crossover trial was to estimate the impact of serving draught beer and cider in straight-sided glasses, compared with usual, predominantly curved glasses, on alcohol sales for on-site consumption in bars.MethodsTwenty-four bars in England completed two intervention periods (A) and two control periods (B) in a randomised order: 1) BABA; 2) BAAB; 3) ABBA; or 4) ABAB. Each period lasted two weeks and involved serving draught beer and cider in either straight-sided glasses (A) or the venue's usual glasses (≥75% curved; B). The primary outcome was the mean volume (in litres) of draught beer and cider sold weekly, compared between A and B periods using a paired-samples t-test on aggregate data. A regression model adjusted for season, order, special events, and busyness.FindingsMean weekly volume sales of draught beer and cider was 690·9 L (SD 491·3 L) across A periods and 732·5 L (SD 501·0 L) across B periods. The adjusted mean difference (A minus B) was 8·9 L per week (95% CI -45·5 to 63·3; p = 0·737).InterpretationThis study provides no clear evidence that using straight-sided glasses, compared with usual, predominantly curved glasses, reduces the volume of draught beer and cider sold for on-site consumption in bars

Plate size and food consumption: a pre-registered experimental study in a general population sample

Abstract: Background: There is considerable uncertainty regarding the impact of tableware size on food consumption. Most existing studies have used small and unrepresentative samples and have not followed recommended procedures for randomised controlled trials, leading to increased risk of bias. In the first pre-registered study to date, we examined the impact on consumption of using larger versus smaller plates for self-served food. We also assessed impact on the underlying meal micro-structure, such as number of servings and eating rate, which has not previously been studied. Methods: The setting was a purpose-built naturalistic eating behaviour laboratory. A general population sample of 134 adult participants (aged 18–61 years) was randomly allocated to one of two groups varying in the size of plate used for self-serving lunch: large or small. The primary outcome was amount of food energy (kcal) consumed during a meal. Additionally, we assessed impact on meal micro-structure, and examined potential modifying effects of executive function, socio-economic position, and sensitivity to perceptual cues. Results: There was no clear evidence of a difference in consumption between the two groups: Cohen’s d = 0.07 (95% CI [− 0.27, 0.41]), with participants in the large plate group consuming on average 19.2 (95% CI [− 76.5, 115.0]) more calories (3%) compared to the small plate group (large: mean (SD) = 644.1 (265.0) kcal, versus small: 624.9 (292.3) kcal). The difference between the groups was not modified by individual characteristics. There was no evidence of impact on meal micro-structure, with the exception of more food being left on the plate when larger plates were used. Conclusions: This study suggests that previous meta-analyses of a low-quality body of evidence may have considerably overestimated the effects of plate size on consumption. However, the possibility of a clinically significant effect – in either direction – cannot be excluded. Well-conducted trials of tableware size in real-world field settings are now needed to determine whether changing the size of tableware has potential to contribute to efforts to reduce consumption at population-level. Trial registration: The study protocol (https://osf.io/e3dfh/) and data analysis plan (https://osf.io/sh5u7/) were pre-registered on the Open Science Framework