Kardiorespiratorische Fitness und das Prostatakarzinom – Analyse der FIT-Cancer Cohort

Objective: High cardiorespiratory fitness reduces the risk of several cancers. However, the relationship between cardiorespiratory fitness and prostate cancer is not well established. This investigation aims to determine the association between cardiorespiratory fitness with prostate-specific antigen (PSA) screening, incident prostate cancer, and mortality. Methods: Participants in this retrospective cohort study were 22,827 men aged 40 to 70 years without cancer in the Henry Ford Exercise Testing (FIT) Project, who received a physician-referred exercise stress testing from 1995 to 2009. Participants were grouped in categories of metabolic equivalents of task (METs) (<6 [reference], 6-9, 10-11, and ≥12 METs) achieved during the maximal exercise stress test. PSA testing was evaluated with multivariable-adjusted Poisson regression. Multivariable adjusted cox-proportional hazards models were used to compute hazard ratios (HR), 95% confidence interval (95% CI) of incident prostate cancer, and all-cause mortality among those diagnosed with prostate cancer. Results: Men with high fitness (METs >=12) were 29% more likely to have undergone PSA screening (95% CI, 1.2-1.3) compared to those with low fitness (<6 METs). Men with high cardiorespiratory fitness were more likely to be diagnosed with prostate cancer after adjusting for PSA screening (men aged 55 years, P ≤ .01). Cardiorespiratory fitness was not associated with advanced prostate cancer. Among men diagnosed with prostate cancer, high pre-diagnostic fitness was associated with a 60% lower risk of all-cause mortality (95% CI, 0.2-0.9). Conclusions: While men with high fitness are more likely to undergo PSA screening tests, they are also more likely to be diagnosed with prostate cancers, although high fitness remains predictive of a lower risk of death, even among men diagnosed with prostate cancer. Cardiorespiratory fitness may identify those more likely to be screened and therefore diagnosed with less clinically significant disease, especially in men < 55.Einleitung Eine hohe kardiorespiratorische Fitness wirkt protektiv für zahlreiche Krebserkrankungen. Jedoch ist der Zusammenhang zwischen kardiorespiratorischer Fitness und dem Auftreten eines Prostatakarzinoms umstritten. Vermutlich erschwert der Bias im PSA-Screening bei Männern mit hoher Fitness die Analyse zwischen der Inzidenz von Prostatakarzinomen und kardiorespiratorischer Fitness. Methodik Insgesamt wurden 22.827 Männer zwischen 40 und 70 Jahren ohne Krebsdiagnose aus der retrospektiven Kohortenstudie, Henry Ford Exercise Testing (FIT) Project, untersucht. Alle Männer erhielten zwischen 1995 und 2009 einen laufbandergometrischen Belastungstest, um ihre kardiorespiratorische Fitness in Metabolic Equivalents of Task (METs) zu quantifizieren. Die Teilnehmer wurden anhand ihres Belastungstests in vier Gruppen eingeteilt: <6 [Referenz-Wert], 6-9, 10-11, und ≥12 METs. Mithilfe multivariabler adjustierter Poisson Regression und Cox Proportional Hazard-Modellen wurde der Zusammenhang zwischen Fitness und jeweils Erhalt eines PSA-Screenings, Prostatakarzinom-Inzidenz und Gesamtmortalität bestimmt. Ergebnisse Männer in der höchsten Fitness-Kategorie (METs >=12) hatten eine 29% höhere Wahrscheinlichkeit sich einem PSA-Screening zu unterziehen (95% CI, 1,2-1,3), als Männer in der niedrigsten Fitness-Kategorie (METs =12 METs in dem Belastungstest erreichten, ein größeres Risiko für eine Prostatakarzinom-Diagnose als Männer mit niedriger Fitness (Männer 55 Jahre, P ≤ 0,01). Wir konnten keine signifikante Beziehung zwischen fortgeschrittenem Prostatakarzinom und kardiorespiratorischer Fitness feststellen. Unter den Männern, die im Verlauf ein Prostatakarzinom entwickelten und eine hohe kardiorespiratorische Fitness hatten, war das Gesamtmortalitäts-Risiko im Vergleich zu Männern mit niedriger kardiorespiratorischer Fitness um 60% reduziert (95% CI, 0,2-0,9). Schlussfolgerung Männer mit einer hohen kardiorespiratorischen Fitness haben eine deutlich höhere Wahrscheinlichkeit sich einem PSA-Screening zu unterziehen als Männer mit niedriger Fitness. Die erhöhte Prostatakarzinom-Inzidenz bei Männern mit einer hohen Fitness konnte sich nicht ganz durch das PSA-Screening-Verhalten erklären. Auch nach dessen Berücksichtigung, hatten Männer mit hoher Fitness ein größeres Risiko für eine Prostatakarzinom-Diagnose als Männer mit niedriger Fitness. Allerdings ist kardiorespiratorische Fitness ein signifikanter Prädiktor für Gesamtmortalität nach einer Prostatakarzinom-Diagnose

Advancing nursing practice : the emergence of the role of Advanced Practice Nurse in Saudi Arabia

Background: The roots of advanced practice nursing can be traced back to the 1890s, but the Nurse Practitioner (NP) emerged in Western countries during the 1960s in response to the unmet health care needs of populations in rural areas. These early NPs utilized the medical model of care to assess, diagnose and treat. Nursing has since grown as a profession, with its own unique and distinguishable, holistic, science-based knowledge, which is complementary within the multidisciplinary team. Today Advanced Practice Nurses (APNs) demonstrate nursing expertise in clinical practice, education, research and leadership, and are no longer perceived as “physician replacements” or assistants. Saudi Arabia has yet to define, legislate or regulate Advanced Practice Nursing. Aims: This article aims to disseminate information from a Saudi Advanced Practice Nurse thought leadership meeting, to chronicle the history of Advanced Practice Nursing within the Kingdom of Saudi Arabia, while identifying strategies for moving forward. Conclusion: It is important to build an APN model based on Saudi health care culture and patient population needs, while recognizing global historical underpinnings. Ensuring that nursing continues to distinguish itself from other health care professions, while securing a seat at the multidisciplinary health care table will be instrumental in advancing the practice of nursing

Health Benefits of Nut Consumption

Nuts (tree nuts and peanuts) are nutrient dense foods with complex matrices rich in unsaturated fatty and other bioactive compounds: high-quality vegetable protein, fiber, minerals, tocopherols, phytosterols, and phenolic compounds. By virtue of their unique composition, nuts are likely to beneficially impact health outcomes. Epidemiologic studies have associated nut consumption with a reduced incidence of coronary heart disease and gallstones in both genders and diabetes in women. Limited evidence also suggests beneficial effects on hypertension, cancer, and inflammation. Interventional studies consistently show that nut intake has a cholesterol-lowering effect, even in the context of healthy diets, and there is emerging evidence of beneficial effects on oxidative stress, inflammation, and vascular reactivity. Blood pressure, visceral adiposity and the metabolic syndrome also appear to be positively influenced by nut consumption. Thus it is clear that nuts have a beneficial impact on many cardiovascular risk factors. Contrary to expectations, epidemiologic studies and clinical trials suggest that regular nut consumption is unlikely to contribute to obesity and may even help in weight loss. Safety concerns are limited to the infrequent occurrence of nut allergy in children. In conclusion, nuts are nutrient rich foods with wide-ranging cardiovascular and metabolic benefits, which can be readily incorporated into healthy diets

Lifetime measurement of neutron-rich even-even molybdenum isotopes

Background: In the neutron-rich A approximate to 100 mass region, rapid shape changes as a function of nucleon number as well as coexistence of prolate, oblate, and triaxial shapes are predicted by various theoretical models. Lifetime measurements of excited levels in the molybdenum isotopes allow the determination of transitional quadrupole moments, which in turn provides structural information regarding the predicted shape change. Purpose: The present paper reports on the experimental setup, the method that allowed one to measure the lifetimes of excited states in even-even molybdenum isotopes from mass A = 100 up to mass A = 108, and the results that were obtained. Method: The isotopes of interest were populated by secondary knock-out reaction of neutron-rich nuclei separated and identified by the GSI fragment separator at relativistic beam energies and detected by the sensitive PreSPEC-AGATA experimental setup. The latter included the Lund-York-Cologne calorimeter for identification, tracking, and velocity measurement of ejectiles, and AGATA, an array of position sensitive segmented HPGe detectors, used to determine the interaction positions of the gamma ray enabling a precise Doppler correction. The lifetimes were determined with a relativistic version of the Doppler-shift-attenuation method using the systematic shift of the energy after Doppler correction of a gamma-ray transition with a known energy. This relativistic Doppler-shift-attenuation method allowed the determination of mean lifetimes from 2 to 250 ps. Results: Even-even molybdenum isotopes from mass A = 100 to A = 108 were studied. The decays of the low-lying states in the ground-state band were observed. In particular, two mean lifetimes were measured for the first time: tau = 29.7(-9.1)(+11.3) ps for the 4(+) state of Mo-108 and tau = 3.2(-0.7)(+ 0.7) ps for the 6(+) state of Mo-102. Conclusions: The reduced transition strengths B(E2), calculated from lifetimes measured in this experiment, compared to beyond-mean-field calculations, indicate a gradual shape transition in the chain of molybdenum isotopes when going from A = 100 to A = 108 with a maximum reached at N = 64. The transition probabilities decrease for Mo-108 which may be related to its well-pronounced triaxial shape indicated by the calculations