Association of body mass index in early adulthood and middle age with future site-specific cancer mortality: the Harvard Alumni Health Study

The association between adiposity in early adulthood and subsequent development of specific malignancies is unclear. Further, the potential for mediation by adiposity in middle age has not been well examined. In a rare study, we investigated the association of body mass index (BMI) in early adulthood with mortality from several site-specific cancers

Mathematical modeling of cell population dynamics in the colonic crypt and in colorectal cancer

Colorectal cancer is initiated in colonic crypts. A succession of genetic mutations or epigenetic changes can lead to homeostasis in the crypt being overcome, and subsequent unbounded growth. We consider the dynamics of a single colorectal crypt by using a compartmental approach [Tomlinson IPM, Bodmer WF (1995) Proc Natl Acad Sci USA 92: 11130-11134], which accounts for populations of stem cells, differential cells, and transit cells. That original model made the simplifying assumptions that each cell popuation divides synchronously, but we relax these assumptions by adopting an age-structured approach that models asynchronous cell division, and by using a continuum model. We discuss two mechanims that could regulate the growth of cell numbers and maintain the equilibrium that is normally observed in the crypt. The first will always maintain an equilibrium for all parameter values, whereas the second can allow unbounded proliferation if the net per capita growth rates are large enough. Results show that an increase in cell renewal, which is equivalent to a failure of programmed cell death or of differentiation, can lead to the growth of cancers. The second model can be used to explain the long lag phases in tumor growth, during which news, higher equilibria are reached, before unlimited growth in cell number ensues

Body mass index relates weight to height differently in women and older adults

This study was partly supported by the University of Manchester’s Health eResearch Centre (HeRC) funded by the Medical Research Council (MRC) Grant MR/K006665/1 and partly funded by the ESRC Obesity eLab Grant (RES-149-25-1076).Background Body mass index (BMI) tends to be higher among shorter adults, especially women. The dependence of BMI–height correlation on age and calendar time may inform us about temporal determinants of BMI. Methods Series of cross-sectional surveys: Health Survey for England, 1992–2011. We study the Benn Index, which is the coefficient in a regression of log(weight) on log(height). This is adjusted for age, gender and calendar time, allowing for non-linear terms and interactions. Results By height quartile, mean BMI decreased with increasing height, more so in women than in men (P < 0.001). The decrease in mean BMI in the tallest compared with the shortest height quartile was 0.77 in men (95% CI 0.69, 0.86) and 1.98 in women (95% CI 1.89, 2.08). Regression analysis of log(weight) on log(height) revealed that the inverse association between BMI and height was more pronounced in older adults and stronger in women than in men, with little change over calendar time. Conclusions Unlike early childhood, where taller children tend to have higher BMI, adults, especially women and older people, show an inverse BMI–height association. BMI is a heterogeneous measure of weight-for-height; height may be an important and complex determinant of BMI trajectory over the life course.Publisher PDFPeer reviewe

Evaluating the Efficacy of the “Support for Life” Program for People with Dementia and Their Families and Carers’ to Enable Them to Live Well: A Protocol for a Cluster Stepped Wedge Randomized Controlled Trial

Introduction Assistance provided to support people living with dementia and carers is highly valued by them. However, current support systems in Australia are disjointed, inaccessible to all, poorly coordinated, and focus on dysfunction rather than ability. Support workers for people with dementia are in short supply, and there is little consistency in their roles. To address this large service gap and unmet need, we have developed an evidence-based optimized model of holistic support for people with dementia and their carers and families. This article describes the “Support for Life” model intervention. Methods A stepped wedge cluster randomized controlled trial will be conducted over 3 years across three Australian states. One hundred participants with dementia and/or their carers/family members will be randomly selected from community health center client lists in each state to receive either the dementia “Support for Life” intervention (Group A) or routine care (Group B). Group A participants will have access to the intervention from year 1. Group B participants will continue to receive usual care and will not be denied information on dementia or dementia services in year 1. In year 2, Group B participants will have access to the intervention. A highly trained expert dementia support worker will provide the “Support for Life” intervention, which is a flexible, individually tailored, holistic support that is relationship-centered, focused on enablement as opposed to dysfunction, and facilitate participants’ continued engagement in their community and the workforce. Additionally, dementia education, information resources, advocacy, and practical support to navigate and access dementia services and health care will be provided. The mode of support will include face to face, telephone, and internet interaction on an “as needed basis” for 12 months. The primary hypothesis is that the intervention will improve the quality of life of people with dementia and the health and well-being of carers/family through facilitating the continuation and enhancement of regular daily activities. Secondary hypotheses will examine other health and service usage outcomes. The outputs will also include a health economic analysis to investigate the costs (and savings) of any associated reduction in unnecessary health services use and delay in accessing permanent residential aged care

Foregrounding Meaning and Motive in the Domestic Abuse Perpetration of and Response to Neurodivergent Men

Typological approaches have thus far neglected the perpetration, profiles, and response to neurodivergent men who are autistic, have attention deficit hyperactivity disorder and those experiencing psychosis. This article addresses this gap, though adopts a psychoanalytic, psychosocial analysis of neurodivergent men’s domestic abuse, using a case study approach. Drawing on the lives of three, non-learning disabled, neurodivergent men, this article reveals that neurodivergence does not cause domestic abuse, as meaning and motive was still discernible in their use of and relevant in the response to their violence and abuse. As I show, this does not obviate the need for more inclusive responses, as neurodivergent men experience additional barriers on mainstream programs that are developed and delivered by and for neurotypical people. This article offers a new contribution to the theoretical and empirical literature on the domestic abuse perpetration of neurodivergent men and criminal justice interventions. Practice and research implications are discussed

Facilitators of probation-based domestic violence perpetrator programmes: ‘Who’s in the room?’

The role that probation practitioners play in the desistance process has begun to receive much needed attention. Yet, the experiences of facilitators of probation-based, domestic violence perpetrator programmes have long been neglected. This article explores the experiences and wellbeing of eight facilitators from one cohort of the Building Better Relationships (BBR) programme in England. Drawing upon five-months’ observations and in-depth interviews, I demonstrate how working with domestically violent men with insufficient knowledge, experience, or support, exacerbated within the context of Transforming Rehabilitation reforms, impacted significantly on facilitator well-being, professional identities, and practice. Practice implications are discussed

Responding to coercive control in criminal justice domestic violence perpetrator programmes in England and Wales: Conceptual, operational, and methodological complexities

Evaluations of domestic violence perpetrator programmes have not produced evidence that they are as effective at reducing male, non-violent, coercively controlling behaviours. This article proposes such limitations are understood by adopting a more complex conceptualisation of coercive control for which the reasons are both gendered and biographically unique. Drawing on document analyses and in-depth interviews with eight programme facilitators and an in-depth case study of one male participant, this article explores the merits and limitations of the cognitive behavioural, skills-based criminal justice programme, Building Better Relationships, in addressing coercively controlling behaviours. The dual (re)conceptualisation of coercive control proposed has implications for both practice and programme evaluation methods

Rising Tuition in Higher Education: Should we be Concerned?

The most pressing concern in higher education amongst students, prospects, and parents is high tuition. I sought to assess the magnitude of the problem of high tuition in America and address potential changes that might be made to curb further rises. I found that high tuition is not necessarily a problem as the benefits of a college degree increasingly outweigh the costs. High tuition does not deter people from attending college; it is one of the best investments an individual can make. The only viable change to make is to invest in new online educational technology which has the potential to substantially lower costs, and improve the quality and accessibility of education

Cholesterol and the risk of grade-specific prostate cancer incidence: evidence from two large prospective cohort studies with up to 37 years' follow up

&lt;b&gt;Background&lt;/b&gt; High cholesterol may be a modifiable risk factor for prostate cancer but results have been inconsistent and subject to potential "reverse causality" where undetected disease modifies cholesterol prior to diagnosis.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods&lt;/b&gt; We conducted a prospective cohort study of 12,926 men who were enrolled in the Midspan studies between 1970 and 1976 and followed up to 31st December 2007. We used Cox-Proportional Hazards Models to evaluate the association between baseline plasma cholesterol and Gleason grade-specific prostate cancer incidence. We excluded cancers detected within at least 5 years of cholesterol assay.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results&lt;/b&gt; 650 men developed prostate cancer in up to 37 years' follow-up. Baseline plasma cholesterol was positively associated with hazard of high grade (Gleason score[greater than or equal to]8) prostate cancer incidence (n=119). The association was greatest among men in the 4th highest quintile for cholesterol, 6.1 to &#60;6.69 mmol/l, Hazard Ratio 2.28, 95% CI 1.27 to 4.10, compared with the baseline of &#60;5.05 mmol/l. This association remained significant after adjustment for body mass index, smoking and socioeconomic status.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions&lt;/b&gt; Men with higher cholesterol are at greater risk of developing high-grade prostate cancer but not overall risk of prostate cancer. Interventions to minimise metabolic risk factors may have a role in reducing incidence of aggressive prostate cancer