Relation between obesity and the oestrogen receptor status of breast cancer

Introduction: Obesity is a growing problem in the Western world. Correlations have been found between increasing body mass index (BMI) and breast cancer. The objectives were to establish whether a relationship exists between BMI and breast cancer and to investigate any association between BMI and tumour oestrogen receptor expression. Method: Clinical and socio-demographic details (age, menopausal status, height and weight) of a sample of women with breast cancer operated in 2010 were collected, dividing the group into oestrogen receptor positive (ER+) and negative (ER–) subgroups. The average BMI of each subgroup was compared to the mean BMI of a sample of the general Maltese female population obtained from the European Health Examination Survey 2010 Report (Pilot Study) by virtue of an ANOVA test. Subsequently, the relations between oestrogen receptor expression and each of menopausal status, age and BMI were statistically analysed using chi-squared analysis and two-sample t-tests. Results: A total of 103 patients were studied. 72 patients (age range: 40 – 90 years) had ER+ malignancy and 31 patients (29 – 81 years) had ER- malignancy. The mean BMI’s of the ER+ and ER- subgroups were 30.1 and 27.1 respectively, while that of the female general population (29 – 90 years) was 28.4. Analysis revealed a significant difference between the BMI’s of the ER+ and ER- subgroups (p<0.05) but no difference between each receptor subgroup and the general population. Neither menopausal status nor age was found to correlate with positive oestrogen receptor expression. Conclusions: Women with ER+ malignancy tended to be significantly more obese than those with ER- breast cancer. However, neither subgroup had a mean BMI significantly different from that of the general population.peer-reviewe

EUROMOD update : feasibility study : Malta (Tax-Benefit Systems 2007-2010)

The purpose of this study is to examine the technical feasibility of micro-simulation model application for the analysis of impact of policy on social integration from the national as well as from the EU perspective. This is the first time that Malta’s tax-benefit system has been analysed from the angle of the main elements of this system implying the policy rules that are underlying the entitlement criteria defining them. This was an opportunity for the main players in this field to work in synergy on this vital issue: the Ministry for the Family and Social Solidarity, in charge of social benefits, Ministry of Finance responsible for the fiscal policy and income tax system in particular, and the National Statistics Office tasked with income data collection based on the EU-SILC methodology. This Feasibility Study describes the situation as it was in year 2007 and the major changes that have taken place in 2008 and 2009 and 2010. Firstly, the study describes the main elements of the tax-benefit system namely: income, income tax brackets, capital resources and Social Security contributions. The second section of the study illustrates the main sources of data to be used for modelling purposes and also shows the examples of the calculation of income tax and social benefits. It has been agreed that the EU SILC 2008 data would be used, for income element since Malta has joined this system of data collection way back in 2005. The third section of the study firstly outlines the qualities and limitations of the input data set. This section also focuses on specificities of Malta’s data collection and possible difficulties regarding model application. The study points at the possible combinations of sample and population databases. Also, simulation possibilities have been specified for both systems separately. Finally, the non-take up of benefit and the issue of tax and benefit fraud illustrate the situation and the possible unknown element on both sides.peer-reviewe

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Economic poverty and inequality at regional level in malta: focus on the situation of children

This paper performs an economic poverty and inequality mapping of three children age categories in Malta; it consists in the first attempt based on income from the EU-SILC survey and Census data. From a policy-making point of view, the availability of such key economic indicators at locality level certainly provides a valuable tool in assessing the effectiveness of national strategies and in identifying areas that need to be targeted by new policies; in fact sample surveys alone cannot provide reliable information at such a fine level of detail, while national censuses are not designed to and cannot be extended to cover specific topics such as economic poverty and inequality. Thus, the merging of the two sources provides policy-makers with a new insight into the differences between localities. There are also benefits of a technical nature, particularly in terms of sampling strategies, that can be derived from this study. Through such an exercise it is possible to identify economic homogeneity and/or heterogeneity among households with children in different localities: this is useful when defining strata for sampling design for surveys aiming at studying other economic phenomena relating to children

EUROMOD I-CUE feasibility study : Malta 2006 Tax-Benefit System’ as part of a project that involves the European Centre and the Institute for Social and Economic Research (ISER)

The purpose of this study is to examine the technical feasibility of the microsimulation model application for the analysis of the impact of policy on social integration from the national as well as from the EU perspective. This is the first time that Malta’s tax-benefit system has been analysed from the angle of the main elements of this system implying the policy rules that are underlying the entitlement criteria defining them. This was an opportunity for the main players in this field to work in synergy on this vital issue: the Ministry for the Family and Social Solidarity, in charge of social benefits, the Ministry of Finance responsible for the fiscal policy and income tax system in particular, and the National Statistics Office tasked with income data collection based on the EU-SILC1 methodology. This Feasibility Study describes the situation as it was in the year 2006. Firstly, the study describes the main elements of the tax-benefit system, namely: income, income tax brackets, capital resources and Social Security contributions. The second section of the study illustrates the main sources of data to be used for modelling purposes and also shows the examples of the calculation of income tax and social benefits. It has been agreed that the EU SILC 2007 data would be used for the income element since Malta has joined this system of data collection way back in 2005. Regarding social benefits, the SABS2 database would be used, where all individual cases are available on daily, monthly or annual basis. The study also gives an overview of the auxiliary data sets that exist and can be used for checking and benchmarking purposes, once the modelling results become available. The third section of the study firstly outlines the qualities and limitations of the input data set. This section also focuses on specificities of Malta’s data collection and possible difficulties regarding model application. The study points at the possible combinations of sample and population databases. Also, simulation possibilities have been specified for both systems separately. Finally, the non-take up of benefits and the issue of tax and benefit fraud illustrate the situation and the possible unknown element on both sides.peer-reviewe

Patient-Centered Simulations to Assess the Usefulness of the 70-Gene Signature for Adjuvant Chemotherapy Administration in Early-Stage Breast Cancer

International audiencePURPOSE: From the MINDACT trial, Cardoso et al. did not demonstrate a significant efficacy for adjuvant chemotherapy (CT) for women with early-stage breast cancer presenting high clinical and low genomic risks. Our objective was to assess the usefulness of the 70-gene signature in this population by using an alternative endpoint: the number of Quality-Adjusted Life-Years (QALYs), i.e., a synthetic measure of quantity and quality of life. METHODS: Based on the results of the MINDACT trial, we simulated a randomized clinical trial consisting of 1497 women with early-stage breast cancer presenting high clinical and low genomic risks. The individual preferences for the different health states and corresponding decrements were obtained from the literature. RESULTS: The gain in terms of 5-year disease-free survival was 2.8% (95% CI from -\,0.1 to 5.7%, from 90.4% for women without CT to 93.3% for women with CT). In contrast, due to the associated side effects, CT significantly reduced the number of QALYs by 62~days (95% CI from 55 to 70 days, from 4.13~years for women without CT to 3.96~years for women with CT). CONCLUSION: Our results support the conclusions published by Cardoso et al. by providing additional evidence that the 70-gene signature can be used to avoid overtreatment by CT for women with high clinical risk but low genomic risk