uncertainty and complexity in the context of COVID-19

Although the first coronavirus disease 2019 (COVID-19) wave has peaked with the second wave underway, the world is still struggling to manage potential systemic risks and unpredictability of the pandemic. A particular challenge is the “superspreading” of the virus, which starts abruptly, is difficult to predict, and can quickly escalate into medical and socio-economic emergencies that contribute to long-lasting crises challenging our current ways of life. In these uncertain times, organizations and societies worldwide are faced with the need to develop appropriate strategies and intervention portfolios that require fast understanding of the complex interdependencies in our world and rapid, flexible action to contain the spread of the virus as quickly as possible, thus preventing further disastrous consequences of the pandemic. We integrate perspectives from systems sciences, epidemiology, biology, social networks, and organizational research in the context of the superspreading phenomenon to understand the complex system of COVID-19 pandemic and develop suggestions for interventions aimed at rapid responses.publishersversionpublishe

Sleep duration and the risk of breast cancer: the Ohsaki Cohort Study

In a prospective study of 23 995 Japanese women, short sleep duration was associated with higher risk of breast cancer (143 cases), compared with women who slept 7 h per day, the multivariate hazard ratio of those who slept ⩽6 h per day was 1.62 (95% confidence interval: 1.05–2.50; P for trend=0.03)

B Vitamins, Methionine and Alcohol Intake and Risk of Colon Cancer in Relation to BRAF Mutation and CpG Island Methylator Phenotype (CIMP)

One-carbon metabolism appears to play an important role in DNA methylation reaction. Evidence suggests that a low intake of B vitamins or high alcohol consumption increases colorectal cancer risk. How one-carbon nutrients affect the CpG island methylator phenotype (CIMP) or BRAF mutation status in colon cancer remains uncertain.Utilizing incident colon cancers in a large prospective cohort of women (the Nurses' Health Study), we determined BRAF status (N = 386) and CIMP status (N = 375) by 8 CIMP-specific markers [CACNA1G, CDKN2A (p16), CRABP1, IGF2, MLH1, NEUROG1, RUNX3, and SOCS1], and 8 other CpG islands (CHFR, HIC1, IGFBP3, MGMT, MINT-1, MINT-31, p14, and WRN). We examined the relationship between intake of one-carbon nutrients and alcohol and colon cancer risk, by BRAF mutation or CIMP status.Higher folate intake was associated with a trend towards low risk of CIMP-low/0 tumors [total folate intake ≥400 µg/day vs. <200 µg/day; the multivariate relative risk = 0.73; 95% CI = 0.53-1.02], whereas total folate intake had no influence on CIMP-high tumor risks (P(heterogeneity) = 0.73). Neither vitamin B(6), methionine or alcohol intake appeared to differentially influence risks for CIMP-high and CIMP-low/0 tumors. Using the 16-marker CIMP panel did not substantially alter our results. B vitamins, methionine or alcohol intake did not affect colon cancer risk differentially by BRAF status.This molecular pathological epidemiology study suggests that low level intake of folate may be associated with an increased risk of CIMP-low/0 colon tumors, but not that of CIMP-high tumors. However, the difference between CIMP-high and CIMP-low/0 cancer risks was not statistically significant, and additional studies are necessary to confirm these observations

Rad u smjenama i rak - znanstvene spoznaje i praktične posljedice

In 2007, an expert Working Group convened by the IARC Monographs Programme concluded that shift work that involves circadian disruption is probably carcinogenic to humans (Group 2A). We scrutinised the epidemiological basis for this conclusion, with a focus on, but not limited to, breast and prostate cancers. We further considered practical consequences for shift workers in our industry against the background of new findings. We carried out a literature search including the epidemiological studies cited by IARC and newer available literature on shift work and cancer. Since the IARC assessment, eleven new studies have emerged, ten of which have already been published, with inconclusive results. Heterogeneity of exposure metrics and study outcomes and emphasis on positive but non-signifi cant results make it diffi cult to draw general conclusions. Also, several reviews and commentaries, which have been published meanwhile, came to equivocal results. Published evidence is widely seen as suggestive but inconclusive for an adverse association between night work and breast cancer, and limited and inconsistent for cancers at other sites and all cancers combined. At this point in time it can not be ruled out that shift work including night work may increase the risk for some cancers in those who perform it. However, shift schedules can be organised in ways that minimise the associated health risks, and the risks may be further reduced through the implementation of structured and sustained health promotion programs specifi cally tailored to the needs of shift workers.Stručna radna skupina, koju je okupio Program monografija Međunarodne agencije za istraživanje raka (eng. International Agency for Research on Cancer, krat. IARC), 2007. godine zaključila je da je rad u smjenama, koji uključuje prekid cirkadijurnoga ritma, najvjerojatnije kancerogen za ljude (skupina 2A). Procijenili smo epidemiološku osnovu takvoga zaključka i usredotočili se na rak dojke i rak prostate između ostalih malignih bolesti. Nadalje, razmatrali smo praktične posljedice koje rad u smjenama ima na radnike u kemijskoj kompaniji BASF u okvirima novih spoznaja na tom području. Istražili smo literaturu, uključujući i epidemiološka istraživanja studije koje citira IARC kao i noviju literaturu o povezanosti rada u smjenama i raku. Od zaključka IARC-a nastalo je jedanaest novih istraživanja, a deset ih je već objavljeno. Njihovi rezultati ipak ne dovode do konačnoga i jednoznačnoga zaključka. Heterogenost mjerenja izloženosti i ishoda istraživanja i naglasak na pozitivne, ali ne uvijek i značajne rezultate, otežavaju postavljanje općih zaključaka. Jednako tako u nekoliko nedavno objavljenih recenzija i komentara ne iznose se jednoznačni rezultati. Objavljeni znanstveno utemeljeni dokazi samo upućuju, ali ne dovode u očiglednu vezu noćni rad i rak dojke. Nadalje, ograničeni su i nedosljedni za malignome na drugim lokacijama u tijelu, kao i za sve malignome zajedno. U ovom trenutku nije moguće odbaciti hipotezu da smjenski rad (uključujući noćni rad) može povećati rizik nastanka određenih malignih bolesti. Međutim, raspored smjena se može organizirati na način da se opasnosti za zdravlje svedu na najmanju moguću mjeru. Rizici se također mogu dodatno smanjiti provedbom strukturiranih programa promicanja održivoga zdravlja koji bi bili posebno osmišljeni prema potrebama radnika

Urinary 6-sulphatoxymelatonin levels and risk of breast cancer in premenopausal women : the ORDET cohort

Background: Lower urinary melatonin levels are associated with a higher risk of breast cancer in postmenopausal women. Literature for premenopausal women is scant and inconsistent. Methods: In a prospective case-control study, we measured the concentration of 6-sulphatoxymelatonin (aMT6s) in the 12-hour overnight urine of 180 premenopausal women with incident breast cancer and 683 matched controls. Results: In logistic regression models, the multivariate odds ratio (OR) of invasive breast cancer for women in the highest quartile of total overnight aMT6s output compared with the lowest was 1.43 [95% confidence interval (CI), 0.83-2.45; Ptrend = 0.03]. Among current nonsmokers, no association was existent (OR, 1.00; 95% CI, 0.52-1.94; Ptrend = 0.29). We observed an OR of 0.68 between overnight urinary aMT6s level and breast cancer risk in women with invasive breast cancer diagnosed &gt;2 years after urine collection and a significant inverse association in women with a breast cancer diagnosis &gt;8 years after urine collection (OR, 0.17; 95% CI, 0.04-0.71; Ptrend = 0.01). There were no important variations in ORs by tumor stage or hormone receptor status of breast tumors. Conclusion: Overall, we observed a positive association between aMT6s and risk of breast cancer. However, there was some evidence to suggest that this might be driven by the influence of subclinical disease on melatonin levels, with a possible inverse association among women diagnosed further from recruitment. Thus, the influence of lag time on the association between melatonin and breast cancer risk needs to be evaluated in further studies

Mortality among Norwegian doctors 1960-2000

<p>Abstract</p> <p>Background</p> <p>To study the mortality pattern of Norwegian doctors, people in human service occupations, other graduates and the general population during the period 1960-2000 by decade, gender and age. The total number of deaths in the study population was 1 583 559.</p> <p>Methods</p> <p>Census data from 1960, 1970, 1980 and 1990 relating to education were linked to data on 14 main causes of death from Statistics Norway, followed up for two five-year periods after census, and analyzed as stratified incidence-rate data. Mortality rate ratios were computed as combined Mantel-Haenzel estimates for each sex, adjusting for both age and period when appropriate.</p> <p>Results</p> <p>The doctors had a lower mortality rate than the general population for all causes of death except suicide. The mortality rate ratios for other graduates and human service occupations were 0.7-0.8 compared with the general population. However, doctors have a higher mortality than other graduates. The lowest estimates of mortality for doctors were for endocrine, nutritional and metabolic diseases, diseases in the urogenital tract or genitalia, digestive diseases and sudden death, for which the numbers were nearly half of those for the general population. The differences in mortality between doctors and the general population increased during the periods.</p> <p>Conclusions</p> <p>Between 1960 and 2000 mortality for doctors converged towards the mortality for other university graduates and for people in human service occupations. However, there was a parallel increase in the gap between these groups and the rest of the population. The slightly higher mortality for doctors compared with mortality for other university graduates may be explained by the higher suicide rate for doctors.</p

Longitudinal study on birthweight and the incidence of endometrial cancer

From 1976 to 2004, we followed 71 751 participants of the Nurses' Health Study and identified 676 invasive endometrial cancer cases. Birthweight, assessed in 1992, was not associated with the incidence of endometrial cancer. No effect modification by menopausal status was observed, but statistical power to detect an interaction was limited