Incidence and long-term outcome of severe asthma-COPD overlap compared to asthma and COPD alone:a 35-year prospective study of 57,053 middle-aged adults

BACKGROUND: Incidence and prognosis for severe asthma–COPD overlap is poorly characterized. We investigated incidence and long-term outcome for patients with asthma–COPD overlap compared to asthma and COPD alone. MATERIALS AND METHODS: A total of 57,053 adults (aged 50–64 years) enrolled in the Danish Diet, Cancer, and Health cohort (1993–1997) were followed in the National Patients Registry for admissions for asthma (DJ45–46) and COPD (DJ40–44) and vital status. Asthma–COPD overlap was defined as at least one hospital admission for asthma and one for COPD (different time points), and incident asthma–COPD overlap as at least one of the diagnoses occurring after enrollment into the Diet, Cancer, and Health cohort. RESULTS: A total of 1,845 (3.2%) and 4,037 (7.1%) participants had admissions for asthma and COPD, respectively, with 662 (1.2%) participants with asthma–COPD overlap. Incidence rate of asthma–COPD overlap per 1,000 person-years was higher in women (0.73) than in men (0.54) (P<0.02). Mortality rate was higher in asthma–COPD overlap (25.9 per 1,000 person-years) compared with COPD (23.1, P<0.05) and asthma (7.9, P<0.001) alone. Compared to COPD alone, mortality was higher in women with asthma–COPD overlap (19.6 and 25.5, respectively; P<0.01), and the excess mortality rate for asthma–COPD overlap patients was most prominent for younger age groups (12.9 compared to 7.2 and 4.6 for COPD and asthma alone, respectively; P<0.01). CONCLUSION: This large population-based study revealed a higher incidence of severe asthma–COPD overlap in women compared to men, and furthermore that all-cause mortality is higher in women and younger subjects with asthma–COPD overlap compared with those with asthma or COPD alone

Polymorphisms in the xenobiotic transporter Multidrug Resistance 1 (MDR1) and interaction with meat intake in relation to risk of colorectal cancer in a Danish prospective case-cohort study

<p>Abstract</p> <p>Background</p> <p>The xenobiotic transporters, Multidrug Resistance 1 <it>(MDR1/ABCB1) </it>and Breast Cancer Resistance Protein <it>(BCRP/ABCG2) </it>may restrict intestinal absorption of various carcinogens, including heterocyclic amines (HCA) and polycyclic aromatic hydrocarbons (PAH). Cyclooxygenase-2 (COX-2) derived prostaglandins promote gastrointestinal carcinogenesis, affecting angiogenesis, apoptosis, and invasiveness.</p> <p>The aim of this study was to investigate if polymorphisms in these genes were associated with risk of colorectal cancer (CRC), and to investigate possible interactions with lifestyle factors such as smoking, meat consumption, and NSAID use.</p> <p>Methods</p> <p>The following polymorphisms were analyzed; a synonymous <it>MDR1 </it>C3435T (rs1045642) in exon26, G-rs3789243-A in intron3, the functional <it>BCRP </it>C421A (rs2231142), the two <it>COX-2 </it>A-1195G (rs689466) and G-765C (rs20417) in the promoter region, and the <it>COX-2 </it>T8473C (rs5275) polymorphisms in the 3'-untranslated region. The polymorphisms were assessed together with lifestyle factors in a nested case-cohort study of 359 cases and a random cohort sample of 765 participants from the Danish prospective Diet, Cancer and Health study.</p> <p>Results</p> <p>Carriers of the variant allele of <it>MDR1 </it>intron 3 polymorphism were at 1.52-fold higher risk of CRC than homozygous wild type allele carriers (Incidence rate ratio (IRR) = 1.52, 95% Confidence Interval (CI): 1.12-2.06). Carriers of the variant allele of <it>MDR1 </it>C3435T exon 26 had a lower risk of CRC than homozygous C-allele carriers (IRR = 0.71 (CI:0.50-1.00)). There was interaction between these <it>MDR1 </it>polymorphisms and intake of red and processed meat in relation to CRC risk. Homozygous <it>MDR1 </it>C3435T C-allele carriers were at 8% increased risk pr 25 gram meat per day (CI: 1.00-1.16) whereas variant allele carriers were not at increased risk (p for interaction = 0.02). <it>COX-2 </it>and <it>BCRP </it>polymorphisms were not associated with CRC risk. There was interaction between NSAID use and <it>MDR1 </it>C3435T and COX-2 T8473C (p-values for interaction 0.001 and 0.04, respectively).</p> <p>Conclusion</p> <p>Two polymorphisms in <it>MDR1 </it>were associated with CRC risk and there was interaction between these polymorphisms and meat intake in relation to CRC risk. Our results suggest that <it>MDR1 </it>polymorphisms affect the relationship between meat and CRC risk.</p

Responses and relationship dynamics of men and their spouses during active surveillance for prostate cancer: health literacy as an inquiry framework

BACKGROUND: Early stage prostate cancer patients may be allocated to active surveillance, where the condition is observed over time with no intervention. Living with a cancer diagnosis may impose stress on both the men and their spouses. In this study we explore whether the scores of and verbal responses to a Health Literacy Questionnaire can be used to identify individuals in need of information and support and to reveal differences in perception and understanding in health related situations within couples. METHODS: We used the nine-domain Health Literacy Questionnaire (HLQ) as a framework to explore health literacy in eight couples where the men were on active surveillance for prostate cancer progression. Scores were calculated for each domain for both individuals. For each couple differences in scores were also calculated and related to the informants\u27 self-reported experiences and reflections in relation to participating in an active surveillance program. Also an inductive analysis was performed to identify themes in the responses and these themes were compared to those of HLQ. RESULTS: The men tended to score higher than their spouses. There was no consistent relation between scores and the reported experiences and reflections. However, some interesting patterns emerged, e.g. in two of the three couples with the largest within couple differences in HLQ scores, responses revealed discrepancies in how the men and their spouses perceived their situation. Also, three themes emerged which related to six of the HLQ domains, i.e. involvement of spouses and other people around the men; support from and interaction with healthcare professionals; and use of the Internet for information retrieval. CONCLUSIONS: Using the HLQ as an interview framework provided insight into the differences within couples and provided new perspectives on their experiences, including their contact with health professionals and the patient-spouse interaction when dealing with prostate cancer. The HLQ used as a dialogue tool may be an adjunct to assist healthcare providers to understand the need for support and information of men with prostate cancer on active surveillance and the dynamics within couples

Childhood height, adult height, and the risk of prostate cancer

PURPOSE: We previously showed that childhood height is positively associated with prostate cancer risk. It is, however, unknown whether childhood height exerts its effects independently of or through adult height. We investigated whether and to what extent childhood height has a direct effect on the risk of prostate cancer apart from adult height. METHODS: We included 5,871 men with height measured at ages 7 and 13 years in the Copenhagen School Health Records Register who also had adult (50–65 years) height measured in the Danish Diet, Cancer and Health study. Prostate cancer status was obtained through linkage to the Danish Cancer Registry. Direct and total effects of childhood height on prostate cancer risk were estimated from Cox regressions. RESULTS: From 1996 to 2012, 429 prostate cancers occurred. Child and adult heights were positively and significantly associated with prostate cancer risk. When adjusted for adult height, height at age 7 years was no longer significantly associated with the risk of prostate cancer. Height at 13 years was significantly and positively associated with prostate cancer risk even when adult height was adjusted for; per height z-score the hazard ratio was 1.15 [95 % confidence interval (CI) 1.01–1.32]. CONCLUSIONS: The effect of height at 13 years on the risk of prostate cancer was not entirely mediated through adult height, suggesting that child height and adult height may be associated with prostate cancer through different pathways