Risk of breast cancer in men in relation to weight change: A national case-control study in England and Wales.
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ABSTRACT:
SUBMITTER: Swerdlow AJ
PROVIDER: S-EPMC9303449 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Breast cancer is rare in men, and information on its causes is very limited from studies that have generally been small. Adult obesity has been shown as a risk factor, but more detailed anthropometric relations have not been investigated. We conducted an interview population-based case-control study of breast cancer in men in England and Wales including 1998 cases incident during 2005-2017 at ages younger than 80 years and 1597 male controls, with questions asked about a range of anthropometric variables at several ages. All tests of statistical significance were 2-sided. Risk of breast cancer statistically significantly increased with increasing body mass index (BMI) at ages 20 (odds ratio [OR] = 1.07, 95% confidence interval [CI] = 1.02 to 1.12 per 2-unit change in BMI), 40 (OR = 1.11, 95% CI = 1.07 to 1.16), and 60 (OR = 1.14, 95% CI = 1.09 to 1.19) years, but there was also an indication of raised risk for the lowest BMIs. Large waist circumference 5 years before interview was more strongly associated than was BMI with risk, and each showed independent associations. Associations were similar for invasive and in situ tumors separately and stronger for HER2-positive than HER2-negative tumors. Of the tumors, 99% were estrogen receptor positive. Obesity at all adult ages, particularly recent abdominal obesity, is associated with raised risk of breast cancer in men, probably because of the conversion of testosterone to estrogen by aromatase in adipose tissue. The association is particularly strong for HER2-expressing tumors.
| S-EPMC8562705 | biostudies-literature
Project description:The frequency and magnitude of extreme weather events are likely to increase with global warming. However, it is not clear how these events might affect agricultural crops and whether yield losses resulting from severe droughts or heat stress will increase in the future. The aim of this paper is to analyse changes in the magnitude and spatial patterns of two impact indices for wheat: the probability of heat stress around flowering and the severity of drought stress. To compute these indices, we used a wheat simulation model combined with high-resolution climate scenarios based on the output from the Hadley Centre regional climate model at 18 sites in England and Wales. Despite higher temperature and lower summer precipitation predicted in the UK for the 2050s, the impact of drought stress on simulated wheat yield is predicted to be smaller than that at present, because wheat will mature earlier in a warmer climate and avoid severe summer drought. However, the probability of heat stress around flowering that might result in considerable yield losses is predicted to increase significantly. Breeding strategies for the future climate might need to focus on wheat varieties tolerant to high temperature rather than to drought.
| S-EPMC2658661 | biostudies-literature
Project description:BackgroundPeople with epilepsy (PWE) and people with intellectual disabilities (ID) both live shorter lives than the general population and both conditions increase the risk of death further. We aimed to measure associations between certain risk factors for death in PWE and ID.MethodsA retrospective case-control study was conducted in ten regions in England and Wales. Data were collected on PWE registered with secondary care ID and neurology services between 2017 and 2021. Prevalence rates of neurodevelopmental, psychiatric and medical diagnoses, seizure frequency, psychotropic and antiseizure medications (ASM) prescribed, and health activity (epilepsy reviews/risk assessments/care plans/compliance etc.) recorded were compared between the two groups.Results190 PWE and ID who died were compared with 910 living controls. People who died were less likely to have had an epilepsy risk assessment but had a greater prevalence of genetic conditions, older age, poor physical health, generalized tonic-clonic seizures, polypharmacy (not ASMs) and antipsychotic use. The multivariable logistic regression for risk of epilepsy-related death identified that age over 50, medical condition prevalence, antipsychotic medication use and the lack of an epilepsy review in the last 12 months as associated with increased risk of death. Reviews by psychiatrists in ID services was associated with a 72% reduction in the odds of death compared neurology services.ConclusionsPolypharmacy and use of antipsychotics may be associated with death but not ASMs. Greater and closer monitoring by creating capable health communities may reduce the risk of death. ID services maybe more likely to provide this holistic approach.
| S-EPMC10078066 | biostudies-literature
Project description:BackgroundHomelessness in England and Wales is on the rise together with the mortality rate among homeless people. Many homeless people have a mental illness, which is a risk factor for suicide.AimsThis study used data from the National Confidential Inquiry into Suicide and Safety in Mental Health to examine demographic and clinical characteristics of homeless people who died by suicide and were in recent contact with mental health services.MethodWe have compared 514 patients (2% of the total sample) who died by suicide and who were reported as being homeless or having no fixed abode by their clinicians with patients in stable accommodation between 2000 and 2016 to identify differences in sociodemographic characteristics and clinical care.ResultsOur analysis suggests that homeless patients who died by suicide had more acute (alcohol: 47% v. 25%, P < 0.01, drug: 39% v. 15%, P < 0.01) and chronic (alcohol: 72% v. 44%, P > 0.01, drug: 64% v. 31%) substance misuse issues than patients in stable accommodation. Homeless patients were also more likely to die as in-patients (21% v. 10%, P < 0.01) or within 3 months of discharge (32% v. 19%, P < 0.01).ConclusionsHomeless patients who died by suicide more often had known risk factors for suicide than patients in stable accommodation. As a result of the higher percentages of post-discharge and in-patient suicides in homeless patients as well as the high prevalence of substance misuse, this study recommends closer integration of services as well as awareness of risks during in-patient admission and in the weeks immediately after discharge.
| S-EPMC8058935 | biostudies-literature
Project description:BackgroundSome people diagnosed with schizophrenia are more prone to committing acts of serious violence, especially in the presence of drug or alcohol misuse. The rarity of homicide has meant that no large controlled study has previously examined clinical risk factors.AimsTo determine the risk factors for homicide by males diagnosed with schizophrenia.MethodA national nested case-control study of all previously admitted males diagnosed with schizophrenia, convicted of homicide between 1 January 1997 and 31 December 2012. Univariate and multivariable conditional logistic regression models were fitted to identify predictors of homicide in this population.ResultsDuring the observation period 160 male patients with schizophrenia and a history of psychiatric admission were convicted of homicide, and they were matched with 542 male control patients who had not been convicted of homicide. Patients who committed homicide were more likely to have a history of violence and comorbid personality disorder or drug misuse. They were more likely to have missed their last contact with services prior to the offence and to have been non-adherent with their treatment plan. Almost all (94%) of homicides were committed by patients who had a history of alcohol or drug misuse and/or who were not in receipt of planned treatment.ConclusionsIn England and Wales, homicides by patients with schizophrenia without substance misuse and in receipt of planned care are exceptionally rare. To prevent serious violence, mental health services should focus on drug and alcohol misuse, treatment adherence and maintaining contact with services.
| S-EPMC7745241 | biostudies-literature
Project description:UnlabelledTo demonstrate trends in trauma care in England and Wales from 1989 to 2000.Study populationDatabase of the Trauma Audit and Research Network that includes hospital patients admitted for three days or more, those who died, were transferred or admitted to an intensive care or high dependency area.MethodTo demonstrate trends in outcome, severity adjusted odds of death per year of admission to hospital were calculated for all hospitals (n=99) and 20 hospitals who had participated since 1989 (adjustments are for Injury Severity Score, age, and Revised Trauma Score). The grade of doctor initially seeing the injured patient in accident and emergency and median prehospital times per year of admission were calculated to demonstrate trends in the process of care. Trend analyses were carried out using simple linear regression (odds ratio versus year).ResultsThe analysis shows a significant reduction in the severity adjusted odds of death of 3% per year over the 1989-2000 time period (p=0.001). During the period 1989-1994 the odds of death declined most steeply (on average 6% per year p=0.004). Between 1994 to 2000 no significant change occurred (p=0.35). This pattern was mirrored by the 20 permanent members where the odds of death also declined more steeply over the 1989-1994 period. The percentage of severely injured patients (ISS >15) seen by a consultant increased from 29 to 40 from 1989-1994 but has remained static subsequently. Median prehospital times for severely injured patients have not changed significantly since 1994 (51 to 45 minutes).ConclusionMost of the case fatality reduction for trauma patients reaching hospital over the 1989-2000 time period occurred before 1995 when there was most marked change in the initial care of severely injured patients.
| S-EPMC1756315 | biostudies-literature
Project description:ObjectiveThe aim of this study was to prospectively investigate the potential effects of alcohol by subtype on reported long-term weight change.MethodsThis study examined changes in alcohol intake (total, wine, light beer, regular beer, and liquor) and simultaneous changes in reported body weight within 4-year periods from 1986 to 2010 from US men in the Health Professionals Follow-Up Study. The study adjusted for age, changes in lifestyle and dietary covariates, and cardiovascular risk factors.ResultsThe study included observations of 44,603 four-year periods from 14,971 men. Total alcohol, total beer, regular beer, and liquor intakes, modeled as the increase in weight per increase in drinks per day, were each directly associated with moderate weight gain over the 4-year periods, in pounds: total alcohol: 0.23 (0.10 to 0.35); total beer: 0.29 (0.08 to 0.51); regular beer: 0.61 (0.22 to 1.00); and liquor: 0.28 (0.09 to 0.48). Results for wine and light beer were as follows: wine: 0.16 (-0.04 to 0.36) and light beer: -0.38 (-1.07 to 0.08). Results were strongest for men < 55 years old.ConclusionsIncreased alcohol consumption was associated with minor reported weight gain at levels unlikely to be clinically meaningful. Beverage-specific differences were not substantial enough to make dietary recommendations for weight loss or maintenance by beverage type. The greatest risk of weight gain was among men who increased consumption to levels well above moderation.
| S-EPMC5679228 | biostudies-literature
Project description:PurposeTo describe drug utilisation patterns in neonatal units.MethodsRetrospective observational cohort study using data held in the National Neonatal Research Database (NNRD) for neonatal units in England and Wales including infants born at 23 to 44 weeks' gestational age (GA) from 01 January 2010 to 31 December 2017.ResultsThe cohort included 17,501 (3%) extremely preterm infants; 40,607 (7%) very preterm infants; 193,536 (31%) moderate-to-late preterm infants; and 371,606 (59%) term infants. The number of unique drugs received by an infant (median (IQR)) increased with decreasing GA: 17 (11-24) in extremely preterm, 7 (5-11) in very preterm, 3 (0-4) in moderate-to-late preterm, and 3 (0-3) in term infants. The two most frequently prescribed drugs were benzylpenicillin and gentamicin in all GA groups, and caffeine in extremely preterm. Other frequently used drugs among preterm infants were electrolytes, diuretics and anti-reflux medications. Among infants <32 weeks' GA, the largest increase in use was for surfactant (given on the neonatal unit), caffeine and probiotics, while domperidone and ranitidine had the largest decline.ConclusionAntibiotics, for all GAs and caffeine, among preterm infants, are the most frequently used drugs in neonatal medicine. Preterm infants are exposed to a high burden of drugs, particularly antibiotics. Changing patterns in use reflect the emergence of evidence in some areas but several non-evidence-based drugs continue to be used widely. Improvements are needed to ensure rational drug use on neonatal units.RegistrationClinicalTrials.gov (NCT03773289). Date of registration 21 Dec 2018.
| S-EPMC8926961 | biostudies-literature
Project description:BackgroundControl of HIV transmission could be achievable through an expansion of HIV testing of at-risk populations together with ready access and adherence to antiretroviral therapy. To examine whether increases in testing rates and antiretroviral therapy coverage correspond to the control of HIV transmission, we estimated HIV incidence in men who have sex with men (MSM) in England and Wales since 2001.MethodsA CD4-staged back-calculation model of HIV incidence was used to disentangle the competing contributions of time-varying rates of diagnosis and HIV incidence to observed HIV diagnoses. Estimated trends in time to diagnosis, incidence, and undiagnosed infection in MSM were interpreted against a backdrop of increased HIV testing rates and antiretroviral-therapy coverage over the period 2001-10.FindingsThe observed 3·7 fold expansion in HIV testing in MSM was mirrored by a decline in the estimated mean time-to-diagnosis interval from 4·0 years (95% credible interval [CrI] 3·8-4·2) in 2001 to 3·2 years (2·6-3·8) by the end of 2010. However, neither HIV incidence (2300-2500 annual infections) nor the number of undiagnosed HIV infections (7370, 95% CrI 6990-7800, in 2001, and 7690, 5460-10 580, in 2010) changed throughout the decade, despite an increase in antiretroviral uptake from 69% in 2001 to 80% in 2010.InterpretationCD4 cell counts at HIV diagnosis are fundamental to the production of robust estimates of incidence based on HIV diagnosis data. Improved frequency and targeting of HIV testing, as well as the introduction of ART at higher CD4 counts than is currently recommended, could begin a decline in HIV transmission among MSM in England and Wales.FundingUK Medical Research Council, UK Health Protection Agency.
| S-EPMC3610092 | biostudies-literature
Project description:ObjectivesTo monitor the impact of health and safety provisions and inform future preventive strategies, we investigated trends in mortality from established occupational hazards in England and Wales.MethodsWe analysed data from death certificates on underlying cause of death and last full-time occupation for 3 688 916 deaths among men aged 20-74 years in England and Wales during 1979-2010 (excluding 1981 when records were incomplete). Proportional mortality ratios (PMRs), standardised for age and social class, were calculated for occupations at risk of specified hazards. Observed and expected numbers of deaths for each hazard were summed across occupations, and the differences summarised as average annual excesses.ResultsExcess mortality declined substantially for most hazards. For example, the annual excess of deaths from chronic bronchitis and emphysema fell from 170.7 during 1979-1990 to 36.0 in 2001-2010, and that for deaths from injury and poisoning from 237.0 to 87.5. In many cases, the improvements were associated with falling PMRs (suggesting safer working practices), but they also reflected reductions in the numbers of men employed in more hazardous jobs, and declining mortality from some diseases across the whole population. Notable exceptions to the general improvement were diseases caused by asbestos, especially in some construction trades and sinonasal cancer in woodworkers.ConclusionsThe highest priority for future prevention of work-related fatalities is the minority of occupational disorders for which excess mortality remains static or is increasing, in particular asbestos-related disease among certain occupations in the construction industry and sinonasal cancer in woodworkers.
| S-EPMC4872835 | biostudies-literature