Costs and benefits of diagnosing familial breast cancer.
(57/3226)
Based on results from our surveillance program for women at risk for inherited breast cancer, we have calculated cost per year earned. Norwegian National Insurance Service reimbursement fees were used in the calculations. The calculated costs are based on empirical figures for expanding already established medical genetic departments and diagnostic outpatient clinics to undertake the work described. Cost per year earned was estimated at Euro 753 using our current practice of identifying the high-risk women through a traditional cancer family clinic. A strategy of identifying the high-risk families through genetic testing of all incident breast and ovarian cancers for founder mutations in BRCA1, will increase the cost to Euro 832. Costs related more to genetic counseling and clinical follow-up than to laboratory procedures. This potential economic limiting factor coincides with a shortage of personnel trained in genetic counseling. The number of relatives counseled to identify one healthy female mutation carrier (i.e. the uptake of genetic testing) is more important to cost-effectiveness than family size. Costs will vary depending upon the penetrance of the mutations detected and the prevalence of founder mutations in the population examined. Prevalences of BRCA1 founder mutations in some high incidence areas of Norway may be sufficiently high to consider population screening. Unlike mutation screening of cancer genes, founder mutation analysis will not identify DNA variants of uncertain clinical significance. Identification of high-risk families through founder mutation analysis of BRCA1 ensures that families with maximum risks are given first access to the limited resources of the high-risk clinics. This may be the greatest contribution to increased cost effectiveness of such a strategy. The assumptions underlying the calculations are discussed. The conclusion is that inherited breast cancer may be managed effectively for the cost of Euro 750-1,600 per year earned. (+info)
Day care attendance, recurrent respiratory tract infections and asthma.
(58/3226)
OBJECTIVE: Our objective was to use a causal model for childhood asthma to determine whether the effect of day care attendance on asthma was mediated by recurrent respiratory tract infections. DESIGN: A cross-sectional survey among 1447 children aged 6-16 years in Oslo. Their parents completed written questionnaires. A recursive logit model was used to estimate direct effects in terms of adjusted odds ratios (aOR). RESULTS: Year of birth, number of siblings and length of maternal education were significantly associated with day care attendance. Attendance at day care increased the risk of early infections, aOR = 1.8 (1.3-2.5), and infections were associated with asthma, aOR = 4.9 (3.4-7.3). The crude association between day care and asthma was cOR = 1.5 (1.0-2.2), whereas the estimated direct effect was small and nonsignificant, aOR = 1.2 (0.8-1.9). The results may be influenced by overreporting of infections among parents of children with asthma. CONCLUSIONS: Our results suggest that children who attend day care have an increased risk of asthma with early infections as a mediator of risk. (+info)
Study of cancer incidence among 6363 male workers in four Norwegian ferromanganese and silicomanganese producing plants.
(59/3226)
OBJECTIVES: Little has been known about the risk of cancer associated with occupational exposure to manganese. The objective of this study was therefore to examine the associations between duration of specific work and cancer incidence among employees in four Norwegian ferromanganese and silicomanganese producing plants. METHODS: Among men first employed in 1933-91 and with at least 6 months in these plants, the incident cases of cancer during 1953-91 were obtained from The Cancer Registry of Norway. The numbers of various cancers were compared with expected figures calculated from age and calendar time specific rates for Norwegian men during the same period. Internal comparisons of rates were performed with Poisson regression analysis. The final cohort comprised 6363 men. RESULTS: A total of 607 cases of cancer were observed against 596 cases expected (standardised incidence ratio (SIR) 1.02). Internal comparisons of rates showed a positive trend between the rate of all cancers and duration of furnace work. A slightly weaker trend was also found for duration of blue collar non-furnace work when lags of 25 or 30 years were applied in the analyses. However, several results indicated that the incidence of all cancers among the non-furnace workers decreased during the period of active employment. CONCLUSIONS: Furnace and non-furnace workers may have exposures that increase the incidence of several cancers. The low incidence of cancer among non-furnace workers during the period of ongoing exposure cannot be explained. As this study cannot identify any causal factors, the role of exposure to manganese remains unclear. (+info)
Study of cancer incidence among 8530 male workers in eight Norwegian plants producing ferrosilicon and silicon metal.
(60/3226)
OBJECTIVES: To examine the association between cancer incidence, in particular incidence of lung cancer, and duration of work among employees in eight Norwegian plants producing ferrosilicon and silicon metal. METHODS: Among men first employed during 1933-91 and with at least 6 months in these plants, the incident cases of cancer during 1953-91 were obtained from The Cancer Registry of Norway. The numbers of various cancers were compared with expected figures calculated from age and calendar time specific rates for Norwegian men during the same period. Internal comparisons of rates were performed with Poisson regression analysis. The final cohort comprised 8530 men. RESULTS: A total of 832 cases of cancer were observed against 786 expected (standardised incidence ratio (SIR) 1.06). Among the furnace workers an increased incidence of lung cancer (SIR 1.57) and testicular cancer (SIR 2.30) was found. Internal comparisons of rates by Poisson regression analysis among the rural furnace workers showed a positive trend between incidence of lung cancer and duration of work of 1.05 (95% confidence interval (95% CI) 1.00 to 1.10)/work-year. Excess cases of prostate and kidney cancer were found among blue collar non-furnace workers, in particular among the mechanics. CONCLUSION: The results suggest associations between furnace work and lung and testicular cancer, and between non-furnace work and prostate cancer. (+info)
Lessons from the story of n-3 fatty acids.
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The discovery of the effects of n-3 fatty acids came about as a result of contacts between scientists in different countries and disciplines who followed up some unexpected observations. There are probably other fields of research in which discoveries of similar importance await the application of lessons from this story. (+info)
The single-breath transfer factor for carbon monoxide and respiratory symptoms in a Norwegian community sample.
(62/3226)
Reduced single-breath transfer factors of the lung for carbon monoxide are seen in a number of conditions. The hypothesis of the present study was that self-reported respiratory symptoms differ in their prediction of TL,CO level in a general population in Norway. A cross-sectional survey of a general population sample in Norway, made up of 1,275 subjects aged 18-73 yrs, was conducted in 1987-1988. The attendees (84% response rate) filled in a questionnaire on respiratory symptoms and underwent standardized spirometric and TL,CO measurements and clinical examination. Associations between TL,CO and respiratory symptoms were assessed using multiple regression models. Tests for interaction were used to examine whether these associations varied with sex, age and smoking habits. Data from 1,221 subjects were analysed. Both males and females who reported respiratory symptoms had significantly lower TL,CO after adjusting for age and height. In a multiple linear regression analysis of TL,CO, adjusting for sex, age, height and smoking habits, the symptoms for which statistical significance was attained, were morning cough, chronic cough and breathlessness. However, only the breathlessness score was independently associated with the TL,CO (-0.42 mmol x min(-1) x kPa(-1) per breathlessness score unit) after adjusting for other respiratory symptoms, and the relationship was stronger in males than in females. In this study, the strongest predictor for a decreased single-breath transfer factor of the lung for carbon monoxide was the presence of self-reported breathlessness, regardless of age, smoking habits and height. (+info)
GPs' treatment of uncomplicated urinary tract infections--a clinical judgement analysis in four European countries. DEP group. Drug Education Project.
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BACKGROUND: Non-adherence to recommendations for treatment of uncomplicated urinary tract infections (UTI) is common, but the reasons are not sufficiently understood. OBJECTIVES: We aimed to assess and compare the influence of specific patient characteristics on GPs' treatment decisions for UTI in four European countries. METHODS: GPs in The Netherlands, Norway, Sweden and Germany were presented 18-26 case vignettes of UTI. Linear regression models were used to determine which patient characteristics predicted non-optimal decisions. RESULTS: Adherence to national recommendations varied both within and between countries, but there were remarkable similarities in the case characteristics predicting non-optimal decisions: a history of UTI and the patient's age were strongly related to prescription of second-choice antibiotics and longer treatment courses. CONCLUSION: In all countries many GPs were reluctant to follow the recommendations in UTI cases that they might perceive as being more complicated. (+info)
Influence of paternal exposure to oil and oil products on time to pregnancy and spontaneous abortions.
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The objective of this study was to evaluate the influence of exposure to oil and oil products among men on the time taken for their wives to conceive and on the incidence of spontaneous abortion among them. A cross-sectional study was performed by posting questionnaires to 1,269 men employed as offshore mechanics, offshore operators, offshore drilling personnel, car mechanics (the 'exposed' occupations) and carpenters ('unexposed'). The married men were asked to give a separate questionnaire to their wives for details about their pregnancies. The time elapsed between the beginning of coitus without contraception and the wife becoming pregnant (time to pregnancy) was analyzed with Cox regression analysis by calculating fecundability ratios for the pregnancies for the men exposed to oil and oil products as compared with the men who were not exposed. Spontaneous abortions were analyzed with logistic regression by calculating odds ratios for the pregnancies in which the men were exposed vs. not exposed. A total of 741 (58%) men returned the questionnaires. A total of 301 pregnancies were analyzed for time taken to conceive and 580 for spontaneous abortion. The results were adjusted for variables that could significantly influence conception time (previous infections of the reproductive system and coffee drinking) or the incidence of spontaneous abortion (mother's age, parity and smoking). The outcomes between the exposed and unexposed pregnancies showed no significant differences. Car mechanics had a lower fecundability ratio before 1992 than after 1992. Paternal exposure to hydrocarbons in the occupations studied did not seem to have had a major influence on time to conception or the incidence of spontaneous abortion among the wives of the men exposed to oil products. (+info)