General supplement use, subsequent use and cancer risk in the UK Women's Cohort Study

BACKGROUND/OBJECTIVES

To determine whether general dietary supplement use is associated with cancer risk in UK women and to estimate risks related to use at one and two recording points.

SUBJECTS/METHODS

Cox's proportional hazard regression models were used to estimate cancer risks for 32 665 middle-aged women in the UK Women's Cohort Study relating to any current supplement use recorded in a baseline questionnaire. During a median follow-up of 15 years, there were 3936 registered cancer incidences, including 1344 breast, 429 smoking-related and 362 colorectal cancers. Cancer risks for 12 948 of these women, who also completed questionnaires on average 4.4 years later, were estimated in relation to any supplement use at both time points (1527 cancers, including 561 breast, 131 smoking-related and 141 colorectal cancers). Adjustments were made for baseline confounders.

RESULTS

Total smoking-related cancers were associated with baseline supplement use (hazard ratio (HR)=1.41, 95% confidence interval (CI): 1.10, 1.81) compared with non-use, but not associated with use at both recording points (HR=1.29; 95% CI: 0.78, 2.13) compared with use at neither. There was no evidence of the associations between total, colorectal or breast cancers and baseline supplement use, or use at both recording points. In sub-analyses, no significant associations with breast cancer were found for premenopausal or postmenopausal baseline users, or similarly for use at both points (HR=1.35, 95% CI: 0.91, 2.01; and HR=0.93, 95% CI: 0.68, 1.26, respectively).

CONCLUSIONS

There was evidence that general supplement use was associated with increased smoking-related cancer risk, but there was no evidence of associations with total, colorectal and breast cancers.

Where do pulse oximeter probes break?

Pulse oximetry, a non-invasive method for accurate assessment of blood oxygen saturation (SPO2), is an important monitoring tool in health care facilities. However, it is often not available in many low-resource settings, due to expense, overly sophisticated design, a lack of organised procurement systems and inadequate medical device management and maintenance structures. Furthermore medical devices are often fragile and not designed to withstand the conditions of low-resource settings. In order to design a probe, better suited to the needs of health care facilities in low-resource settings this study aimed to document the site and nature of pulse oximeter probe breakages in a range of different probe designs in a low to middle income country. A retrospective review of job cards relating to the assessment and repair of damaged or faulty pulse oximeter probes was conducted at a medical device repair company based in Cape Town, South Africa, specializing in pulse oximeter probe repairs. 1,840 job cards relating to the assessment and repair of pulse oximeter probes were reviewed. 60.2 % of probes sent for assessment were finger-clip probes. For all probes, excluding the neonatal wrap probes, the most common point of failure was the probe wiring (>50 %). The neonatal wrap most commonly failed at the strap (51.5 %). The total cost for quoting on the broken pulse oximeter probes and for the subsequent repair of devices, excluding replacement components, amounted to an estimated ZAR 738,810 (USD $98,508). Improving the probe wiring would increase the life span of pulse oximeter probes. Increasing the life span of probes will make pulse oximetry more affordable and accessible. This is of high priority in low-resource settings where frequent repair or replacement of probes is unaffordable or impossible.

MiR203 mediates subversion of stem cell properties during mammary epithelial differentiation via repression of ΔNP63α and promotes mesenchymal-to-epithelial transition

During reproductive life, the mammary epithelium undergoes consecutive cycles of proliferation, differentiation and apoptosis. Doing so relies on the retained proliferative capacity, prolonged lifespan and developmental potency of mammary stem cells (MaSCs). ΔNp63α, the predominant TP63 isoform in mammary epithelia, is robustly expressed in MaSCs and is required for preservation of self-renewing capacity in diverse epithelial structures. However, the mechanism(s) underlying subversion of this activity during forfeiture of self-renewing capacity are poorly understood. MicroRNAs (miRNAs) govern critical cellular functions including stem cell maintenance, development, cell cycle regulation and differentiation by disrupting translation of target mRNAs. Data presented here indicate that expression of miR203, a miRNA that targets ΔNp63α and ΔNp63β is activated during luminal epithelial differentiation and that this pattern is observed in the murine mammary hierarchy. In addition, we present evidence that the transcription factor Zeb1 represses miR203 expression, thus enhancing ΔNp63α protein levels. Furthermore, ectopic miR203 suppresses ΔNp63α expression, proliferation and colony formation. The anti-clonogenic effects mediated by miR203 require suppression of ΔNp63α. In addition, ectopic miR203 promotes mesenchymal-to-epithelial transition and disrupts activities associated with epithelial stem cells. These studies support a model in which induction of miR203 mediates forfeiture of self-renewing capacity via suppression of ΔNp63α and may also have anti-tumorigenic activity through its reduction of EMT and cancer stem cell populations.

STIFCompetency: development and evaluation of a new clinical training and assessment programme in sexual health for primary care health professionals

UK sexual health services are shifting from hospital-based clinics into primary care, creating a need for high quality clinical sexual health training for non-specialists. Here we describe development, evaluation and costing of a new competency-based training programme, the Sexually Transmitted Infection (STI) Foundation Competency (STIF Competency) programme, based on the Department of Health's toolkit for delivering more specialized sexual health in primary care. We used an action research paradigm with two iterative cycles. Evaluation was to Kirkpatrick's third level with triangulation of results between trainers and trainees, and different methods, including portfolio evaluation, nominal group technique process, semi-structured interviews, Likert questionnaires and chlamydia testing rates. All 13 primary care clinicians completed the training successfully (median 20 hours) and rated STIF Competency highly. Trainers needed to reduce their clinical workload to accommodate the training. Average cost per trainee was £1125, reflecting the need for direct observation of competence across a wide range of clinical skills.

Managing risk: a qualitative study of community-based professionals working with learning-disabled sex offenders

This study reports on research conducted to examine how community practitioners manage the difficulties of risk assessment in relation to people with a learning disability and a history of sexually offensive or abusive behaviour. Semi-structured interviews were conducted with a number of key professionals from various disciplines, all currently involved in the assessment process with the aim of determining potential referral to community settings. Data analysis revolved around a thematic exposition of factors influencing the relationship between the objective science of psychiatric investigation and the subjective interpretation of real-world practicalities in working with this group. Findings surrounded three major themes, frame conflict, relating to the difficulties of decision making in this area, therapeutic performance, whereby professionals were expected to engage in some form of active intervention, and safety outcomes, involving consideration of the problematic nature of judging the likelihood of re-offending.

Smoking in pregnancy and disruptive behaviour in 3-year-old boys and girls: an analysis of the UK Millennium Cohort Study

BACKGROUND

Maternal smoking during pregnancy has been consistently associated with disruptive behaviour in male offspring; however, results for girls are inconsistent and little is known about emergent patterns in young children. Additionally, it is unclear whether maternal smoking is independently associated in offspring with hyperactivity-inattention or only when it co-occurs with conduct problems. Further, few studies have controlled for a broad range of maternal psychosocial problems.

METHODS

Associations between self-reported smoking in pregnancy and maternal reports of externalising behaviour were analysed in more than 13 000 3-year-old boys and girls in the UK Millennium Cohort Study. Conduct and hyperactivity-inattention problems were assessed using the Strength and Difficulties Questionnaire.

RESULTS

Boys whose mothers persistently smoked throughout pregnancy were at significant risk of conduct and hyperactivity-inattention problems compared with sons of non-smokers: the effect was stronger for heavy smokers. After excluding children with co-occurring problems, conduct-only problems remained a significant risk for sons of heavy smokers, OR 1.92 (95% CI 1.29 to 2.86); and hyperactivity-inattention only for sons of light or heavy smokers, OR 1.79 (95% CI 1.27 to 2.51) and 1.64 (1.10 to 2.46). Daughters of light or heavy smokers were at significant risk of conduct-only problems, OR 1.73 (95% CI 1.14 to 2.61) and 1.73 (1.06 to 2.83). Relative to non-smokers, daughters of pregnancy quitters had significantly reduced odds of having conduct 0.61(0.39 to 0.97) or co-occurring problems 0.26(0.08 to 0.82), although only 79 and 20 girls met these criteria, respectively. All findings were robust to controlling for key social and psychosocial factors.

CONCLUSIONS

Associations between maternal smoking during pregnancy and disruptive behaviour in 3-year-old children vary by sex, smoking status and whether or not conduct or hyperactivity problems occur together or separately.