Social inequalities in overweight and obesity in 26 European countries

Background

Previous studies have shown inequalities in overweight and obesity in disfavor of the socially disadvantaged groups. This study examines the extent of these inequalities in 26 European countries.

Methods

Data from the 2017 EU Statistics on Income and living Conditions (EU-SILC) were used (18 years and older, n = 482,595). A body mass index of 25.0 to 29.9 kg/m2 was classified as overweight and 30.0 and more as obese. Educational level (EL) was used as socioeconomic indicator. Generalized linear models were fitted to compute low-versus high absolute (RD) and relative (RR) inequality. Absolute inequality amplitude (RDA) was calculated as RD/Prevalence.

Results

Among men, average EU inequalities for overweight were slightly in disfavor of the low educated (RR = 1.05, RDA=5%). A mixed inequality pattern was observed across countries, as the risk of overweight was higher among high educated men in most Eastern countries, in contrast to other parts of Europe (RR from 0.74 to 1.19, RDA from -27% to 20%). Male obesity showed more pronounced inequalities (RR = 1.22, RDA=18%), and a consistent pattern of higher risk among the low educated and wide variation across countries (RR from 1.20 to 2.18, RDA from 16% to 49%). Among women, significant inequalities in overweight were observed (RR = 1.23, RDA=21%), with a consistent pattern of higher risk among the lowest EL, and substantial variation across countries (RR from 1.06 to 1.53, RDA from 7% to 36%). Inequalities were even larger for female obesity, with average RR and RDA reaching 1.49 and 35%, and wider variation (RR from 1.35 to 2.77, RDA from 12% to 88%).

Conclusions

Social inequalities in weight status are widespread in Europe, but vary substantially between countries. Inequalities are larger among women. For male overweight, a reverse inequality is observed in most Eastern countries. This study allows countries to benchmark the inequalities observed nationally to the situation in other EU countries.

Key messages

Social inequalities in weight status are widespread in Europe. The pattern of social inequalities in overweight and obesity varies substantially by country and gender.

Changes in life expectancy and contribution of causes of deaths and age groups in Belgium, 1997-2018

Background

Concerns have been expressed about a recent decreasing growth of life expectancy (LE) in some developed countries. This study examines whether a slowing down in the LE increase was observed in Belgium between 1997 and 2018, and describes the contribution of causes of deaths (COD) and age groups to the 2000-2015 change in LE.

Methods

Changes in yearly LE increase were analyzed by linear regression and joinpoint regression analysis. The contribution of age and COD to the change in LE in Belgium was measured with the Arriaga decomposition method using 3-year moving average to reduce random fluctuations over years.

Results

No significant breakpoint was identified. The slope of the linear regression of annual LE changes in men was practically flat (slope = -0.0002, CI: -0.014, 0.013) and slightly, but not significantly, decreasing in women (slope = -0.002, CI: -0.019, 0.015). A larger increase in LE was observed in men compared to women and in people aged 70 years and over compared to younger ages. The COD contributing the most to the increase in LE was ischemic heart disease in men and in women. It was followed by transport accident and lung cancer in men and by cerebrovascular diseases and other circulatory diseases in women. Dementia, Alzheimer, and Parkinson contributed negatively to the LE increase in men and in women. The largest negative contributor was lung cancer in women.

Conclusions

In contrast to neighboring countries, no evidence for a significant stalling of life expectancy were found in Belgium between 1997 and 2018. Progress in reducing the major causes of deaths (cardiovascular diseases, some cancers, and transport accidents) have contributed to the increase of LE, but some COD are impeding further progress, particularly lung cancer in women.

Key messages

No evidence of stalling life expectancy in Belgium between 1997 and 2018. Monitoring causes of deaths is crucial to identify conditions impeding progress in life expectancy.

An online health status report to support public health in Belgium

Issue

Monitoring population health is crucial for policymakers. In Belgium, health monitoring only existed at regional level, with no integrated view at country level.

Policy/tool

The Health Status Report (HSR) project developed a tool for centralizing key health indicators. The HSR aims to support policymakers in multiple ways: as a ’warning signal’, by contributing to the planning of health policies, and as an assessment tool for those policies. Rather than being exhaustive, the HSR selects key indicators to highlight important needs. These indicators have been identified through literature and consultations with experts and stakeholders. Topics include life and health expectancies, mortality, morbidity, and lifestyles, with an important focus on socioeconomic inequalities. Good results and health gaps are underlined with international comparisons, trend analyses, and comparisons with reference values. By disaggregating the data by sex, age, geographic level or socio-economic level, specific health needs are identified.

Results

The main outcome of the project is a continuously updated website: www.healthybelgium.be. The report highlighted that, although the Belgian health status is rather good, there is room for improvement: for some indicators Belgium lags behind other European countries; regional disparities remain important, with most indicators revealing a better health status in Flanders than in Brussels and Wallonia. Socioeconomic disparities also remain very important, and for some indicators even tend to worsen. Comparing the Belgian health status to that of the EU-15 results in more severe conclusions than in international reports.

Conclusions

We developed a new tool to support public health policy in Belgium through benchmarking and trend and disparity analyses of several health indicators. The tool will be expanded in the next years, integrating for instance the results of the Belgian national burden of disease study.

Key messages

We developed an online health status monitoring tool to inform policymakers. The rather good health status hides important regional and socioeconomic disparities in Belgium.

Monitoring of non-communicable diseases in Belgium

Key messages

There is currently no national plan to prevent and monitor the health impact of non-communicable diseases in Belgium. The Belgian Health Status Report and the Belgian National Burden of Disease Study provide new opportunities for monitoring non-communicable diseases in an integrated and comparable way.

Measurement of the potential geographic accessibility from call to definitive care for patient with acute stroke

BACKGROUND

The World Health Organization refers to stroke, the second most frequent cause of death in the world, in terms of pandemic. Present treatments are only effective within precise time windows. Only 10% of thrombolysis patients are eligible. Late assessment of the patient resulting from admission and lack of knowledge of the symptoms is the main explanation of lack of eligibility.

METHODS

The aim is the measurement of the time of access to treatment facilities for stroke victims, using ambulances (firemen ambulances or EMS ambulances) and private car. The method proposed analyses the potential geographic accessibility of stroke care infrastructure in different scenarios. The study allows better considering of the issues inherent to an area: difficult weather conditions, traffic congestion and failure to respect the distance limits of emergency transport.

RESULTS

Depending on the scenario, access times vary considerably within the same commune. For example, between the first and the second scenario for cities in the north of Rhône county, there is a 10 min difference to the nearest Primary Stroke Center (PSC). For the first scenario, 90% of the population is 20 min away of the PSC and 96% for the second scenario. Likewise, depending on the modal vector (fire brigade or emergency medical service), overall accessibility from the emergency call to admission to a Comprehensive Stroke Center (CSC) can vary by as much as 15 min.

CONCLUSIONS

The setting up of the various scenarios and modal comparison based on the calculation of overall accessibility makes this a new method for calculating potential access to care facilities. It is important to take into account the specific pathological features and the availability of care facilities for modelling. This method is innovative and recommendable for measuring accessibility in the field of health care. This study makes possible to highlight the patients' extension of care delays. Thus, this can impact the improvement of patient care and rethink the healthcare organization. Stroke is addressed here but it is applicable to other pathologies.

Measurement of the potential geographic accessibility from call to definitive care for patient with acute stroke

BACKGROUND

The World Health Organization refers to stroke, the second most frequent cause of death in the world, in terms of pandemic. Present treatments are only effective within precise time windows. Only 10% of thrombolysis patients are eligible. Late assessment of the patient resulting from admission and lack of knowledge of the symptoms is the main explanation of lack of eligibility.

METHODS

The aim is the measurement of the time of access to treatment facilities for stroke victims, using ambulances (firemen ambulances or EMS ambulances) and private car. The method proposed analyses the potential geographic accessibility of stroke care infrastructure in different scenarios. The study allows better considering of the issues inherent to an area: difficult weather conditions, traffic congestion and failure to respect the distance limits of emergency transport.

RESULTS

Depending on the scenario, access times vary considerably within the same commune. For example, between the first and the second scenario for cities in the north of Rhône county, there is a 10 min difference to the nearest Primary Stroke Center (PSC). For the first scenario, 90% of the population is 20 min away of the PSC and 96% for the second scenario. Likewise, depending on the modal vector (fire brigade or emergency medical service), overall accessibility from the emergency call to admission to a Comprehensive Stroke Center (CSC) can vary by as much as 15 min.

CONCLUSIONS

The setting up of the various scenarios and modal comparison based on the calculation of overall accessibility makes this a new method for calculating potential access to care facilities. It is important to take into account the specific pathological features and the availability of care facilities for modelling. This method is innovative and recommendable for measuring accessibility in the field of health care. This study makes possible to highlight the patients' extension of care delays. Thus, this can impact the improvement of patient care and rethink the healthcare organization. Stroke is addressed here but it is applicable to other pathologies.

Reliability of White Matter Microstructural Changes in HIV Infection: Meta-Analysis and Confirmation

BACKGROUND

Diffusion tensor imaging has been widely used to measure HIV effects on white matter microarchitecture. While many authors have reported reduced fractional anisotropy and increased mean diffusivity in HIV, quantitative inconsistencies across studies are numerous.

PURPOSE

Our aim was to evaluate the consistency across studies of HIV effects on DTI measures and then examine the DTI reliability in a longitudinal seropositive cohort.

DATA SOURCES

Published studies and investigators.

STUDY SELECTION

The meta-analysis included 16 cross-sectional studies reporting fractional anisotropy and 12 studies reporting mean diffusivity in the corpus callosum.

DATA ANALYSIS

Random-effects meta-analysis was used to estimate study standardized mean differences and heterogeneity. DTI longitudinal reliability was estimated in seropositive participants studied before and 3 and 6 months after beginning treatment.

DATA SYNTHESIS

Meta-analysis revealed lower fractional anisotropy (standardized mean difference, -0.43; P < .001) and higher mean diffusivity (standardized mean difference, 0.44; P < .003) in seropositive participants. Nevertheless, between-study heterogeneity accounted for 58% and 66% of the observed variance (P < .01). In contrast, the longitudinal cohort fractional anisotropy was higher and mean diffusivity was lower in seropositive participants (both, P < .001), and fractional anisotropy and mean diffusivity measures were very stable during 6 months, with intraclass correlation coefficients all >0.96.

LIMITATIONS

Many studies pooled participants with varying treatments, ages, and disease durations.

CONCLUSIONS

HIV effects on WM microstructure had substantial variations that could result from acquisition, processing, or cohort-selection differences. When acquisition parameters and processing were carefully controlled, the resulting DTI measures did not show high temporal variation. HIV effects on WM microstructure may be age-dependent. The high longitudinal reliability of DTI WM microstructure measures makes them promising disease-activity markers.

Formation of porous calcite mesocrystals from CO2–H2O–Ca(OH)2 slurry in the presence of common domestic drinks

Simple method to synthesize porous calcite mesocrystals by aqueous carbonation of portlandite in presence of common domestic drinks.

[Early detection to prevent mental illness during adolescence: ethical and theoretical considerations]

In the face of changes that characterise adolescence, a number of youth experience ill-being, as part of a normal developmental process. For some of them, however, this ill-being may represent early signs of a psychopathological process. Regarding depression and psychosis, such early signs are non-specific, which complicates and delays treatment. In addition, issues such as stigmatization and unfamiliarity with these psychopathologies represent major obstacles to treatment access. Attempts to early detection, which involves identifying risk factors in order to provide support and follow-up, making an effort to take these clinical signs seriously, while at the same time avoiding to mistake a normal developmental process for a pathological condition.

Global Functional Disconnections in Post-anoxic Coma Patient

Disorders of consciousness have been related to different disconnection patterns as assessed by neuroimaging tools such as PET or fMRI. In this report, we use resting-state functional MRI acquisition and a functional connectivity analysis by graph of brain networks, to investigate the global residual connection pattern in a patient with consciousness disorders following post-anoxic injury. We then compare this pattern with those of a group of twenty controls. We observed that the patient's graph presents multiple disconnections in primary areas and in high-order associative areas. This pattern is consistent with a vegetative state, as reported by other groups. Further, the informations conveyed by this approach are consistent with those provided by PET, fMRI and EP. This new approach presents a very strong potential for diagnosis for consciousness disorder patients since it is applicable very early after the insult.

Decline in breast cancer incidence in the Flemish region of Belgium after a decline in hormonal replacement therapy

BACKGROUND

Breast cancer incidence rate in Belgian women was as high as 152.7 for 100 000 in 2003 (adjusted on European population). We made an estimation of the contribution of hormone replacement therapy (HRT) on breast cancer incidence from 1999 to 2005 in women aged 50-69 years in Flanders.

METHODS

Breast cancer data were extracted from the Belgium Cancer Registry. Drug consumption was computed from drug sales data. The fraction of breast cancers attributable to HRT was calculated by year, using the relative risks of the Million Women Study in the UK.

RESULTS

The proportion of women aged 50-69 years using HRT in Flanders increased since 1992, peaked at 20% in 2001, then decreased to 8% in 2008. The incidence of breast cancer in 100 000 women aged 50-69 years in Flanders increased from 332.8 in 1999 to 407.9 in 2003, then decreased to 366.1 in 2005; the variations were mostly noticeable for tumors <20 mm in size. The fraction of breast cancers attributed to HRT peaked at 11% in 2001 and decreased afterward.

CONCLUSION

The high level of breast cancer observed in the years 2001-2003 in Flanders can be partly attributed to the use of HRT. Since participation to mammography screening of Flemish women aged 50-69 years was still on the rise in 2003 and never exceeds 62%, the decrease in breast cancer incidence was likely to be due to the decrease in HRT use and not to screening saturation.

Removal of oxyanions from synthetic wastewater via carbonation process of calcium hydroxide: applied and fundamental aspects

Removal of oxyanions (selenite, selenate, arsenate, phosphate and nitrate) during calcite formation was experimentally studied using aqueous carbonation of calcium hydroxide under moderate pressure (P(CO2) congruent with 20 bar) and temperature (30 degrees C). The effects of Ca(OH)(2) dose (10 and 20 g), Ca(OH)(2) source (commercial pure material or alkaline paper mill waste) and oxyanion initial concentration (from 0 to 70 mg atom/L) were investigated for this anisobaric gas-liquid-solid system. The Ca(OH)(2) carbonation reaction allowed successfully the removal of selenite (>90%), arsenate (>78%) and phosphate (congruent with 100%) from synthetic solutions. Conversely, nitrate and selenate had not any physicochemical affinity/effect during calcite formation. The rate of CO(2) transfer during calcite formation in presence of oxyanions was equal or slower than for an oxyanion-free system, allowing to define a retarding kinetic factor RF that can vary between 0 (no retarding effect) to 1 (total inhibition). For selenite and phosphate RF was quite high, close to 0.3. A small retarding effect was detected for arsenate (RF approximately 0.05) and no retarding effect was detected for selenate and nitrate (RF approximately 0). In general, RF depends on the oxyanion initial concentration, oxyanion nature and Ca(OH)(2) dose. The presence of oxyanions could also influence the crystal morphology and aggregation/agglomeration process. For example, a c-axis elongation of calcite crystals was clearly observed at the equilibrium, for calcite formation in presence of selenite and phosphate. The oxyanions removal process proposed herein was inspired on the common physicochemical treatment of wastewater using calcium hydroxide (Ca(OH)(2)). The particularity, for this novel method is the simultaneous calcium hydroxide carbonation with compressed carbon dioxide in order to stabilise the solid matter. This economical and ecological method could allow the removal of various oxyanions as well as the ex situ mineral sequestration of CO(2); particularly, when the Ca(OH)(2) source comes from alkaline solid waste.

Mineral sequestration of CO(2) by aqueous carbonation of coal combustion fly-ash

The increasing CO(2) concentration in the Earth's atmosphere, mainly caused by fossil fuel combustion, has led to concerns about global warming. A technology that could possibly contribute to reducing carbon dioxide emissions is the in-situ mineral sequestration (long term geological storage) or the ex-situ mineral sequestration (controlled industrial reactors) of CO(2). In the present study, we propose to use coal combustion fly-ash, an industrial waste that contains about 4.1 wt.% of lime (CaO), to sequester carbon dioxide by aqueous carbonation. The carbonation reaction was carried out in two successive chemical reactions, first, the irreversible hydration of lime. second, the spontaneous carbonation of calcium hydroxide suspension. A significant CaO-CaCO(3) chemical transformation (approximately 82% of carbonation efficiency) was estimated by pressure-mass balance after 2h of reaction at 30 degrees C. In addition, the qualitative comparison of X-ray diffraction spectra for reactants and products revealed a complete CaO-CaCO(3) conversion. The carbonation efficiency of CaO was independent on the initial pressure of CO(2) (10, 20, 30 and 40 bar) and it was not significantly affected by reaction temperature (room temperature "20-25", 30 and 60 degrees C) and by fly-ash dose (50, 100, 150 g). The kinetic data demonstrated that the initial rate of CO(2) transfer was enhanced by carbonation process for our experiments. The precipitate calcium carbonate was characterized by isolated micrometric particles and micrometric agglomerates of calcite (SEM observations). Finally, the geochemical modelling using PHREEQC software indicated that the final solutions (i.e. after reaction) are supersaturated with respect to calcium carbonate (0.7 < or = saturation index < or = 1.1). This experimental study demonstrates that 1 ton of fly-ash could sequester up to 26 kg of CO(2), i.e. 38.18 ton of fly-ash per ton of CO(2) sequestered. This confirms the possibility to use this alkaline residue for CO(2) mitigation.

Stress-driven phase transformation and the roughening of solid-solid interfaces

The application of stress to multiphase solid-liquid systems often results in morphological instabilities. Here we propose a solid-solid phase transformation model for roughening instability in the interface between two porous materials with different porosities under normal compression stresses. This instability is triggered by a finite jump in the free energy density across the interface, and it leads to the formation of fingerlike structures aligned with the principal direction of compaction. The model is proposed as an explanation for the roughening of stylolites-irregular interfaces associated with the compaction of sedimentary rocks that fluctuate about a plane perpendicular to the principal direction of compaction.

[The Cancer Registry of the Jules Bordet Institute, a new tool for the institution and its researchers. Description of cases incident in 2000-2001]

A hospital Cancer Registry has recently been initiated at the Jules Bordet Institute. The collected information allows to report pathology items such as incidence date, site, morphology and stage. It permits to describe the therapeutic choices, which, broken down by organ and stage, can be compared to guidelines in a process assessment. The objectives of this registry are institutional (statistical and organisational finalities as well as quality control ones), extra-institutional (participation to the public network of cancer registration), and scientific (providing the researchers a common database that can be queried using multiple criteria to be completed by further detailed data). This paper reports on 3,587 incident cancer cases in 2000 and 2001 which were managed at the Jules Bordet Institute for the primary episode. Cancers in women represent 64.3% of all records, for only 35.7% of men, while in the Belgian National Cancer Registry, the proportion is reversed to 46.7% of women and 53.3% of men. The distribution of cancer by site is also quite different in our hospital registry where breast cancer in women, melanoma in both sexes, lung cancer and head and neck cancers in men are over-represented compared to the general population, while colorectal cancer is underrepresented in both sexes.

[Newly immigrant adolescents health and quality of life in Belgium: screening and prevention in school medicine]

OBJECTIVES

Little is known so far about the health of newly immigrant adolescents. The present study aimed to evaluate their health and quality of life (QoL) and to reinforce prevention and health promotion in school medicine.

METHODS

One hundred and fifty-eight adolescents (mean age: 15,4 years) from 37 nationalities were included in the study in two health centers in Brussels. This study was carried out by medical records analysis and administration of a questionnaire about health and QoL (VSP-A) in several languages.

RESULTS

The results showed adolescents in good physical health. Nevertheless their quality of life deteriorated over time in Belgium. The QoL was significantly lower for adolescents without social support: 48,0 (SD=13,5) vs 60,6 (SD=11,1) compared with adolescents with social support - i.e. with one resource person - on a scale from 0 to 100. Adolescents had many subjective health problems, like "the future" cited by half of them.

CONCLUSION

This study shows the importance of developping a specific approach to newly immigrant adolescents health and the contribution of school medicine in the identification of biological, psychological and social needs and hightlights the preventive answers carried out by school medicine.

Primary Stenting for the Acute Treatment of Carotid Artery Dissection

OBJECTIVES

To review and evaluate our experience with carotid artery stenting in the acute treatment of carotid artery dissection (CAD).

PATIENTS AND METHODS

Reviewing the charts of our hospital between 2000 and 2001, we found two consecutive patients who benefited from primary stenting for the acute treatment of spontaneous extracranial internal CAD.

RESULTS

Primary stenting of the internal carotid artery was successful in both cases without any post-operative complications. Clinical and US duplex scan follow-up confirmed the absence of neurological symptoms and the patency of the internal carotid artery with complete disappearance of the dissection at 36 and 42 months after the procedure, respectively.

CONCLUSION

Despite the small number of patients, primary stenting for acute CAD seems to be safe and effective.

[Assessing adolescent's health in school medicine: quality of life as a complement to clinical indicators]

Current medical practices of school health for adolescents are more based on the screening of specific physical problems than on psychosocial and subjective aspects of their health.

OBJECTIVES

This study aimed at evaluating the usefulness of a quality of life (QoL) questionnaire during the consultations.

POPULATION AND METHODS

Ninety-five adolescents (mean age: 16.9 years) present for the obligatory medical check-up in a health center in Brussels, were involved in the study. Data of the medical records were analysed and two questionnaires were administrated, one exploring the quality of life (VSP-A), the other the presence of depressive symptoms (CES-D).

RESULTS

These adolescents were in good physical health and had a mean score of global quality of life of 62 (DS =11.2); 17% of the adolescents had significant depressive symptoms (score > or =24). There was a significant negative correlation between the scores of QoL and depression (R =-0.680, P <0.01), the QoL psychological dimension and depression (R =-0.656, P <0.01), the QoL energy-vitality dimension and depression (R= -0.763, P <0.01).

CONCLUSION

An evaluation of the quality of life, approaching the mental health of the teenagers in a multidimensional and positive way, can be useful in school medicine for better identifying the medical and psychosocial adolescents needs. It can improve the relevance of the preventive consultation and the interventions of health promotion in schools.

Roughness of stylolites: implications of 3D high resolution topography measurements

Stylolites are natural pressure-dissolution surfaces in sedimentary rocks. We present 3D high resolution measurements at laboratory scales of their complex roughness. The topography is shown to be described by a self-affine scaling invariance. At large scales, the Hurst exponent is zeta(1) approximately 0.5 and very different from that at small scales where zeta(2) approximately 1.2. A crossover length scale at around L(c)=1 mm is well characterized. Measurements are consistent with a Langevin equation that describes the growth of a stylolitic interface as a competition between stabilizing long range elastic interactions at large scales or local surface tension effects at small scales and a destabilizing quenched material disorder.

Measurement of the generalized polarizabilities of the proton in virtual Compton scattering at Q2=0.92 and 1.76 GeV2

We report a virtual Compton scattering study of the proton at low c.m. energies. We have determined the structure functions P(LL)-P(TT)/epsilon and P(LT), and the electric and magnetic generalized polarizabilities (GPs) alpha(E)(Q2) and beta(M)(Q2) at momentum transfer Q(2)=0.92 and 1.76 GeV2. The electric GP shows a strong falloff with Q2, and its global behavior does not follow a simple dipole form. The magnetic GP shows a rise and then a falloff; this can be interpreted as the dominance of a long-distance diamagnetic pion cloud at low Q2, compensated at higher Q2 by a paramagnetic contribution from piN intermediate states.

Clinical outcome of breast cancer patients with liver metastases alone in the anthracycline-taxane era: a retrospective analysis of two prospective, randomised metastatic breast cancer trials

Liver metastases have long been known to indicate an unfavourable disease course in breast cancer (BC). However, a small subset of patients with liver metastases alone who were treated with pre-taxane chemotherapy regimens was reported to have longer survival compared with patients with liver and metastases at other sites. In the present study, we examined the clinical outcome of breast cancer patients with liver metastases alone in the context of two phase III European Organisation for Research and Treatment of Cancer (EORTC) trials which compared the efficacy of doxorubicin (A) versus paclitaxel (T) (trial 10923) and of AC (cyclophosphamide) versus AT (trial 10961), given as first-line chemotherapy in metastatic BC patients. The median follow-up for the patients with liver metastases was 90.5 months in trial 10923 and 56.6 months in trial 10961. Patients with liver metastases alone comprised 18% of all patients with liver metastases, in both the 10923 and 10961 trials. The median survival of patients with liver metastases alone and liver plus other sites of metastases were 22.7 and 14.2 months (log rank test, P=0.002) in trial 10923 and 27.1 and 16.8 months (log rank test, P=0.19) in trial 10961. The median TTP (time to progression) for patients with liver metastases alone was also longer compared with the liver plus other sites of metastases group in both trials: 10.2 versus 8.8 months (log rank test, P=0.02) in trial 10923 and 8.3 versus 6.7 months (log rank test, P=0.37) in trial 10961. Most patients with liver metastases alone have progression of their disease in their liver again (96 and 60% of patients in trials 10923 and 10961, respectively). Given the high prevalence of breast cancer, improved detection of liver metastases, encouraging survival achieved with currently available cytotoxic agents and the fact that a significant portion of patients with liver metastases alone have progression of their tumour in the liver again, a more aggressive multimodality treatment approach through prospective clinical trials seems worth exploring in this specific subset of women.

Double pi(0) Photoproduction on the Proton at GRAAL

The double pi(0) photoproduction off the proton has been measured in the beam energy range of 0.65-1.5 GeV. The total and differential cross sections and the Sigma beam asymmetry were extracted. The total cross section measured for the first time in the third resonance region of the nucleon shows a prominent peak. The interpretation of these results by two independent theoretical models infers mostly the selective excitation of P11- and D13-nucleon resonances.

Aggressive endometrial carcinoma in a breast cancer patient treated with tamoxifen with normal transvaginal ultrasonography. Case report

Since tamoxifen therapy can induce endometrial disorders, surveillance schemes of women taking tamoxifen have been recommended. Transvaginal ultrasonography is a very sensitive test and therefore is often performed as a first-line screening test. We described a very atypical case of a high stage, high grade endometrial cancer associated with tamoxifen in a 64-year-old woman with a past history of breast cancer. This women was assessed yearly by ultrasonography and Pap smear. The cancer developed on a very thin endometrium and transvaginal ultrasonography failed to detect it. The patient remained asymptomatic up to the diagnosis. Normal endometrial cells in the Pap smear test were the only signs associated with this cancer. Surveillance strategies and significance of endometrial cells on the Pap smear are reviewed. In conclusion, TVUS can fail to detect cancers if the endometrial lining is not enlarged. In case of normal endometrial cells in the Pap smear, a careful evaluation should be performed.

Endometrial disorders in 406 breast cancer patients on tamoxifen: the case for less intensive monitoring

OBJECTIVES

To describe the endometrial appearance in postmenopausal breast cancer patients on tamoxifen and to assess a routine surveillance scheme for endometrial lesions.

STUDY DESIGN

Three hundred and seventeen postmenopausal breast cancer women already on tamoxifen at the start of the study (group I) and 89 breast cancer women assessed before any tamoxifen intake (group II) underwent an initial and then yearly scans with transvaginal ultrasonography, followed by an hysteroscopy and biopsy for women with an endometrium thickened above 8mm. Endometrial thickness was also measured in 823 women with no breast cancer nor tamoxifen intake (group III).

RESULTS

Initial mean endometrial thickness was 8.2mm in group I, 4.4mm in group II and 3.4mm in group III (P<0.001). Eighteen percent endometrial lesions were found in group I and 3.3% in group II. We observed a significant association between endometrial pathology and both cumulated dose and total duration. Polyps were the most frequent and first to appear pathology. Five cancers were detected in group I, and all of them had taken tamoxifen for more than 3 years.

CONCLUSION

Our surveillance scheme could be lightened; an acceptable screening scheme might include a baseline assessment before the start of tamoxifen and, if normal, yearly screening after 3 years of tamoxifen therapy, yearly surveillance for women with an abnormal baseline assessment and immediate investigation for symptomatic women.

The body site distribution of melanocytic naevi in 6-7 year old European children

The number and size of melanocytic naevi are the main predictors of cutaneous melanoma. Naevus development per unit of skin surface is greatest during childhood. We assessed the body distribution of naevi 2-4.9 mm and > or = 5 mm in 649 European children aged 6-7 years old from Brussels (Belgium), Bochum (Germany), Lyon (France) and Rome (Italy). The numbers of naevi 2-4.9 mm and naevi > or = 5 mm were strongly correlated, especially on the trunk. For naevi 2-4.9 mm, the highest relative densities were found on the face, back, shoulders and the external surface of the arms. The lowest relative densities were found on the hands, legs, feet and abdomen. The relative density of naevi > or = 5 mm was higher on the trunk than on any other body site. Similar body distributions were observed in both sexes and at each centre. The body site distribution of naevi 2-4.9 mm seemed to parallel the usual sun exposure patterns of young European children. It is suggested that the development of naevi > or = 5 mm might be a marker of the vulnerability of melanocytes to the harmful effects of solar radiation. Vulnerability would be maximal on the back, and would decrease from proximal to distal skin areas, with melanocytes of the hands and feet having the lowest vulnerability. The number of naevi acquired on a specific area of skin would result from the combined effects of local vulnerability to solar radiation and local sun exposure history. The origin of acquired body site differences in the susceptibility of melanocytes to ultraviolet radiation is unknown, although it seems to parallel the body site density of sensory innervation.

Evaluation of a low-invasive strategy for prostate cancer screening with prostate-specific antigen

OBJECTIVES

To evaluate a two-step strategy for the detection of prostate cancer within the context of serial screening and compare this strategy with other screening strategies. The optimal combination of tests proposed for prostate cancer screening remains undetermined, particularly when screening is repeated over time.

METHODS

A prospective serial prostate cancer screening study with follow-up to 55 months was performed in a general community screening clinic. One thousand seven hundred seven self-referred men, 50 to 75 years old, without a history of prostate cancer agreed to undergo screening for prostate cancer on an annual basis. Serum prostate-specific antigen (PSA) measurement was the first-step screening test. If the serum PSA test was positive, a standard urologic evaluation was performed. Biopsy was recommended only if a test other than serum PSA was suspicious for cancer. The outcome measures were the biopsy rate and prostate cancer detection rate. The comparisons with other studies were age-standardized to correct for differences in age distribution.

RESULTS

The biopsy and cancer detection rates after the first test were 7.0% and 2.0%, respectively. After 4 years of the study, the cumulative biopsy rate and cumulative cancer detection rate per enrolled man was 12% and 4.1%, respectively. The comparisons between studies revealed that screening strategies using serum PSA as a first-line test had similar detection rates but lower biopsy rates than strategies performing biopsy when one of several screening tests was positive.

CONCLUSIONS

A two-step screening strategy using serum PSA alone as the initial test seemed able to detect as many cancers as when all screening tests were used at the same time but reduced the number of unnecessary biopsies.

Breast cancer screening pathology: an assessment of the practise and needs in Belgium and Luxembourg

Education and quality assurance (QA) in breast screening pathology have been encouraged by the Europe Against Cancer programme. As a prerequisite for the set-up of a QA programme in Belgium and in the Grand Duchy of Luxembourg, an inquiry was initiated to evaluate the daily practise in breast pathology, the modalities in handling and analysing breast specimens and the willingness of the pathologists to participate in a QA scheme. Of the 278 mailed questionnaires, 109 confidential and valid questionnaires were returned, meaning a participation rate of 40%. All 109 respondents indicated their willingness to voluntarily participate in the further QA programme. Segmental resections for conservative surgery and excision biopsies ranked first and second, respectively, in examination requests. Of the respondents, 50% complained about the lack of clinical information on the pathology request form. A multidisciplinary team approach for the diagnosis of screen-detected lesions was deemed desirable by 87% of the respondents, but only 16% of them actually participate in such pre-operative meetings. Even more puzzling is that 75% of the respondents report regular unavailability of the control radiogram of the surgical specimen removed for non-palpable lesions. One-quarter to one-third of the pathologists still regularly perform frozen sections on microcalcifications or tumours smaller than 1 cm. However, 81% of the respondents estimate that pre-operative diagnosis is not appropriate for this type of lesion. The results of this inquiry show that the guidelines for the diagnosis of screen-detected breast lesions are not yet fully applied in daily practise. The development of local comprehensive breast teams involving a pathologist should improve the co-ordination between the medical disciplines, represent an important way of disseminating the guidelines on breast screening pathology and stimulate the relay unit to conduct QA programmes.

Sunscreen use, wearing clothes, and number of nevi in 6- to 7-year-old European children. European Organization for Research and Treatment of Cancer Melanoma Cooperative Group

BACKGROUND

Previous epidemiologic studies have suggested that sunscreen use is associated with an increased risk of melanoma skin cancer. Because high nevi (mole) count in adults is a strong predictor of melanoma, we conducted a study examining the number of nevi in 6- to 7-year-old European children, according to their sunscreen use.

METHODS

Whole-body and site-specific counts of nevi 2 mm or larger were performed in 631 children in their first year of primary school in four European cities. Independently, parents were interviewed regarding sun exposure, sunscreen use, and physical sun protection of their child.

RESULTS

After adjustment for sun exposure and host characteristics (e.g., skin phototype, eye color), the relative risk for high nevus count on the trunk was 1.68 (95% confidence interval [CI] = 1.09-2.59) for the highest level of sunscreen use and 0.59 (95% CI = 0.36-0.97) for the highest level of wearing of clothes while in the sun. The sun protection factor had no effect on nevus counts despite a high median value of 17.4. Sunburn number was not associated with nevus count. The highest risk associated with sunscreen use was found among children who had never experienced sunburn.

CONCLUSIONS

In white, European children, sunscreen use appears to be associated with development of nevi, probably because it allows longer sun exposures. Wearing clothes may be an effective way to prevent proliferation of nevi. Since a high nevus count is a strong predictor of melanoma, sunscreen use may be involved in melanoma occurrence because it may encourage recreational sun exposure.

Melanoma and sunscreen use: need for studies representative of actual behaviours

Experiments in rodents and humans have shown the ability of sunscreens to prevent UVB-induced skin cancers. Sunscreen use has thus become part of the panoply for melanoma prevention. However, results from epidemiological investigations indicate that sunscreen use could be a risk rather than a protective factor for melanoma. This article discusses possible explanations for discrepancies between experimental and observational results, suggesting that experiments did not reproduce usual human behaviours towards the sunlight. Also, marketing of sunscreens fosters unconsidered exposure to sunlight through associating sunscreen use to the acquisition of a 'safe suntan', or to the possibility to let children go naked into the sunlight without incurring sunburns. It has therefore been hypothesized that, because it prevents sunburn, sunscreen use allows prolonged exposure to sunlight. If this hypothesis holds, modern sunscreens with high protection factor could also represent a threat if their use is motivated by the desire of unrestricted exposure to sunlight. To explore this hypothesis, the design of a retrospective cohort study is presented, including children 5-7 years old, with the total body naevi count as principal endpoint. This study will have the opportunity to examine the qualities of modern sunscreens among young children.

In vitro evaluation of the antibacterial effects of intracanal micro plasma system treatment

Forty freshly extracted single-rooted teeth were prepared to a size 25 master apical file, autoclaved, and inoculated with a known quantity of Actinomyces naeslundii. The teeth were divided into four groups (n = 10), including an untreated control group. The three treatment groups were exposed to Micro Plasma System (MPS), 0.5% NaOCl and 0.5% NaOCl + MPS respectively. The content of each root canal was absorbed by sterile paper points, diluted in 2 ml Schaedler Broth Medium, and incubated on blood agar. The number of CFU was determined. Data analysis, using an analysis of variance and Scheffe's test at the 1% level (Statview II software), indicated a significant reduction in CFU count for the three treatment groups compared to the control group. For the three treatment groups, no significant intergroup differences were observed.

Effect of stiripentol on carbamazepine plasma concentration and metabolism in epileptic children

OBJECTIVE

To study the relationship between the plasma concentration of stiripentol (STP), a new antiepileptic drug, and its inhibitory effect on the formation of carbamazepine epoxide (CBZE) in epileptic children treated with carbamazepine (CBZ) either alone or in combination with another antiepileptic drug.

METHODS

Minimum plasma concentration of antiepileptic drugs was measured before initiation of STP therapy (day 0) and on days 28 (STP 60 mg.kg-1.day-1) and 84 (STP 90 mg.kg-1.day-1) by HPLC.

RESULTS

The CBZE/CBZ plasma concentration ratio decreased exponentially with increasing minimum plasma STP concentration (r = 0.80). The asymptote of the curve allowed the calculation of the minimum plasma STP concentration required to obtain the maximum inhibitory effect, i.e. 6.7 mg.l-1.

CONCLUSION

The inhibitory effect of STP on CBZ metabolism expressed as the CBZE/CBZ plasma concentration ratio is dependent on STP plasma concentration, with a maximum effect at an average of 7 mg.l-1. The present data suggest that in order to evaluate the anticonvulsant efficacy of STP as add-on therapy, the minimum plasma STP concentration should be maintained above 7 mg.l-1 and the dosage of CBZ should simultaneously be decreased in steps by more than 50% to minimize the change in CBZ plasma concentration.