Symptoms and signs of urogenital cancer in primary care.

BACKGROUND: Urogenital cancers are common, accounting for approximately 20% of cancer incidence globally. Cancers belonging to the same organ system often present with similar symptoms, making initial management challenging. In this study, 511 cases of cancer were recorded after the date of consultation among 61,802 randomly selected patients presenting in primary care in six European countries: a subgroup analysis of urogenital cancers was carried out in order to study variation in symptom presentation. METHODS: Initial data capture was by completion of standardised forms containing closed questions about symptoms recorded during the consultation. The general practitioner (GP) provided follow-up data after diagnosis, based on medical record data made after the consultation. GPs also provided free text comments about the diagnostic procedure for individual patients. RESULTS: The most common symptoms were mainly associated with one or two specific types of cancer: 'Macroscopic haematuria' with bladder or renal cancer (combined sensitivity 28.3%), 'Increased urinary frequency' with bladder (sensitivity 13.3%) or prostatic (sensitivity 32.1%) cancer, or to uterine body (sensitivity 14.3%) cancer, 'Unexpected genital bleeding' with uterine cancer (cervix, sensitivity 20.0%, uterine body, sensitivity 71.4%). 'Distended abdomen, bloating' had sensitivity 62.5% (based on eight cases of ovarian cancer). In ovarian cancer, increased abdominal circumference and a palpable tumour also were important diagnostic elements. Specificity for 'Macroscopic haematuria' was 99.8% (99.7-99.8). PPV > 3% was noted for 'Macroscopic haematuria' and bladder or renal cancer combined, for bladder cancer in male patients. In males aged 55-74, PPV = 7.1% for 'Macroscopic haematuria' and bladder cancer. Abdominal pain was an infrequent symptom in urogenital cancers. CONCLUSIONS: Most types of urogenital cancer present with rather specific symptoms. If the GP considers ovarian cancer, increased abdominal circumference should be actively determined. Several cases were clarified through the GP's clinical examination, or laboratory investigations.

Quantification of methane emitted by ruminants: a review of methods.

The contribution of greenhouse gas (GHG) emissions from ruminant production systems varies between countries and between regions within individual countries. The appropriate quantification of GHG emissions, specifically methane (CH4), has raised questions about the correct reporting of GHG inventories and, perhaps more importantly, how best to mitigate CH4 emissions. This review documents existing methods and methodologies to measure and estimate CH4 emissions from ruminant animals and the manure produced therein over various scales and conditions. Measurements of CH4 have frequently been conducted in research settings using classical methodologies developed for bioenergetic purposes, such as gas exchange techniques (respiration chambers, headboxes). While very precise, these techniques are limited to research settings as they are expensive, labor-intensive, and applicable only to a few animals. Head-stalls, such as the GreenFeed system, have been used to measure expired CH4 for individual animals housed alone or in groups in confinement or grazing. This technique requires frequent animal visitation over the diurnal measurement period and an adequate number of collection days. The tracer gas technique can be used to measure CH4 from individual animals housed outdoors, as there is a need to ensure low background concentrations. Micrometeorological techniques (e.g., open-path lasers) can measure CH4 emissions over larger areas and many animals, but limitations exist, including the need to measure over more extended periods. Measurement of CH4 emissions from manure depends on the type of storage, animal housing, CH4 concentration inside and outside the boundaries of the area of interest, and ventilation rate, which is likely the variable that contributes the greatest to measurement uncertainty. For large-scale areas, aircraft, drones, and satellites have been used in association with the tracer flux method, inverse modeling, imagery, and LiDAR (Light Detection and Ranging), but research is lagging in validating these methods. Bottom-up approaches to estimating CH4 emissions rely on empirical or mechanistic modeling to quantify the contribution of individual sources (enteric and manure). In contrast, top-down approaches estimate the amount of CH4 in the atmosphere using spatial and temporal models to account for transportation from an emitter to an observation point. While these two estimation approaches rarely agree, they help identify knowledge gaps and research requirements in practice.

There is a need to accurately and precisely quantify greenhouse gas (GHG) emissions, specifically methane (CH4), to ensure correct reporting of GHG inventories and, perhaps more importantly, determine how to best mitigate CH4 emissions. The objective of this study was to review existing methods and methodologies to quantify and estimate CH4 emissions from ruminants. Historically, most techniques were developed for specific purposes that may limit their widespread use on commercial farms and for inventory purposes and typically required frequent calibration and equipment maintenance. Whole animal and head respiration chambers, spot sampling techniques, and tracer gas methods can be used to measure enteric CH4 from individual animals, but each technique has its own inherent limitations. The measurement of CH4 emissions from manure depends on the type of storage, animal housing, CH4 concentration inside and outside the boundaries of the area of interest, and ventilation rate, which is likely the most complex variable creating many uncertainties. For large-scale areas, aircraft, drones, and satellites have been used in association with the tracer flux method, inverse modeling, imagery, and LiDAR (Light Detection and Ranging), but research is lagging in validating these methods. Bottom-up approaches to estimating CH4 emissions rely on empirical or mechanistic modeling to quantify the contribution of individual sources. Top-down approaches estimate the amount of CH4 in the atmosphere using spatial and temporal models to account for transportation from an emitter to an observation point.

Corrigendum to "protocol for life cycle assessment modeling of US fruit and vegetable supply chains- cases of processed potato and tomato products" [Data in Brief 34 (2021) 1-24/ 106639].

[This corrects the article DOI: 10.1016/j.dib.2020.106639.].

Symptoms and signs of colorectal cancer, with differences between proximal and distal colon cancer: a prospective cohort study of diagnostic accuracy in primary care.

BACKGROUND: In an abdominal symptom study in primary care in six European countries, 511 cases of cancer were recorded prospectively among 61,802 patients 16 years and older in Norway, Denmark, Sweden, Netherlands, Belgium and Scotland. Colorectal cancer is one of the main types of cancer associated with abdominal symptoms; hence, an in-depth subgroup analysis of the 94 colorectal cancers was carried out in order to study variation in symptom presentation among cancers in different anatomical locations. METHOD: Initial data capture was by completion of standardised forms containing closed questions about symptoms recorded during the consultation. Follow-up data were provided by the GP after diagnosis, based on medical record data made after the consultation. GPs also provided free text comments about the diagnostic procedure for individual patients. Fisher's exact test was used to analyse differences between groups. RESULTS: Almost all symptoms recorded could indicate colorectal cancer. 'Rectal bleeding' had a specificity of 99.4% and a PPV of 4.0%. Faecal occult blood in stool (FOBT) or anaemia may indicate gastrointestinal bleeding: when these symptoms and signs were combined, sensitivity reached 57.5%, with 69.2% for cancer in the distal colon. For proximal colon cancers, none of 18 patients had 'Rectal bleeding' at the initial consultation, but three of the 18 did so at a later consultation. 'Abdominal pain, lower part', 'Constipation' and 'Distended abdomen, bloating' were less specific and also less sensitive than 'Rectal bleeding', and with PPV between 0.7% and 1.9%. CONCLUSIONS: Apart from rectal bleeding, single symptoms did not reach the PPV 3% NICE threshold. However, supplementary information such as a positive FOBT or persistent symptoms may revise the PPV upwards. If a colorectal cancer is suspected by the GP despite few symptoms, the total clinical picture may still reach the NICE PPV threshold of 3% and justify a specific referral.

Dairy and swine manure management - Challenges and perspectives for sustainable treatment technology.

Global dairy and swine production growth has increased significantly over the past decades, resulting in higher manure generation in certain areas and environmental concerns. Therefore, manure management is an essential focus for farmers and environmental regulators. Systematic selection of manure management practices can provide environmental benefits, but accounting for local constraints, economics and farming practices are significant challenges. All these factors drive the selection of appropriate manure management systems (MMSs). MMSs are highly varied for their design, partly due to individual farm settings, geography, and the end-use applications of manure. However, the benefits of technological advancements in MMSs provide higher manure treatment efficiency and co-production of value-added products such as recycled water, fiber, sand bedding, and nutrient-rich bio-solids, among others. To achieve higher environmental benefits, advanced manure treatment technologies have to be implemented, which comes with additional costs. So, there is a tradeoff between environmental benefits and cost. With the above prospects, this article reviews: 1) the different treatment technologies used in dairy and swine farms, 2) the life cycle assessment (LCA) method's importance in evaluating various treatment technologies for better environmental returns, and 3) decision support tools (DST) and their significance in MMSs prioritization. We found considerable heterogeneity in the available datasets, mainly on crucial parameters such as water consumption, types and amount of bedding materials, manure removal frequency, manure treatment technologies, and the extent of resource recovery. Thus, suitable environmental impact assessment inventory models are needed to evaluate a more comprehensive range of treatment technologies in MMSs, representing the spatial and farming system heterogeneities. There is also a need for user-friendly DST with adjustable inputs for the functional components of MMSs and evaluation criteria, which can rapidly evaluate the techno-economic feasibility of alternative systems.

A Systematic Review of the Prevalence of Gestational Diabetes in Norway.

Gestational diabetes mellitus (GDM) is a major public health problem and a threat to maternal and child health. There is a lack of integrated and systematically synthesized knowledge about the prevalence GDM in Norway. Therefore, this systemic review aimed to present the best available peer-reviewed published evidence from the past 20 years about the prevalence of GDM in Norway. A comprehensive literature search was performed on online databases consisting of PubMed (including Medline), Web of Science, and Scopus to retrieve original research articles published on the prevalence of GDM up to August 2020. Also, databases of Norart and SveMed+ in the Norwegian language were searched to enhance the search coverage. Data were extracted using a standardized protocol and data collection form and were presented narratively. A total of 11 studies were selected to include for data analysis and synthesis with the total sample size of 2,314,191 pregnant women. The studies included heterogenous populations and mostly reported the prevalence of GDM in healthy mothers with singleton pregnancies. The prevalence of GDM in population registered-based studies in Norway was reported to be lower than 2%, using the World Health Organization (WHO) 1999 criteria. However, studies on high-risk populations such as the non-European ethnicity reported prevalence rates ranging from 8% to 15%. Given the evidence from available literature that reported trends in the prevalence of GDM, an increase in the prevalence of GDM across most racial/ethnic groups studied in Norway was observed. Overall, the prevalence of GDM in the low risk population of Norway is fairly low, but the available literature supports the perspective that the prevalence of GDM has shown an increasing trend in recent decades. This finding is very important for health service planning and evaluation, policy development, and research in Norway. Large-scale prospective studies, using the national data, are warranted to provide firm evidence over coming years. Our review findings can help policy makers devise appropriate strategies for improving women's reproductive health.

Protocol for life cycle assessment modeling of US fruit and vegetable supply chains- cases of processed potato and tomato products.

This article elaborates on the life cycle assessment (LCA) protocol designed for formulating the life cycle inventories (LCIs) of fruit and vegetable (F&V) supply chains. As a set of case studies, it presents the LCI data of the processed vegetable products, (a) potato: chips, frozen-fries, and dehydrated flakes, and (b) tomato-pasta sauce. The data can support to undertake life cycle impact assessment (LCIA) of food commodities in a "cradle to grave" approach. An integrated F&V supply chain LCA model is constructed, which combined three components of the supply chain: farming system, post-harvest system (processing until the consumption) and bio-waste handling system. We have used numbers of crop models to calculate the crop yields, crop nutrient uptake, and irrigation water requirements, which are largely influenced by the local agro-climatic parameters of the selected crop reporting districts (CRDs) of the United States. For the farming system, LCI information, as shown in the data are averaged from the respective CRDs. LCI data for the post-harvest stages are based on available information from the relevant processing plants and the engineering estimates. The article also briefly presents the assumptions made for evaluating future crop production scenarios. Future scenarios integrate the impact of climate change on the future productivity and evaluate the effect of adaptation measures and technological advancement on the crop yield. The provided data are important to understand the characteristics of the food supply chain, and their relationships with the life cycle environmental impacts. The data can also support to formulate potential environmental mitigation and adaptation measures in the food supply chain mainly to cope with the adverse impact of climate change.

Cradle to grave environmental impact evaluation of the consumption of potato and tomato products.

This study discusses the environmental life cycle impacts of potato and tomato supply chains in a "cradle-to-grave" perspective. The principal focus is to evaluate the processed products, while fresh products are also briefly discussed. Processed products included are potato-chips, frozen fries and dehydrated flakes, and tomato-pasta sauce. The functional unit (FU) is 1 kg product(s), eaten at the consumer stage. Life cycle assessment (LCA) modeling has utilized multiple mechanistic crop models to estimate the crop yields, crop nutrient uptakes and irrigation water requirements. The farming systems represent the primary crop reporting districts where the selected crops are produced on a commercial scale in the United States. The post-harvest system was constructed utilizing the data collected from a processing plant and from other available studies. LCA modeling also constituted handling of co-products (e.g. starch in potatoes) and biowaste. A wide range of environmental impact categories were selected for the evaluation, which showed environmental differences between fresh and processed products. For instance, global warming potential for potato-fresh, chips, fries and dehydrated was 0.97, 0.85, 1.21 and 0.65 kg CO2-eq/FU respectively. For fresh tomato and tomato sauce, it was 0.74 and 1.5 kg CO2-eq/FU respectively. Likewise, fossil resource scarcity for fresh potatoes was higher than chips and dehydrated flakes, but lower than fries. Water consumption was slightly higher in fresh potatoes compared to the processed products. Similar impact patterns were found in fresh and processed tomato products. For most of the impact categories, processing and the agriculture systems were the major contributors. The contribution from the consumer stage varied with the ways the product is prepared, e.g. whether fries are oven heated or deep-fried in oil. Environmental mitigation measures include, the use of drip irrigation (for potatoes), and reducing: food miles, food waste and the use of secondary packaging materials.

Supply chains for processed potato and tomato products in the United States will have enhanced resilience with planting adaptation strategies.

Food systems are increasingly challenged to meet growing demand for specialty crops due to the effects of climate change and increased competition for resources. Here, we apply an integrated methodology that includes climate, crop, economic and life cycle assessment models to US potato and tomato supply chains. We find that supply chains for two popular processed products in the United States, French fries and pasta sauce, will be remarkably resilient, through planting adaptation strategies that avoid higher temperatures. Land and water footprints will decline over time due to higher yields, and greenhouse gas emissions can be mitigated by waste reduction and process modification. Our integrated methodology can be applied to other crops, health-based consumer scenarios (fresh versus processed) and geographies, thereby informing decision-making throughout supply chains. Employing such methods will be essential as food systems are forced to adapt and transform to become carbon neutral due to the imperatives of climate change.

Environmental sustainability of fruit and vegetable production supply chains in the face of climate change: A review.

This study discusses importance of assessing environmental sustainability of fruits and vegetable (F&V) production sector in future climate change (CC) scenarios. For the current production scenario, life cycle environmental footprints of F&V supply chain are discussed considering the influences of: agro-climates, production systems, raw material inputs, post-harvest managements to the products' yield and quality. Potential risks of CC to the sector are discussed in the context of elevated global temperature and carbon dioxide level, ozone depletion and changes in precipitation patterns. Potential risks due to CC are on the productivity and the quality of F&V products, such as texture, color, maturity and nutrients. Increased risk of failure of the current crop protection strategies, e.g. due to pest infestations and different crop-water and nutrient stresses are among the short and long-term risks. It also discusses potential adaptation and mitigation measures to CC, and therefrom argues on the related environmental consequences in the supply chain. From the LCA studies, it was revealed that environmental impacts of F&V supply chain varied as per agro-ecological characteristics and farming systems, e.g. greenhouse vs open-field, organic vs conventional, and grown in different agro-climatic conditions. The nexus among the climatic stresses, potential adaptation and mitigation measures, hence were in the form of potential changes in the raw material inputs and resource flows depending on the preferred future agro-management strategies and farming practices. Adaptation and other management options, included are, changes in: crop calendar, nutrient and pest management strategies, post-harvest handling and improved preservation of F&V products. These are argued eventually being determining factors leading to different environmental footprints compared to the existing management scenarios. Prospective life cycle environmental evaluation of F&V supply chain considering the relationship among product yield and qualities, CC stresses and potential adaptation and mitigation measures is thus a new thrust and direction.

Abdominal symptoms and cancer in the abdomen: prospective cohort study in European primary care.

BACKGROUND: Different abdominal symptoms may signal cancer, but their role is unclear. AIM: To examine associations between abdominal symptoms and subsequent cancer diagnosed in the abdominal region. DESIGN AND SETTING: Prospective cohort study comprising 493 GPs from surgeries in Norway, Denmark, Sweden, Scotland, Belgium, and the Netherlands. METHOD: Over a 10-day period, the GPs recorded consecutive consultations and noted: patients who presented with abdominal symptoms pre-specified on the registration form; additional data on non-specific symptoms; and features of the consultation. Eight months later, data on all cancer diagnoses among all study patients in the participating general practices were requested from the GPs. RESULTS: Consultations with 61 802 patients were recorded and abdominal symptoms were documented in 6264 (10.1%) patients. Malignancy, both abdominal and non-abdominal, was subsequently diagnosed in 511 patients (0.8%). Among patients with a new cancer in the abdomen (n = 251), 175 (69.7%) were diagnosed within 180 days after consultation. In a multivariate model, the highest sex- and age-adjusted hazard ratio (HR) was for the single symptom of rectal bleeding (HR 19.1, 95% confidence interval = 8.7 to 41.7). Positive predictive values of >3% were found for macroscopic haematuria, rectal bleeding, and involuntary weight loss, with variations according to age and sex. The three symptoms relating to irregular bleeding had particularly high specificity in terms of colorectal, uterine, and bladder cancer. CONCLUSIONS: A patient with undiagnosed cancer may present with symptoms or no symptoms. Irregular bleeding must always be explained. Abdominal pain occurs with all types of abdominal cancer and several symptoms may signal colorectal cancer. The findings are important as they influence how GPs think and act, and how they can contribute to an earlier diagnosis of cancer.

Can farmers mitigate environmental impacts through combined production of food, fuel and feed? A consequential life cycle assessment of integrated mixed crop-livestock system with a green biorefinery.

This study evaluates environmental impacts of an integrated mixed crop-livestock system with a green biorefinery (GBR). System integration included production of feed crops and green biomasses (Sys-I) to meet the demand of a livestock system (Sys-III) and to process green biomasses in a GBR system (Sys-II). Processing of grass-clover to produce feed protein was considered in Sys-II, particularly to substitute the imported soybean meal. Waste generated from the livestock and GBR systems were considered for the conversion to biomethane (Sys-IV). Digestate produced therefrom was assumed to be recirculated back to the farmers' field (Sys-I). A consequential approach of Life Cycle Assessment (LCA) method was used to evaluate the environmental impacts of a combined production of suckler cow calves (SCC) and Pigs, calculated in terms of their live weight (LW). The functional unit (FU) was a basket of two products "1kgLW-SCC+1kgLW-Pigs", produced at the farm gate. Results obtained per FU were: 19.6kg CO2 eq for carbon footprint; 0.11kg PO4 eq for eutrophication potential, -129MJ eq for non-renewable energy use and -3.9 comparative toxicity units (CTUe) for potential freshwater ecotoxicity. Environmental impact, e.g. greenhouse gas (GHG) emission was primarily due to (i) N2O emission and diesel consumption within Sys-I, (ii) energy input to Sys-II, III and IV, and (iii) methane emission from Sys-III and Sys-IV. Specifically, integrating GBR with the mixed crop-livestock system contributed 4% of the GHG emissions, whilst its products credited 7% of the total impact. Synergies among the different sub-systems showed positive environmental gains for the selected main products. The main effects of the system integration were in the reductions of GHG emissions, fossil fuel consumption, eutrophication potential and freshwater ecotoxicity, compared to a conventional mixed crop-livestock system, without the biogas conversion facility and the GBR.

Abdominal symptoms in general practice: Frequency, cancer suspicions raised, and actions taken by GPs in six European countries. Cohort study with prospective registration of cancer.

BACKGROUND: Abdominal symptoms are diagnostically challenging to general practitioners (GPs): although common, they may indicate cancer. In a prospective cohort of patients, we examined abdominal symptom frequency, initial diagnostic suspicion, and actions of GPs in response to abdominal symptoms. METHODS: Over a 10-day period, 493 GPs in Norway, Denmark, Sweden, Belgium, the Netherlands, and Scotland, recorded consecutive consultations: sex, date of birth and any specified abdominal symptoms. For patients with abdominal symptoms, additional data on non-specific symptoms, GPs' diagnostic suspicion, and features of the consultation were noted. Data on all cancer diagnoses among all included patients were requested from the GPs eight months later. FINDINGS: Consultations with 61802 patients were recorded. Abdominal symptoms were recorded in 6264 (10.1%) patients. A subsequent malignancy was reported in 511 patients (0.8%): 441 (86.3%) had a new cancer, 70 (13.7%) a recurrent cancer. Abdominal symptoms were noted in 129 (25.2%) of cancer patients (P < 0.001), rising to 34.5% for the 89 patients with cancer located in the abdominal region. PPV for any cancer given any abdominal symptom was 2.1%. In symptomatic patients diagnosed with cancer, GPs noted a suspicion of cancer for 85 (65.9%) versus 1895 (30.9%) when there was no subsequent cancer (P < 0.001). No suspicion was noted in 32 (24.8%) cancer patients. The GP's intuitive cancer suspicion was independently associated with a subsequent new cancer diagnosis (OR 2.11, 95% CI 1.15-3.89). Laboratory tests were ordered for 45.4% of symptomatic patients, imaging for 10.4%, referral or hospitalization for 20.0%: all were more frequent in subsequent cancer patients (P < 0.001). INTERPRETATION: Abdominal symptoms pointed to abdominal cancers rather than to other cancers. However, the finding of abdominal symptoms in only one third of patients with an abdominal cancer, and the lack of cancer suspicion in a quarter of symptomatic cancer patients, provide challenges for GPs' diagnostic thinking and referral practices.

Environmental impacts of producing bioethanol and biobased lactic acid from standalone and integrated biorefineries using a consequential and an attributional life cycle assessment approach.

This study evaluates the environmental impacts of biorefinery products using consequential (CLCA) and attributional (ALCA) life cycle assessment (LCA) approaches. Within ALCA, economic allocation method was used to distribute impacts among the main products and the coproducts, whereas within the CLCA system expansion was adopted to avoid allocation. The study seeks to answer the questions (i) what is the environmental impacts of process integration?, and (ii) do CLCA and ALCA lead to different conclusions when applied to biorefinery?. Three biorefinery systems were evaluated and compared: a standalone system producing bioethanol from winter wheat-straw (system A), a standalone system producing biobased lactic acid from alfalfa (system B), and an integrated biorefinery system (system C) combining the two standalone systems and producing both bioethanol and lactic acid. The synergy of the integration was the exchange of useful energy necessary for biomass processing in the two standalone systems. The systems were compared against a common reference flow: "1MJEtOH+1kgLA", which was set on the basis of products delivered by the system C. Function of the reference flow was to provide service of both fuel (bioethanol) at 99.9% concentration (wt. basis) and biochemical (biobased lactic acid) in food industries at 90% purity; both products delivered at biorefinery gate. The environmental impacts of interest were global warming potential (GWP100), eutrophication potential (EP), non-renewable energy (NRE) use and the agricultural land occupation (ALO). Regardless of the LCA approach adopted, system C performed better in most of the impact categories than both standalone systems. The process wise contribution to the obtained environmental impacts also showed similar impact pattern in both approaches. The study also highlighted that the recirculation of intermediate materials, e.g. C5 sugar to boost bioethanol yield and that the use of residual streams in the energy conversion were beneficial for optimizing the system performance.

Environmental life cycle assessment of producing willow, alfalfa and straw from spring barley as feedstocks for bioenergy or biorefinery systems.

The current study aimed at evaluating potential environmental impacts for the production of willow, alfalfa and straw from spring barley as feedstocks for bioenergy or biorefinery systems. A method of Life Cycle Assessment was used to evaluate based on the following impact categories: Global Warming Potential (GWP100), Eutrophication Potential (EP), Non-Renewable Energy (NRE) use, Agricultural Land Occupation (ALO), Potential Freshwater Ecotoxicity (PFWTox) and Soil quality. With regard to the methods, soil organic carbon (SOC) change related to the land occupation was calculated based on the net carbon input to the soil. Freshwater ecotoxicity was calculated using the comparative toxicity units of the active ingredients and their average emission distribution fractions to air and freshwater. Soil quality was based on the change in the SOC stock estimated during the land use transformation and land occupation. Environmental impacts for straw were economically allocated from the impacts obtained for spring barley. The results obtained per ton dry matter showed a lower carbon footprint for willow and alfalfa compared to straw. It was due to higher soil carbon sequestration and lower N2O emissions. Likewise, willow and alfalfa had lower EP than straw. Straw had lowest NRE use compared to other biomasses. PFWTox was lower in willow and alfalfa compared to straw. A critical negative effect on soil quality was found with the spring barley production and hence for straw. Based on the energy output to input ratio, willow performed better than other biomasses. On the basis of carbohydrate content of straw, the equivalent dry matter of alfalfa and willow would be requiring higher. The environmental impacts of the selected biomasses in biorefinery therefore would differ based on the conversion efficiency, e.g. of the carbohydrates in the related biorefinery processes.

Social inequalities and smoking-associated breast cancer - Results from a prospective cohort study.

OBJECTIVE: The association between smoking and breast cancer has been found in most recent, large cohort studies. We wanted to investigate how smoking-associated breast cancer varies by level of education, a well-established measure of socioeconomic status. METHODS: We included 302,865 women with 7490 breast cancer cases. Participants were assigned to low, moderate or high level of education and analyzed by smoking status (ever/never), and stratified by birth cohorts (≤1950>). We used Cox proportional hazard to estimate hazard ratios (HRs) and confidence intervals (CIs), adjusting for age, number of children, age at first childbirth, BMI, age at enrollment and physical activity. RESULTS: Women born ≤1950 with low and moderate levels of education had a 40% increase in smoking-associated breast cancer risk (HR=1.40, 95% CI 1.25-1.57 and HR=1.14, 95% CI 1.05-1.24, respectively). Women in the same age group with high level of education did not have an increase in risk. No increased breast cancer risk was found among women born after 1950 for any level of education, when analyzed by smoking status. Longer duration of smoking before first childbirth was consistently associated with increasing risk of breast cancer in all three categories of education (all p for trends<0.01). CONCLUSION: Smoking for several years before first childbirth increases the risk of breast cancer, regardless of educational level.

The association between lifetime smoking exposure and breast cancer mortality--results from a Norwegian cohort.

Several recent cohort studies have found an association between smoking and breast cancer, but the association between lifetime smoking exposure and breast cancer mortality is less well described. We examined whether smoking before breast cancer diagnosis is a predictor of breast cancer mortality in a large cohort with more than 4.1 million years of follow-up, with a special focus on women who initiated smoking before first childbirth. Information on smoking status was collected before breast cancer diagnosis and used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of breast cancer mortality in a cohort of 302,865 Norwegian women with 1106 breast cancer deaths. Women were enrolled between 1974 and 2003 and followed up through linkages to national registries until 31 December 2007. We found that breast cancer mortality was slightly but significantly increased for current (HR = 1.15, 95% CI 1.01-1.32) and ever (HR = 1.15, 95% CI 1.02-1.30) smokers as compared to never smokers. No statistically significantly increased mortality was found for women who initiated smoking before first childbirth, and no dose-response association was revealed for any of the different measures of smoking exposure. A large proportion of heavy smokers may have died from other causes than breast cancer during follow-up, possibly diluting our results. This study found that lifetime smoking exposure had a significantly increased risk of breast cancer mortality compared with never smokers.

Smoking increases rectal cancer risk to the same extent in women as in men: results from a Norwegian cohort study.

BACKGROUND: Smoking has recently been established as a risk factor for rectal cancer. We examined whether the smoking-related increase in rectal cancer differed by gender. METHODS: We followed 602,242 participants (49% men), aged 19 to 67 years at enrollment from four Norwegian health surveys carried out between 1972 and 2003, by linkage to Norwegian national registries through December 2007. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by fitting Cox proportional hazard models and adjusting for relevant confounders. Heterogeneity by gender in the effect of smoking and risk of rectal cancer was tested with Wald χ2. RESULTS: During a mean follow-up of 14 years, 1,336 men and 840 women developed invasive rectal cancer. Ever smokers had a significantly increased risk of rectal cancer of more than 25% for both men (HR = 1.27, 95% CI = 1.11-1.45) and women (HR = 1.28, 95% CI = 1.11-1.48) compared with gender-specific never smokers. Men smoking ≥20 pack-years had a significantly increased risk of rectal cancer of 35% (HR = 1.35, 95% CI = 1.14-1.58), whereas for women, it was 47% (HR = 1.47, 95% CI = 1.13-1.91) compared with gender-specific never smokers. For both men and women, we observed significant dose-response associations between the risk of rectal cancer for four variables [Age at smoking initiation in years (both ptrend <0.05), number of cigarettes smoked per day (both ptrend <0.0001), smoking duration in years (ptrend <0.05, <0.0001) and number of pack-years smoked (both ptrend <0.0001)]. The test for heterogeneity by gender was not significant between smoking status and the risk of rectal cancer (Wald χ2, p -value; current smokers = 0.85; former smokers = 0.87; ever smokers = 1.00). CONCLUSIONS: Smoking increases the risk of rectal cancer to the same extent in women as in men.

Cigarette smoking and colorectal cancer mortality among 602,242 Norwegian males and females.

BACKGROUND: Colorectal cancer (CRC) is one of the main cancer types, with high incidence and mortality in Norway. We examined the association between different measures of smoking exposure and CRC mortality overall and by subsite in a large Norwegian cohort. METHODS: We followed 602,242 participants from four Norwegian health surveys, aged 19-67 years at enrollment between 1972 and 2003 by linkage to the national registries through December 2007. We used Cox proportional hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) by smoking categories for different CRC endpoints. RESULTS: During a mean follow-up of 14 years, 2,333 Norwegian males and females died of CRC (60% men). Male and female ever smokers had a 20% (HR 1.23, CI 1.08-1.40 and HR 1.22, 95% CI 1.06-1.40, respectively) increased risk of death from CRC compared with sex-specific never smokers. For proximal colon cancer mortality, female ever smokers had a 50% (HR 1.49, 95% CI 1.20-1.87) increased risk compared with female never smokers. The increased risk of rectal cancer mortality was about 40% higher for male ever smokers (HR 1.43, 95% CI 1.14-1.81) compared with male never smokers. A test for heterogeneity by sex showed an increased risk of rectal cancer mortality among men which was significant for former smokers (Wald χ(2) =0.02) and an increased risk of proximal colon cancer mortality among women which was significant for ever and former smokers (Wald χ(2) =0.02 and χ(2) =0.04, respectively). CONCLUSION: Smoking is associated with increased CRC mortality in both sexes. The risk of rectal and proximal colon cancer mortality was most pronounced among male and female smokers respectively.