Vitamin B6 catabolism and lung cancer risk: results from the Lung Cancer Cohort Consortium (LC3).

BACKGROUND: Increased vitamin B6 catabolism related to inflammation, as measured by the PAr index (the ratio of 4-pyridoxic acid over the sum of pyridoxal and pyridoxal-5'-phosphate), has been positively associated with lung cancer risk in two prospective European studies. However, the extent to which this association translates to more diverse populations is not known. MATERIALS AND METHODS: For this study, we included 5323 incident lung cancer cases and 5323 controls individually matched by age, sex, and smoking status within each of 20 prospective cohorts from the Lung Cancer Cohort Consortium. Cohort-specific odds ratios (ORs) and 95% confidence intervals (CIs) for the association between PAr and lung cancer risk were calculated using conditional logistic regression and pooled using random-effects models. RESULTS: PAr was positively associated with lung cancer risk in a dose-response fashion. Comparing the fourth versus first quartiles of PAr resulted in an OR of 1.38 (95% CI: 1.19-1.59) for overall lung cancer risk. The association between PAr and lung cancer risk was most prominent in former smokers (OR: 1.69, 95% CI: 1.36-2.10), men (OR: 1.60, 95% CI: 1.28-2.00), and for cancers diagnosed within 3 years of blood draw (OR: 1.73, 95% CI: 1.34-2.23). CONCLUSION: Based on pre-diagnostic data from 20 cohorts across 4 continents, this study confirms that increased vitamin B6 catabolism related to inflammation and immune activation is associated with a higher risk of developing lung cancer. Moreover, PAr may be a pre-diagnostic marker of lung cancer rather than a causal factor.

Patients' stories: science, clinical facts or fairy tales?

OBJECTIVE: To explore potentials and attributes of the qualitative research interview as a tool for acquiring knowledge about illness. DESIGN: A qualitative approach, comparing knowledge about consultations originating from 1) data from interviews with immigrant female patients, and 2) evaluative data from registration forms from the doctors. SETTING AND SUBJECTS: 24 Pakistani female patients, recruited from the appointment list at a primary health care centre in central Oslo were interviewed in their homes. Evaluation forms were filled in by the ten physicians consulted. MAIN OUTCOME MEASURES: Illness knowledge derived from different communicative contexts. Contextual prerequisites suggest potential roads to the inquiry of illness applicable in the clinical context. CASE STORIES: Patients' illness perspectives and resources were probably encouraged in the interview by means of discourse underlining the women's resources. This position may have emerged because the women were actually consulted by the interviewer. Dialogues actively seeking out the other person's illness perspective, as recommended in the qualitative interview, seem to encourage adequate exchange of medical information. CONCLUSION/IMPLICATIONS: Pursuing and modifying strategies from the qualitative interview for exploration of illness may contribute to clinical facts as well as scientific knowledge concerning illness.

[Norwegian and immigrant patients at a health care center. Are there real differences?]. / Norske pasienter og innvandrerpasienter ved et legesenter. Er det virkelig forskjeller?

Routine data from a Primary Health Care Centre in Oslo have been analysed to find differences between Norwegian and immigrant patients. We compared frequencies of diagnoses, as well as pattern and outcome of contacts (laboratory-tests, referrals and follow-up appointments). The two patient groups showed different age and gender distribution. There were fewer children, more elderly and more women among the Norwegians than among the immigrants. This explains the differences in the pattern of contact, and its outcome. Differences in the distribution of diagnoses also depended on group related factors other than the unequal age and gender distribution. The higher frequency of non-specific conditions among immigrants and mental diseases among Norwegians were due to group-specific factors alone. The first of these differences is interpreted as a sign of poor communication between the doctor and the immigrant patients. More seldom than expected, the differences were related to other factors than age and gender distribution. It is therefore important to focus also on similarities when comparing native and immigrant patients.