Does obesity compromise survival in women with breast cancer?

Obesity, measured by high body mass index (BMI >30 kg/m2) is associated with an increased risk of postmenopausal breast cancer but the effect of obesity on prognosis is not clear. A prospectively accrued and regularly validated database of 1579 patients with breast cancer treated in a district general hospital between 1963 and 1999 was analysed for clinical and pathological tumour characteristics including the family history, grade, tumour type, treatment and outcome. The risk factors and outcome of obese and non-obese patients were compared. Breast cancer in obese women was associated with significantly larger tumour size and worse Nottingham prognostic index. There was no statistically significant difference in overall and disease-free survival between obese and non-obese group. Hazard ratios (95% Cl) were 0.81 (0.62-1.06) and 0.80 (0.63-1.01), respectively. In the present study, obesity is not an indicator of worst prognosis of breast cancer.

The long-term outcome of synchronous bilateral breast cancer is worse than metachronous or unilateral tumours.

AIM: There is uncertainty in the literature as to whether bilateral breast cancer carries a worse prognosis than unilateral disease because some studies suggest that the development of a second primary does not influence survival, while others report a decreased survival in patients suffering from bilateral disease. METHODS: A prospectively accrued and regularly validated database of 1945 patients with breast cancer treated in a district general hospital between 1963 and 1999 was analysed for clinical and pathological tumour characteristics including family history, grade, type of tumour, treatment and outcome. RESULTS: Five per cent of patients (92) suffered from metachronous and 43 (2%) from synchronous bilateral breast cancer. A family history of breast cancer was more common in patients with metachronous bilateral breast cancer (38%), compared with the unilateral group (15%) and the synchronous bilateral breast cancer group (17%) (chi(2)=22.9, P<0.001). Patients with synchronous bilateral breast cancer had a significantly worse overall survival when compared with those with metachronous bilateral or unilateral breast cancer (log-rank test chi(2)=6.1, P=0.047). CONCLUSION: Women with metachronous breast cancer were more likely to have positive family history, while those with synchronous bilateral breast cancer tend to have shorter survival when compared with those with unilateral breast cancer. Synchronous bilaterality is not, however, an independent risk factor on multivariate analysis.

Community nurses & discharge planning.

The role of community nurses in discharge planning for elderly patients leaving hospital is of increasing importance in the wake of the NHS and Community Care Act 1990. Community nurses can play a key role in contributing to pre-discharge assessments and in providing continuing post-discharge assessment and care. The Nursing Research Unit at the University of Edinburgh conducted a survey early in 1993, just prior to implementation of the Community Care Act in Scotland, to ascertain the views and experiences of a national 1 in 3 sample of community nurses relating to the discharge of elderly people from acute hospitals. This article presents the results of that survey and offers recommendations regarding the role of community nurses in discharge planning for elderly patients.

Dietary survey in 40-year-old Edinburgh men.

One hundred and seven healthy 40-yr-old Edinburgh men were asked to participate in a dietary survey involving a 7-d weighed record. Ninety seven successfully completed the record. The results showed that the total energy was made up of 13 per cent protein, 38 per cent fat, 40 per cent carbohydrate and 9 per cent alcohol. A small proportion of the men had exceptionally high alcohol intakes. The mean intake of fat was high, 121 g, it is nevertheless lower than amounts consumed in other areas of Britain. Of the energy from fat, 16 per cent came from saturated-fatty acid, 15 per cent from monounsaturated-fatty acid and 4 per cent from polyunsaturated-fatty acid. Linoleic acid contributed 3 per cent of the mean energy intake. In some mens' diet this essential fatty acid provided under 2 per cent of their total energy consumption.

Prevalence of antibody to hepatitits B surface antigen among staff in an Edinburgh hospital.

Antibody to hepatitis B surface antigen was detected by radioimmunoprecipitation in 74 (5-5%) of 1336 staff members in a large general hospital in Edinburgh, in 14 (2-9%) of 480 volunteer blood donors in the area, and in 12 (6-1%) of 197 pregnant women attending for the first time at the ante-natal clinic in the hospital. Rates of antibody prevalence rose with age in the sample of hospital staff and in that of the blood donors, particularly among males. On the other hand, in the ante-natal patients antibody prevalence declined with age. The rates in hospital staff were higher than those in blood donors of comparable age and sex, and high titres of antibody were more common in the staff group. However, no association was found between antibody prevalence and a history of clinical hepatitis, blood transfusion, or recognized contact with cases of hepatitis. Staff who had previously worked in an infectious disease hospital did not show increased antibody prevalence, indicating that simple isolation measures have been adequate to minimize exposure to hepatitis B. No particular prevalence of infection was seen in physicians and surgeons, in the nursing staff, or in workers in clinical diagnostic laboratories, hospital administration or other areas. One group clearly showing increased antibody prevalence was staff currently working, or who had worked, in the Haemodialysis Unit; this correlated with the outbreak of dialysis-associated hepatitis in 1969--70. However, no evidence suggested that significant dissemination of infection had occurred to other defined groups of hospital staff. Elevated rates were also observed in a small sample of kitchen and portering staff, and in obstetric medical and nursing staff; the latter observation indicate a need for further investigation to identify unsuspected exposure to hepatitis B virus.