Julius Center for Health science and Primary Care and

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PubMed | Karolinska Institutet, Danish Cancer Society, Public Health Directorate, University of Tromsø and 23 more.
Type: Journal Article | Journal: The American journal of clinical nutrition | Year: 2016

Carotenoids and vitamin C are thought to be associated with reduced cancer risk because of their antioxidative capacity.This study evaluated the associations of plasma carotenoid, retinol, tocopherol, and vitamin C concentrations and risk of breast cancer.In a nested case-control study within the European Prospective Investigation into Cancer and Nutrition cohort, 1502 female incident breast cancer cases were included, with an oversampling of premenopausal (n = 582) and estrogen receptor-negative (ER-) cases (n = 462). Controls (n = 1502) were individually matched to cases by using incidence density sampling. Prediagnostic samples were analyzed for -carotene, -carotene, lycopene, lutein, zeaxanthin, -cryptoxanthin, retinol, -tocopherol, -tocopherol, and vitamin C. Breast cancer risk was computed according to hormone receptor status and age at diagnosis (proxy for menopausal status) by using conditional logistic regression and was further stratified by smoking status, alcohol consumption, and body mass index (BMI). All statistical tests were 2-sided.In quintile 5 compared with quintile 1, -carotene (OR: 0.61; 95% CI: 0.39, 0.98) and -carotene (OR: 0.41; 95% CI: 0.26, 0.65) were inversely associated with risk of ER- breast tumors. The other analytes were not statistically associated with ER- breast cancer. For estrogen receptor-positive (ER+) tumors, no statistically significant associations were found. The test for heterogeneity between ER- and ER+ tumors was statistically significant only for -carotene (P-heterogeneity = 0.03). A higher risk of breast cancer was found for retinol in relation to ER-/progesterone receptor-negative tumors (OR: 2.37; 95% CI: 1.20, 4.67; P-heterogeneity with ER+/progesterone receptor positive = 0.06). We observed no statistically significant interaction between smoking, alcohol, or BMI and all investigated plasma analytes (based on tertile distribution).Our results indicate that higher concentrations of plasma -carotene and -carotene are associated with lower breast cancer risk of ER- tumors.


PubMed | University Utrecht, Julius Center for Health science and Primary Care and and Julius Center for Health science and Primary Care and National Institute for Public Health and the Environment
Type: Journal Article | Journal: Pediatrics | Year: 2016

Daycare attendance has been associated with increased acute gastroenteritis (AGE) incidence in the first years of life. We investigated the effects of first-year daycare attendance on AGE incidence and primary care contact rate up to age 6 years.Children enrolled in the Wheezing Illnesses Study Leidsche Rijn cohort were managed until age 6 years. Data on primary care diagnosed AGE episodes and number of associated contacts per episode were collected from health records. Children were categorized according to first year daycare attendance and age-month at entry when applicable. Generalized estimating equations were used to assess associations between first-year daycare and AGE incidence or primary care contact rate.A total of 1344 out of 2220 children (83%) attended daycare before age 1 year. Overall, the 6-year primary care AGE incidence rate (IR) among first-year daycare attendees and nonattendees was comparable (IR: 12.2/100 vs 13.3/100 child-years). First-year daycare attendees had a higher AGE incidence during the first year (IRR: 1.13; 95% confidence interval: 1.06-1.21) and lower during the third to sixth year of age compared with nonattendees (P < .001). The daycare-associated increase in AGE incidence was most pronounced during the first 12 months after enrollment into daycare and demonstrated clear seasonality. A similar pattern was observed for primary care contact rate per AGE episode.First-year daycare attendance advances the timing of AGE infections, resulting in increased AGE disease burden in the first year and relative protection thereafter. Protection against AGE infection persists at least up to age 6 years. Future studies should address whether this protective effect persists during later childhood.


PubMed | University Utrecht and Julius Center for Health science and Primary Care and
Type: Journal Article | Journal: Family practice | Year: 2015

Secondary care studies showed that a recorded allergy to beta-lactams could not be confirmed by valid allergy testing in >85% of cases. In daily practice, recorded beta-lactam allergies probably cause prescription of secondary choice antibiotics. This overrating of beta-lactam allergy hampers appropriate use of narrow spectrum antibiotic and generates unnecessary cost and bacterial resistance.To assess registration and over diagnosis of allergies against beta-lactams in Dutch primary care.A retrospective cohort study in 8288 primary care subjects was performed. Patients with recorded allergy were identified through International Classification for Primary Care coding. Signs and symptoms of the recorded allergic reaction and patients characteristics were extracted from patients files and patients were sent a questionnaire. The probability of allergy was based on a composite reference standard that was scored by two authors independently.One hundred sixty-three subjects had a recorded allergy (2.0%). In 51.5% of cases, no characteristics of the recorded allergic reaction were reported in patients medical files. Based on our composite reference standard, allergy was excluded in 19 subjects (11.7%). Risk factors for allergy registration were female gender, age <4 years, and the comorbidities-asthma, allergies and skin disorders.The prevalence of recorded allergy against beta-lactam antibiotics in a large Dutch primary care centre was 2%. Due to lack of registration of accompanying signs and symptoms of the recorded allergy, this diagnosis is uncertain in most patients. Better documentation and classification by a screening algorithm of future possible allergic reactions to beta-lactams are needed in primary care.


PubMed | University Utrecht and Julius Center for Health science and Primary Care and
Type: Journal Article | Journal: Family practice | Year: 2015

We aimed to validate the Oudega diagnostic decision rule-which was developed and validated among younger aged primary care patients-to rule-out deep vein thrombosis (DVT) in frail older outpatients.In older patients (>60 years, either community dwelling or residing in nursing homes) with clinically suspected DVT, physicians recorded the score on the Oudega rule and d-dimer test. DVT was confirmed with a composite reference standard including ultrasonography examination and 3-month follow-up. The proportion of patients with a very low probability of DVT according to the Oudega rule (efficiency), and the proportion of patients with symptomatic venous thromboembolism during 3 months follow-up within this very low risk group (failure rate) was calculated.DVT occurred in 164 (47%) of the 348 study participants (mean age 81 years, 85% residing in nursing homes). The probability of DVT was very low in 69 patients (Oudega score 3 points plus a normal d-dimer test; efficiency 20%) of whom four had non-fatal DVT (failure rate 5.8%; 2.3-14%). With a simple revised version of the Oudega rule for older suspected patients, 43 patients had a low risk of DVT (12% of the total population) of whom only one had DVT (failure rate 2.3%; 0.4-12%).In older suspected patients, application of the original Oudega rule to exclude DVT resulted in a higher failure rate as compared to previous studies. A revised and simplified Oudega strategy specifically developed for elderly suspected patients resulted in a lower failure rate though at the expense of a lower efficiency.

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