Experiences of positive encounters with healthcare professionals among women on long-term sickness absence due to breast cancer or due to other diagnoses: a nationwide survey.

BACKGROUND: Experiences of encounters with professionals have been shown to influence return to work (RTW) among sickness absentees in general. The aim was to gain knowledge on experiences of encounters with healthcare professionals and the ability to RTW among women on long-term sickness absence (SA) due to breast cancer (BC) compared to among women on long-term SA due to other diagnoses. METHODS: Analyses of questionnaire data about experiences of encounters with healthcare professionals among 6197 women aged 19-65 years and on a SA spell lasting 4-8 months. Of those, 187 were on SA due to BC. Descriptive statistics and adjusted (for age, birth country, educational level, depressive symptoms) logistic regression analyses with 95% confidence intervals (CI) were conducted. RESULTS: About 95% in both groups of women stated that they had experienced positive encounters with healthcare, and a minority, about 20%, had experienced negative encounters. Four specific types of positive encounters had been experienced to a lesser extent by women with BC: "allowed me to take own responsibility" (odds ratio (OR) 0.6; 95% CI 0.4-0.8), "encouraged me to carry through my own solutions" (OR 0.5; 95% CI 0.4-0.7), "made reasonably high demands" (OR 0.6; 95% CI 0.4-0.9), and "sided with me/stood on my side" (OR 0.6; 95% CI 0.4-0.8). Among the women with BC, 46% stated that positive encounters promoted their ability to RTW compared to 56% among the others. CONCLUSION: Most of the women had experienced positive encounters and about half stated that positive encounters promoted their ability to RTW, although a slightly smaller proportion of the women with BC stated that. This study emphasizes that not only medical treatment but also encounters may influence the ability to RTW, something that is of clinical importance.

Women's experiences of encounters with healthcare professionals' regarding work after breast-cancer surgery and associations with sickness absence: a 2-year follow-up cohort study.

INTRODUCTION: Breast cancer (BC) is the most common cancer among women, and half of those diagnosed are of working age. Positive encounters regarding work from healthcare professionals have been shown to promote return to work among sickness absentees in general. However, the knowledge about encounters possible associations with sickness absence (SA) in women with BC is scarce. AIM: To explore if women had experienced encounters regarding work from healthcare professionals during the first year after BC surgery and if this was associated with SA during the second year after surgery, controlled for treatment and sociodemographic effects. METHODS: A prospective cohort study of 690 Swedish women with primary BC, aged 24-63 years included after surgery. Descriptive statistics and adjusted logistic regression (age, birth country, education, self-rated health, treatment) with 95% confidence intervals (CI) were used. RESULTS: Eighty percent of the women had experienced encounters regarding work. Women who got advice and support regarding work (adjusted odds ratio (OR) 0.5; 0.3-0.9) or were encouraged to work (adjusted OR 0.6; 0.3-0.9) had less SA. A larger proportion of those encouraged to work had less advanced cancer, surgery, hormone, or radiotherapy. Consistently, women encouraged to be on SA had more SA, but this was partly explained by disease or treatment factors (crude OR 1.6; 1.1-2.4, adjusted OR 1.2 (0.8-1.9) since a larger proportion of those with more advanced cancer, surgery, or chemotherapy had more SA. CONCLUSION: Most women experienced encounters regarding work, and the nature of these encounters were associated with SA 2 years after BC surgery.

Inspection of cardiology departments in Norway: are they making it great in radiation protection?

Staff involved in interventional cardiology receive the highest occupational doses in Norway, and skin burns of patients have been reported. To identify the level of radiation protection (RP) for patients and staff, and compliance with the RP regulation, the Norwegian Radiation Protection Authority carried out inspections. The inspections were conducted (2013-14) as quality system reviews, based on document reviews, interviews, on-site inspections and observations of interventional procedures. The inspections revealed that most of the hospitals had non-compliances according to the RP regulation. Most deviations were associated with education in RP and follow-up of patients who had received high radiation doses. Lack of systematic optimisation of procedures and estimation of eye lens doses to evaluate the risk for cataracts were also common. Inspections turned out to increase the awareness of RP in cardiology and are identified as an effective tool for improving RP.

Level of compliance with the radiation protection regulation--a survey among Norwegian hospitals and X-ray institutes.

To identify the level of compliance with the new radiation protection regulation among Norwegian health care enterprises (HCEs). Totally, 41 HCEs were authorised to use advanced X-ray equipment for medical purposes during 2005-07. Follow-up inspections with 14 HCEs were carried out during 2007-09. Main topics for the inspections were those requirements identified as most challenging to implement in the authorisation process. Totally, 192 non-conformities with the regulation were revealed during the authorisation process. The inspections revealed that 93 % of the inspected HCEs had non-conformities with the regulation. Most common non-conformities dealt with skills in radiation protection, establishment of local diagnostic reference levels, access to medical physicists and performance of quality control of X-ray equipment. Inspections are an effective tool for implementation of regulation the requirements at the HCEs, thus improving radiation protection awareness.

How 'do's' and 'dont's' can be of significant importance in radiation protection: a case report.

The Norwegian Radiation Protection Authority (NRPA) was contacted by a cardiology department because of a suspicious radiation burn on a patient. The patient had undergone two bi-ventricular pacemaker implantations and the lesion was recognised as radiation dermatitis. The NRPA sent sets of thermoluminescense dosemeters to the department to measure the skin dose on eight successive patients undergoing bi-ventricular pacemaker implantations. The average maximum entrance surface dose for the eight patients was 5.3 Gy, ranging from 2.0 to 13.1 Gy. A site audit was performed during a procedure, with the aim to observe the general skills in radiation protection. Based on the findings in the audit, a few very simple 'Do's' and 'Don'ts' were highlighted in a meeting directly after the audit. After the audit, dose measurements were performed on six new patients showing an average maximum entrance surface dose of 0.4 Gy, ranging from 0.2 to 0.8 Gy. The aim of this work was to illustrate the dose reductions that are possible to achieve with a very few basic advices, especially when the operator has suboptimal competence.

Alcohol intake and endometrial cancer risk: a meta-analysis of prospective studies.

BACKGROUND: Studies on alcohol intake in relation to endometrial cancer risk have produced inconsistent results. METHODS: For a meta-analysis, we identified cohort studies of alcohol and endometrial cancer by a literature search of Pub-Med and Embase up to 1 March 2010 and by searching the reference lists of relevant articles. RESULTS: Seven cohort studies, including 1,511,661 participants and 6086 endometrial cancer cases, were included in the dose-response random-effect meta-regression model. Compared with non-drinkers, women drinking less than 1 drink of alcohol (13 g of ethanol) per day had a lower risk for endometrial cancer; this risk was lower by 4% (95% confidence interval (95% CI): 0.93-1.00) for consumption up to 0.5 drink per day and by 7% (95% CI: 0.85-1.02) for consumption up to 1 drink. However, we found evidence of an increased risk for endometrial cancer for intakes higher than two alcoholic drinks per day: compared with non-drinkers, the risk was higher by 14% (95% CI: 0.95-1.36) for 2-2.5 drinks per day and by 25% (95% CI: 0.98-1.58) for >2.5 drinks per day. CONCLUSION: Our meta-analysis indicates a possible J-shaped relationship between alcohol intake and endometrial cancer risk.

Diabetes mellitus and risk of endometrial cancer: a meta-analysis.

AIMS/HYPOTHESIS: Diabetes has been associated with a statistically significantly increased risk of endometrial cancer in most, but not all studies. To provide a quantitative assessment of the association between diabetes and risk of endometrial cancer, we conducted a meta-analysis of case-control studies and cohort studies. SUBJECTS AND METHODS: We identified studies by a literature search of PubMed and Embase through to January 2007 and by searching the reference lists of relevant articles. Summary relative risks (RRs) with 95% CIs were calculated using random-effects model. RESULTS: The analysis of diabetes (largely type 2) and endometrial cancer is based on 16 studies (three cohort and 13 case-control studies), including 96,003 participants and 7,596 cases of endometrial cancer. Twelve of the studies showed a statistically significantly increased risk and four a non-significant increased risk of endometrial cancer. In our meta-analysis we found that diabetes was statistically significantly associated with an increased risk of endometrial cancer (summary RR 2.10, 95% CI 1.75-2.53). The risk estimates were somewhat stronger among case-control (RR 2.22, 95% CI 1.80-2.74) than among cohort studies (RR 1.62, 95% CI 1.21-2.16), stronger among studies adjusting only for age (RR 2.74, 95% CI 1.87-4.00) compared with multivariate adjustment (RR 1.92, 95% CI 1.58-2.33) and slightly lower in studies performed in the USA than in those performed Europe. The analysis of type 1 diabetes and endometrial cancer was based on three studies and found a statistically significant positive association (summary RR 3.15, 95%CI 1.07-9.29). CONCLUSIONS/INTERPRETATION: Results from the meta-analysis support a relationship between diabetes and increased risk of endometrial cancer.

Diurnal variation in n(2) fixation and photosynthesis by aquatic blue-green algae.

Rates of (14)CO(2) fixation, O(2) evolution, and N(2) fixation (acetylene reduction) by natural populations of blue-green algae recovered from Lake Mendota were measured at frequent intervals between sunrise and sunset. Photosynthesis and N(2) fixation were depressed during midday when light intensity was greatest. As the light intensity rose, most of the algal population migrated to deeper, light-limited waters where radiation damage would be diminished. As the relative rate of N(2) fixation compared to CO(2) fixation increases with depth, it is suggested that the algae maintain balanced growth by migrating vertically via buoyancy regulation. High concentrations of dissolved O(2) in lake water may inhibit N(2) fixation by enhancing photorespiration. Several factors such as photosynthetic rate, light intensity, dissolved O(2), species composition, and vertical and horizontal migration all affect observed rates of in situ N(2) fixation.