Prospective cohort study of lifetime physical activity and breast cancer survival.

Few studies have examined the association between physical activity and disease outcomes in breast cancer survivors. Here, we report the association between lifetime total physical activity performed prior to diagnosis and disease outcomes in a population-based sample of breast cancer survivors. A cohort of 1,231 women diagnosed with breast cancer between 1995 and 1997 was followed for a minimum of 8.3 years for any cancer progressions, recurrences and new primaries; and a minimum of 10.3 years for deaths. All treatment and follow-up care received was abstracted from medical records. Data on physical activity including type (occupational, household, recreational) and dose (frequency, intensity and duration) performed during the entire lifetime until diagnosis were examined in Cox proportional hazards models as well as with cumulative incidence curves. An average of 126 MET-hr/week were reported for total physical activity (of which 13.9, 46.9 and 65.3 MET-hr/week were, respectively, for recreational, occupational and household activity). A decreased risk of breast cancer death and all deaths was observed among women in the highest versus the lowest quartiles of recreational activity (MET-hr/week/year) (HR = 0.54, 95% CI = 0.36-0.79). Both moderate (0.56, 95% CI = 0.38-0.82) and vigorous intensity recreational activity (0.74, 95% CI = 0.56-0.98) decreased the risk of breast cancer death. Moderate intensity recreational activity decreased the risk of a recurrence, progression or new primary cancer (0.66, 95% CI = 0.48-0.91). No other association with breast cancer survival was observed for other types of physical activity. Prediagnosis recreational activity conferred a benefit for survival after breast cancer. Moderate intensity recreational activity was particularly protective.

The effect of culture on symptom reporting: Hispanics and irritable bowel syndrome.

PURPOSE: To explore whether the symptoms reported by Mexican-American patients with irritable bowel syndrome (IBS) meet the current diagnostic criteria. DATA SOURCES: A retrospective review of charts of Mexican-American patients diagnosed with IBS at three large medical centers in central California was performed. Demographic information was extracted, and descriptive statistics were used to determine how symptoms were reported and whether the described symptoms met the Rome II criteria. CONCLUSIONS: Only 63% of the Mexican-American patients in this study reported symptoms that met any of the nine Rome II criteria. There was no significant difference between patients who were English dominant and those who were monolingual Spanish in the concordance of their presenting complaint and the current diagnostic criteria. In addition, there was no significant gender difference in the rate at which symptoms met the Rome II criteria. IMPLICATIONS FOR PRACTICE: Assessment of illness and its symptoms requires that the practitioner have a clear understanding of what the illness means to the patient in order to develop an accurate diagnosis and an appropriate and timely plan of treatment. This study highlights the necessity of revising the symptom-based criteria for diagnosing IBS to include a wider array of reported complaints, taking into account the impact of culture on the perception and description of symptoms.