Non-participation in breast cancer screening for women with chronic diseases and multimorbidity: a population-based cohort study

Background

Chronic diseases and multimorbidity are common in western countries and associated with increased breast cancer mortality. This study aims to investigate non-participation in breast cancer screening among women with chronic diseases and multimorbidity and the role of time in this association.

Method

This population-based cohort study used regional and national registries. Women who were invited to the first breast cancer screening round in the Central Denmark Region in 2008–09 were included (n = 149,234). Selected chronic diseases and multimorbidity were assessed up to 10 years before the screening date. Prevalence ratios (PR) were used as an association measure.

Results

The results indicated that women with at least one chronic condition were significantly more likely not to participate in breast cancer screening. In adjusted analysis, a significantly higher likelihood of non-participation was found for women with cancer (PR = 1.50, 95 % CI: 1.40–1.60), mental illness (PR = 1.51, 95 % CI: 1.42–1.60), chronic obstructive pulmonary disease (PR = 1.51, 95 % CI: 1.42–1.62), neurological disorders (PR = 1.24, 95 % CI: 1.12–1.37) and kidney disease (PR = 1.70, 95 % CI 1.49–1.94), whereas women with chronic bowel disease (PR = 0.75, 95 % CI 0.65–0.88) were more likely to participate than women without these disease. Multimorbidity was associated with increased non-participation likelihood. E.g. having 3 or more diseases was associated with 58 % increased non-participation likelihood (95 % CI: 27–96 %). Higher non-participation was also observed for women with severe multimorbidity (PR = 1.53, 95 % CI: 1.23–1.90) and mental-physical multimorbidity (PR = 1.54, 95 % CI: 1.36–1.75).

Conclusion

In conclusion, we found a strong association between non-participation in breast cancer screening for some chronic diseases and for multimorbidity. The highest propensity not to participate was observed for women with hospital contacts related to the chronic disease in the period closest to the screening date.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-015-1829-1) contains supplementary material, which is available to authorized users.

Long-term mortality of persons with severe mental illness and diabetes: a population-based cohort study in Denmark

BACKGROUND

Persons with severe mental illness (SMI) have excess mortality, which may partly be explained by their high prevalence of diabetes.

METHOD

We compared the overall and cause-specific mortality in persons with SMI and diabetes with that of the general Danish population between 1997 and 2009 by linking data from Danish national registries.

RESULTS

The cohort counted 4 734 703 persons, and during follow-up 651 080 persons died of whom 1083 persons had SMI and diabetes. Compared with the background population, the overall mortality rate ratios (MRRs) for persons with SMI and diabetes were 4.14 [95% confidence interval (CI) 3.81-4.51] for men and 3.13 (95% CI 2.88-3.40) for women. The cause-specific MRRs for persons with SMI and diabetes were lowest for malignant neoplasms (women: MRR = 1.98, 95% CI 1.64-2.39; men: MRR = 2.08, 95% CI 1.69-2.56) and highest for unnatural causes of death (women: MRR = 12.31, 95% CI 6.80-22.28; men: MRR = 7.89, 95% CI 5.51-11.29). The cumulative risks of death within 7 years of diabetes diagnosis for persons with SMI and diabetes were 15.0% (95% CI 12.4-17.6%) for those younger than 50 years, 30.7% (95% CI 27.8-33.4%) for those aged 50-69 years, and 63.8% (95% CI 58.9-68.2%) for those aged 70 years or older. Among persons suffering from both diseases, 33.4% of natural deaths were attributed to diabetes and 14% of natural deaths were attributed to the interaction between diabetes and SMI.

CONCLUSIONS

Long-term mortality is high for persons with SMI and diabetes. This calls for effective intervention from a coordinated and collaborating healthcare system.

Loss of a close family member the year before or during pregnancy and the risk of placental abruption: a cohort study from Denmark and Sweden

BACKGROUND

Maternal stress during pregnancy is associated with a modestly increased risk of fetal growth restriction and pre-eclampsia. Since placental abruption shares similar pathophysiological mechanisms and risk factors with fetal growth restriction and pre-eclampsia, we hypothesized that maternal stress may be implicated in abruption risk. We investigated the association between maternal bereavement during pregnancy and placental abruption.

METHOD

We studied singleton births in Denmark (1978-2008) and Sweden (1973-2006) (n = 5,103,272). In nationwide registries, we obtained data on death of women's close family members (older children, siblings, parents, and partners), abruption and potential confounders.

RESULTS

A total of 30,312 (6/1000) pregnancies in the cohort were diagnosed with placental abruption. Among normotensive women, death of a child the year before or during pregnancy was associated with a 54% increased odds of abruption [95% confidence interval (CI) 1.30-1.82]; the increased odds were restricted to women who lost a child the year before or during the first trimester in pregnancy. In the group with chronic hypertension, death of a child the year before or in the first trimester of pregnancy was associated with eight-fold increased odds of abruption (odds ratio 8.17, 95% CI 3.17-21.10). Death of other relatives was not associated with abruption risk.

CONCLUSIONS

Loss of a child the year before or in the first trimester of pregnancy was associated with an increased risk of abruption, especially among women with chronic hypertension. Studies are needed to investigate the effect of less severe, but more frequent, sources of stress on placental abruption risk.

Preschool behavioral problems in children prenatally exposed to antiepileptic drugs - a follow-up study

We studied the association between maternal epilepsy, antiepileptic drug (AED) treatment, and behavioral problems in preschool children. In the Danish National Birth Cohort, we identified 4- to 5-year-old children whose mothers had epilepsy and received AED treatment (n=133) or not (n=304) during pregnancy and compared them with randomly selected children whose mothers did not have epilepsy (n=1193). The children's behavioral problems were assessed by the use of the Strengths and Difficulties Questionnaire (SDQ). Children prenatally exposed to AEDs more often had an abnormal total SDQ score as compared with children of women without epilepsy (odds ratio (OR)=4.8 (95% CI: 1.9-12.1)) and as compared with children of women with epilepsy who were not treated with AEDs during their pregnancy (OR=4.0 (95% CI: 1.3-12.8)). In conclusion, prenatal AED exposure may increase the risk of behavioral problems in preschool children even after adjustments for potential confounders and maternal epilepsy.

Influence of feeding intensity, grazing and finishing feeding on meat and eating quality of young bulls and the relationship between muscle fibre characteristics, fibre fragmentation and meat tenderness

Forty-one autumn-born Friesian bull calves were allocated to two production systems (Extensive='E'and Intensive='I'). In the E-system, animals were loose-housed and fed a roughage-based diet from October to May, followed by a grazing period from May to October. Ten animals were slaughtered directly from pasture in October [360 kg body weight (BW)] and 11 after a 10-week finishing period in tie-stalls (460 kg). The E-bulls were compared with intensively-fed tie-stall-housed young bulls (I) slaughtered at comparable weights (360 kg, n=11 and 460 kg, n=9). The myofibril fragmentation index (MFI) was measured 24 h post mortem in semitendinosus (ST), longissimus dorsi (LD), and supraspinatus (SU) muscles, and meat quality characteristics and sensory evaluation of LD were performed on aged meat. Intramuscular fat content was lower (P<0.001) in all three muscles of E- compared with I-bulls. MFI of ST and LD was lower in E-bulls compared with I-bulls, but only at 360 kg. In contrast, MFI of SU was higher in E- compared with I-bulls at 360 kg. In E- compared with I-bulls, shear force value of ST was higher (P<0.003) at 360 kg, but not at 460 kg. Panel scores for tenderness, taste and juiciness were all lower (P<0.006 to 0.001) and remarks for off-flavour higher in E- compared with I-bulls, the effects being most pronounced at 360 kg. A 10-week finishing period improved all meat and eating quality characteristics of E-bulls. In LD, the correlation between MFI and tenderness was 0.79 (P<0.001), which indicates a potential of MFI as an early predictor of tenderness.

Antenatal maternal bereavement and childhood cancer in the offspring: a population-based cohort study in 6 million children

Background:

Prenatal stress may increase the susceptibility to childhood cancer by affecting immune responses and hormonal balance. We examined whether antenatal stress following maternal bereavement increased the risk of childhood cancer.

Methods:

All children born in Denmark from 1968 to 2007 (N=2 743 560) and in Sweden from 1973 to 2006 (N=3 400 212) were included in this study. We compared cancer risks in children born to women who lost a first-degree relative (a child, spouse, a parent, or a sibling) the year before pregnancy or during pregnancy with cancer risks in children of women who did not experience such bereavement.

Results:

A total of 9795 childhood cancer cases were observed during follow-up of 68 360 707 person years. Children born to women who lost a child or a spouse, but not those who lost other relatives, had an average 30% increased risk of any cancer (hazard ratio (HR) 1.30, 95% confidence interval (CI) 0.96–1.77). The HRs were the highest for non-Hodgkin disease (512 cases in total, HR 3.40, 95% CI 1.51–7.65), hepatic cancer (125 cases in total, HR 5.51, 95% CI 1.34–22.64), and testicular cancer (86 cases in total, HR 8.52, 95% CI 2.03–37.73).

Conclusion:

Our data suggest that severe antenatal stress following maternal bereavement, especially due to loss of a child or a spouse, is associated with an increased risk of certain childhood cancers in the offspring, such as hepatic cancer and non-Hodgkin disease, but not with childhood cancer in general.

Technical note: ruminal cannulation technique in young Holstein calves: effects of cannulation on feed intake, body weight gain, and ruminal development at six weeks of age

Ruminal cannulation techniques are frequently used to study fermentation in the ruminant forestomach. Unsatisfactory results with the traditionally applied procedure for cannulation of young calves stimulated the development of a simpler and more robust procedure; this procedure was tested for effects on performance traits and gross anatomy of the gastrointestinal tract compared with a control group not undergoing surgery. Five calves were ruminally cannulated at approximately 10 d of age and 5 matching calves were used as controls. All calves were fed milk replacer and a diet based on clover grass silage and sodium hydroxide-treated wheat. Ruminal fluid was collected from cannulated calves once weekly for 3 consecutive weeks. All calves were euthanized at 43+/-3 d of age. No apparent adverse effects of cannulation were observed. Feed intake, BW gain, and gross anatomy of the gastrointestinal tract were not affected by cannulation. Minimum ruminal pH increased with sampling week, but average ruminal pH, total volatile fatty acids concentration, and volatile fatty acids proportions were not affected by sampling week. In conclusion, the implemented surgical technique was found to have no major effect on apparent animal health and performance traits, and the cannula proved useful for multiple samplings of ruminal contents in young calves.

Asphyxia-related risk factors and their timing in spastic cerebral palsy

OBJECTIVE

To investigate the association of asphyxia-related conditions (reducing blood flow or blood oxygen levels in the fetus) with spastic cerebral palsy (CP) considering different gestational age groups and the timing of risk.

DESIGN

Population-based case-control study.

SETTING

Danish Cerebral Palsy Register in eastern Denmark and Danish Medical Birth Register.

POPULATION OR SAMPLE

271 singletons with spastic CP and 217 singleton controls, frequency matched by gestational age group, born 1982-1990 in eastern Denmark.

METHODS

Data were abstracted from medical records, and a priori asphyxia-related conditions and other risk factors were selected for analysis. Each factor was classified according to the time at which it was likely to first be present.

MAIN OUTCOME MEASURES

Spastic CP.

RESULTS

Placental and cord complications accounted for the majority of asphyxia conditions. In multivariate analysis, placental infarction was significantly associated with a four-fold increased risk for spastic quadriplegia and cord around the neck was significantly associated with a three-fold increased risk for spastic CP overall. The combination of placental infarction and being small for gestational age (SGA) afforded an especially high risk for spastic quadriplegia. Placental and cord complications were present in 21% of cases and 12% of controls.

CONCLUSIONS

The risk for spastic quadriplegia from placental infarction may be linked in some cases with abnormal fetal growth (17% of all children with spastic quadriplegia and 3% of control children both had an infarction and were SGA) -- suggesting an aetiologic pathway that encompasses both factors. The risk for spastic CP from cord around the neck is not accounted for by other prepartum or intrapartum factors we examined. Considering the relative timing of risk factors provides a useful framework for studies of CP aetiology.

Effect of Milk Allowance on Concentrate Intake, Ruminal Environment, and Ruminal Development in Milk-Fed Holstein Calves

The aim of the present experiment was to test the hypothesis that a barley-based concentrate would induce an acidic ruminal environment in young calves and that increased milk allowance would alleviate this condition. Eight Holstein calves ruminally cannulated at d 7 +/- 1 of age were used to study the effect of variation in barley-based starter concentrate intake induced by 4 different milk allowances (3.10, 4.84, 6.60, and 8.34 kg of milk replacer/d; 123 g of dry matter/kg of milk) on the ruminal environment, blood variables, and fore-stomach development from wk 2 to 5 of age. Twelve ruminal fluid samples were collected during a weekly 24-h sampling in 4 consecutive weeks. Blood samples were collected by venipuncture between 1200 and 1300 h on ruminal sampling days. Rumen papillae development and visceral organ mass were recorded at slaughter. A linear treatment x week effect was observed for concentrate intake, with the calves fed the lowest milk allowance having the fastest increase in concentrate intake whereby these calves reached the same ME intake in wk 5 compared with calves with the highest milk allowance. Effects on ruminal variables were dominated by week of sampling, with minor differences among treatments. Ruminal pH was below 5.5 for 5 to 13 h/d and all calves with concentrate intake above 20 g of dry matter/d were observed to have a daily ruminal pH minimum at pH 5.5 or lower. The ruminal concentration of total volatile fatty acids (VFA) increased from 71 to 133 +/- 9 mmol/L in wk 2 to 5 and was characterized by a relatively high molar proportion of propionate, increasing from 34 to 40 mol/100 mol of VFA in wk 2 to 5. In addition, the presence of ethanol and propanol as well as numerous VFA esters points to a ruminal environment with a relatively high hydrogen pressure. Plasma glucose and insulin responded to the highest milk allowance in wk 2 to 4. Plasma VFA and ketone bodies increased with the lowest milk allowance in wk 4 to 5. At slaughter, empty wet weights of the rumen + reticulum and omasum as well as mass of digesta in these compartments were found to decrease linearly and perirenal fat was found to increase linearly with milk allowance, indicating that the milk allowance changed the body composition of the calves. Lengths of ruminal papillae in the atrium and ventral ruminal sac were not affected by treatment. We concluded that the ruminal environment of young calves fed a barley-based starter concentrate was characterized by a low ruminal pH and high VFA concentration regardless of the milk allowance.

Effects of sow nutrition on maternal and foetal serum growth factors and on foetal myogenesis

The objective of this study was to examine the effect of increased maternal nutrition in early to mid gestation on changes in serum growth factors of the sow and foetuses. Furthermore, the effect of the foetal sera on in vitro proliferation and differentiation of porcine primary myoblasts was examined. Pregnant sows were either given food either in accordance to requirements (2 kg/day; C) until day 50 or 70 of gestation or given food in accordance to requirements until day 25 and then ad libitum (A) until day 50 or 70. Sows were slaughtered at the Institute's veterinary controlled slaughterhouse at day 50 or 70, respectively. Serum from sows and pools of cord-blood serum from each litter were analysed for glucose, lactate, insulin, insulin-like growth factor (IGF; IGF-1 and -2) and IGF binding proteins (IGFBPs). IGF-1 (P < 0·001) was higher in A compared with C sows, and a 28-kDa IGFBP (P < 0·05) and a 24-kDa IGFBP (P < 0·05) was higher in serum from day 70 compared with day 50 sows. There was no significant effect of food intake on growth factor concentrations in foetal serum or on serum-induced proliferation and differentiation of myoblasts. A 28 kDa IGFBP, IGFBP-2 and -3 were all higher (P < 0·06) and serum-induced proliferation (P < 0·001) and differentiation (P < 0·1) lower at day 70 than day 50. Maternal food intake did not influence the DNA and RNA concentrations and the CPK activity in the foetal longissimus dorsi muscle. The glucose concentration in the liver was higher in C than A foetuses at day 70 of gestation, but not at day 50.

In conclusion, no significant effects of maternal nutrition were found on serum growth factor concentrations in the foetuses or on serum-induced proliferation and differentiation of primary myoblasts.

Consequences of two or four months of finishing feeding of culled dry dairy cows on carcass characteristics and technological and sensory meat quality

Finishing feeding was evaluated as a way to improve carcass-, meat- and eating quality of culled dairy cows. In total, 125 Danish Friesian cows were purchased from commercial dairy herds. Cows were culled for various typical reasons at different stages of lactation, were non-pregnant and had milk yield at culling ranging from 1 to 25kg/d and had LW varying from 330 to 778kg. Cows were housed in tie-stalls and had free access to barley straw and water during a 7-d drying-off period. Cows were allocated to three equal treatment groups based on parity, LW, BCS, and culling reason. A control group (C) was slaughtered immediately after drying-off (n=43), a group (F2) was finishing-fed for 63 days (n=41), and a group (F4) was finishing-fed for 126 days (n=41). In the finishing period, cows had free access to a TMR (10.6 MJ ME and 130g CP per kg of DM). Cows on treatment, F2 and F4 gained 1.16±0.05kg/d in the finishing period. Compared with C-cows, F2- and F4-cows had 56 and 97kg higher carcass weight, 10% and 21% larger Longissimus muscle area, and 14 and 70% more backfat, respectively, at time of slaughter. EUROP conformation scores were 2.2 (C), 3.4 (F2) and 4.4 (F4) and EUROP fat scores were 1.9, 3.0 and 3.7. Finishing feeding increased IMF, improved meat flavour and colour, and tended to reduce shear force value and improve tenderness and juiciness. The F4 cows also had higher fat trim than C- and F2-cows. Cows were divided into two parity groups (1st parity and older cows). Compared with 1st parity cows, older cows ate 12% more feed, had similar daily gain, were heavier, and had higher BCS and fatness including IMF. The results show that it is possible to dry-off and finish-feed culled dairy cows resulting in larger muscles, increased fatness, improved overall carcass quality and better technological as well as sensory quality characteristics.

Cell Turnover and Activity in Mammary Tissue During Lactation and the Dry Period in Dairy Cows

Milk yield of the dairy cow follows a pattern termed the lactation curve. We have investigated the cellular background for this pattern. Seven mammary biopsies were obtained from each of 10 cows: at the end of lactation (d 347, equal to d 77 before next parturition); during the dry period at d 48 (4 d after dry off); 16 d before parturition; and during lactation at d 14, 42, 88, and 172. The fraction of proliferating (staining positive for Ki-67) alveolar cells was higher during the dry period (8.6%) than during lactation (0.5%). The fraction of apoptotic (staining positive by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling) alveolar cells was higher immediately after dry off (0.37%) and in early lactation (0.76%) than during other periods (0.15%). The enzyme activities of fatty acid synthetase, acetyl CoA-carboxylase, and galactosyl transferase were approximately 12-, 11-, and 4-fold higher, respectively, during lactation than during the dry period. In conclusion, mammary cell proliferation is substantial in a period near parturition but otherwise low, and apoptosis is elevated at dry off and in early lactation. The increase in apoptosis in early lactation may be due to discarding nonfunctional or senescent cells or to removal of a surplus of newly synthesized cells. The activity of selected enzymes central for milk synthesis is probably not limiting for milk production.