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Background: Nocturnal enuresis (NE) is a common disease with multiple pathogenic mechanisms. This study aimed to compare levels of metabolites and proteins between wet and dry nights in urine samples from children with monosymptomatic NE (MNE). Methods: Ten boys with MNE and nocturnal polyuria (age: 7.6 ± 1.3 years) collected their total nighttime urine production during a wet and a dry night. Untargeted metabolomics and proteomics were performed on the urine samples by liquid chromatography coupled with high-mass accuracy tandem mass spectrometry (LC-MS/MS). Results: On wet nights, we found reduced urine osmolality (P = 0.025) and increased excretion of urinary potassium and sodium by a factor of, respectively, 2.1 (P = 0.038) and 1.9 (P = 0.19) compared with dry nights. LC-MS identified 59 metabolites and 84 proteins with significantly different levels between wet and dry nights (fold change (FC) < 0.67 or > 1.5, P < 0.05). Some compounds were validated by different methodologies. During wet nights, levels of compounds related to oxidative stress and blood pressure, including adrenalin, were increased. We found reduced levels of aquaporin-2 on wet nights. The FCs in the 59 metabolites were positively correlated to the FCs in the same metabolites identified in urine samples obtained during the evening preceding wet and dry nights. Conclusions: Oxidative stress, which in the literature has been associated with nocturia and disturbances in sleep, might be increased during wet nights in children with MNE. We further found evidence of increased sympathetic activity. The mechanisms related to having wet nights in children with MNE seem complex, and both free water and solute handling appear to be important. [ABSTRACT FROM AUTHOR]

Simple Summary: Our research focused on understanding how specific patient and clinical factors, present at the diagnosis of advanced renal cell carcinoma (RCC), influence the mortality and recurrence of the disease. We studied patients with advanced RCC from a national Danish database and monitored them over time. Our findings showed that having a positive surgical margin, synchronous metastasis, and poor health status were linked with a higher chance of death and recurrence of the disease. Interestingly, for non-ccRCC patients, having a multidisciplinary team (MDT) discussion during diagnosis was found to lower the risk of death. This suggests that individual clinical details play more significant roles in RCC outcomes than lifestyle factors. Moreover, including MDT discussions in treatment plans may benefit patients. Background: The aim was to investigate whether patient-related or clinical risk factors present at the diagnosis of advanced stage renal cell carcinoma (RCC) had an impact on the overall mortality, cancer-specific mortality, and recurrence risk in a national cohort. Methods: Patients registered with stage III and IV RCC in the Danish Renal Cancer Database (DaRenCa) in 2014–2016 were included in the study and followed up until recurrence or death. We conducted a Cox Proportional Hazard Model to examine the association between several variables and the development of RCC. These variables included BMI, hypertension, smoking status, symptoms at diagnosis, performance status, multidisciplinary team (MDT) discussion, surgical margin, and primary metastasis. Separate analyses were performed for cc-RCC and non-ccRCC patients. Results: In our cohort of 929 patients, 424 individuals died from RCC during the follow-up period, with a median follow-up time of 4.1 (95% CI: 0.8–5.0) years for ccRCC and 2.0 (95% CI: 0.1–5.0) years for non-ccRCC. A multivariate analysis demonstrated that a positive surgical margin (HR 1.53 and 1.43), synchronous metastasis (HR 2.06 and 3.23), and poor performance status (HR 4.73 and 5.27) were significantly associated with a decreased 5-year overall and cancer-specific survival, respectively. Furthermore, a positive surgical margin was associated with a higher risk of recurrence in ccRCC. MDT discussion was found to reduce mortality risk in non-ccRCC. Conclusion: Clinical- and disease-related variables have a greater impact on RCC mortality and recurrence than the selected lifestyle-related factors. The inclusion of MDT discussion in the diagnosis and management of advanced RCC should be further evaluated for its potential to improve patient outcomes. [ABSTRACT FROM AUTHOR]

The psychological consequences of losing a parent to cancer are unclear. We investigated whether experiencing parental death to cancer before 18 years of age increases the risk of psychotropic medication. We used register data of all children born in Denmark between 1 January 1987 and 31 December 2016 (N = 1,488,846). We assessed rate ratios (RRs) with 95% confidence intervals (CIs) for first redeemed prescription of antidepressants, anxiolytics and hypnotics according to parental death status using Poisson multi-state models. We further examined whether the associations differed according to the gender of the deceased parent, child's age at the time of death or the parental length of illness. Cancer-bereaved children had a significantly increased risk of first prescription of psychotropic medication (rate ratio, RR 1.22, 95% confidence interval, CI 1.10–1.34 for males; RR 1.18, 95% CI 1.09–1.28 for females). Associations were strongest if the parent had the same sex as the child and if the parent died within one year of diagnosis. The risk was highest during the first six months after the loss (RR 2.35, 95% confidence interval, CI 1.48–3.73 for males; RR 1.81, 95% CI 1.17–2.80 for females). Children who lose a parent to cancer, particularly in cases when the disease progressed quickly, may need extra psychological support, especially during the first six months after the death. [ABSTRACT FROM AUTHOR]

Background: High intake of whole grains has been associated with lower risk of coronary heart disease; however, the research that has been used to evaluate different effects of different whole-grain cereals (e.g., wheat, rye, and oats) has been sparse. Objective: We investigated the association between whole-grain intake in terms of total intake and intakes of different cereals and myocardial infarction. Design: This prospective study included 54,871 Danish adults aged 50-64 y, of whom 2329 individuals developed myocardial infarction (13.6 y of follow-up). Detailed information on daily intake of whole-grain products was available from a self-administered foodfrequency questionnaire, and intakes of total whole grain and whole-grain species (wheat, rye, and oats) were estimated. The association between intake of whole grains and risk of myocardial infarction was examined with the use of a Cox proportional hazards model adjusted for potential confounders. Results: For both men and women with total whole-grain intake in the highest quartile, lower risks of myocardial infarction were shown [HRs: 0.75 (95% CI: 0.65, 0.86) and 0.73 (95% CI: 0.58, 0.91), respectively] than for individuals with intake in the lowest quartile. When the specific cereal species were considered, rye and oats, but not wheat, were associated with lower myocardial infarction risk in men. No significant associations were seen in women. For total whole-grain products, significantly lower myocardial infarction risks were seen with higher intakes in both men and women. Rye bread (in men and women) and oatmeal (in men) were associated with significantly lower risk of myocardial infarction, whereas no significant association was shown for whole-grain bread, crispbread, and wheat. Conclusion: In this study, we provide support for the hypothesis that whole-grain intake is related to lower risk of myocardial infarction and suggest that the cereals rye and oats might especially hold a beneficial effect. [ABSTRACT FROM AUTHOR]

No study has yet investigated the intake of different types of whole grain (WG) in relation to all-cause and cause-specific mortality in a healthy population. The aim of the present study was to investigate the intake of WG products and WG types in relation to all-cause and cause-specific mortality in a large Scandinavian HELGA cohort that, in 1992–8, included 120 010 cohort members aged 30–64 years from the Norwegian Women and Cancer Study, the Northern Sweden Health and Disease Study, and the Danish Diet Cancer and Health Study. Participants filled in a FFQ from which data on the intake of WG products were extracted. The estimation of daily intake of WG cereal types was based on country-specific products and recipes. Mortality rate ratios (MRR) and 95 % CI were estimated using the Cox proportional hazards model. A total of 3658 women and 4181 men died during the follow-up (end of follow-up was 15 April 2008 in the Danish sub-cohort, 15 December 2009 in the Norwegian sub-cohort and 15 February 2009 in the Swedish sub-cohort). In the analyses of continuous WG variables, we found lower all-cause mortality with higher intake of total WG products (women: MRR 0·89 (95 % CI 0·86, 0·91); men: MRR 0·89 (95 % CI 0·86, 0·91) for a doubling of intake). In particular, intake of breakfast cereals and non-white bread was associated with lower mortality. We also found lower all-cause mortality with total intake of different WG types (women: MRR 0·88 (95 % CI 0·86, 0·92); men: MRR 0·88 (95 % CI 0·86, 0·91) for a doubling of intake). In particular, WG oat, rye and wheat were associated with lower mortality. The associations were found in both women and men and for different causes of deaths. In the analyses of quartiles of WG intake in relation to all-cause mortality, we found lower mortality in the highest quartile compared with the lowest for breakfast cereals, non-white bread, total WG products, oat, rye (only men), wheat and total WG types. The MRR for highest v. lowest quartile of intake of total WG products was 0·68 (95 % CI 0·62, 0·75, Ptrend over quartiles< 0·0001) for women and 0·75 (95 % CI 0·68, 0·81, Ptrend over quartiles< 0·0001) for men. The MRR for highest v. lowest quartile of intake of total WG types was 0·74 (95 % CI 0·67, 0·81, Ptrend over quartiles< 0·0001) for women and 0·75 (95 % CI 0·68, 0·82, Ptrend over quartiles< 0·0001) for men. Despite lower statistical power, the analyses of cause-specific mortality according to quartiles of WG intake supported these results. In conclusion, higher intake of WG products and WG types was associated with lower mortality among participants in the HELGA cohort. The study indicates that intake of WG is an important aspect of diet in preventing early death in Scandinavia. [ABSTRACT FROM PUBLISHER]

The prevalence of dietary supplement use varies largely among populations, and previous studies have indicated that it is high in the Danish population compared with other European countries. The diversity in supplement use across countries indicates that cultural and environmental factors could influence the use of dietary supplements. Only few studies investigating the use of dietary supplements have been conducted in the Danish population. The present cross-sectional study is based on 54 948 Danes, aged 50-64 years, who completed self-administrated questionnaires on diet, dietary supplements and lifestyle between 1993 and 1997.Ahealth index including smoking, physical activity, alcohol and diet, and a metabolic risk index including waist circumference, urinary glucose and measured hypertension were constructed. Logistic regression was used to investigate these determinants in relation to the intake of dietary supplements. We found that 71% of the participants were dietary supplement users; female sex, older age groups and higher educated participants were more likely to be users of any dietary supplements. One additional point in the health index was associated with 19, 16 and 9% higher likelihood of being user of any, more common and less common supplements, respectively. In the metabolic risk index, one additional point was associated with 17 and 16% lower likelihood of being user of any supplement and more common supplements, respectively. No significant association was found for less common supplement use. In conclusion, those with the healthiest lifestyle were more likely to use dietary supplements. Thus, lifestyle and dietary composition should be considered as confounders on supplement use and health outcomes. [ABSTRACT FROM AUTHOR]

Objective. Little is known about the development of psychological wellbeing over time among women who have been treated for breast cancer. The aim of this study was to identify distinct patterns of distress, anxiety, and depression in such women. Methods. We invited 426 consecutive women with newly diagnosed primary breast cancer to participate in this study, and 323 (76%) provided information on distress ('distress thermometer') and on symptoms of anxiety and depression ('hospital anxiety and depression scale'). Semiparametric group-based mixture modeling was used to identify distinct trajectories of distress, anxiety, and depressive symptoms assessed the week before surgery and four and eight months later. Logistic regression analysis was used to evaluate the characteristics of women in the distinct groups. Results. Although no sub-group of women with chronic severe anxiety or depressive symptoms was found, we did identify a sub-group of 8% of the women who experienced continuously severe distress. Young age, having a partner, shorter education, and receiving chemotherapy but not radiotherapy might characterize women whose psychological symptoms remain strong eight months after diagnosis. Conclusion. By looking beyond the mean, we found that 8% of the women experienced chronic severe distress; no sub-groups with chronic severe anxiety or depression were identified. Several socio-demographic and treatment factors characterized the women whose distress level remained severe eight months after diagnosis. The results suggest that support could be focused on relatively small groups of patients most in need. [ABSTRACT FROM AUTHOR]

Background. Women with breast cancer experience different symptoms related to surgical or adjuvant therapy. Previous findings and theoretical models of mind-body interactions suggest that psychological wellbeing, i.e. levels of distress, influence the subjective evaluation of symptoms, which influences or determines functioning. The eight-week mindfulness-based stress reduction (MBSR) program significantly reduced anxiety and depression in breast cancer patients in a randomized controlled trial (NCT00990977). In this study we tested the effect of MBSR on the burden of breast cancer related somatic symptoms, distress, mindfulness and spiritual wellbeing and evaluated possible effect modification by adjuvant therapy and baseline levels of, distress, mindfulness and spiritual wellbeing. Material and methods. A population-based sample of 336 women Danish women operated for breast cancer stages I-III were randomized to MBSR or usual care and were followed up for somatic symptoms, distress, mindfulness skills and spiritual wellbeing post-intervention and after six and 12 months. Effect was tested by general linear regression models post-intervention, and after six and 12 months follow-up and by mixed effects models for repeated measures of continuous outcomes. Effect size (Cohen's d) was calculated to explore clinical significance of effects among intervention group. Finally, modification of effect of MBSR on burden of somatic symptoms after 12 months' follow-up by adjuvant therapy and baseline levels of, distress, mindfulness and spiritual wellbeing were estimated. Results. General linear regression showed a significant effect of MBSR on the burden of somatic symptoms post-intervention and after 6 months' follow-up. After 12 months' follow-up, no significant effect of MBSR on the burden of somatic symptoms was found in mixed effect models. A statistically significant effect of MBSR on distress was found at all time-points and in the mixed effect models. Significant effects on mindfulness were seen after six and 12 months and no significant effect was observed for spiritual wellbeing. No significant modification of MBSR effect on somatic symptom burden was identified. Conclusion. This first report from a randomized clinical trial on the long-term effect of MBSR finds an effect on somatic symptom burden related to breast cancer after six but not 12 months follow-up providing support for MBSR in this patient group. [ABSTRACT FROM AUTHOR]

Whole-grain intake has been reported to be associated with a lower risk of several lifestyle-related diseases such as type 2 diabetes, CVD and some types of cancers. As measurement errors in self-reported whole-grain intake assessments can be substantial, dietary biomarkers are relevant to be used as complementary tools for dietary intake assessment. Alkylresorcinols (AR) are phenolic lipids found almost exclusively in whole-grain wheat and rye products among the commonly consumed foods and are considered as valid biomarkers of the intake of these products. In the present study, we analysed the plasma concentrations of five AR homologues in 2845 participants from ten European countries from a nested case–control study in the European Prospective Investigation into Cancer and Nutrition. High concentrations of plasma total AR were found in participants from Scandinavia and Central Europe and lower concentrations in those from the Mediterranean countries. The geometric mean plasma total AR concentrations were between 35 and 41 nmol/l in samples drawn from fasting participants in the Central European and Scandinavian countries and below 23 nmol/l in those of participants from the Mediterranean countries. The whole-grain source (wheat or rye) could be determined using the ratio of two of the homologues. The main source was wheat in Greece, Italy, the Netherlands and the UK, whereas rye was also consumed in considerable amounts in Germany, Denmark and Sweden. The present study demonstrates a considerable variation in the plasma concentrations of total AR and concentrations of AR homologues across ten European countries, reflecting both quantitative and qualitative differences in the intake of whole-grain wheat and rye. [ABSTRACT FROM PUBLISHER]

Background. Social differences in prostate cancer (PC) incidence and mortality might be related to testing for prostate-specific antigen (PSA). Although routine PSA screening is not recommended in Denmark, testing without clinical indication increased during the past decade. We evaluated associations between socio-demographic or clinical characteristics and PSA testing without clinical indication. Material and methods. In the Danish Diet, Cancer and Health Cohort, we identified 1051 men with PC diagnosed in 1993-2008. Diagnostic and clinical characteristics were obtained from medical records, and socio-demographic information was retrieved from administrative registers. We used general logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between socio-demographic or clinical characteristics and PSA testing without clinical indication. Cox regression analysis was used to examine associations with mortality. Results. PSA testing without clinical indication was less likely among patients > 67 years (OR 0.7; 0.5-1.0). Men who were, PSA tested without clinical indication, were more likely to have vocational training (OR 1.8; 1.1-2.9) or higher education (OR 1.5; 0.9-2.5) and less likely to have advanced disease (OR 0.6; 0.4-0.9). PSA testing without clinical indication more often preceded therapy with curative intent (OR 1.8; 1.1-2.9) and less often palliative treatment (OR 0.6; 0.3-1.0). Men who were PSA tested without clinical indication had non-significantly lower overall and PC-specific mortality [hazard ratios 0.8 (0.5-1.2) and 0.6 (0.3-1.1), respectively]. Conclusions. PSA testing without clinical indication was associated with higher educational level. PC detected by PSA testing with no clinical indication was more often localized and treated with curative intent. [ABSTRACT FROM AUTHOR]

The phyto-oestrogen enterolactone has been hypothesised to protect against hormone-dependent cancers, probably through its anti-oestrogenic potential. We investigated whether a higher level of plasma enterolactone was associated with a lower incidence of endometrial cancer in a case–cohort study in the ‘Diet, Cancer and Health’ cohort. The cohort study included 29 875 women aged 50–64 years enrolled between 1993 and 1997. Information on diet and lifestyle was provided by self-administrated questionnaires and blood was drawn from each participant. Time-resolved fluoroimmunoassay was used for biochemical determination of plasma enterolactone. A total of 173 cases and 149 randomly selected cohort members were included. We estimated incidence rate ratio (IRR) and 95 % CI by a Cox proportional hazards model. A 20 nmol/l higher plasma concentration of enterolactone was associated with a non-significant lower risk of endometrial cancer (IRR 0·93, 95 % CI 0·84, 1·04). When excluding women with low enterolactone concentrations (quartile 1) due to potential recent antibiotic use, the association became slightly stronger, but remained non-significant (IRR 0·90, 95 % CI 0·79, 1·02). Menopausal status, hormone replacement therapy or BMI did not modify the association. In conclusion, we found some support for a possible inverse association between plasma enterolactone concentration and endometrial cancer incidence. [ABSTRACT FROM PUBLISHER]

Background. The incidence of prostate cancer (PC) has increased during the last 15 years in Denmark, whereas the mortality has remained largely unchanged. This register study aimed to investigate the trends in PC incidence and mortality in Denmark 1978-2009 with special focus on the recent 15 years. Material and methods. From the nationwide Danish Cancer Registry and Register of Causes of Death, we obtained information on all cases of PC and all deaths in Denmark during 1978-2009. Age-standardised (World Standard Population) incidence and mortality rates were computed for five-year calendar periods (1978-2007) and a two-year calendar period (2008-2009). Trends in incidence rates were estimated for specific age groups, birth cohorts, and clinical stage. Results. The age-standardised incidence rate of PC increased from 29.2 per 100 000 person-years in 1978-1982 to 76.2 per 100 000 person-years in 2008-2009. The incidence increase began primarily in the mid-1990s. The corresponding mortality rates of PC remained largely unchanged during the entire study period; around 19 per 100 000 person-years. The incidence increase was most pronounced among men aged 60 + years. A clear pattern was also seen for selected birth cohorts, with increasing incidence rates among the youngest cohorts, and the highest relative increase in age-specific incidence rates was seen among men born between 1943 and 1947. The distribution of stage changed from 1998, with an increasing proportion of PC patients with localised disease. Conclusion. The observed increase in PC incidence during the period 1993-2009 in Denmark may be attributed primarily to increasing unsystematic use of prostate specific antigen (PSA) testing. The mortality rates remained stable during the same period suggesting that there is not yet any major influence of intensified PSA screening and more frequent use of curatively intended therapy on the overall prognosis of PC. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is a multi-factorial disease in which diet is believed to play a role. Little is known about the health effects of specific regional diets. The Nordic diet is high in fat and sugar but also includes a range of traditional products with anticipated health-promoting effects. The aim of this cohort study was to determine whether a healthy Nordic food index consisting of fish, cabbage, rye bread, oatmeal, apples, pears and root vegetables was related to CRC incidence. Data were obtained from a prospective cohort study of 57 053 Danish men and women aged 50–64 years, of whom 1025 developed CRC (13 years' follow-up). Incidence rate ratios (IRR) with 95 % CI were calculated from Cox proportional hazard models. Women who strongly adhered to a healthy Nordic food index had a 35 % lower incidence of CRC than women with poor adherence (adjusted IRR, 0·65; 95 % CI 0·46, 0·94); a similar tendency was found for men. Women had a 9 % lower incidence of CRC per point adherence to the healthy Nordic food index, but no significant effect was found for men. A regional diet based on healthy Nordic food items was therefore associated with a lower incidence of CRC in women. The protective effect was of the same magnitude as previously found for the Mediterranean diet, suggesting that healthy regional diets should be promoted in order to ensure health; this will also preserve cultural heredity and the environment. [ABSTRACT FROM PUBLISHER]

Background. Although up to 80% of women can return to work after treatment for breast cancer, maintaining an affiliation to the labour market may be a challenge, as shown by the fact that the risks for unemployment and early retirement are increased in the years after treatment of cancer. It is important to understand the work problems experienced by cancer survivors, including their ability to work. The aim of this study was to determine whether the ability of long-term breast cancer survivors to work was different from that of a cancer-free control group. Material and methods. In this population-based cross-sectional questionnaire study, 776 breast cancer survivors were matched with 1552 cancer-free women. Women with breast cancer diagnosed in 1997-2000 were identified in the Danish Cancer Registry, and the cancer-free controls were sampled from the Central Population Registry. Work ability was measured from a single question on the 'work ability index'. Furthermore, the questionnaire contained questions on socioeconomic factors, health-related factors and factors related to the workplace. Results. The overall response rate was 57% (493 survivors and 830 controls). After exclusions, the study population consisted of 170 survivors and 391 controls. Women with a diagnosis of breast cancer who had survived at least five years and had returned to work reported significantly poorer work ability than cancer-free controls. In models with adjustment for socioeconomic factors, health-related factors and support at work, the factors most strongly associated with impaired work ability were low income, fatigue and little help and support from a supervisor. Conclusion. Our findings indicate that the work ability of long-term breast cancer survivors who are disease-free and back in work is impaired in comparison with that of cancer-free women. [ABSTRACT FROM AUTHOR]

Background. Although breast cancer (BC) may have negative psychological sequelae, it may also be experienced as an existential challenge, which can derive personal growth. Only one study has been conducted, however, on whether women with BC experience more post-traumatic growth (PTG) than BC-free women. We examined PTG in women with and without BC and whether the characteristics and treatment of BC were associated with PTG. Material and methods. We used data from the questionnaire administered in the Diet, Cancer and Health cohort and included 774 women with BC and 666 randomly sampled BC-free women aged 63-81 years. PTG was measured with the PTG inventory, for which the women identified their own traumatic or life-changing event. Linear regression was used to compare PTG in women with and without BC and to examine the association between BC characteristics and treatment and PTG. Results. Although women with BC experienced significantly more PTG in the domains 'appreciation of life' and 'relating to others' compared to BC-free women, no statistically significant difference in overall PTG was observed according to BC status, indicating that PTG is not limited to women with BC. Tumor size, number of positive lymph nodes, having undergone mastectomy and having received endocrine treatment were positively associated with overall PTG and/or specific PTG domains, implying that the severity of disease plays a role in the development of PTG. Conclusion. In order to avoid unnecessary pressure for personal growth, healthcare professionals should not expect that women with BC experience more PTG than BC-free women. [ABSTRACT FROM AUTHOR]

The prevalence of sleep disturbance is high among cancer patients, and the sleep problems tend to last for years after the end of treatment. As part of a large randomized controlled clinical trial (the MICA trial, NCT00990977) of the effect of mindfulness-based stress reduction (MBSR) on psychological and somatic symptoms among breast cancer patients, the aim of the current study was to evaluate the effect of MBSR on the secondary outcome, 'sleep quality'. Material and methods. A total of 336 women operated on for breast cancer stage I-III 3-18 months previously were randomized to MBSR (n = 168) or treatment as usual (n = 168); both groups received standard clinical care. The intervention consisted of an eight-week MBSR program (psycho-education, meditation and gentle yoga). Sleep quality was assessed on the Medical Outcome Study sleep scale at baseline, after the intervention and at six- and 12-months' follow-up. Results. The mean sleep problem scores were significantly lower in the MBSR group than in controls immediately after the intervention. Quantile regression analyses showed that the effect was statistically significant only for the participants represented by the lower percentile of change between baseline and post-intervention, i.e. those who had more sleep problems; the MBSR group had a significantly smaller increase in sleep problems than the control group. After the 12-month follow-up, there was no significant between-group effect of MBSR on sleep quality in intention-to-treat analyses. Conclusion. MBSR had a statistically significant effect on sleep quality just after the intervention but no long-term effect among breast cancer patients. Future trials in which participation is restricted to patients with significant sleep problems are recommended for evaluating the effect of MBSR on sleep quality. [ABSTRACT FROM AUTHOR]

Background. A breast cancer diagnosis has been suggested as a teachable moment when a woman is more open to making healthier lifestyle changes. Little is known about the health behaviour changes women with breast cancer initiate compared to those made by other women. Material and methods. We examined changes in body mass index (BMI) and tobacco and alcohol consumption among women with a diagnosis of breast cancer and among cancer-free women. We used data from 23 420 women aged 50-64 years who participated in the Diet, Cancer and Health cohort, of whom 449 were diagnosed with breast cancer between baseline (1993-1997) and follow-up (2000-2002), and 22 971 remained cancer-free. We used multiple linear regression analysis to examine differences in BMI and alcohol and tobacco consumption between the two groups and to examine whether demographic and prognostic factors were associated with behavioural changes in women with breast cancer. Results. There were no significant differences in changes in BMI, alcohol and tobacco consumption between the two groups. Only in sub-analyses among women who lost weight between baseline and follow-up, women with breast cancer lost more weight than cancer-free women (β = 0.2; CI 0.1; 0.4), but residual confounding from stage cannot be excluded. Among the women with breast cancer we found no significant changes in BMI, alcohol and tobacco consumption by level of education, marital status, chemotherapy, hormone therapy or radiation. Conclusion. Women with breast cancer did not reduce their BMI, or modify their alcohol use or tobacco consumption compared with cancer-free women. This study indicates that guidelines and interventions to change health behaviour are needed after a cancer diagnosis. [ABSTRACT FROM AUTHOR]

Integrated plans will be required to ensure care and rehabilitation for the growing number of cancer survivors. Information is lacking, however, about the extent to which patients' rehabilitation needs are being met, and characteristics of patients who experience unmet needs after their diagnosis and throughout the disease trajectory. Material and methods. Consecutive women with newly diagnosed breast cancer, undergoing surgery at the Breast Surgery Clinic, Rigshospitalet, Denmark, between 2008 and 2009 (N = 261), completed questionnaires on their unmet needs, anxiety, physical functioning, social support and demographic factors at the time of surgery and four and eight months after diagnosis. Associations between demographic and clinical factors at baseline and unmet needs four and eight months after diagnosis were examined in logistic regression models. Results. The percentage of women with unmet needs remained stable between four (42%) and eight months (40%). Unmet needs were reported for patient education, counselling and alternative treatment. The factors significantly associated with having unmet needs were younger age (OR 0.92; 95% CI 0.89-0.95), higher education (OR 2.49; 95% CI 1.14-5.44), not having a partner (OR 2.25; 95% CI 1.22-4.17) and anxiety (OR 1.13; 95% CI 1.05-1.20) at four months; and age (OR 0.91; 95% CI 0.87-0.94), not having a partner (OR 2.21; 95% CI 1.10-4.46) and having had one or more unmet needs at four months (OR 6.83, 95% CI 3.55-13.16) at eight months. Conclusion. A total of 53% of women with breast cancer had unmet needs at some time between diagnosis and the end of primary treatment (eight months after diagnosis). A contextual understanding of unmet needs is necessary for planning cancer rehabilitation, as not only factors such as anxiety, physical functioning and previous unmet needs but also age, education and relationship status are associated with unmet needs. [ABSTRACT FROM AUTHOR]

Background: Few studies have considered source-specific micronutrient intake in relation to mortality under the consideration that dietary and supplemental intake could exhibit different effects.Objective: To evaluate the association between intake of vitamin C, E, folate, beta-carotene from diet and supplements, and overall mortality. Furthermore, to examine effect modification by smoking, alcohol intake,and BMI and to investigate if the effect of supplement use differs with dietary micronutrient intake.Methods and Material: In a prospective cohort study of 55,453 middle-aged Danes, information regarding diet, supplement use, and lifestyle was collected through questionnaires. During follow-up, 6,767 deaths were identified and incidence rate ratios (IRRs) of mortality related to micronutrient intake were calculated using Cox proportional hazards models.Results: The present study found no effect of dietary vitamin C, E, folate, or beta-carotene in relation to mortality. In contrast, supplemental folic acid was associated with a significantly increased mortality, whereas no other micronutrient supplement was associated with mortality. Effect modification by smoking and alcohol intake, but not BMI, was suggested in relation to some dietary micronutrients. The effect of supplements did not differ in groups defined by dietary micronutrient intake.Conclusion: This study suggests no effect of dietary micronutrients in relation to overall mortality.Supplemental folic acid was found to be associated with increased mortality, but further studies are required.No other supplemental micronutrient was associated with mortality. [ABSTRACT FROM AUTHOR]

We evaluated factors associated with use of antidepressant medication subsequent to a diagnosis of breast cancer. We also evaluated the effect of participation in a cancer rehabilitation program on use of antidepressants. Material and methods. We conducted a register-based cohort study of 1 247 women with breast cancer diagnosed between 1998 and 2006 who attended a week-long rehabilitation program and a comparison group of 2 903 women who did not attend the program matched through the registers of the Danish Breast Cancer Cooperative Group. The associations between breast cancer-related, treatment-related, and sociodemographic factors and use of antidepressants were evaluated in multivariate Cox proportional hazard models separated on use of antidepressants before diagnosis of breast cancer. Results. The mean follow-up for the 4 150 women in the study was 3.3 years (5-95% range, 0.3-7.0 years) and 1 020 (25%) were users of antidepressants after diagnosis of breast cancer. Among women who had not used antidepressants before their breast cancer, the diagnosis of a new primary cancer increased the adjusted hazard ratio (HR) to 3.34 (95% CI, 1.50-7.76), and recurrence of breast cancer increased the HR for first use of antidepressants to 2.56 (95% CI, 1.86-3.52). Unemployment was associated significantly with use of antidepressants, whereas having no children living at home, lower income, and the number of tumor-positive axillary lymph nodes were of borderline significance. No effect of the rehabilitation program was observed on first use of antidepressants after breast cancer. Discussion. Diagnosis of a new cancer or recurrence of breast cancer considerably increased the rate of use of antidepressants. Sociodemographic rather than disease- or treatment-related characteristics at the time of diagnosis were associated with first use of antidepressants after a breast cancer diagnosis. [ABSTRACT FROM AUTHOR]

Introduction. The purpose of this register-based study was to identify factors related to disease, treatment, sociodemographics and comorbidity associated with taking early retirement among women treated for breast cancer, and to evaluate the risk for taking early retirement among breast cancer survivors who attended a six-day rehabilitation course. Material and methods. The study population consisted of 856 women who attended the rehabilitation course and a comparison group of 1 805 women who did not attend the course identified through the Danish Breast Cancer Cooperative Group. We obtained information on receipt of unemployment benefits, sickness benefits and early retirement pension for each of the years 1996-2007. Multivariate cox-regression models were used to analyze disease-specific, treatment-related, comorbidity and sociodemographics factors associated with early retirement after breast cancer and to evaluate the effect of attending a rehabilitation course on taking early retirement. Results. The rate of retirement was higher for women with somatic comorbidity (hazard ratio [HR], 1.91; 95% CI, 1.3; 2.9 for score 1, and HR 1.42; 95% CI, 0.7; 2.7 for score ≥2), previous depression (HR, 2.29; 95% CI, 1.7; 3.2) or having received sickness benefits in the year before their breast cancer diagnosis (HR, 3.75; 95% CI, 1.8; 7.8). Living with a partner was associated with a reduced hazard ratio for taking early retirement (HR, 0.70; 95% CI, 0.5-0.9). Having received chemotherapy, alone or in combination with anti-hormone treatment, reduced the hazard ratio (HR, 0.49; 95% CI, 0.3; 0.8 and HR, 0.5; 95% CI, 0.3; 0.8, respectively). The rate of retirement was higher for women the year after attending the rehabilitation course but returned to unity by three years. Discussion. The results of this study contribute to the identification of at-risk women and point to the need for tailored rehabilitation to avoid unnecessary marginalization of breast cancer survivors due to permanent labor market withdrawal. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To test the effectiveness of a psycho-educational group intervention to improve psychological distress measured by POMS TMD, Quality of Life measured by European Organisation for Research and Treatment of Cancer (EORTC), the core and breast cancer module, Mental Adjustment measured by MAC and marital relationship measured by BLRI in women with primary breast cancer conducted 10weeks after surgery. A secondary outcome was 4-year survival. Patients and methods: We randomly assigned 210 patients with primary breast cancer to a control or an intervention group. Patients in the intervention group were offered two weekly 6-h sessions of psycho-education and eight weekly 2-h sessions of group psychotherapy. All participants were followed up for Quality of Life, coping ability and social relations 1, 6 and 12months after the intervention and on survival 4years after surgical treatment. Results: No statistically significant effects of the intervention were found on any of the psychosocial questionnaire outcomes. There were not enough cases of death to analyse overall survival. The only statistically significant result was for patients who used anti depressive medication, for whom almost all measures improved over time, in both the control and intervention groups. Conclusion: Psycho-education and group psychotherapy did not decrease psychological distress or increase Quality of Life, Mental Adjustment or improve marital relationship among patients with primary breast cancer. [Copyright &y& Elsevier]

Type 2 diabetes is characterized by insulin resistance and mitochondrial dysfunction in classical target tissues such as muscle, fat, and liver. Using a murine model of type 2 diabetes, we show that there is hypothalamic insulin resistance and mitochondrial dysfunction due to downregulation of the mitochondrial chaperone HSP60. HSP60 reduction in obese, diabetic mice was due to a lack of proper leptin signaling and was restored by leptin treatment. Knockdown of Hsp60 in a mouse hypothalamic cell line mimicked the mitochondrial dysfunction observed in diabetic mice and resulted in increased ROS production and insulin resistance, a phenotype that was reversed with antioxidant treatment. Mice with a heterozygous deletion of Hsp60 exhibited mitochondrial dysfunction and hypothalamic insulin resistance. Targeted acute downregulation of Hsp60 in the hypothalamus also induced insulin resistance, indicating that mitochondrial dysfunction can cause insulin resistance in the hypothalamus. Importantly, type 2 diabetic patients exhibited decreased expression of HSP60 in the brain, indicating that this mechanism is relevant to human disease. These data indicate that leptin plays an important role in mitochondrial function and insulin sensitivity in the hypothalamus by regulating HSP60. Moreover, leptin/insulin crosstalk in the hypothalamus impacts energy homeostasis in obesity and insulin-resistant states. [ABSTRACT FROM AUTHOR]