Comparing interval breast cancer rates in Norway and North Carolina: results and challenges.

OBJECTIVE: To compare interval breast cancer rates (ICR) between a biennial organized screening programme in Norway and annual opportunistic screening in North Carolina (NC) for different conceptualizations of interval cancer. SETTING: Two regions with different screening practices and performance. METHODS: 620,145 subsequent screens (1996-2002) performed in women aged 50-69 and 1280 interval cancers were analysed. Various definitions and quantification methods for interval cancers were compared. RESULTS: ICR for one year follow-up were lower in Norway compared with NC both when the rate was based on all screens (0.54 versus 1.29 per 1000 screens), negative final assessments (0.54 versus 1.29 per 1000 screens), and negative screening assessments (0.53 versus 1.28 per 1000 screens). The rate of ductal carcinoma in situ was significantly lower in Norway than in NC for cases diagnosed in both the first and second year after screening. The distributions of histopathological tumour size and lymph node involvement in invasive cases did not differ between the two regions for interval cancers diagnosed during the first year after screening. In contrast, in the second year after screening, tumour characteristics remained stable in Norway but became prognostically more favorable in NC. CONCLUSION: Even when applying a common set of definitions of interval cancer, the ICR was lower in Norway than in NC. Different definitions of interval cancer did not influence the ICR within Norway or NC. Organization of screening and screening performance might be major contributors to the differences in ICR between Norway and NC.

Effect of the September 11, 2001 terrorist attack on a state highway patrol trooper's heart rate variability

BACKGROUND: On September 11, 2001, terrorists attacked the United States. By coincidence, a North Carolina highway patrol trooper was wearing an ambulatory ECG Holter monitor at this time as part of an air pollution study. METHODS: Heart rate variability parameters were analyzed: standard deviation of normal to normal beat intervals (SDNN) and percentage of interval differences >50 ms (PNN50). RESULTS: The trooper's heart rate variability changed immediately after learning about the terrorist attacks. Heart rate increased and PNN50 decreased, while SDNN increased strongly. CONCLUSIONS: These changes suggest strong emotional sympathetic stress associated with parasympathetic withdrawal in response to the news about the terrorist attack. [Authors]

Cannabis use as a means of socialization?: new consumption patterns among heavy users

Purpose: After tobacco and alcohol, cannabis is the most used substance among adolescents in Switzerland. Our aim is to assess whether cannabis use has become an ordinary means of socialization. We hypothesize that cannabis consumption has become a normative, although still illegal, behavior. Methods: As part of a larger qualitative study aimed at assessing new ways [patterns] of cannabis consumption, 16 daily cannabis consumers (11 males) and 2 former heavy consumers (both females), aged 15 to 20 years, participated in interviews and focus groups. Data were transcribed verbatim and analyzed using Atlas.ti qualitative analysis software. Results: Most consumers define the beginning of their consumption as a moment when they made new friends. They commonly use cannabis in group settings, which encourages the belief that all adolescents use cannabis. Thus, cannabis is mainly identified as an everyday social act. Joints are smoked like cigarettes: at all times of the day, during or after school or work with peers, often starting at lunch break, and mostly in public places. Friends offer a joint in a group setting, much like beer in a bar, as a means of making contact. Consumption invariably increases while socializing on vacation: "During vacation, we smoke up to 10-15 joints a day; at the end we're just dead." Additionally, in order to obtain cannabis, consumers have to be part of the right networks; they generally have several dealers to assure their supply, buy and sell themselves, or practice group-buying. As a result, all friends or acquaintances of consumers are themselves cannabis users. For instance, 4 boys, who say they are best friends, always smoke together and that, in order to quit, "All four of us should say to ourselves, 'Okay, now, let's all stop smoking'. That would be the only solution. . .but it would be impossible!" The 2 former consumers state that when they started using cannabis, "I found myself little by little in a vicious circle where I saw only people who also smoked". When they quit, they separated from their group of friends: "Either you make new friends who don't smoke or you smoke." Conclusions: Discussions with consumers demonstrate a normative facet of cannabis consumption as part of teenage socialization. Consequently, cannabis consumers develop a significant dependency since a majority of their friends use cannabis and their consumption involves most of their daily social life. Our study highlights the need for clear messages about the harmful aspects of using this substance while also suggesting that cessation efforts should include helping users separate from their consumption milieu. Sources of Support: Dept. of Public Health of the canton of Vaud.

Cannabis and tobacco co-consumptions: can cannabis consumers quit cigarette smoking?

Purpose: To assess the relation between cannabis and tobacco consumption among adolescents in Switzerland and whether cannabis and tobacco co-users can quit cigarette smoking. Methods: Based on individual interviews and focus groups, 22 youths aged 15-20 discussed cannabis consumption behaviours. Twenty (14 males) were cannabis consumers - of which 18 also smoked tobacco and 2 quit tobacco smoking - and 2 were former cannabis consumers (both females and daily smokers). Data were transcribed verbatim and analyzed using Atlas.ti qualitative analysis software. Results: Among the co-consumers, 9 started with tobacco, 7 with cannabis, and 2 with both. The main consumption mode among all cannabis consumers is joints, while other ways of consuming such as food preparations and water pipes are rare and experimental. Joints always mix cannabis with tobacco for 3 reasons: to burn correctly, pure cannabis is too strong, and smoking cannabis alone is too expensive. Two cannabis consumers - one former tobacco smoker and one occasional tobacco smoker - consider rolling tobacco less addictive than cigarette tobacco alone, and hence use it in their joints. Overall cannabis is considered 'natural' and less harmful to health than tobacco. Thus, many users describe their wish, in the longer term, to quit tobacco consumption without excluding occasional cannabis consumption. Nonetheless, all coconsumers declare that they smoke cigarettes as a substitute for cannabis: For example, "If I don't have a joint, I need fags; if I don't have fags, I need joints; and if I don't have anything, I go crazy!" or "About 20 minutes after smoking a joint we feel like smoking something again, because in the joint there is pure tobacco without a filter as in cigarettes, and that creates a crazy dependency!". Finally, all co-consumers state that the consumption of one of the substances increases when trying to diminish the other: "A few months ago I stopped smoking joints for a month. Well I was smoking more than a pack [of cigarettes] a day." Similarly, the 2 former cannabis consumers increased their cigarette use since quitting cannabis. Conclusions: The majority of cannabis users co-consume tobacco as a way of compensating for one substance or the other. Using tobacco within joints implies that there is a risk that even occasional joints can revive nicotine addiction. Consequently, health professionals wishing to help adolescents in substance use cessation and prevention efforts should consider both substances in a global perspective. Sources of Support: Dept. of Public Health of the canton of Vaud.