BACKGROUND: Growing evidence supports the concept that traffic noise exposure leads to long-term health complications other than annoyance, including cardiovascular disease. Similar effects may be expected from wind turbine noise exposure, but evidence is sparse. Here, we examined the association between long-term exposure to wind turbine noise and incidence of myocardial infarction (MI).

METHODS: We used the Danish Nurse Cohort with 28,731 female nurses and obtained data on incidence of MI in the Danish National Patient and Causes of Death Registries until ultimo 2013. Wind turbine noise levels at residential addresses between 1982 and 2013 were estimated using the Nord2000 noise propagation model, as the annual means of a weighted 24-hour average (Lden) at the most exposed façade. Time-varying Cox proportional hazard regression was used to examine the association between the 11-, 5- and 1-year rolling means prior to MI diagnosis of wind turbine noise levels and MI incidence.

RESULTS: Of 23,994 nurses free of MI at cohort baseline, 686 developed MI by end of follow-up in 2013. At the cohort baseline (1993 or 1999), 10.4% nurses were exposed to wind turbine noise (≥1 turbine within a 6000-m radius of the residence) and 13.3% in 2013. Mean baseline residential noise levels among exposed nurses were 26.3 dB, higher in those who developed MI (26.6 dB) than among those who didn't develop MI (26.3 dB). We found no association between wind turbine noise and MI incidence: adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) comparing nurses with 11-years mean residential noise levels of <21.5 dB, 21.5-25.4 dB, 25.4-29.9 dB, and >29.9 dB, to non-exposed nurses were 0.89 (0.64-1.25), 1.20 (0.82-1.77), 1.38 (0.95-2.01), and 0.88 (0.53-1.28), respectively. Corresponding HR (95% CI) for the linear association between 11-year mean levels of wind turbine noise (per 10 dB increase) with MI incidence was 0.99 (0.77-1.28). Similar associations were observed when considering the 5- and 1-year running means, and with no evidence of dose-response.

CONCLUSIONS: The results of this comprehensive cohort study lend little support to a causal association between outdoor long-term wind-turbine noise exposure and MI. However, there were only few cases in the highest exposure groups and our findings need reproduction.

BACKGROUND: We investigated the comparability of Complete Decongestive Therapy (CDT) including manual lymphatic drainage (MLD) vs. without MLD in the management of arm lymphoedema in patients with breast cancer.

METHODS: Patients randomised into either treatment including MLD (T+MLD) or treatment without MLD (T-MLD) received treatment 2×weekly for 4 weeks. The primary outcome was the volume reduction (%) of arm lymphoedema at 7-month follow-up. The secondary outcomes were volume reduction after the end of treatment, circumference of the arm, patient experience of heaviness and tension, and health status.

RESULTS: Despite difficulties enrolling the planned number of patients (160), 77 were randomised and 73 (38 in T+MLD, 35 in T-MLD) completed the trial. In both groups, the volume of lymphoedema decreased significantly, with no difference between groups (1.0% [95% CI, -4.3;2.3%]): the precision in the 95% confidence interval indicates that the efficacy was comparable; the mean (SE) changes at month 7 were -6.8%(1.2) and -5.7% (1.2) in the T+MLD and T-MLD, respectively. There were no statistically significant differences with respect to any of the secondary outcomes. The results were robust and the conclusion was not sensitive even to various alternative assumptions or analytic approaches to data analysis.

CONCLUSION: Manual lymphatic drainage adds no further volume reduction in breast cancer patients.

OBJECTIVES: Most studies report that marriage carries a lower risk of stroke than single living. Whether the marriage advantage is applicable with respect to all other marital status categories (unmarried, divorced, widow) remains unclear. We studied marital status and its association with incident stroke.

MATERIAL AND METHODS: We included all patients > 40 years of age admitted to hospital for stroke in Denmark during 2003-2012 and compared marital status to the general Danish population (5.5 millions). Relative risks (RR) for stroke were estimated in log-linear Poisson regression models adjusting for age, sex, calendar year, income, and length of education.

RESULTS: A total of 58 847 patients with incident stroke were included. Crude incidence rates of stroke (per 1000 per year) among the four marital status categories were as follows: 1.96 (married), 1.52 (unmarried), 2.36 (divorced), and 5.43 (widowed). Compared to married persons, adjusted risk of stroke was significantly increased for divorced (RR 1.23; CI 1.19-1.27) and unmarried men (RR 1.07; CI 1.03-1.11) but not for widowed men (RR 1.02; CI 0.98-1.06); risk was slightly increased for divorced women (RR 1.10; CI 1.06-1.15) while not for widowed (RR 1.0; CI 0.97-1.03) and unmarried women (RR 0.97; CI 0.97-1.03).

CONCLUSIONS: Divorce was associated with higher risk of stroke, especially in men. Living in marriage or as unmarried or widower had only little or no impact on the risk of stroke.

A 59-year-old woman developed a rash and severe arthralgia, which primarily affected her fingers. She displayed digital arthritis and nodules on the hands, chest, face, and oral cavity. Blood samples were normal. Skin biopsies revealed histiocytic proliferation. The surface marker profile and clinical findings were consistent with multicentric reticulohistiocytosis, which may occur as a paraneoplastic phenomenon. On workup, she was diagnosed with an otherwise asymptomatic stage IVC fallopian tube cancer. She experienced little effect of prednisolone, but her condition improved on antineoplastic treatment.

Background: Non-Hodgkin lymphoma (NHL) is the most common hematologic malignancy in the world. Involvement of organochlorines has been proposed in disease etiology. No study has investigated organochlorine exposure in relation to survival after a NHL diagnosis.Methods: In a survivor cohort consisting of 232 NHL cases from the Danish Diet, Cancer and Health cohort, we examined the association between adipose tissue organochlorine concentrations [polychlorinated biphenyls (PCBs) and pesticides] and subsequent survival, using Cox proportional hazards models.Results: We found no statistically significant association between organochlorine concentrations and subsequent survival. If anything, there was a nonsignificant tendency toward an inverse association with PCBs, but not pesticides.Conclusions: In conclusion, the current study does not support an increased risk of death among NHL patients with high tissue concentrations of organochlorines.Impact: This is the first study to investigate adipose organochlorine concentrations and survival after a NHL diagnosis. Cancer Epidemiol Biomarkers Prev; 27(2); 224-6. ©2017 AACR.

OBJECTIVE: To present the evidence for nutritional lifestyle changes recommended for gout patients; an explicit focus will be on the evidence for weight loss in overweight gout patients based on a recent systematic review and to describe methodological details for an upcoming weight loss trial.

METHODS: We did a pragmatic but systematic search in MEDLINE for current guidelines that had made an attempt to make nutritional recommendations for gout. The quality of the evidence for the nutritional recommendations was evaluated based on the guidelines' own ratings and converted into a common simple version based on the GRADE system. The recently published systematic review on weight loss for gout, was based on six databases from which longitudinal studies that had quantified the effects following weight loss were included. The internal validity was assessed with the ROBINS-I tool and the quality of the evidence was assessed with the GRADE approach. Based on the results of the systematic review, a trial was designed, adhering to the principles of evidence based research.

RESULTS: We included 17 guidelines. Most guidelines recommend avoiding or limiting alcohol intake (15; i.e. 88%), lose weight if relevant (12; 71%), and reduce fructose intake (11; 65%). The majority of the evidence for the nutritional recommendations was rated Moderate/Low or Very Low quality. Our recent systematic review on weight loss included 10 studies and found that the available evidence indicates beneficial effects of weight loss for overweight and obese gout patients, but the evidence is of low to moderate quality. As a consequence, researchers from the Parker Institute are launching a randomized trial to explore the short-term effects related to a diet-induced weight loss in obese gout patients.

CONCLUSIONS: The nutritional recommendations for gout are generally based on low quality evidence. In terms of weight loss as a management strategy, the available evidence is in favor of weight loss for overweight/obese gout patients. However, since the current evidence consists of only a few studies (mostly observational) of low methodological quality, the Parker Institute are now initiating a rigorous exploratory randomized trial. Similar efforts are needed for other nutritional management strategies for gout.