Lena Rosenberg

Perceived difficulty in everyday technology use among older adults with or without cognitive deficits

This studys purpose was comparing perceived relevance of and difficulty in use of everyday technology such as remote controls, cell phones, and microwave ovens, in older adults with/without cognitive deficits. Three groups included 157 participants; 34 had mild-stage dementia, 30 had mild cognitive impairment (MCI), and 93 lacked known cognitive impairments. Data were collected in structured interviews with the Everyday Technology Use Questionnaire (ETUQ). Analyses revealed that participants with no known cognitive deficits (Group 3) considered a higher proportion of technologies relevant to their life situation than participants with mild-stage dementia (Group 1) and those with MCI (Group 2). Furthermore, participants with no known cognitive deficits reported the lowest mean level of perceived difficulty in everyday technology use, followed by those with MCI and those with mild-stage dementia. All three groups differed significantly (p <0.01; p <0.001) in perceived difficulty using technology, indicating that measurement of perceived difficulty in everyday technology use may sensitively detect changes resulting from MCI/dementia. Findings indicate that perceived difficulty in using everyday technology increases in people with MCI and is accentuated in mild-stage dementia. This calls for increased attention to these issues when assessing functional ability in daily activities of older adults with possible MCI/dementia, and for further research.

Risk Factors for Hormone Receptor-Defined Breast Cancer in Postmenopausal Women

The effect of classic breast cancer risk factors on hormone receptor-defined breast cancer is not fully clarified. We explored these associations in a Swedish population-based study. Postmenopausal women ages 50 to 74 years, diagnosed with invasive breast cancer during 1993 to 1995, were compared with 3,065 age frequency-matched controls. We identified 332 estrogen receptor (ER−) and progesterone receptor (PR−) negative, 286 ER+PR−, 71 ER−PR+, 1,165 ER+PR+, and 789 tumors with unknown receptor status. Unconditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (95% CI). Women ages ≥30 years, compared with those ages 20 to 24 years at first birth, were at an increased risk of ER+PR+ tumors (OR, 1.5; 95% CI, 1.2-1.8) but not ER−PR− tumors (OR, 1.1; 95% CI, 0.8-1.6). Women who gained ≥30 kg in weight during adulthood had an ∼3-fold increased relative risk of ER+PR+ tumors (OR, 2.7; 95% CI, 1.9-3.8), but no risk increase of ER−PR− tumors (OR, 1.0; 95% CI, 0.5-2.1), compared with women who gained <10 kg. Compared with never users, women who used menopausal estrogen-progestin therapy for at least 5 years were at increased risk of ER+PR+ tumors (OR, 3.0; 95% CI, 2.1-4.1) but not ER−PR− tumors (OR, 1.3; 95% CI, 0.7-2.5). In conclusion, other risk factors were similarly related to breast cancer regardless of receptor status, but high age at first birth, substantial weight gain in adult age, and use of menopausal estrogen-progestin therapy were more strongly related to receptor-positive breast cancer than receptor-negative breast cancer. (Cancer Epidemiol Biomarkers Prev 2006;15(12):2482–8)

Menopausal hormone therapy and other breast cancer risk factors in relation to the risk of different histological subtypes of breast cancer: a case-control study

IntroductionBreast cancers of different histology have different clinical and prognostic features. There are also indications of differences in aetiology. We therefore evaluated the risk of the three most common histological subtypes in relation to menopausal hormone therapy and other breast cancer risk factors.MethodsWe used a population-based case-control study of breast cancer to evaluate menopausal hormone therapy and other breast cancer risk factors for risk by histological subtype. Women aged 50 to 74 years, diagnosed with invasive ductal (n = 1,888), lobular (n = 308) or tubular (n = 93) breast cancer in Sweden in 1993 to 1995 were compared with 3,065 age-frequency matched controls randomly selected from the population. Unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for ductal, lobular, and tubular cancer.ResultsWomen who had used medium potency estrogen alone were at increased risks of both ductal and lobular cancer. Medium potency estrogen-progestin was associated with increased risks for all subtypes, but the estimates for lobular and tubular cancer were higher compared with ductal cancer. We found OR 5.6 (95% CI 3.2–9.7) for lobular cancer, OR 6.5 (95% CI 2.8–14.9) for tubular cancer and OR 2.3 (95% CI 1.6–3.3) for ductal cancer with ≥5 years use of medium potency estrogen-progestin therapy. Low potency oral estrogen (mainly estriol) appeared to be associated with an increased risk for lobular cancer, but the association was strongest for short-term use. Reproductive and anthropometric factors, smoking, and past use of oral contraceptives were mostly similarly related to the risks of the three breast cancer subtypes. Recent alcohol consumption of > 10 g alcohol/day was associated with increased risk only for tubular cancer (OR 3.1, 95% CI 1.4–6.8).ConclusionMenopausal hormone therapy was associated with increased risks for breast cancer of both ductal and lobular subtype, and medium potency estrogen-progestin therapy was more strongly associated with lobular compared with ductal cancer. We also found medium potency estrogen-progestin therapy and alcohol to be strongly associated with tubular cancer. With some exceptions, most other risk factors seemed to be similarly associated with the three subtypes of breast cancer.

Everyday Technology Use Questionnaire: Psychometric Evaluation of a New Assessment of Competence in Technology Use

People with mild cognitive impairment or dementia in a mild phase who live at home are expected to manage the everyday technology that is common in this context. However, the knowledge of how technology use may interfere with the performance of daily activities is sparse. The purpose of this study was to evaluate whether a new instrument measuring relevance and competence in everyday technology use, the Everyday Technology Use Questionnaire, could generate linear measures of competence in a valid manner when used in a population of 157 older adults with and without cognitive impairment or dementia. The results from this study indicate that the Everyday Technology Use Questionnaire demonstrates acceptable levels of scale validity and person response validity, supporting researchers and clinicians with a tool that generates a valid measure of competence in use of everyday technology for people with mild cognitive impairment or dementia in a mild phase who live at home.

Readiness for technology use with people with dementia: The perspectives of significant others

Technology is believed to have a potential for supporting significant others of people with dementia but little is known of their experiences and views of technology. The aim of this study is to explore how significant others relate to technology and to their relatives with dementia as technology users. The focus is on both their own use of technology as significant others and the use of technology by their relatives with dementia. Individual interviews and focus group discussions were undertaken and analyzed using a grounded theory approach. The significant others showed an overall readiness toward using technology in their present roles. Technology use in daily activities was perceived to be an important means to keeping retained abilities exercised but could also be perceived as a possible threat to health if activities were oversimplified. The significant others asked for flexible technology not perceived as stigmatizing, to be integrated into existing habits.

CHILDBIRTH AND BREAST CANCER PROGNOSIS

Although certain risk factors for breast cancer incidence may also effect survival, findings have been inconsistent and the long‐term role of childbirth is unknown. We studied the influence of number and timing of births on breast cancer prognosis prospectively. From 1958 to 1997, altogether 32,003 women, born 1932 or later, were notified to the Swedish Cancer Registry due to a primary invasive breast cancer. We obtained information on dates of all childbirths and achieved complete follow‐up through 1997 by means of linkage to other nation‐wide databases. Proportional hazards analyses were used to compute crude and multivariate hazard ratios (HR) with 95% confidence intervals (CI) of dying from breast cancer. We found a successively worse prognosis for women with a shorter delay between their last birth and breast cancer diagnosis (p for trend <0.0001). Compared to women with their last birth more than 10 years before diagnosis, the multivariate HR of breast cancer death was 1.39 (95% CI 1.17–1.67) for those with breast cancer diagnosis in the 3rd year after last birth and 1.72 (CI 95% 1.42–2.09) for those with diagnosis within 1 year after last birth. This adverse effect on prognosis of childbirth persisted beyond 10 years among women with a first birth before the age of 20 years. A pregnancy has marked adverse effects on the prognosis of a breast cancer diagnosed within 10 years after delivery. These findings suggest that pregnancy influences tumor biology.

Menopausal hormone therapy in relation to breast cancer characteristics and prognosis: a cohort study

IntroductionMenopausal hormone therapy has been reported to increase the risk of certain subtypes of breast cancer and to be associated with a favorable survival. These associations could either be due to an increased mammographic surveillance or to a biological effect. We assessed these associations in a Swedish cohort of postmenopausal breast cancer patients holding information on mammographic examinations, menopausal hormone therapy use, other breast cancer risk factors, and cancer treatment.MethodsWe analyzed 2,660 postmenopausal women aged 50 to 74 years, diagnosed with invasive breast cancer in 1993 to 1995 and followed until the end of 2003 (median follow-up, 9 years and 3 months). We assessed the influence of hormone therapy before diagnosis on tumor characteristics and breast cancer-specific survival. We analyzed hormone therapy before diagnosis by regimen (estrogen–progestin therapy or estrogen alone therapy), recency (current or past), and duration of use (<5 years or ≥ 5 years).ResultsCurrent use, but not past use, compared with never use of hormone therapy before diagnosis seemed to be associated with tumors of low grade and with improved breast cancer-specific survival. The associations were stronger with longer duration, but did not vary significantly by regimen. The favorable survival among current users of hormone therapy was only partly explained by differences in available tumor characteristics and mammographic surveillance.ConclusionsWe conclude that current menopausal hormone therapy, especially long term, is associated with favorable tumor characteristics and survival.

Persons with dementia become users of assistive technology: A study of the process

The aim of this study was to explore actions and driving forces of the actors involved in the process of bringing assistive technology (AT) into the life of a person with dementia. Specific focus is placed on the unfolding transactions and what they led to, and how the AT intervention corresponded to the situation of the person with dementia. Three cases, i.e. three persons with dementia and their significant others (n = 13), were followed using case methodology and grounded theory. The findings show how doing the right thing was the main driving force, although sometimes a source of conflict between actors. The actors’ views differed in many aspects, influencing the choice of problem and selected AT solution as well as the role of the AT and how it was placed and adjusted. A potential risk scenario was also identified, exemplifying how profoundly the view of the one who had decision power influenced the process.

Amount Drained at Ultrasound-Guided Thoracentesis and Risk of Pneumothorax

Background: It has been suggested that no upper limit of the fluid amount drained is necessary when performing ultrasound-guided thoracentesis, but the risk of pneumothorax when large amounts of fluid are drained has not been studied in detail. Purpose: To study the amount of drained fluid at ultrasound-guided thoracentesis and the subsequent risk of pneumothorax. Material and Methods: Prospectively collected information on all ultrasound-guided thoracenteses performed at a county hospital between 2004 and 2006 was evaluated. In total, 735 thoracenteses in 471 patients were included. Chest radiographs performed within 14 days after thoracentesis were identified to obtain cases of pneumothorax and cases treated with tube thoracostomy. Data were analyzed by logistic regression. The study was approved by the regional research ethics committee. Results: There was a steep increase in risk for pneumothorax when large amounts of fluid were drained. Compared to a thoracentesis of 0.8–1.2 l, drainage of 1.8–2.2 l was associated with a more than threefold increase in risk for pneumothorax (odds ratio [OR] 3.8, 95% confidence interval [CI] 1.28–11.2), and after drainage of 2.3 l or more, the increase in risk was almost sixfold (OR 5.7, 95% CI 1.30–24.7). The association between the amount drained and the risk of pneumothorax was even more pronounced for pneumothoraces requiring tube thoracostomy (P for trend <0.0001). Nine of 11 tube thoracostomies occurred after thoracenteses of 1.8 l or more. Conclusion: Our study suggests that drainage of large amounts of fluid at ultrasound-guided thoracentesis is a risk factor for pneumothorax.

Mammographic density and survival in interval breast cancers

IntroductionMammographic density (MD) is the strongest risk factor for breast cancer. It is also strongly associated with interval cancers (ICs) due to decreased screening sensitivity and possibly by also giving rise to more aggressive tumors. With this information as background, we compared survival in interval and screen-detected cancers, taking MD into consideration.MethodsThe patients were postmenopausal women ages 50 to 74 years who were diagnosed with breast cancer in Sweden between 1993 and 1995. A total of 1,115 women with screen-detected cancers and 285 with ICs had available mammograms. Cox proportional hazards models were used to compare breast cancer-specific survival between interval and screen-detected cancers stratified on MD.ResultsHazard rates for breast cancer-specific survival were approximately three times higher in ICs than in screen-detected cancers, independent of MD. After adjustment for tumor size, a proxy for time to diagnosis, ICs in nondense breasts still had a statistically significantly increased hazard rate compared to screen-detected cancers in nondense breasts (5-yr survival hazard ratio (HR) 2.43, P = 0.001). In dense breasts, however, there was no longer evidence of a difference in survival between ICs and screen-detected cancers (5-yr survival HR 1.41, P = 0.486).ConclusionsIn nondense breasts, ICs seem to be truly more aggressive than screen-detected cancers. In dense breasts, the poorer prognosis of ICs compared to that of screen-detected cancers may be attributable at least partially to later detection. However, to the best of our knowledge, this study is the first to investigate these relationships, and further studies are warranted to confirm our results.