Background: Self-managementinterventionsimprovevarious outcomes for many chronic diseases. The definite place of self-management in the care of chronic obstructive pulmonary disease (COPD) has not been established. We evaluated the effect of a continuum of self-management, specific to COPD, on the use of hospital services and health status among patients with moderate to severe disease.

Non-steroidal anti-inflammatory drugs (NSAIDs) interfere with the growth of mammary tumours (Lala et al, 1997;Robertson et al, 1998) and prevent distant metastasis (Hubbard et al, 1988;Khoo et al, 1992) in rodents. The epidemiologic evidence for similar effects in women is limited and inconsistent (Isomäki et al, 1978;Friedman and Ury, 1980;Gridley et al, 1993;Thun et al, 1993;Schreinemachers and Everson, 1994;Harris et al, 1995Harris et al, , 1996Egan et al, 1996).To study the effects of NSAID use on breast cancer risk we carried out a nested case-control study, using the records of the Saskatchewan Cancer Agency (SCA) and data collected routinely by the Saskatchewan Prescription Drug Plan (SPDP), which has provided full or partial outpatient drug coverage to the Saskatchewan population since 1975.To study the effects of NSAID use on breast cancer growth and spread we carried out analyses using the drug exposure histories of the cases and attributes of the stage of their tumours at diagnosis, as assessed by the international tumour-lymph node-metastasis (TNM) system (Spiessl et al, 1992). SUBJECTS AND METHODS Study populationsThe source population was the open population of women aged ≥ 35 years, eligible to receive benefits from the SPDP during 1981 to mid-1995 with no history of cancer since 1970 other than nonmelanoma skin cancer or cervical carcinoma in situ.Subjects entered the source population on 1 January 1981, their 35th birthday, or on the date of immigration to Saskatchewan, whichever occurred latest. Subjects left the source population on 30 June 1995, or on the date of diagnosis of breast cancer, death or emigration, whichever occurred first.The SPDP has provided coverage for outpatient prescription drugs for 94% of the Saskatchewan population (1.01 million people in mid-1991; Rawson et al, 1992). Excluded are aboriginals, military personnel, members of the Royal Canadian Mounted Police, and inmates of federal penitentiaries: they are covered by federal agencies. The accuracy of the identifying and recorded prescription information both exceed 99% (Risch and Howe, 1994).The cases were subjects in the source population who were diagnosed with histologically proven invasive female breast cancer and reported to the SCA. Registration of cancer cases was nearly complete (Parkin et al, 1997). To be in our study, cases must have been eligible to benefit from the SPDP for ≥ 5 years before diagnosis. Hereafter, the date of diagnosis will be designated as the 'index date'. Summary We carried out a nested case-control study to measure the rate ratio (RR) for invasive female breast cancer in relation to nonsteroidal anti-inflammatory drug (NSAID) use. The source population consisted of the female beneficiaries of the Saskatchewan Prescription Drug Plan from 1981 to 1995 with no history of cancer since 1970. Four controls/case, matched on age and sampling time, were randomly selected. Dispensing rates during successive time periods characterized NSAID exposure. RRs associated with exposure during each period we...

Unreported chronic obstructive pulmonary disease (COPD) exacerbations are common, but their intermediate-to-long-term impacts on health-related quality of life (HRQoL) are unknown. The aim of the present study was to examine the impact of unreported exacerbations on HRQoL at 1 yr.A multicentric prospective cohort study in 491 COPD patients was conducted in China. HRQoL was measured using the St George's Respiratory Questionnaire (SGRQ). Other measurements included sociodemographic, clinical, psychosocial and treatment profiles. Patients were monitored monthly for 12 months to document exacerbations (at least one symptom worsening for o48 h). Patients were categorised into six groups: no exacerbation, one unreported exacerbation only, more than one unreported exacerbation only, one reported exacerbation only, more than one reported exacerbation only, and both unreported and reported exacerbations. Generalised estimating equations were used to estimate the adjusted associations between exacerbations and HRQoL change.A total of 466 unreported and 410 reported exacerbations were recorded. Compared with patients with no exacerbations, the change in SGRQ total score was similar amongst patients with one unreported exacerbation (adjusted mean change 1.22 points (95% CI -4.05-6.48)), but significantly worse among patients with more than one unreported exacerbation (4.61 (95% CI 0.09-9.13)).Development and evaluation of self-management programmes emphasising early recognition of exacerbations and consequent action appear to be warranted.

To test the hypothesis that tricyclic antidepressant use increases invasive female breast cancer incidence, we carried out a case -control study within the population of female beneficiaries of the Saskatchewan Prescription Drug Plan aged 535 years from 1981 -1995 with no history of cancer since 1970. This agency has provided full or partial coverage for outpatient prescriptions to Saskatchewan residents since 1975. We accrued 5882 histologically proven cases and 23 517 controls, randomly selected from the source population and individually matched on age and sampling time. Heavy exposure to any tricyclic antidepressants was associated with an elevated rate ratio for breast cancer 11 -15 years later (2.02, 95% confidence interval: 1.34 -3.04). Post hoc analyses based on the results of genotoxicity studies carried out using Drosophila melanogaster suggested that the increased risk could be attributed to the use of the six genotoxic tricyclic antidepressants, and not to the use of the four nongenotoxic tricyclic antidepressants. However, our results may have been confounded by the effects of other determinants of breast cancer associated with tricyclic antidepressant use.