How women can improve their quality of life after breast cancer treatment
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Women need to be well-informed about options for minimising harm from breast cancer treatment / Acting early could avoid long-term problems like lymphedema
Cologne, Germany: 6 November 2008. Opting for less damaging treatments, staying active and learning about the warning signs of lymphedema: that’s how women with breast cancer can avoid developing chronic lymphedema, according to the German Institute for Quality and Efficiency in Health Care (IQWiG). Women can learn more about how to protect themselves from this common and distressing adverse effect of treatment as well as handle the condition at the Institute’s website, http://www.informedhealthonline.org.
Protecting women’s lymph systems
Breast cancer treatment is becoming more effective, with a survival rate of more than 80% for this disease in Germany.
Efficacy, Dosage Concerns Unresolved on Sublingual Immunotherapy
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Although sublingual immunotherapy (SLIT) is used in Europe and other countries, experts at the annual meeting of the American College of Allergy, Asthma and Immunology (ACAAI) in Seattle say questions remain unanswered regarding its effectiveness, appropriate use, dosage, and safety of administration.
“Sublingual immunotherapy has gained wide acceptance in the treatment of allergic disease throughout Europe and South America, but the research studies in the United States have yet to show results that will convince the FDA to approve a product,” said Ira Finegold, M.D., clinical professor of medicine at Columbia University and chairman of the R.A. Cook Institute of Allergy, St. Luke’s-Roosevelt Hospital, New York.
“The main advantage of SLIT over traditional immunotherapy is patient convenience, since it is not an injection but oral drops or tablets that can be administered at home, and it appears to be safer than conventional immunotherapy,” he said.
Clinical Guideline on Prevention of Cardiovascular Disease and Diabetes in Patients at Highest Risk
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Clinical Guideline on Prevention of Cardiovascular Disease and Diabetes in Patients at Highest Risk Released
The Endocrine Society has released a new clinical practice guideline for the primary prevention of cardiovascular disease and type 2 diabetes in patients at metabolic risk. The guideline appears in the Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of The Endocrine Society.
There is growing evidence that many patients who develop cardiovascular disease or diabetes have a pre-existing metabolic risk. This risk includes conditions such as enlarged waist circumference, hypertension, and elevated plasma glucose levels. The presence of three of more such conditions should alert a clinician to a patient at metabolic risk, said Dr. James Rosenzweig, director of diabetes services in the Section of Endocrinology, Diabetes and Nutrition at Boston Medical Center, and chair of the task force that developed this guideline.
“The dramatic increase in the incidence of patients at risk for cardiovascular disease and diabetes throughout the developed and developing world requires physicians and other care providers to be aware of the risk factors for these conditions and identify patients at risk in order to initiate treatment,” said Dr. Rosenzweig. “This guideline was developed for just this purpose.”
Review examines breast cancer prevention strategies in the United States
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A new review outlines potential pharmaceutical, dietary, surgical, and other approaches to reducing the risk of breast cancer among women in the United States, and examines the evidence for specific recommendations.
The review says risk reduction strategies for women at average risk of breast cancer should focus primarily on lifestyle factors. Among the recommendations: aside from following general dietary recommendations for healthy eating, there is no clear evidence that specific dietary components can effectively reduce breast cancer risk; while all women should be advised to moderate alcohol use, women at increased risk of breast cancer should moderate alcohol intake or even avoid alcohol; women should maintain a healthy body weight, since gaining over 20 pounds during adulthood has been reported to result in an increased risk of breast cancer.
The authors say use of pharmacotherapy to reduce the risk should be individualized to each patient after a thorough discussion of risks and benefits as part of a shared decision-making process.
Experts Available to Comment on New Study about Risk of Sudden Cardiac Death
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A new study in the November 5th 2008 issue of JAMA finds that during the first month after a heart attack, patients may have an increased risk for sudden cardiac death.
“The study justifies why we are so aggressive in treating patients during and after myocardial infarction,” says Howard S Weintraub, MD, FACC, clinical director of Center for the Prevention of Cardiovascular Disease at New York University Langone Medical Center. “If you survive the first thirty days, your risk is lowered over the next months to years.”
According to Dr. Weintraub, patients at risk for sudden cardiac death during the first month are those with recurrent chest pain (similar to the symptoms they had with their heart attack) and heart failure. “Identification of people at risk is very important,” says Dr. Weintraub. “Patients should be very vigilant reporting symptoms of shortness of breath, especially when lying down, ankle swelling, recurrent symptoms of chest pain, symptoms similar to initial heart attack experience, or problems during exertion or at rest.” They should also understand that using the medications that were prescribed on discharge may be influential in preventing recurrent ischemia and the risk of sudden cardiac death.
Folic Acid, B Vitamins Do Not Appear to Affect Cancer Risk
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A daily supplementation combination that included folic acid and vitamin B6 and B12 had no significant effect on the overall risk of cancer, including breast cancer, among women at high risk of cardiovascular disease, according to a study in the November 5 issue of JAMA.
Folate, vitamin B6, and vitamin B12 (water-soluble, essential B vitamins) are thought to play an important role in cancer prevention. “Background fortification of the food supply with folic acid (a synthetic form of folate), a policy that began in the United States in 1998 to reduce risk of neural tube defects, has improved folate status in the general population. Approximately one-third of U.S. adults currently take multivitamin supplements containing folic acid, vitamin B6, and vitamin B12,” the authors write. Data from randomized trials of folic acid alone or in combination with B vitamins and cancer risk are limited, not entirely consistent, and one trial has even raised concerns about harmful effects.
Shumin M. Zhang, M.D., Sc.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues conducted a trial to evaluate the effect of combined folic acid, vitamin B6, and vitamin B12 treatment on cancer risk in women at high risk for cardiovascular disease. The Women’s Antioxidant and Folic Acid Cardiovascular Study included 5,442 U.S. female health professionals age 42 years or older, with pre-existing cardiovascular disease or three or more coronary risk factors, who were randomly assigned to receive either a daily combination (n = 2,721) of folic acid (2.5 mg.), vitamin B6 (50 mg.), and vitamin B12 (1 mg.) or a matching placebo (n = 2,721). They were treated for 7.3 years, from April 1998 through July 2005.
PTSD Symptoms Linked to Increased Risk of Death After Heart Events
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Individuals who receive implantable cardiac defibrillators after a sudden heart event appear more likely to die within five years if they experience symptoms of post-traumatic stress disorder, regardless of the severity of their disease, according to a report in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Surviving a life-threatening heart condition, such as heart attack or cardiac arrest, causes significant distress, according to background information in the article. Resulting symptoms—including intense fear, painful intrusive memories and hyperarousal (a state of physical and psychological tension resulting from the flight-or-fight response)—may qualify an individual for a diagnosis of post-traumatic stress disorder (PTSD). Between 8 percent and 20 percent of patients with acute coronary syndromes and 27 percent to 38 percent of those who survive a cardiac arrest develop PTSD.
Karl-Heinz Ladwig, Ph.D., M.D., of Technische Universitaet Muenchen, Munich, and Helmholtz Zentrum National Research Center for Environmental Health, Neuherberg, Germany, and colleagues studied 211 patients who had received implantable cardiac defibrillators (devices that administer shocks to help restore normal heartbeat) following a heart event in 1998. Participants were surveyed an average of 27 months after implantation and 38 reported severe PTSD symptoms. All patients were then tracked through medical records, telephone interviews, reports from family members and death certificates through March 2005.
Healthy Bones Program Reduces Hip Fractures by 37 Percent, Study Finds
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Proactive measures can reduce hip fracture rates by an average of 37.2 percent—and as much as 50 percent—among those at risk, according to a study conducted by Kaiser Permanente Southern California. The study was published online on November 3 by The Journal of Bone & Joint Surgery, a peer-reviewed journal.
The largest study of its kind, the five-year study tracked more than 625,000 male and female patients over the age of 50 in Southern California who had specific risk factors for osteoporosis and/or hip fractures. The implementation of a number of initiatives in the Kaiser Permanente Southern California Healthy Bones Program reduced the hip fracture rates beyond the goal rate of 25 percent.
“One-half of all women and one-third of all men will sustain a fragility fracture in their lifetime. The mortality rate due to osteoporosis-related fractures is greater than the rates for breast cancer and cervical cancer combined,” said study lead author Richard M. Dell, MD, an orthopedic surgeon at the Kaiser Permanente Bellflower Medical Center. “Yet it’s a misconception that nothing can be done to prevent or treat osteoporosis. It is possible to achieve at least a 25 percent reduction in the hip fracture rate in the United States if a more active role is taken by all orthopedic surgeons in osteoporosis disease management.”
Scientists Map Molecular Regulation of Fat-Cell Genetics
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A research team led by Mitchell Lazar, MD, PhD, Director of the Institute for Diabetes, Obesity, and Metabolism at the University of Pennsylvania School of Medicine, has used state-of-the-art genetic technology to map thousands of positions where a molecular “master regulator” of fat-cell biology is nestled in DNA to control genes in these cells. The findings appear online this week in Genes & Development.
The international obesity epidemic is leading to major health risks, including increased rates of diabetes, heart disease, and cancer. Obesity is caused by increased numbers of fat cells that store more fat than normal. “This research has the potential to lead to new ways to think about therapies aimed at reducing the number of fat cells or altering fat cell function in ways that reduce the complications of obesity,” says Lazar.
The master molecule is called PPAR gamma, a gene regulator that is also the target of a major class of antidiabetic drugs, which include Actos® and Avandia. PPAR gamma binds directly to DNA, regulating the production of proteins by turning genes on or off. Actos® and Avandia are effective in treating diabetes, but their side effects, which include weight gain, prevent them from being recommended as a first-line therapy. The drugs bind to PPAR gamma in the nucleus of fat cells, which affects the expression of many genes, about twenty of which were previously known.
Lung Airway Cells Activate Vitamin D, Help Immunity
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Vitamin D is essential to good health but needs to be activated to function properly in the human body. Until recently, this activation was thought to happen primarily in the kidneys, but a new University of Iowa study finds that the activation step can also occur in lung airway cells.
The study also links the vitamin D locally produced in the lung airway cells to activation of two genes that help fight infection. The study results appear in the Nov. 15 issue of the Journal of Immunology, now online.
In addition to contributing to calcium absorption and bone health, vitamin D is increasingly recognized for its beneficial effects on the immune system. Vitamin D deficiency has been recently linked to increased risk of some infections, autoimmune diseases such as multiple sclerosis and type 1 diabetes, and some cancers.
Pregnancy disorder signals need to screen for heart disease, study shows
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High blood pressure experienced during pregnancy could be a woman’s earliest warning that she is at risk of developing heart disease - the number one killer of Canadian women - says Queen’s University professor of Obstetrics and Gynecology, Graeme Smith.
Called pre-eclampsia, this type of high blood pressure occurs in 5-10 per cent of all pregnancies.
But because most practicing physicians are unaware of the connection between pre-eclampsia and the risk for future cardiovascular problems, they fail to follow up with screening tests. As a result, their patients aren’t taking proactive steps to avoid potential heart attacks and strokes.
Response rates to antidepressants differ among English- and Spanish-speaking Hispanics
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In the first-ever study of its kind, a team led by researchers at Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed) report in November’s Psychiatric Services journal that Spanish-speaking Hispanics took longer to respond to medication for depression and were less likely to go into remission than English-speaking Hispanics.
Using data from the nation’s largest real-world clinical study of depression, the researchers found the Spanish-speaking participants in the study were older and were more likely to be women than the English speakers. The Spanish speakers also had less education and lower income, more medical issues and were more likely than English speakers to be seen in primary care than psychiatric clinics.
“Once we adjusted for these differences in their socioeconomic status, both groups responded about the same to medication for depression,” said Ira Lesser, M.D., a LA BioMed investigator who authored the report. “These results are important for clinicians and patients to be aware that Spanish-speaking Hispanics with depression who come from lower social economic groups may need more than medication for depression.”
Probiotic for babies doesn’t ward off allergies
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Giving children a type of “good bacteria” during their first 6 months of life doesn’t reduce their risk of developing allergies in early childhood, researchers from Australia report.
But it’s possible that other strains of probiotics could be more helpful in allergy prevention, Dr. Susan L. Prescott and colleagues from the University of Western Australia in Perth note in the journal Allergy.
Based on the “hygiene hypothesis”—or the idea that children in the developed world are increasingly likely to develop asthma and other allergic conditions because they are living in overly clean environments—probiotics are being investigated both for treating these conditions and possibly preventing them.
Flu Vaccination Rates Lag for At-risk Adolescents
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Influenza vaccination rates for adolescents who suffer from asthma and other illnesses are still far too low, according to a recent study.
The research, published in the November 2008 issue of Pediatrics, was based at the Department of Ambulatory Care and Prevention at Harvard Medical School and Harvard Pilgrim Health Care.
“Influenza vaccination has been recommended for adolescents with high-risk conditions for well over a decade,” notes lead author Mari Nakamura, a clinical fellow in pediatrics at Children’s Hospital Boston. “We wanted to examine how effective this risk-based policy has been in achieving vaccination coverage.”
Each year, between 20 and 40 percent of children and adolescents come down with the flu. For children with certain high-risk conditions, this can lead to hospitalizations. Because of this, the Centers for Disease Control strongly recommends that all adolescents vulnerable to influenza complications get vaccinated.
Are Pediatricians Getting the Training They Need to Meet Patient Needs?
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The face of pediatric medicine is changing. Beyond new technology, treatments and vaccines, more children than ever before are requiring care for chronic diseases and more families also are seeking pediatricians who have expertise in specialty areas such as sports medicine and mental health.
But are future pediatricians getting the training they need to meet the demands of the changing world of medicine, as well as the needs of their patients?
Although medical training has been adapted to educate trainees about new diseases and therapies, the fundamentals of the training process in pediatrics have remained relatively unchanged during the past decade.
Four studies led by the Child Health Evaluation and Research (CHEAR) Unit at the University of Michigan C.S. Mott Children’s Hospital finds recently trained pediatricians and pediatricians-in-training agreed that a one-size-fits-all approach to education in pediatrics may no longer be the right course of action. The studies are set to appear in November Pediatrics supplement
