All Posts tagged medicine

Social ties help breast cancer

Breast cancer patients who have a strong social support system in the first year after diagnosis are less likely to die or have a recurrence of cancer, according to new research from investigators at Vanderbilt-Ingram Cancer Center and the Shanghai Institute of Preventive Medicine. The study, led by first author Meira Epplein, Ph.D., assistant professor of Medicine, was published in a recent edition of the Journal of Clinical Oncology.

 

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Patients in the study were enrolled in the Shanghai Breast Cancer Survivor Study, a large, population-based review of female breast cancer survivors in China, which Vanderbilt University Medical Center and the Shanghai Institute of Preventive Medicine have carried out since 2002 under the leadership of principal investigator Xiao Ou Shu, M.D., Ph.D., professor of Medicine, and senior author of the study.

From 2002 to 2004, a total of 2,230 breast cancer survivors completed a quality of life survey six months after diagnosis and a majority responded to a follow-up survey 36 months postdiagnosis. The women were asked about physical issues like sleep, eating, pain, psychological well-being, social support and material well-being. The answers were converted to an overall quality of life score. During a median follow-up of 4.8 years after the quality of life assessment, the investigators documented participants who had died or been diagnosed with a cancer recurrence.

Six months after diagnosis, only greater social well-being was significantly associated with a decreased risk of dying or having a cancer recurrence. Compared to women with the lowest scores, women who scored highest on the social well-being quality of life scale had a 48 percent reduction in their risk of a cancer recurrence and a 38 percent reduction in the risk of death.

Among the facets that comprise the social well-being domain, emotional support was the strongest predictor of cancer recurrence. Specifically, women reporting the highest satisfaction with marriage and family had a 43 percent risk reduction, while those with strong social support had a 40 percent risk reduction and those with favorable interpersonal relationships had a 35 percent risk reduction.

“We found that social well-being in the first year after cancer diagnosis is an important prognostic factor for breast cancer recurrence or death,” said Epplein. “This suggests that the opportunity exists for the design of treatment interventions to maintain or enhance social support soon after diagnosis to improve disease outcomes.” While a strong social support network influenced cancer recurrence and mortality during the first year, the association tapered off and was no longer statistically significant by the third year after diagnosis.

This may be related to a smaller sample size of patients who answered the questionnaire, or other factors beyond quality of life that take precedence in the later years of survival. The study was supported by grants from the U.S. Department of Defense Breast Cancer Research Program and the National Cancer Institute.

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Diabetes Plus Depression

Women suffering from diabetes plus depression have a greater risk of dying, especially from heart disease, a new study suggests.In fact, women with both conditions have a twofold increased risk of death, researchers say. “People with both conditions are at very high risk of death,” said lead researcher Dr. Frank B. Hu, a professor of medicine at Harvard Medical School. “Those are double whammies.” When people are afflicted by both diseases, these conditions can lead to a “vicious cycle,” Hu said. “People with diabetes are more likely to be depressed, because they are under long-term psychosocial stress, which is associated with diabetes complications.”

People with diabetes plus depression are less likely to take care of themselves and effectively manage their diabetes, he added. “That can lead to complications, which increase the risk of mortality.” Hu stressed that it is important to manage both the diabetes and the depression to lower the mortality risk. “It is possible that these two conditions not only influence each other biologically, but also behaviorally,” he said.

Type 2 diabetes plus depression are often related to unhealthy lifestyles, including smoking, poor diet and lack of exercise, according to the researchers. In addition, depression may trigger changes in the nervous system that adversely affect the heart, they said.

The report is published in the January issue of the Archives of General Psychiatry.

Commenting on the study, Dr. Luigi Meneghini, an associate professor of clinical medicine and director of the Eleanor and Joseph Kosow Diabetes Treatment Center at the Diabetes Research Institute of the University of Miami Miller School of Medicine, said the findings were not surprising.

“The study highlights that there is a clear increase in risk to your health and to your life when you have a combination of diabetes and depression,” he said. Meneghini noted there are many diabetics with undiagnosed depression. “I am willing to bet that there are quite a number of patients with diabetes and depression walking around without a clear diagnosis.” Patients and doctors need to be more aware that depression is an issue, Meneghini added.

For the study, Hu’s team collected data on 78,282 women who were aged 54 to 79 in 2000 and who were participants in the Nurses’ Health Study. Over six years of follow-up, 4,654 women died, including 979 who died of cardiovascular disease, the investigators found. Women who had diabetes had about a 35 percent increased risk of dying, and those with depression had about a 44 percent increased risk, compared with women with neither condition, the researchers calculated. Those with both conditions had about twice the risk of dying, the study authors found.

When Hu’s team looked only at deaths from heart disease, they found that women with diabetes had a 67 percent increased risk of dying and those with depression had a 37 percent increased risk of death. But women who had both diabetes and depression had a 2.7-fold increased risk of dying from heart disease, the researchers noted.

In the United States, some 15 million people suffer from depression and 23.5 million have diabetes, the researchers say. Up to one-fourth of people with diabetes also experience depression, which is nearly twice as many as among people who don’t have diabetes, they added. “The combination of diabetes and depression needs to be addressed,” Meneghini concluded. He added that patients need to tell their doctors if they are feeling depressed, and doctors also need to be on the lookout for signs of depression in their diabetic patients.

SOURCES: HealthDay News; Frank B. Hu, M.D., Ph.D., professor, medicine, Harvard Medical School, Boston; Luigi Meneghini, M.D., associate professor, clinical medicine and director, Eleanor and Joseph Kosow Diabetes Treatment Center, Diabetes Research Institute, University of Miami Miller School of Medicine; January 2011, Archives of General Psychiatry

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Placebos may work – even when the patient knows

For most of us, the “placebo effect” is synonymous with the power of positive thinking; it works because you believe you're taking a real drug. But a new study rattles this assumption.Researchers at Harvard Medical School's Osher Research Center and Beth Israel Deaconess Medical Center (BIDMC) have found that placebos work even when administered without the seemingly requisite deception.

Placebos—or dummy pills—are typically used in clinical trials as controls for potential new medications. Even though they contain no active ingredients, patients often respond to them. In fact, data on placebos is so compelling that many American physicians (one study estimates 50 percent) secretly give placebos to unsuspecting patients. Because such “deception” is ethically questionable, HMS associate professor of medicine Ted Kaptchuk teamed up with colleagues at BIDMC to explore whether or not the power of placebos can be harnessed honestly and respectfully.

To do this, 80 patients suffering from irritable bowel syndrome (IBS) were divided into two groups: one group, the controls, received no treatment, while the other group received a regimen of placebos—honestly described as “like sugar pills”—which they were instructed to take twice daily. “Not only did we make it absolutely clear that these pills had no active ingredient and were made from inert substances, but we actually had 'placebo' printed on the bottle,” says Kaptchuk. “We told the patients that they didn't have to even believe in the placebo effect. Just take the pills.”

For a three-week period, the patients were monitored. By the end of the trial, nearly twice as many patients treated with the placebo reported adequate symptom relief as compared to the control group (59 percent vs. 35 percent). Also, on other outcome measures, patients taking the placebo doubled their rates of improvement to a degree roughly equivalent to the effects of the most powerful IBS medications. “I didn't think it would work,” says senior author Anthony Lembo, HMS associate professor of medicine at BIDMC and an expert on IBS. “I felt awkward asking patients to literally take a placebo. But to my surprise, it seemed to work for many of them.”

The authors caution that this study is small and limited in scope and simply opens the door to the notion that placebos are effective even for the fully informed patient—a hypothesis that will need to be confirmed in larger trials. “Nevertheless,” says Kaptchuk, “these findings suggest that rather than mere positive thinking, there may be significant benefit to the very performance of medical ritual. I'm excited about studying this further. Placebo may work even if patients knows it is a placebo.”

This study was funded by the National Center for Complementary and Alternative Medicine and Osher Research Center, Harvard Medical School.

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New test can predict complications from kidney disease

Cystatin C, a blood marker of kidney function, proved significantly more accurate than the standard blood marker, creatinine, in predicting serious complications of kidney disease, in a study by researchers at the San Francisco VA Medical Center and the University of California, San Francisco. Among adults who were identified as having chronic kidney disease by high creatinine levels, the researchers found that only patients who also had abnormally high levels of cystatin C were at high risk for death, cardiovascular disease, heart failure, or kidney failure. People with high creatinine but normal cystatin C levels had risks similar to those with normal creatinine levels.

The researchers also found that a small but important segment of the study population was missed by creatinine but identified by cystatin C as being at significant risk of serious complications, according to lead author Carmen A. Peralta, MD, MAS, an SFVAMC researcher and an assistant professor of medicine in residence in the division of nephrology at UCSF.

The study of 11,909 participants appears online on December 16, 2010, in the JASN Express section of the Journal of the American Society of Nephrology. The authors analyzed patient data from two prospective studies: the Multi-Ethnic Study of Atherosclerosis and the Cardiovascular Health Study, both sponsored by the National Heart, Lung, and Blood Institute.

Principal investigator Michael G. Shlipak, MD, MPH, chief of general internal medicine at SFVAMC, said that the current study highlights a potential clinical use for cystatin C as a method for confirming a diagnosis of chronic kidney disease. Shlipak has been a leader among physicians in identifying cystatin C as an alternative, accurate, and reliable marker of kidney function.

Both cystatin C and creatinine are substances made in the body and filtered by the kidneys. High levels of the substances in the blood indicate that the kidneys are losing the ability to filter them, and thus are losing function. However, explained Peralta, creatinine is a byproduct made in muscles, so it is affected by what you eat and especially by how much muscle you have. Thus, a bodybuilder with healthy kidneys might have an elevated creatinine level because of high muscle mass, whereas a frail elderly person might have normal or even low levels of creatinine, but in fact this persons kidneys are not working well – its just that theres not much creatinine because theres not much muscle.

In contrast, cystatin C is a protein made in cells throughout the body. In studies so far, it does not seem to be that affected by age or muscle mass or diet, said Shlipak, who is also a professor in residence of medicine and epidemiology and biostatistics at UCSF.

Shlipak proposes that cystatin C, which can cost as little as $17 per test, be added as a method for confirming or staging chronic kidney disease in guidelines that are currently being formulated by nephrologists. Its vital that we have an accurate diagnostic test, because kidney disease does not show symptoms until its too late, when your kidneys have almost failed completely, he said. Being missed by creatinine is an important limitation in our current method of diagnosing kidney disease, said Peralta. Yet, she adds, being falsely identified with kidney disease through inaccurate test results can be disastrous as well. There is fear and psychological stress, particularly in communities of color, where people have a lot of friends and family members who are on dialysis, she noted. You can also be subjected to unnecessary and expensive tests and medications.

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US NIAID Issues Food Allergy Management Guidelines

A coordinating committee representing 34 professional organizations, advocacy groups and federal agencies oversaw the development of the guidelines. The coordinating committee selected a 25-member expert panel, chaired by Joshua Boyce, M.D., co-director of the Inflammation and Allergic Disease Research Section at Boston's Brigham and Women's Hospital. The panel used an independent, systematic literature review of food allergy and their own expert clinical opinions to prepare draft guidelines. Public comments were invited and considered as well during the development of the guidelines.

“These guidelines are an important starting point toward a goal of a more cogent, evidence-based approach to the diagnosis and management of food allergy,” says Dr. Boyce. “We believe that they provide healthcare professionals with a clear-cut definition of what constitutes a food allergy and a logical framework for the appropriate use of diagnostic testing and accurate interpretation of the results.”

Additional topics covered by the guidelines include the prevalence of food allergy, natural history of food allergy and closely associated diseases, and management of acute allergic reactions to food, including anaphylaxis, a severe whole-body reaction. They also identify gaps about what is known about food allergy.

“The food allergy guidelines provide a rigorous assessment of the state of the science, and clearly identify the areas where evidence is lacking and where research needs to be pursued,” says Daniel Rotrosen, M.D., director of the Division of Allergy, Immunology and Transplantation at NIAID. “This information will help shape our research agenda for the near future.”

Food allergy has become a serious health concern in the United States. Recent studies estimate that food allergy affects nearly 5 percent of children younger than 5 years old and 4 percent of teens and adults. Its prevalence appears to be on the rise. Not only can food allergy be associated with immediate and sometimes life-threatening consequences, it also can affect an individual's health, nutrition, development and quality of life. While several potential treatments appear promising, currently no treatments for food allergy exist and avoidance of the food is the only way to prevent complications of the disease.

More information on the guidelines may be found at http://www.niaid.nih.gov/topics/foodAllergy/clinical/Pages/default.aspx

 

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Diabetes may be linked to air pollution

Cardiovascular and lung researchers at The Ohio State University Medical Center are the first to report a direct link between air pollution and diabetes. If the ongoing research continues to confirm this association, scientists fear human health in both industrialized and developing countries could be impacted.

“We now have even more compelling evidence of the strong relationship between air pollution and obesity and type II diabetes,” said Dr. Sanjay Rajagopalan, section director of vascular medicine at Ohio State's medical center and principal investigator of the study. The latest study builds upon previous research from Rajagopalan's team implicating air pollution as a major adverse risk factor for cardiovascular effects, high blood pressure and acute coronary syndromes.

Researchers found that exposure to air pollution, over a period of 24 weeks, exaggerates insulin resistance and fat inflammation. The results of the study are available online in the current issue of Circulation. “The prevalence of obesity has reached epidemic proportions with 34 percent of adults in the U.S., ages 20 and over, meeting the criteria for obesity,” said Rajagopalan. “Obesity and diabetes are very prevalent in urban areas and there have been no studies evaluating the impact of poor air quality on these related conditions until now.”

Type II diabetes, a consequence of obesity, has soared worldwide with a projected 221 million people expected to suffer from this disease in 2010, a 46 percent increase compared to 1995.

In the Ohio State research, scientists fed male mice a diet high in fat over a 10-week period to induce obesity and then exposed them to either filtered air or air with particulate matter for six hours a day, five days a week, over a 24-week period. Researchers monitored measures of obesity, fat content, vascular responses and diabetic state. The air pollution level inside the chamber containing particulate matter was comparable to levels a commuter may be exposed to in urban including many metropolitan areas in the U.S.

According to the U.S. Environmental Protection Agency, the four most common pollutants emitted into the air are particulate matter, ozone, nitrogen dioxide and sulfur dioxide. Air pollution is commonly the result of industrial emissions, power plants and automobile exhaust.

“This study provides additional guidance for the EPA to review air pollution standards,” says Rajagopalan. “Our study also confirmed a need for a broader based approach, from the entire world, to influence policy development.”

Dr. Qinghua Sun, first author of the study, is leading an international effort to understand the effects of urban air pollution in Beijing, where the impact of recent stringent measures on air quality during the Olympics is being monitored in another controlled experiment. Researchers at the University of Michigan and the New York University School of Medicine participated in the study. Along with Rajagopalan and Sun, other Ohio State researchers involved in the study were Peibin Yue, Jeffrey A. Deiuliis, Thomas Kampfrath, Michael B. Mikolaj, Ying Cai, Michael C. Ostrowski, Bo Lu, Sampath Parthasarathy and Susan D. Moffatt-Bruce.

Funding from the National Institutes of Health supported this research.

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Breastfeeding reduces diabetes risk

Mothers who did not breastfeed their children have significantly higher rates of type 2 diabetes later in life than moms who breastfed, report University of Pittsburgh researchers in a study published in the September issue of the American Journal of Medicine.

“We have seen dramatic increases in the prevalence of type 2 diabetes over the last century,” said Eleanor Bimla Schwarz, MD, MS, assistant professor of medicine, epidemiology, and obstetrics, gynecology and reproductive sciences at the University of Pittsburgh. She also has a secondary appointment in epidemiology at the GSPH. “Diet and exercise are widely known to impact the risk of type 2 diabetes, but few people realize that breastfeeding also reduces mothers’ risk of developing the disease later in life by decreasing maternal belly fat.”

The study included 2,233 women between the ages of 40 and 78. Overall, 56 percent of mothers reported they had breastfed an infant for at least one month. Twenty-seven percent of mothers who did not breastfeed developed type 2 diabetes and were almost twice as likely to develop the disease as women who had breastfed or never given birth. In contrast, mothers who breastfed all of their children were no more likely to develop diabetes than women who never gave birth. These long-term differences were notable even after considering age, race, physical activity and tobacco and alcohol use.

“Our study provides another good reason to encourage women to breastfeed their infants, at least for the infant’s first month of life,” said Schwarz. “Clinicians need to consider women’s pregnancy and lactation history when advising women about their risk for developing type 2 diabetes.”

Schwarz also is an assistant investigator at the Magee-Womens Research Institute. Co-authors of the study include Jeanette Brown, MD, Jennifer M. Creasman, MPH, and David Thom, MD, PhD, University of California, San Francisco; Alison Stuebe, MD, MSc, University of North Carolina School of Medicine; Candace K. McClure, PhD, University of Pittsburgh; and Stephen K. Van Den Eeden, PhD, Kaiser Permanente, CA.

The research was funded by grants from the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Child Health and Development.

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Iranian scholars share Avicenna’s mediaeval medical wisdom

For pulmonary ailments, certain mediaeval physicians had a useful medical textbook on hand offering detailed information remarkably similar to those a modern doctor might use today. One of the fathers of medicine, the great Persian scholar Avicenna left a wealth of information in his many works. Iranian academics dust off one of these in an article published today in the SAGE journal Therapeutic Advances in Respiratory Disease, sharing in English details of Avicenna's work that still fascinate both physicians and historians of medicine alike.

Seyyed Mehdi Hashemi and Mohsen Raza dug deep into Avicenna's original ancient text, housed in the Central Library of the Tehran University of Medical Sciences in Iran, where they both work. In particular, they aimed to highlight Avicenna's work on respiratory diseases, which may be informative or interesting to physicians and pulmonologists today.

Avicenna discusses respiratory diseases in volume three of the Canon of Medicine, covering the functional anatomy and physiopathology of the pulmonary diseases that were known in his time in detail. His descriptions of the signs and symptoms of various respiratory diseases and conditions are remarkably similar to those found in modern pulmonary medicine. The topic is covered under five chapters: breathing, voice, cough and haemoptysis, internal wounds and inflammations and principles of treatments.

The authors also highlight both herbal and non-herbal treatments Avicenna recommends for respiratory diseases, and their signs and symptoms from the second volume of the Canon of Medicine. Avicenna suggested 21 herbs to treat respiratory disorders, and today we know that several of these herbs contain bioactive compounds with analgesic, antispasmodic, bronchodilatory or antimicrobial activities. For instance, Avicenna would have prescribed opium at that time for cough and haemoptysis, a practice which today has an established therapeutic basis.

“In the time of Avicenna, the presentation of respiratory diseases, their treatment and their prognosis was much different than in modern times,” says Hashemi. Mediaeval physicians had a greater reliance on history, physical examination (which was mostly based on visual observation), individual variation, environmental factors, diet, and so on, for diagnosis and treatment.

Even so, several of Avicenna's observations related to signs and symptoms, aggravating and relieving factors and the treatment of pulmonary disorders are still valid and can be explained by modern science. For example, one of the important symptoms in the diagnosis of asthma that Avicenna discusses is dyspnea during sleep that leads to awakening. Avicenna also observed plaster-like material in tuberculosis patients' sputum, which is now known as lithoptysis (stone spitting), where a patient coughs up calcified material due to perforated bronchial lymph node.

Despite many limitations and the lack of modern instruments in his day, Avicenna adopted a scientific approach to the diagnosis and treatment, not only of respiratory disorders, but also more generally to illnesses he treated and mentioned throughout the Canon of Medicine.

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Benefits of Calcium and Vitamin D

Led by researchers at Copenhagen University in Denmark, Robbins and an international team of colleagues analyzed the results of seven large clinical trials from around the world to assess the effectiveness of vitamin D alone or with calcium in reducing fractures among people averaging 70 years or older. The researchers could not identify any significant effects for people who only take vitamin D supplements.

Among the clinical trial results analyzed was Robbins' WHI research, which was part of a 15-year, national program to address the most common causes of death, disability and poor quality of life in postmenopausal women such as cardiovascular disease, cancer and osteoporosis. Those trials were primarily designed to study the effect of calcium and vitamin D supplementation in preventing hip fractures, with a secondary objective of testing the supplements on spine and other types of fractures, as well as on colorectal cancer. The results were published in the Feb. 16, 2006 edition of the New England Journal of Medicine.

Fractures are a major cause of disability, loss of independence and death for older people. The injuries are often the result of osteoporosis, or porous bone, a disease characterized by low bone mass and bone fragility. The National Osteoporosis Foundation estimates that about 10 million Americans have osteoporosis; 80 percent of them are women. Four of 10 women over age 50 will experience a fracture of the hip, spine or wrist in their lifetime, and osteoporosis-related fractures were responsible for an estimated $19 billion in health-related costs in 2005.

“This study supports a growing consensus that combined calcium and vitamin D is more effective than vitamin D alone in reducing a variety of fractures,” said Robbins. “Interestingly, this combination of supplements benefits both women and men of all ages, which is not something we fully expected to find. We now need to investigate the best dosage, duration and optimal way for people to take it.”

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Probiotics Reduce Childhood Infections

The randomized, double-blind, placebo-controlled study, which was funded by The Dannon Company, Inc., involved 638 healthy children aged three to six, all of whom attended school five days a week. Parents were asked to give their child a strawberry yogurt-like drink every day. Some of the drinks contained the probiotic strain Lactobacillus casei (L. casei) and the others did not. Parents were also asked to record how many yogurt drinks their child consumed and to keep notes on their child's health.

At the end of the study, there was a 19 percent decrease in the number of common infections—e.g., ear infections, flu, diarrhea, sinusitis–among children who had consumed the yogurt drink with the probiotics than those who had the drink without the beneficial bacteria. When the researchers broke out the individual types of illness, they found that children who had the probiotic beverage had 24 percent fewer gastrointestinal infections (e.g., diarrhea, nausea, vomiting), and 18 percent fewer upper respiratory tract infections (e.g., ear, sinusitis, strep).

The reduction in infections did not, however, result in fewer days lost from school. Merenstein commented that “It is my hope that safe and tolerable ways to reduce illnesses could eventually result in fewer missed school days which means fewer work days missed by parents.”

The finding that the probiotic yogurt drink reduced infections in children, however, is significant. This joins results from other studies demonstrating benefits of probiotics in children, including one published in Pediatrics in which they reduced cold and flu symptoms, another in which they eased diarrhea, and one showing they helped prevent eczema in infants. Generally, probiotics have also been shown to benefit people who have celiac disease, irritable bowel, colitis, and possibly autism.

SOURCE:
Georgetown University Medical Center

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