Vitamin D May Lower Colon Cancer Risk

April 25th, 2010

High levels of vitamin D in the blood appear to be linked to lower risks of colorectal cancer, although it’s not clear if higher intake of the vitamin actually prevents the disease, researchers say.

Still, the findings are food for thought: Scientists found that those with the highest levels of vitamin D in their blood had as much as a 40 percent lower risk for developing colorectal cancer than those with the lowest levels.

The research, published online Jan. 21 in BMJ, is based on a study of more than 520,000 people from 10 countries in Western Europe. The study participants gave blood samples and filled out diet and lifestyle questionnaires between 1992 and 1998. They were then tracked for several more years to see what happened to them.

During the follow-up period, 1,248 were diagnosed with colorectal cancer. These participants were compared with a similar group of 1,248 people who were not diagnosed with the disease.

The researchers cautioned that it’s not clear if there are risks from consuming high levels of vitamin D, which is available in supplements. It’s also not known whether supplements are necessary if people reach certain levels through a healthy diet, exercise and moderate exposure to sunlight.

The study authors noted that current recommendations for preventing colorectal cancer include exercising, not smoking, reducing obesity and abdominal fat, and limiting consumption of alcohol and red and processed meats.

SOURCE: BMJ, news release

Weak evidence of benefit for scoliosis bracing

April 19th, 2010

The use of braces to correct excessive curvature of the spine (scoliosis) in adolescents is a subject of ongoing debate and a new review of the medical literature does little to resolve the matter.

Although there is some evidence that adolescents with scoliosis may benefit from wearing hard or elastic braces to correct spinal curvature, research thus far has failed to prove definitively that bracing works, the investigators conclude.

The evidence for bracing is weak, as is the evidence of any long-term benefits of bracing, Dr. Stefano Negrini of the Italian Scientific Spine Institute of Milan, Italy, and colleagues report in the latest issue of The Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research.

Negrini and his team searched the medical literature for studies comparing braces with no treatment, other treatment, surgery, and different types of braces. From a pool of 1,285 titles, the researchers read 128 full texts, and found only 2 that fit their criteria.

One study involved 286 girls; some wore a brace, some received electrical stimulation, and some received no treatment at all, for up to 4 years.

This study found evidence that bracing was more effective than observation (wait-and-see) or electrical stimulation. At three years, the success rates were 80 percent for bracing, 46 percent for observation and 39 percent for electrical stimulation. At four years, the success rates were 74 percent, 34 percent and 33 percent, respectively. However, over the long term, formerly braced patients reverted back to their pre-treatment curvatures.

The other study compared the efficacy of rigid versus elastic braces in 43 girls over 45 months. This study found evidence that rigid braces were more effective than elastic braces.

However, both studies, the researchers emphasize, constituted very “low quality evidence” in favor of using braces.

Despite the lack of strong evidence, Negrini told the Health Behavior News Service, that his clinic often prescribes braces in conjunction with exercises for patients with scoliosis.

“We are aware of the very good results it is possible to obtain with high-quality bracing and making sure there is good patient compliance with wearing the brace,” Negrini said.

Dr. John Dormans, chief of orthopedic surgery at the Children’s Hospital of Philadelphia and president of the Pediatric Orthopedic Society of North America, also favors bracing.

“If you polled the orthopedists who treat the vast majority of patients with adolescent idiopathic scoliosis, the overwhelming opinion would be that bracing is effective, that it does alter the natural history of the disease,” Dormans said.

But getting teenagers to wear the brace for an adequate number of hours each day is a big issue. “The efficacy of bracing depends on two main factors: efficacy of the brace itself and compliance,” Negrini wrote in an email to Reuters Health.

Questions about the effectiveness of bracing for adolescent scoliosis might soon be answered by more definitive research: a five-year, multimillion-dollar study funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases is currently under way.

SOURCE: The Cochrane Library, 2010.

Health Tip: What’s Prompting My Seizures?

February 23rd, 2010

A seizure is a sudden spurt of abnormal electrical activity in the brain.

While the causes can be varied and complex, the Epilepsy Foundation offers this list of common triggers:
Missing medications, especially those used to control seizures.
Changes in sleep routines or lack of sleep.
Hormonal changes in women, such as during menstruation or pregnancy.
Abusing alcohol or drugs, or withdrawing from them.
Stress and anxiety.
Factors that unpredictably change metabolism, such as diarrhea or vomiting.

Kids should get moving to avoid obesity

February 16th, 2010

Vigorous exercise may be an especially good way to keep kids lean, but sitting around, in and of itself, doesn’t appear to have a major role in making them fat, new research shows.

Nevertheless, there are still plenty of reasons to avoid too much sedentary “screen time,” Dr. Ulf Ekelund of the MRC Epidemiology Unit in Cambridge, UK and colleagues say, given potential negatives including “violence and aggressive behavior, poor academic performance, and poor body image.”

To help tease out the role of time spent in different types of activity in making children fat, independent of screen time and otherwise being a couch potato, Ekelund and his team looked at 1,862 children 9 to 10 years old, 23 percent of whom were overweight or obese.

Using a wristwatch-like device to measure the amount and intensity of activity children got throughout the day, the researchers looked for associations between this activity and children’s waist size, amount of body fat, and body mass index (BMI). Kids also reported how much time they spent watching TV or using a computer.

Sixty-nine percent of the children were getting at least an hour of moderate physical activity a day, while 58 percent reported having less than two hours of screen time daily.

While children who spent more time not moving had bigger waists and a larger percentage of body fat, much of this relationship could be attributed to the fact that they spent less time engaging in moderate physical activity.

But the time children spent engaging in vigorous activity, and their combined moderate activity-vigorous activity time, had the strongest ties to waist circumference and fat mass.

For instance, every 6.5 minutes a child spent doing vigorous activity like playing ball, bicycling, or running around outside was associated with a 1.32-centimeter reduction in waist size, the researchers found. But 13.6 minutes of moderate physical activity only reduced waist size by half a centimeter.

Based on the findings, the researchers say, children should still be encouraged to limit their sedentary time, but this alone won’t be enough to tackle childhood obesity.

“Interventions may therefore need to incorporate higher intensity-based activities to curb the growing obesity epidemic,” they conclude.

Boys in the study got an average of a half-hour of vigorous activity each day, while girls got 22 minutes. “There is no clear cut answer” as to how much vigorous activity is optimal, Ekelund noted in an email to Reuters Health.

“For most health outcomes, the more activity you do the better.” But, he added, people who do lots of strenuous activity may still put on too much weight if they take in too many calories.

Many pregnant women take drugs harmful to baby

February 9th, 2010

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A third of Americans die in hospitals, study finds

January 31st, 2010

Nearly a third of Americans who die are in the hospital at the time and their last treatments cost the U.S. economy $20 billion, according to a report released on Wednesday.

The single biggest cause of hospital death was septicemia, an overwhelming infection of the blood, which killed 15 percent of patients, the team at the U.S. Agency for Healthcare Research and Quality found.

Eight percent died of respiratory failure, 6 percent died of stroke and 5 percent had fatal heart attacks in the hospital, according to the report, available at http://www.hcup-us.ahrq.gov/reports/statbriefs/sb82.pdf.

“In 2007, it is estimated by the Centers for Disease Control that 2,423,995 people died in the United States. Of these, we estimate that 765,651 died in the hospital,” the agency’s Yafu Zhao and William Encinosa wrote.

“That is, 32 percent of all deaths in the U.S. in 2007 occurred in the hospital.”

Their analysis, using federal survey data, found that the average cost of a hospital stay that ended with the patient’s death was $26,035, compared to $9,447 for patients discharged alive.

Patients covered by Medicare, the federal health insurance plan for the elderly and disabled, accounted for 67 percent of in-hospital deaths and $12 billion in hospital costs.

Private insurance covered 20 percent of patients who died at a cost of $4 billion. Medicaid patients made up 2 percent and uninsured patients accounted for 3 percent and $630 million in costs.

“Overall, the costs of hospitalizations ending in death were $20 billion, which accounted for 5.2 percent of total in-patient hospital costs in the U.S. in 2007,” they wrote.

Zhao and Encinosa used their survey data, which covered 90 percent of U.S. hospitals, along with CDC data to calculate that 74 percent of infants who die are being treated in the hospital at the time.

“Among the elderly, 31 percent of deaths occurred in the hospital, while 34 percent of nonelderly deaths took place in the hospital,” they said.

Gene Discovery Gives Clues to Crohn’s Disease, Colitis

January 25th, 2010

People with painful, chronic bowel conditions such as Crohn’s disease and ulcerative colitis could see a glimmer of hope from new research.

Scientists say they’ve spotted a genetic flaw that could drive a rare childhood form of colitis, and the finding might have implications for the broader range of illnesses collectively known as inflammatory bowel disease (IBD).

Genetic analysis of nine children with a severe form of early-onset colitis found mutations of two genes producing cell receptors for interleukin-10, a protein that controls the body’s inflammatory response, according to a report published online Nov. 4 in the New England Journal of Medicine.

In one case, a bone marrow transplant eliminated a child’s disease, the report said.

About one million Americans have been diagnosed with IBD, which includes ulcerative colitis and Crohn’s disease. These conditions involve a persistent inflammation of the intestinal tract that can cause bouts of diarrhea, rectal bleeding and other symptoms.

The study is not the first to link interleukin-10 with IBD, noted study researcher Alejandro A. Schaffer, a staff scientist at the U.S. National Center for Biotechnology Information. Previous animal and human studies led to trials of interleukin-10 treatment for IBD patients that were not successful, he said.

But the new study shows that “there may be some subsets of adult patients who have insufficient amounts of interleukin-10,” Schaffer said. “We are suggesting that there might be a subset of patients worth identifying and treating differently.”

It’s not now possible to say how large that subset might be, he said.

“We’re very excited about this discovery,” said study lead author Dr. Erik-Oliver Glocker, a postdoctoral researcher at University College London in the United Kingdom.

The study, done at centers in Germany, the United Kingdom and the United States, identified two mutated genes for the molecules that allow interleukin-10 to act on cells. “These mutations have very severe consequences,” Glocker said. “If you have a mutation in the receptor, interleukin-10 doesn’t work and the entire immune system is off-balance.”

It took a lot of screening to find young people with this specific genetic flaw, Glocker said. The disease usually emerges later in life, and “in older patients, it could be different,” he said.

“There have been a lot of different genetic studies of Crohn’s disease, and they have always found genes that might be concerned,” Glocker said. “Maybe we can screen adult patients for the genes we have described and think of a similar treatment. If you have this mutation, you might be suitable for a bone marrow transplant.”

But adult IBD is a complex condition, genetically speaking, he added.

“The problem is that in Crohn’s disease patients, the cause of the disease is not well understood,” Glocker said. “In the patients we had, we know the genes and the functions of the genes and the proteins. And that makes treatment — a bone marrow transplant — much easier. We’re not sure that a transplant should be considered in adult Crohn’s patients.”

A number of variants of other genes have been detected in people with IBD, Schaffer said. “We’re not saying anything about those patients, unless they also have the interleukin-10 variant,” he said.

Health Tip: Keep a Health Journal

January 18th, 2010

When your doctor asks you about any illnesses, injuries or past procedures, there’s no need to commit it all to memory if you keep a health journal.

The American Academy of Family Physicians suggests your journal include the following:
Any injuries you’ve had or illnesses for which you’ve been treated.
Any time you were hospitalized, including when and why.
Any allergies you have to foods, medications, household items, pollens, etc.
Any past surgeries or procedures.
All prescription and over-the-counter medications, vitamins or supplements taken. Be sure to include the dose and how often you take them.
Diseases, illnesses or health conditions that have affected immediate family members.

PSA Reading Could Predict Post-Radiation Survival

January 11th, 2010

Prostate cancer patients whose prostate-specific antigen (PSA) levels rise within 18 months after radiotherapy have an increased risk of death, say U.S. researchers.

Their study included more than 2,100 patients with clinically localized prostate cancer who experienced biochemical failure (lowest PSA level plus 2 nanograms per milliliter) after treatment. The median interval between treatment and biochemical failure was 35.2 months, but 19 percent of patients developed biochemical failure at 18 months or less.

Five-year, cancer-specific survival for patients who developed biochemical failure within 18 months was 69.5 percent, compared with 89.8 percent for those who developed biochemical failure more than 18 months after treatment.

The study was to be presented Wednesday at the annual meeting of the American Society for Radiation Oncology in Chicago.

“PSA is the gold standard for following prostate cancer patients after they receive radiation or surgery. But we haven’t known if having PSA rise sooner means a patient has a greater danger of dying of prostate cancer, though it seems logical,” study leader Dr. Mark K. Buyyounouski, a radiation oncologist at the Fox Chase Cancer Center in Philadelphia, said in a news release from the center.

“Now we can use the simple criteria from this study, which is widely available for anyone who has PSA testing, to identify men who have a greater than 25 percent chance of dying from prostate cancer in the next five years. That is huge. There is nothing else that can do that.”

Currently, biochemical failure alone doesn’t prompt treatment. Doctors usually wait until a patient’s PSA reaches a high level or there is some other evidence of tumor spread.

This study suggests that treatment can begin “far sooner without waiting for other signs or symptoms of prostate cancer,” Buyyounouski said. “If a patient has biochemical failure at 16 months, rather than wait and learn later that the PSA is rising sharply and risk the development of distant metastasis, therapy can be started sooner based on the increased risk of death.”

Cost Savings Adds to Value of Preventing Chronic Disease

December 21st, 2009

Prevention of chronic diseases such as diabetes, obesity and high blood pressure improves the lives of older Americans and also reduces medical costs, study findings show.

Researchers looked at a group of 51- and 52-year-olds from across the nation and projected their future state of health and medical costs if they could avoid developing certain chronic diseases. In a 51-year-old, prevention of obesity would extend life by 0.85 years, preventing high blood pressure would give them an additional 2.05 years, and by avoiding diabetes they would gain 3.17 years. People aged 51 and 52 who quit smoking would gain 3.44 more years of life, the study authors noted in a news release from the American Public Health Association.

Prevention of these conditions also would have lower lifetime medical costs for the individual: Preventing obesity would save $7,168; preventing high blood pressure would save $13,702; and preventing diabetes would save $34,483. However, the lifetime medical costs for a person who quits smoking would be $15,959 higher, the researchers noted in the news release.

“Our data indicate that primary prevention could improve the health and longevity of future cohorts of elderly persons in the United States at a relatively low cost,” the researchers concluded.