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Researchers in Sweden who studied data on over 35,000 middle aged and older women followed for 10 years found a link between taking multivitamins and increased risk of breast cancer and said this was of concern to public health and should be investigated further.

You can read about the study, conducted at the Karolinska Institutet in Stockholm, Sweden, online in the 24 March issue of the American Journal of Clinical Nutrition.

Many women use multivitamins in the belief that they will protect them from chronic diseases like cancer and heart disease, wrote the authors in their background information.

In fact, in February 2009, the Archives of Internal Medicine published details of a large US study of over 160,000 postmenopausal women that found no convincing evidence that long term use of multivitamins changed their risk of developing common cancers, cardiovascular disease or dying prematurely.

But, as the authors of this Swedish study pointed out, the effect of multivitamins on breast cancer only is unclear.

For the prospective study, lead and corresponding author Dr. Susanna C. Larsson, of the Division of Nutritional Epidemiology, National Institute of Environmental Medicine at the Karolinska Institutet, and colleagues, looked at data from 35,329 women in the Swedish Mammography Cohort, who filled in questionnaires about their use of multivitamins and breast cancer risk factors. The women were cancer free and aged between 49 and 83 when they filled in the questionnaires in 1997.

The results showed that:

• 974 women were diagnosed with incident breast cancer over a mean follow up of 9.5 years.
• 293 of the diagnoses were among 9,017 women who reported using multivitamins.
• Use of multivitamins was linked to a statistically significant 19 per cent increased risk of breast cancer (after adjusting for lifestyle and risk factors like weight, diet, smoking, exercise, and family history of breast cancer, the relative risk of women who reported using multivitamins was 1.19, with confidence interval ranging from 1.04 to 1.37).
• Hormone receptor status did not change the strength of this link significantly.

The authors concluded that:

“These results suggest that multivitamin use is associated with an increased risk of breast cancer. This observed association is of concern and merits further investigation.”

Readers concerned about these findings should note that they don’t prove that multivitamins caused the women’s breast cancer: a prospective study, which this was, can only show whether there is a link or not and try and rule out possible influencers.

As Larsson pointed out in an email to Reuters Health, it is possible that something they did not measure is responsible for the link. Also, even if the link was causal, these findings show that for any one woman, using multivitamins has a small effect on her risk of breast cancer, she noted.

However, given the widespread use of multivitamins, there is an important public health message in this study, said the authors.

Speculating on what the biological reasons might be, the researchers mentioned various previous studies that taken as a whole reveal a conflicting picture. For example, some studies on folic acid suggested it increases breast cancer risk while others suggested it has no effect and may even decrease it.

In the meantime, Larsson recommends women eat a healthy and varied diet instead of using pills to get the nutrients they need.

Read more at:
MedicalNewsToday

Increasing rate of HIV/STD disease is being reported among ‘men who have sex with men’ with high risk behaviors in Africa and Asia, according to a groundbreaking paper in the April issue of Sexually Transmitted Diseases, official journal of the American Sexually Transmitted Diseases Association. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

The epidemic of HIV/STD in men who have sex with men (MSM) has been perceived as a public health problem occurring mainly in the Western world. However, three articles in the April issue of the Journal of Sexually Transmitted Diseases, highlight the fact that increasing HIV/STD disease is being reported in MSM with high risk behaviors in Africa and Asia.

In one article, Dr. Yang and colleagues address the associated factors and increasing spread of HIV among MSM in Nanjing, China. Using respondent-driven sampling methods, he reported an HIV incidence rate of 5.12 cases per 100 person years. In a commentary, Dr. Chen et. al. summarize the rapid increase of HIV and syphilis infections among MSM in China which they consider could lead to a potential pandemic in the country. They stress that in recent years, China has considered “MSM as a priority population for HIV prevention and control.”

An editorial by Dr. Mayer and his colleagues points out that MSM exists in all populations. They stress that the simple compartmentalization of the HIV epidemic into one that affects MSM in industrialized countries and is a heterosexual epidemic in developing or less developed countries is not valid. They document the high prevalence of HIV/STD in some MSM populations in Africa and Asia, and emphasize the need to act now to prevent the massive spread of disease. Certainly an epidemic of HIV in MSM can help drive an epidemic among heterosexuals.

That HIV/STD disease transmission in MSM is often hidden in resource poor countries, which may reflect failure of public health programs, or homophobia that stigmatizes MSM behaviors and inhibits MSM seeking medical care. The new research reported in three scholarly articles in the April issue of Sexually Transmitted Diseases demonstrate that MSM high risk behaviors are global and should be acknowledged, so HIV/STD control and prevention programs can be made available for this population. Comprehensive prevention programs for HIV/STD in MSM are necessary to help control spread. Concealing or denying this behavior simply leads to more disease.

Source
MedicalNewsToday

A new study reports a surge in drug-resistant strains of a dangerous type of bacteria in US hospitals: Acinetobacter strikes patients in Intensive Care Units (ICUs) and others and often causes severe pneumonias or bloodstream infection, some of which are now resistant to imipenem, an antibiotic that is reserved for last-line treatment.

The study is the work of researchers at the Extending the Cure project, led by Dr. Ramanan Laxminarayan, of the Washington DC-based think-tank Resources for the Future, and appears as an electronically published paper in the December 23 issue of the journal Infection Control and Hospital Epidemiology. (Extending the Cure is supported by the Robert Wood Johnson Foundation’s Pioneer Portfolio).

As well as affecting ICU and other patients, Acinetobacter infections are arising in soldiers returning from the war in Iraq.

For the study Laxminarayan and colleagues looked at data from 300 hospitals around the US and analyzed trends in resistance to imipenem, a highly potent, broad spectrum antibiotic often reserved as a last-line treatment.

They found that between 1999 and 2006, there was a three-fold plus increase in the proportion of Acinetobacter cases resistant to the drug.

Laxminarayan, who is also a visiting scholar and lecturer at Princeton University, told the media the finding was troublesome because it suggests “this bacteria is becoming resistant to nearly everything in our arsenal”.

“There is a lot of attention on MRSA, but less on infections caused by bacteria like Acinetobacter for which there are fewer drugs in the development pipeline,” he said, adding that “while all drug resistance is of concern, it is particularly worrying in the case of bugs for which we have few treatment options.”

He and his co-authors said the US should adopt a comprehensive solution to the problem of antibiotic resistance. For example, there should be more infection control at a regional level, and drug companies should be encouraged to develop new antibiotics that attack and destroy the resistant strains.

According to the US Centers for Disease Control and Prevention (CDC), Acinetobacter bacteria are common in soil and water, and can also be found on the skin of healthy people, especially those working in the healthcare profession.

The bacteria cause a variety of diseases, ranging from pneumonia to serious blood or wound infections, with varying symptoms, and they can also colonize a patient without showing any signs of infection, especially in tracheostomy sites or open wounds.

While Acinetobacter poses little risk to healthy people, those with weakened immune systems, chronic lung disease, or diabetes may be more susceptible to infections, as are very ill hospitalized patients on ventilators, those with a prolonged stay, or those with open wounds.

The bacteria spread through person-to-person contact, contact with contaminated surfaces, or exposure in the environment.

Source:
MedicalNewsToday

Following our recent report on failings at Basildon and Thurrock University Hospitals NHS Foundation Trust, we have begun exploring when and how we will intervene to protect the public in future cases of suspected systematic failure.

We have appointed Dame Elizabeth Fradd to assist us in identifying how the NMC should address similar failures in healthcare settings when nurses or midwives are involved.

List of triggers

The project will aim to create a list of triggers that might lead to a healthcare setting coming under scrutiny by the NMC, a set of criteria against which that healthcare setting would be evaluated and details of how such interventions will be carried out.

Proactively working

Director of standards and registrations Roger Thompson said:

“The Nursing and Midwifery Council exists to safeguard the health and wellbeing of the public and this includes protecting them when systemic failures prevent nurses and midwives from providing adequate care.

“Over the coming months we will be looking into how and when the NMC should go about proactively working to ensure that neither care of the public nor education of student nurses and midwives is compromised by systemic failings.

“We are looking forward to putting in place a robust system for effectively tackling these cases in the future.”

Determination

Independent health service adviser Dame Elizabeth Fradd said:

“I am delighted to be involved in such an important piece of work which I hope will ensure the future safety of patient care and nursing and midwifery practice. It is a measure of the determination of the NMC to prevent either individual or systemic failings undermining the level of care the public receive from nurses and midwives.”

Working with other organizations

The project, which will be completed this autumn, will also explore ways the NMC can work more productively with other organizations, such as the Care Quality Commission, to improve patient safety and care in healthcare settings where systems appear inadequate.

This is in keeping with the Council for Healthcare Regulatory Excellence’s ‘Performance review of health professional regulatory bodies 2008/09′, which recommends that “regulators give consideration to how they can co-operate more effectively to ensure that any relevant intelligence on individuals or organizations is shared and that cross regulatory learning is encouraged.”

Background

The review into Basildon and Thurrock University Hospitals NHS Foundation Trust was carried out in response to concerns raised in a report in November 2009 by the CQC and Monitor who are the regulators of NHS systems and clinical standards. The extraordinary review looked specifically at the education environment of pre-registration students to make sure it was suitable and safe, whether women in the maternity unit were receiving safe care from midwives and whether the supervision of midwives was meeting the required NMC standards within the trust.

Dame Elizabeth Fradd DBE

Dame Elizabeth Fradd DBE is an independent health service adviser whose work focuses on the continuous improvement of healthcare. She was until April 2004 the Nurse Director and lead Director for the Review and Inspection program in the Commission for Health Improvement (CHI). Prior to this appointment she was Assistant Chief Nurse in the Department of Health. Her current portfolio of work includes commissioned independent inquiries / investigations, the delivery of innovative professional development programs and the mentoring of senior personnel.

Source
Nursing & Midwifery Council

An article published Online First in The Lancet Oncology reports that variations in a gene called GPC5 have been identified. They might contribute to a significantly higher risk of developing lung cancer in people who have never smoked. The findings from the largest effort to determine the genetic changes involved in lung cancer in never smokers (LCINS) suggest that GPC5 might be a new target for investigation and drug development. Furthermore, this could be used to identify high-risk individuals.

People who have never smoked are defined as those who have smoked less than one hundred cigarettes in their lifetime. Lung cancer in those people is an increasing public-health problem. It is responsible for a quarter of all lung cancer cases worldwide. Regardless of numerous attempts to identify the responsible specific genetic mechanisms, the causes of lung cancer in never-smokers remain unclear. Recent studies have identified several candidate genes that have a moderate effect on the risk of lung cancer. However, no study has identified the genetic basis of lung cancer in never smokers.

Ping Yang from the Mayo Clinic College of Medicine, Rochester, USA, led an international team of researchers. They conducted a four-stage study to try and identify genetic variations responsible for increasing the risk of LCINS. The researchers began by examining DNA samples from 754 never smokers. Then they analyzed 331,918 DNA variants known as single nucleotide polymorphisms (SNPs) in 377 matched case-control pairs. This was carried out in order to find the genetic variations most likely to alter the risk of lung cancer in never smokers. Community residents who had never smoked were selected as controls and matched to patients according to age, sex, and ethnic background.

The Mayo genome-wide association study used conditional logistical regression which is a type of statistical analysis. The researchers worked to identify associations between SNPs and lung cancer risk while controlling for history of chronic obstructive pulmonary disease (COPD), exposure to second-hand smoke, and family history of lung cancer. Two specific genetic markers or SNPs (rs2352028 and rs235209) emerged as significant.

To validate their findings, the researchers took the 44 most frequently occurring genetic alterations from the Mayo study. They assessed them in two additional independent groups of never smokers:

• The first group of 735 people (from which 328 were patients and 407 were healthy controls) from the MD Anderson Cancer Center in Houston study
• The second groups of 253 people (from which 92 were patients and 161 were healthy controls) from the Harvard University in Boston study.

The two SNPs remained significant in both these replication sets.

An additional replication of rs2352028 was done in 530 never smokers in the University of California in Los Angeles (UCLA) study. The authors estimate that more than 10 percent of lung cancer cases in never smokers could be attributed to genetic variations at this locus.

Ultimately, a series of statistical analysis and examination of gene-expression levels were carried out. This provided additional explanation of the causal relationship between the two validated SNPs and the risk of LCINS. The results strongly indicated that the top two SNPs were connected with LCINS through their regulation of GPC5 expression.

Additional tests showed that GPC5 expression levels were 50 percent lower in adenocarcinoma which is the most common form of lung cancer than in matched normal lung tissue. This indicates that reduced GPC5 expression could be specific for adenocarcinoma in never smokers.

The authors write in conclusion: “Genetic variants at 13q31.3 alter the expression of GPC5, and are associated with susceptibility to lung cancer in never smokers… Future studies are needed to investigate the regulatory effects of these SNPs (or tagged variants) and the functional role of GPC5 in lung tumorigenesis.”

In an associated statement, Ramaswamy Govindan warns that: “Even though this study reports a two-fold reduction in expression in adenocarcinoma tissues compared to matched normal controls, it is far from clear how reduced GPC5 expression could predispose individuals to lung cancer. More studies are needed to confirm these preliminary observations in the tumor samples from those with no history of tobacco smoking.”

Source:
MedicalNewsToday

BD Diagnostics, a segment of BD (Becton, Dickinson and Company), announced the launch of the BD Protect™ Infection Surveillance and Data Management System, a portfolio of healthcare management software solutions that tracks infections and helps prevent their transmission at three levels — from patient to patient, between patients and healthcare workers, and from community sources to healthcare settings.

“This strategic expansion of BD’s portfolio enables us to provide a set of integrated information solutions to clinicians striving to reduce the incidence and transmission of infections in their facilities,” said Philippe Jacon, President of BD Diagnostics Diagnostic Systems. “It is a natural complement to our rapid molecular and chromogenic assays for detection and diagnosis of these infectious organisms.”

“Preventing the spread of infections is becoming more challenging each day,” said Tracy Gustafson, M.D., Worldwide Director, Infection Prevention Software Development and Medical Affairs, BD Diagnostics Diagnostic Systems. “The problem is magnified by global travel, new and more dangerous microbes, overuse and misuse of antibiotics, healthcare staffing cuts, and risks to immuno-compromised patients. The BD Protect system provides actionable information that assists infection prevention professionals in making timely decisions.”

The Centers for Disease Control and Prevention (CDC) has identified healthcare-associated infections (HAIs) as one of the top 10 causes of death in the United States.(see link) Designed by CDC-trained epidemiologists, the BD Protect system addresses multiple issues confronting healthcare administrators and public health officers, including the transmission of multidrug-resistant organisms in healthcare settings and escalating costs related to HAIs.

The portfolio includes three modules. BD Protect™ Infection Prevention targets reduction of HAIs in patients. BD Protect™ Healthcare Worker Safety monitors employee vaccinations, testing, in-service education, injuries and illnesses to protect both employees and patients.

BD Protect™ Syndromic Surveillance continuously analyzes emergency department patient data for reportable diseases and symptoms that could signal a possible community outbreak. It also can be used at a Health Department to collect and analyze community-wide data from multiple hospitals.

With assistance from the complete BD Protect portfolio, infection preventionists can identify, control and help prevent infections in patients, employees and the community. The software also analyzes length of stay, isolation days and infection costs and supports antibiotic stewardship, enabling hospitals to reduce expenses while providing better patient care.

Source:
BD (Becton, Dickinson and Company)