A new UK study that followed a large number of people found that those who took 10 or more prescriptions for oral bisphosphonates, a group of drugs commonly used to treat the bone disease osteoporosis, were at higher risk of developing esophageal cancer.

You can read about the research behind this finding in a paper published online in the British Medical Journal, BMJ on 2 September. The study was led by a team from the Cancer Epidemiology Unit at the University of Oxford, and the lead and corresponding author of the paper is Dr. Jane Green, a clinical epidemiologist at the Unit.

In Europe and North America, the risk of developing esophageal cancer is very small, typically about 1 per 1,000 people aged 60 to 79 over five years.

Green and colleagues estimated that taking 10 or more prescriptions for oral bisphosphonates and taking them over a period of five years doubles that risk.

However, the authors themselves and experts commenting in an accompanying editorial said this evidence is not enough to justify doctors changing their prescription policy, but they should perhaps prescribe more cautiously and be more vigilant about follow up.

In many countries, including the UK and the US, oral bisphosphonates are the recommended first line drugs for preventing bone fracture in people with osteoporosis, a common disease that affects especially postmenopausal women.

In their paper, the authors note that prescribing of bisphosphonates is increasing; for example in the UK, the percentage of women aged over 70 receiving prescriptions for oral bisphosphonates has gone up from 3 per cent in 2000 to 10 per cent in 2005.

For their study they searched the UK General Practice Research Database cohort for cases where men and women aged 40 and over, with esophageal (2,954 cases), gastric (2,018), and colorectal (10,641) cancer, diagnosed between 1995 and 2005, and their prescription medication were being followed.

To estimate the relative risk of incident invasive cancer of the esophagus, stomach, or colorectum, they matched the cancer cases with controls (5 controls per case) of the same age, sex, attending the same general practice, and who were followed for the same period.

After adjusting the results for known risk factors such as smoking, alcohol and body mass index, the researchers found that:

• The rate of esophageal cancer was increased in patients with one or more previous prescriptions for oral bisphosphonates compared with those who had no prescriptions (relative risk RR was 1.30, 95% confidence interval CI ranged from 1.02 to1.66; statistical significance P=0.02).
• However, this risk was significantly higher in those patients whose records showed they had 10 or more prescriptions (RR 1.93, CI 1.37 to 2.70), compared to those who had 9 or less (RR 0.93, CC 0.66 to 1.31; P for heterogeneity=0.002).
• This was also the case for patients whose records showed they took the drugs for over 3 years: eg. for an average of about 5 years, the RR for prescription vs no prescription was 2.24, with CI 1.47 to 3.43.
• esophageal cancer risk did not differ significantly by bisphosphonate type, and for patients taking 10 or more prescriptions, it did not vary by age, gender, smoking status, alcohol consumption, or body mass index.
• And neither did it vary by diagnosis of osteoporosis, fracture, or upper gastrointestinal disease, nor by whether the patients were also prescribed acid suppressants, non-steroidal anti-inflammatory drugs, or corticosteroids.
• Stomach and colorectal cancers were not associated with being prescribed with bisphosphonates.

The authors concluded that:

“The risk of esophageal cancer increased with 10 or more prescriptions for oral bisphosphonates and with prescriptions over about a five year period.”

They explained that this approximately doubles the small risk of developing esophageal cancer, which in Europe and North America is about 1 per 1,000 people aged 60-79.

They wrote that treatment of osteoporosis is a growing public health concern, “with large scale clinical and economic implications”, and that if confirmed, these findings “would add to our knowledge of the risks and benefits of use of oral bisphosphonates”.

However, they stressed that further studies are needed to “confirm or refute” these findings, and particularly to “examine the associations between use of different types and formulations of bisphosphonates and risk of the different histological types of esophageal cancer”.

Green and colleagues also mention a JAMA study published last month conducted by Cardwell et. al., that also used the UK General Practice Research Database but found no link between oral bisphosphonates and risk of esophageal cancer.

However, they suggest the reason this study has found a link and the JAMA one did not, was the difference in the observation time: Cardwell et. al. analyzed data covering an average of 4.5 years whereas Green et. al. covered 7.7 years on average:

“Our study thus had the potential to include people with longer durations of bisphosphonate use and also had greater statistical power, with five matched controls per case compared with equal numbers in the exposed and comparison groups in Cardwell et. al.’s study,” they write.

Source:
MedicalNewsToday

Girls eating a high-fat diet during puberty, even those who do not become overweight or obese, may be at a greater risk of developing breast cancer later in life, according to Michigan State University researchers.

The implications – that a high-fat diet may have detrimental effects independent of its effect to cause obesity – could drive new cancer prevention efforts.

The findings come from research at MSU’s Breast Cancer and the Environment Research Center, established in 2003 and funded through 2010 by the National Institute of Environmental Health Sciences and the National Cancer Institute.

Physiology professor Sandra Haslam, director of the center, and Richard Schwartz, microbiology professor and associate dean in the College of Natural Science, are now expanding that research with a new, five-year, $2.3 million federal grant. They will use that funding to continue their work studying the impact of prenatal-to-adult environmental exposures that predispose women to breast cancer as part of the extended nationwide Breast Cancer and the Environment Research Program.

“The pubertal time period is crucial, as this is when the basic framework is created for mammary gland development,” Haslam said. “What we are seeing from preliminary research in animals is that a high-fat diet during puberty can lead to the production of inflammatory products in the mammary glands of adults, which can promote cancer growth.”

The work builds on the team’s previous research that found the hormone progesterone activates genes that trigger inflammation in the mammary gland; that inflammation may be a key factor in increasing the risk of breast cancer. Those findings were published last year in the Journal of Steroid Biochemistry and Molecular Biology.

Haslam and Schwartz discovered that a high-fat diet during puberty produced many of the same effects seen as part of their progesterone research.

“Understanding what genes were turned on by progesterone led us to look at some of the same suspects with high-fat diets,” Schwartz said. “It appears both processes may lead to inflammation in the mammary glands.”

Since these inflammatory changes first occur during the crucial time of puberty, a period of intense development and cell division, it can have effects lasting a lifetime.

To test their findings, Haslam and Schwartz will lead a team analyzing two different mouse models of breast cancer and the effects of high-fat diets during puberty. They also will test several anti-inflammation interventions designed to overcome the negative effects of a high-fat diet on inflammation.

The initial MSU Breast Cancer and the Environment Research Center brought together researchers from MSU’s colleges of Natural Science, Human Medicine and Veterinary Medicine to perform research into environmental impacts during puberty that affect breast cancer risk, as well as researchers in the College of Communication Arts and Sciences to study how to best communicate breast cancer health messages to the public.

The next phase of the studies will be through the expanded national Breast Cancer and the Environment Research Program. Besides performing biomedical research, the new project also will strive to communicate findings that can lessen the risk of breast cancer via awareness and avoidance of environmental risk factors. To that end, the Michigan Breast Cancer Coalition and colleagues in MSU’s College of Communication Arts and Sciences are helping bring research findings to the public.

Source: Michigan State University via MedicalNewsToday

Nurse-Family Partnership®, a leading non-profit organization addressing the needs of low income, first-time parents and their children, has received a $210,000 grant from the WellPoint Foundation. The WellPoint Foundation, a private, non-profit organization wholly funded by WellPoint, Inc., promotes WellPoint’s inherent commitment to enhance the health and well-being of individuals and families in communities that WellPoint’s affiliate health plans serve. The grant will be used to help augment Nurse-Family Partnership (NFP) nurse home visitors’ ongoing educational and monitoring efforts to reduce the rate of low birth-weight newborns among women enrolled in the NFP program.

The grant is specific to NFP sites in California, Colorado, Kentucky, Missouri, Nevada, New York, Ohio, and Wisconsin. More than 400 NFP nurses and close to 5,000 NFP clients stand to benefit from this funding.

“We are grateful to the WellPoint Foundation for their generous support of NFP’s efforts to help more women deliver healthy babies,” said Thomas R. Jenkins, Jr., President and CEO, Nurse-Family Partnership.

“While NFP has strong evidence of helping to reduce pre-term deliveries which are associated with low birth weight there is much to be done, especially with more than 600,000 first-time mothers eligible for NFP every year,” Jenkins added. “This grant will help our educational outreach efforts considerably.”

“The WellPoint Foundation is proud to support Nurse-Family Partnership in their efforts to increase the number of healthy pregnancies in these communities,” said Lance Chrisman, Executive Director, WellPoint Foundation. “We have high hopes that this grant will reap measurable benefits for families.”

Today, Nurse-Family Partnership serves more than 22,000 families in 32 U.S. states in a program of ongoing nurse home visitation.

Source: Nurse-Family Partnership

The Royal College of Nursing (RCN) called for sustained investment to make 24-hour district nursing a reality in all areas, as they responded to the Second Annual Report on the End of Life Care Strategy.

Dr. Peter Carter, RCN Chief Executive & General Secretary, said: “Progress is clearly being made towards ensuring that no matter where or when a person dies, they are afforded the same exemplary standards provided by hospices. This aim will only be achieved when round-the-clock District Nursing teams are available everywhere.

“District Nurses provide expert symptom control, care and dignity for patients at the end of their lives. With this support, patients are often able to die at home in the way they choose, which in turn helps loved ones through their bereavement. All too often, they are admitted to hospital during the night simply due to the unavailability of district nursing services. This adds not only to the patient’s distress in their last hours but to the suffering of the bereaved.”

Source:
Royal College of Nursing

The US Centers for Disease Control and Prevention (CDC) said this week that updated estimates of flu deaths in the US in recent decades show that rather than widely cited annual figure of 36,000, which is too high anyway, the estimated numbers have fluctuated from as low as 3,500 to as high as nearly 49,000, depending on which flu viruses have been prominent.

Based on the revised estimates, the annual average is closer to 23,000, significantly lower that the previously cited 36,000. But even that figure is misleading because of the wide fluctuations, said the federal agency.

The CDC published the updated estimates for the period 1976 to 2007, the latest year for which national death certificate reports are available and so it excludes the period of the 2009 H1N1 pandemic, in the 27 August issue of their Morbidity and Mortality Weekly Report (MMWR).

The federal agency explained that the widely cited estimate of 36,000 annual flu deaths was based on an estimating model that only covered the 1990s, which were dominated by influenza A (H3N2) viruses.

“Seasons when influenza A (H3N2) viruses were prominent had 2.7 times more influenza-associated deaths than years when influenza A (H1N1) or B viruses were prominent,” said the CDC in a statement.

Experts believe that one reason could be because H3N2 mutates more quickly, thus rendering ineffective any immunity people might have from a previous infection.

Using death certificate reports covering 1976 to 2007, the CDC looked at two categories of underlying cause of death, pneumonia and influenza causes and respiratory and circulatory causes, to estimate the lower and upper bounds for the number of flu-related deaths.

Their estimates show that about 90 per cent of flu-related deaths were of adults aged 65 and over. This is in stark contrast to the recent H1N1 swine flu pandemic which claimed mostly younger lives.

The CDC also analyzed the figures by flu virus type and subtype to see if there were any links between these and the numbers of deaths in a season.

They found that flu-related deaths varied significantly each year, by type of circulating flu virus, and by age group, and suggest that future summaries should show estimates according to these categories rather just lump them all together into one annual figure.

Because the deaths vary so much in this way from year to year, the overall message is that “there is no average flu season”, as Dr. David Shay of the CDC’s National Center for Immunization and Respiratory Diseases, said in a news conference reported by the Los Angeles Times. Shay is also the lead author of the new report.

Shay said we still have no way of predicting which strains will dominate when a new flu season begins, even in the first few weeks, the picture is unclear.

He urged people to follow the CDC’s recommendation and get vaccinated every year as the best way to protect themselves from the flu.

Source:
MedicalNewsToday

It’s common knowledge that exercise, even light amounts, can have many health benefits, especially for those who are getting older or are at high risk for such diseases as diabetes or heart disease. Throughout the years, medical researchers have been trying to establish how, exactly, exercise may affect moods. Previous studies have demonstrated a positive relationship between “happiness” and light exercise activities. Those suffering from depression have likewise been told to exercise to combat the disorder’s debilitating mood impairments.

However, a recent study has indicated that there may exist a relationship between exercise and the moderation of anger. The study was conducted at the University of Georgia and presented at the American College of Sports Medicine. Researchers found a group of undergraduate male students who indicated through a questionnaire that they were particularly prone to anger.

Members of the group were shown pictures containing anger-inducing images, like children in war situations and Ku Klux Klan gatherings. Many of these images triggered electrical activity in the brain that demonstrated the members of the test group were angry. The anger was confirmed after the subjects filled out a questionnaire asking their then current level of anger.

Every other day, one group of men was asked to sit quietly while the other group was asked to exercise on a stationary bike for 30 minutes. Of those who didn’t exercise, the average anger levels stayed about the same. However, for those who did exercise, the images did provoke anger, but the levels very quickly subsided after viewing the images.

While the study only demonstrated rather loosely that exercise can curb anger in a short time frame, other studies have shown that long-term exercise may substantially change the brain. The New York Times article that reported on the anger and exercise study also noted a 2007 Yale experiment in which it was shown that long-term running significantly altered the expression of several genes related to mood.

These recent studies and experiments can give renewed hope for patients who are suffering from mood disorders. Although medications can effectively treat many with such disorders, doctors emphasize the need for patients who struggle with mood to implement positive lifestyle changes. Insofar as this particular study is concerned, however, Nathaniel Thom, the leader of the study, suggested that if we find ourselves approaching a potentially angry situation, we should go for a run before confronting the situation.

By-line:
This guest post is contributed by Tisha Dotson, who writes on the topics of medical coding certification.  She welcomes your comments at her email Id: tishadotson86@gmail .com.

For the first time, an international team of medical researchers has successfully treated patients with a fatal and rare skin disease called recessive dystrophic epidermolysis bullosa (RDEB) using bone marrow stem cells: so far 10 children with an aggressive form of the disease have been treated successfully although two have since died from related complications.

Drs. John E. Wagner and and Jakub Tolar from the University of Minnesota Medical School in the US and colleagues from Portland, Oregon, also in the US as well as colleagues in the UK and Japan, wrote about their research in a paper published in the New England Journal of Medicine on 12 August.

Epidermolysis bullosa (EB), is a rare, genetic skin disease where even the slightest friction causes the skin to blister and scrape off. As well as affecting skin, EB also affects the lining of the mouth and the esophagus.

EB varies widely in severity and forms, the most severe of which are generally lethal. Patients with more severe forms are very fragile, living in constant pain and scarring, which can leave them disfigured and disabled, and they often die young.

The website EB Info World describes the condition as one where the skin has no anchors to hold its layers together. For instance, people with RDEB have no collagen 7, the protein responsible for keeping layers of skin “glued” to one another and to the body.

The National Epidermolysis Bullosa Registry estimates that EB occurs in 20 newborns per 1 million live births in the United States. While the exact number of people with EB is unclear, estimates suggest there are around 25,000 – 50,000 Americans living with EB, most of which have the simplex form, which is mild and for which they may not even seek medical help. But a minority of people with EB have severe forms like Recessive Dystrophic EB, requiring hours of daily intense care, because any activity that rubs or causes pressure produces a painful sore akin to a second-degree burn.

A child born with a severe form EB has an extremely difficult life ahead; it will scream with pain when bathed, it will never run and jump and play like other kids, as even the act of crawling as an infant will cause its knees to bleed. Parents and carers of babies with severe EB painstakingly wrap each of their little fingers with Vaseline gauze and then more gauze to try and prevent their hands from scarring, webbing and contracting.

Despite this, many teenagers with severe EB have stumps for hands because their fingers have scarred and healed together. Of those who go on to live to their 20s and 30s, most develop an aggressive form of skin cancer. Some countries have even considered euthanasia for newborns with the severest forms of EB.

That is because until now there has been no treatment and no chance of a cure.

This study is the first to show that bone marrow stem cells can home to the skin and upper gastrointestinal tract and change the natural course of the disease.

Wagner, who is University of Minnesota Medical School’s director of pediatric blood and marrow transplantation and clinical director of the Stem Cell Institute, told the press that:

“Whether stem cells from marrow could repair tissues other than itself has been quite controversial.”

“But in 2007 we found a rare subpopulation of marrow stem cells that could repair the skin in laboratory models. This astounding finding compelled us to test these stem cells in humans. This has never been done before,” he added.

Tolar, an associate professor of pediatric transplantation at the Medical School said they found that:

“Stem cells contained in bone marrow can travel to sites of injured skin, leading to increased production of collagen which is deficient in patients with RDEB.”

Tolar went on to explain that bone marrow trasplants are one of the riskiest yet also one of the most successful procedures in medicine.

“Patients who otherwise would have died from their disease can often now be cured. It’s a serious treatment for a serious disease,” he added.

Wagner, Tolar and colleagues started working on the study in 2007. Since then 10 children with the most aggressive forms of EB have received bone marrow transplants at the University of Minnesota Amplatz Children’s Hospital, with some responding better than others.

Wagner said you have to look at these results in context: “you have to understand how horrible this disease actually is,” he urged, in order to understand the achievement.

“From the moment of birth, these children develop blisters from the slightest trauma which eventually scar. They live lives of chronic pain, preventing any chance for a normal life. My hope is to do something that might change the natural history of this disease and enhance the quality of life of these kids,” said Wagner.

In their paper, Wagner, Tolar and colleagues describe how they treated seven children with RDEB between October 2007 and August 2009 with “immunomyeloablative chemotherapy and allogeneic stem-cell transplantation”.

The aim was to increase the amount of C7 expression which they assessed “by means of immunofluorescence staining” and use of “transmission electron microscopy to visualize anchoring fibrils”. They also kept a photographic record of blister formation and wound healing.

In their results they reported that one patient died of “cardiomyopathy before transplantation”, and of the remaining six, one had “severe regimen-related cutaneous toxicity”, while all had improved wound healing and reduced blister formation between 30 and 130 days after receiving the new bone marrow.

One further patient died at 183 days after transplant “as a consequence of graft rejection and infection”. The other five were alive 799 days after transplantation.

The researchers concluded that:

“Increased C7 deposition and a sustained presence of donor cells were found in the skin of children with recessive dystrophic epidermolysis bullosa after allogeneic bone marrow transplantation.”

They said further studies should now be done to “assess the long-term risks and benefits of such therapy in patients with this disorder”.

Wagner and Tolar are continuing to assess the progress of the children. They are checking their overall health and the strength of their skin, and also using lab tests to see how well the donor cells are integrating into their skin, as well as measuring levels of collagen 7.

“What we now know is that after this treatment, healthy donor cells reside in the skin, collagen 7 consistently increases over time and the skin gradually becomes more resistant to blister formation,” said Wagner.

“This discovery expands the scope of marrow transplantation and serves as an example of the power of stem cells in the treatment of disease,” he added.

“While the treatment offers a chance for a better life, it comes with significant risk,” said Tolar. “Two children have died from complications related to the treatment, so refinements are needed.”

Source:
MedicalNewsToday