Archives for: July 2004
STUDY: Topical better then Oral
JOURNAL: J Rheumatol 2003;30:523-528.
AUTHORS: Dr. Cohen
ABSTRACT: A topical glucosamine/chondroitin sulfate cream containing camphor and peppermint oil provides fast and effective relief of pain from osteoarthritis (OA) of the knee.
COMMENTARY: "These results support the growing volume of evidence that glucosamine and chondroitin sulfate are active agents against the pain from OA of the knee, and further suggest that these agents are effective when applied topically," Dr. Marc Cohen and colleagues write.
They randomized 63 patients with OA knee pain unrelieved by other agents to topical glucosamine/chondroitin cream, marketed in the US as Jointflex, or placebo. Patients were instructed to apply the creams as needed for 8 weeks. Average usage was 2.5 applications per day.
A reduction in pain was evident in the active treatment group after 1 day and "clinically significant" improvement" was seen at both 4 and 8 weeks. After 4 weeks, the difference between active and placebo groups in the mean reduction in pain from baseline as assessed by Visual Analog Scale (VAS) was 1.2 (p = 0.03) increasing to 1.8 after 8 weeks (p = 0.002).
In studies of oral glucosamine and chondroitin, effective pain relief is reported only after some weeks of treatment. In this study, they observed a noticeable effect after a single day of use. They were also surprised that the pain relief observed by the topical treatment continually improved over time.
There are theoretical reasons why topical application may be preferable to oral delivery of glucosamine and chondroitin. "Glucosamine is rapidly absorbed from the gastrointestinal tract when taken orally yet it is subject to rapid degradation by the liver and uptake into non-joint tissues," he explained. "Chondroitin on the other hand is poorly absorbed through the gastrointestinal tract. Topical application therefore has the potential to avoid these problems and deliver these substances directly to the painful joint."
Topical application of glucosamine and chondroitin may also modify the underlying disease process, he said, noting that "this has been demonstrated with oral glucosamine."
STUDY: Mothers Milk Best
JOURNAL: Pediatrics 2003;111:1017-1023.
AUTHORS: Dr. Koo
ABSTRACT: Use of palm oil and its more liquid fraction, palm olein, to supplement infant formula may adversely affect skeletal development.
COMMENTARY: Optimization of bone mass can begin during infancy with appropriate nutritional intake," but "infant formulas with similar contents can have different biological outcomes, depending on the ingredients added.
Dr. Koo of Wayne State University, Detroit, and colleagues point out that palm oil and olein "are used in some infant formula fat blends to match the fatty acid profile of human milk." Nevertheless, there is evidence that such additives lower calcium and fat absorption.
To investigate, the researchers conducted a double-blind study of 128 infants who were randomized to receive cow milk-based formulas with or without palm olein. The palm olein-containing formula was Enfamil with iron (Bristol Myers); the palm olein-free was Similac with iron (Abbott Laboratories).
Measurements taken at baseline (2 weeks of age) and at 3 and 6 months showed no significant differences between groups in factors such as weight and formula intake. However, infants fed the palm-containing formula showed significantly lower bone mineral content and bone mineral density at 3 and 6 months.
Matching the fatty acid profile of human milk by using palm olein, the researchers conclude, "may result in an unintended depression of bone mass accretion and may potentially be detrimental to optimal bone health."
JOURNAL: Pediatrics 2003;111:1113-1116.
AUTHORS: Dr. Weiss
ABSTRACT: By the time they reach 6 months of age, all infants should be examined by a pediatrician to determine their risk of developing dental caries.
COMMENTARY: Children who appear most likely to develop caries should perhaps have their first visit with a dentist before the recommended age of 12 months.
More than 40% of US children show signs of tooth decay when they enroll in kindergarten, making the condition many times more common than either asthma or hay fever.
Pediatricians need to be aware of the risk factors for dental caries in young children and, if indicated, make a referral to the dentist, the authors emphasize.
Although tooth decay is a general problem in children, some risk factors have been identified. For example, low socioeconomic status and consumption of sugary foods are known to increase the risk of dental caries.
Still, the direct cause of such disease is generally the overgrowth of certain bacterial types. Dr. Weiss explained that the types of bacteria a person carries in his or her mouth is essentially set by the age of 2 years old. This makes intervening early in life especially important.
Infants are likely get their first dose of these bacteria from their mothers or other close caretakers--often from sharing utensils--so risk assessments involve checking a mother's oral health, which can help determine her child's risk of also inheriting her cavities.
STUDY: Physiotherapy and local steroid injections were of similar effectiveness for treating new episodes of unilateral shoulder pain
JOURNAL: Ann Rheum Dis. 2003;62:385-387, 394-399
ABSTRACT: Steroid injection or physical therapy offers similar outcomes for the treatment of acute unilateral shoulder pain.
COMMENTARY: Community physiotherapy and local steroid injections were of similar effectiveness for treating new episodes of unilateral shoulder pain in primary care, but those receiving physiotherapy had fewer co-interventions.
Although the reasons for lower reconsultation rate during follow-up in the physical therapy group are unclear, the authors noted that it reduced their workload with no change in overall patient outcome.
They recommend that patients and clinicians deciding on acute treatment for shoulder problems consider personal preference, availability of physical therapy and/or of doctors trained in injection, need for cointerventions, and concerns about the long-term effectiveness of steroid injections.
STUDY: Careful with Sunbeds
JOURNAL: BMA's Board of Science and Education
AUTHORS: British Medical Association
ABSTRACT: People should stop using sun beds because of the dangers of ultra-violet radiation.
COMMENTARY: The "Sunbeds" report, from the BMA's Board of Science and Education, calls on the Government to regulate sunbed use after research has shown that some people are having more than 100 sunbed sessions a year.
It's ironic, people use sunbeds because they think they'll look better and yet they will probably end up looking old prematurely and possibly getting skin cancer.
The report said the risk of skin cancer appeared to be greatest for the young, with the chances of developing a tumour increasing by up to 20% per decade of sunbed use before the age of 56.
Other health risks include premature ageing of the skin and damage to the cornea, as people often do not wear protective goggles. There is also increasing evidence that sunbeds have an immunosuppressive effect.
The BMA noted that ultra-violet radiation is sometimes used to treat psoriasis and eczema. However in these circumstances a dermatologist records every dose after each treatment and a lifetime total is recorded as a safety measure. This careful dosing does not happen with tanning salons or when people have sunbeds in their home.
JOURNAL: ARVO 2003 Annual Meeting: Abstract 811/B786, presented May 4, 2003; abstracts 2111 and 2112, presented May 6, 2003.
AUTHORS: J. P. SanGiovanni,K. A. Trivedi
ABSTRACT: Dietary omega-3 fatty acids but not beta-carotene supplementation is associated with a reduced risk of age-related macular degeneration (AMD).
COMMENTARY: Higher intake of omega n-3 long-chain polyunsaturated fatty acid (LCPUFA) and fish was associated with decreased risk of having neovascular AMD after adjusting for nutrient- and nonnutrient-based predictors and correlates of AMD.
Total fish consumption of more than two servings per week was associated with a decreased risk for neovascular AMD compared with no fish in the diet (OR, 0.49; 95% CI, 0.28 - 0.84). Having more than one four-ounce weekly serving of broiled or baked fish (OR, 0.64; 95% CI, 0.44 - 0.94) or tuna (OR, 0.66; 95% CI, 0.45 - 0.98) also protected against neovascular AMD.
A second study, by W. G. Christen, from Brigham and Women's Hospital in Boston, Massachusetts, and colleagues, showed no protective effect of beta-carotene against AMD.
In the third study, by K. A. Trivedi and colleagues from Harvard Medical School in Boston, Massachusetts, women with a higher dietary intake of omega-3 fatty acids were at decreased risk of developing dry eye syndrome (DES).
Of 39,876 women participating in the Women's Health Study, 32,470 female health professionals aged between 45 and 84 years provided information on diet and DES. The highest versus the lowest dietary intake of omega-3 fatty acids was associated with decreased risk of DES (OR, 0.83; 95% CI, 0.70 - 0.98; P for trend = 0.04), after adjustments for age, other demographic factors, postmenopausal hormone therapy, and total fat intake.
STUDY: Maintain your ideal weight
JOURNAL: New England Journal of Medicine April
ABSTRACT: Men and women who were overweight were 52 percent and 62 percent, respectively, more likely to die of cancer than men and women of normal weight. The finding echoes the results of animal studies in which animals fed fewer calories experienced a decreased incidence of tumors and lived longer, compared to animals allowed to consume as much as they wanted.
COMMENTARY: The current investigation enrolled 404,576 men and 495,477 women who were cancer free in 1982, and followed them for 16 years. During this period, 57,145 subjects died from cancers.
The researchers, from the Department of Epidemiology and Surveillance Research at the American Cancer Society, calculated participants’ body mass index (BMI) and examined the relation to deaths from cancers at individual sites and at all sites.
The heaviest male participants, who had a body mass index of at least 40, were 52 percent likelier to die from all cancers than men whose body mass was between 18.5 to 24.9, which is considered normal.
The heaviest women experienced greater cancer mortality than the heaviest men, with a 62 percent higher risk of cancer death than normal weight women, possibly due to the greater incidence of hormonally dependent cancers that have been shown to be associated with adiposity.
Trends of increasing risk of death with greater BMI values were found for cancers of the breast, uterus, cervix and ovary in the female participants, and for cancers of the stomach and prostate in men.
The authors estimate that more 90,000 cancer deaths in the United States could be prevented yearly by normal weight maintenance in men and women.
Given the additional links between obesity and cardiovascular disease, diabetes, and other conditions, maintaining a proper weight is one life-extending measure that no one can afford to ignore.
STUDY: Being Overweight A Risk
JOURNAL: JAMA 2003;289:1799-1804.
AUTHORS: Dr. Katherine Esposito
ABSTRACT: Vascular inflammation markers and insulin resistance improve in obese women after weight loss and lifestyle changes.
COMMENTARY: Elevated levels of proinflammatory cytokines have been associated with indicators of elevated body fat and with cardiovascular disease risk factors.
Obesity itself is an independent risk factor for cardiovascular disease.
Dr. Katherine Esposito and associates from Second University of Naples, Italy measured markers of vascular inflammation and insulin resistance in 120 premenopausal obese women randomly assigned to a program of lifestyle changes designed to provide sustained weight loss.
Prior to the intervention, the obese women had higher levels of serum IL-6, IL-18, and C-reactive protein, as well as higher body-mass indices, insulin resistance, and free fatty acids, compared with nonobese women, the report indicates.
After 2 years of lifestyle change, the authors report, body weight, body-mass index, waist-hip ratio, insulin resistance, blood pressure, and free fatty acid levels had all declined to a greater extent than in the control group.
Serum levels of IL-1, IL-18, and C-reactive protein were significantly reduced in the intervention group compared with controls, the results indicate, while serum levels of adiponectin (a hormone that enhances insulin action) were significantly higher.
Cytokine and C-reactive protein declines correlated with the reduction in body-mass index, while free fatty acid, IL-6, and adiponectin were independent predictors of insulin resistance.
A multidisciplinary program aimed to reduce body weight in obese women through lifestyle changes, including a low-energy Mediterranean-type diet and increased exercise, is feasible and gives sustained results over 2 years, as indicated by the significant reduction of markers of inflammation and improved insulin sensitivity.
The effective prevention of many diseases, including obesity and type 2 diabetes, starts at table with a Mediterranean-type diet and continues with physical activity.
"Although not easy to implement, this strategy will allow us to enjoy the spectacular increase in life expectancy we have experienced in the last century. It is time to move towards a more integrated approach for a large-scale control of obesity, based on lifestyle changes."
"Since both obesity and diabetes are two major risk factors for cardiovascular disease, it is reasonable to hypothesize that any intervention aimed at reducing the prevalence of these two conditions in the population will lead to a decrease of the level of cardiovascular risk," Dr. Esposito concluded.
JOURNAL: Experimental Biology Conference
AUTHORS: Dr. Fred D. Finkelman
ABSTRACT: As many asthmatics know, a blast of diesel exhaust can trigger bouts of wheezing, coughing and other asthma symptoms. Now researchers say they have figured out why these fumes are so tough on those afflicted with the illness.
COMMENTARY: The fine particles in diesel exhaust hit the human immune system with a double whammy, upping the production of an immune protein that triggers asthma attacks while suppressing a second protein that might otherwise bring symptoms to a halt.
Numerous studies have found that individuals living in urban areas or near busy highways are at much higher risk for asthma and other allergies compared with those living in less congested locales. While most experts have suspected diesel fumes as the prime culprit, until now the exact mechanism by which truck exhaust aggravates the immune system has remained unclear.
In their study, Finkelman and his colleagues injected small amounts of diesel exhaust particles into the bloodstreams of mice. The investigators found that, after injection, the mice secreted abnormally high levels of interleukin-6 (IL-6), an immune system protein "released by cells of the immune system in response to substances such as bacteria and viruses that the immune system perceives as dangerous." In the asthmatic lung, this response can go overboard, triggering airway constriction, coughing and congestion.
Luckily, the immune system has a kind of countering mechanism, a protein called interferon-gamma. When released in large quantities, interferon-gamma works to put the brakes on runaway immune responses.
Diesel exhaust appears to dampen interferon-gamma production--giving IL-6 free reign to trigger asthmatic symptoms.
STUDY: Study suggests older remedy may trump new medicines
JOURNAL: Journal of the American Medical Association
AUTHORS: Dr. Jackson T. Wright Jr.
ABSTRACT: An old-fashioned diuretic is as good, if not better, than some newer, more expensive medicines for treating high blood pressure and preventing its complications.
COMMENTARY: Diuretics, commonly called water pills, should be the first medicine prescribed to treat high blood pressure and that, when multiple medications are needed, a diuretic be one of them.
Diuretics, which work by ridding the body of excess sodium and water, have long been used as a standard blood pressure medicine.
The study compared the generic diuretic chlorthalidone with two newer, more expensive blood pressure treatments, the ACE inhibitor lisinopril and the calcium channel blocker amlodipine.
The findings show a slightly greater percentage of patients got their blood pressure below 140/90, which was the goal of the study, when they used the diuretic compared to the two newer medicines.
Researchers also found the diuretic was better than the calcium channel blocker in preventing heart failure and better than the ACE inhibitor in preventing stroke, heart failure and chest pains.
A third blood pressure drug, the alpha blocker doxazosin, was dropped from the study more than two years ago because it proved significantly less effective than diuretic treatment
JOURNAL: Iowa Women's Health Study
AUTHORS: Dr. Paul Limburg
ABSTRACT: Among postmenopausal women, excess body weight is a statistically significant risk factor for the development of colorectal cancer.
COMMENTARY: There have been consistent observational data that have suggested high body mass index is a risk factor for colon and rectal cancer among men and also among women at younger age. But excess body weight is a controversial risk factor for colorectal cancer among postmenopausal women.
Dr. Paul Limburg of the University of Minnesota in Minneapolis and colleagues assessed excess body weight, defined as a BMI > 25, as a predictor of incident colorectal cancer among 35,354 women in the prospective Iowa Women's Health Study.
During roughly a 12-year period, 988 women developed colorectal cancer. For women with excess body weight at baseline, at age 18, 30, and at menopause, the adjusted relative risk of colorectal cancer was 1.32, 1.37, 1.39, and 1.40, respectively.
The risk of colorectal cancer was attenuated among women with a history of excess body weight but no excess body weight at baseline. This suggests that weight loss may help reduce the risk of colorectal cancer.
STUDY: Get Moving
JOURNAL: Arterioscler Thromb Vasc Biol 2002;22:1869-1876.
AUTHORS: Dr. Timothy S. Church
ABSTRACT: Exercise is inversely associated with levels of C-reactive protein (CRP), an inflammatory marker directly related to coronary heart disease risk.
COMMENTARY: The investigators found that men who were the most fit tended to have the lowest CRP levels, while those deemed the least fit had the highest levels. The relationship between CRP levels and exercise remained even after adjusting for age and obesity.
Specifically, the authors discovered that people who were in the second-to-lowest category of fitness were 57% less likely to have elevated CRP levels compared with those in the least fit group.
The risk of elevated CRP decreased incrementally with increasing fitness, with most fit subjects being 83% less likely to have elevated CRP levels than least fit subjects.
The relationship between CRP levels and physical activity in women is probably similar to that in men, but more complicated due to the hormonal changes that occur during menopause.
STUDY: Eat your Greens
JOURNAL: Lancet 2003;361:1316
AUTHORS: Dr. Gad Barkai
ABSTRACT: Impaired folate status may increase the risk of Down's syndrome.
COMMENTARY: Mothers of infants with Down's syndrome are believed to have an elevated risk for abnormal folate metabolism that could result in aneuploidy, Dr. Gad Barkai, of Sheba Medical Centre, Tel Hashomer, Israel, and colleagues explain. However, evidence regarding the rate of genetic polymorphisms in mothers with Down's syndrome offspring is inconsistent.
The multinational research team found that Downs' syndrome and neural tube defects (NTD) arise more often in the same families than would be expected from the incidence of each disorder considered separately.
It is on the basis of such an association, and knowledge that folate supplementation reduces the risk of NTD, that they recommend preconception folate supplementation for mothers at risk.
Dr. Barkai's group reviewed the record of 493 families referred to the Sheba Medical Centre between 1971 and 2001 because of prior pregnancies affected by NTD or isolated hydrocephalus. The families included those with at least one sibling in addition to the proband.
Among the 1492 at-risk pregnancies, there were 11 with Down's syndrome. This rate is significantly higher than the 1.87 affected Down's syndrome cases that would be expected among women of the same age in the general population (p < 0.00001), their report indicates.
They also examined data from 516 families who underwent genetic counseling in the Ukraine because of their risk of Down's syndrome. Among 1847 pregnancies, seven families had children affected by NTD. Again, this is a significant increase from the 1.37 cases expected in the general population (p = 0.0005).
Dr. Barkai's team maintains that genomic instability is minimized when maternal plasma folate exceeds 34 nmol/L and homocysteine levels are kept below 7.5 mcg/L. To achieve such levels, folate intake should be no lower than 5 mg/day.
STUDY: Don't Stress Out
JOURNAL: American Journal of Epidemiology 2003;157:14-24.
AUTHORS: Dr. Nancy Dole
ABSTRACT: While studies on the effects of stress during pregnancy have yielded conflicting results, the latest report finds that it may raise a woman's risk of premature delivery.
COMMENTARY: Pregnant women who said they were experiencing high levels of stress from events such as marital separation, problems with in-laws or issues at work were 80% more likely to have a preterm delivery than those who reported low stress levels.
Overall, there were 71 preterm births and 402 full-term births among women reporting high stress, compared with 39 preterm births and 416 full-term births in the low-stress group.
Among those most at risk are women in low socioeconomic groups who may get inadequate prenatal care and have constant worries about critical issues such as paying rent and putting food on the table.
"Stress is a fight-or-flight kind of phenomenon," Heyl said, explaining that pregnant women under stress may have increased steroid secretions in the womb that can stimulate cellular receptors that control uterine contraction and relaxation. "Chronic stress could over-stimulate those receptors," he said.
The new study involved 1,962 pregnant women who were being treated at two prenatal clinics in North Carolina. In addition to their medical exams, the women were instructed to complete and mail in a survey that asked various questions about their psychological state, stressful life events, social support and other issues that might impact their pregnancies.
There's a general feeling that if women recognize the stress in their lives and can do some stress reduction during pregnancy they can change this risk.
JOURNAL: J Natl Cancer Inst 2003;95:825-828.
AUTHORS: Dr. Eva S. Schernhammer
ABSTRACT: Women who work regular night shifts appear to be at increased risk for colorectal cancer.
COMMENTARY: The findings support earlier research showing that women who work night shifts have a higher risk of breast cancer.
The US Bureau of Labor Statistics estimates that about 4% of adults work rotating night shifts.
Shift work is known to disrupt normal melatonin production and increase levels of other hormones such as estrogen.
Malignancies in women are often associated with estrogen levels, but in the case of colon cancer the data are beginning to show that it may be melatonin, not estrogen, that is influencing cancer risk.
The researchers studied 78,586 women who took part in the Nurses' Health Study. The nurses who worked night shifts at least three times a month for 15 years or more had a 35% greater risk of developing colorectal cancer compared with women who did not work rotating night shifts.
STUDY: Get Your Proberry
JOURNAL: BMJ 2003;326:1235-1240.
AUTHORS: Alexander Sutton
ABSTRACT: A meta-analysis of data from randomised clinical trials supports the efficacy of neuraminidase inhibitors for treating and preventing influenza.
COMMENTARY: The analysis of 17 treatment trials and seven prevention trials by researchers at the University of Leicester showed that oseltamivir (Tamiflu; Roche) and zanamivir (Relenza; GlaxoSmithKline) reduced the odds of developing flu by about 70-90% and cut the duration of symptoms by about a day.
The drugs are both effective at reducing the length of symptoms and incidence if properly administered. They have to be given within 48 hours of onset.
Bottom Line is to get your Proberry.