Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Reblog] Could finding more cancer lead us to understand risk factors less?

From an article at the HealthNewsReview.org blog, by Michael Joyce

An opinion piece in last week’s Annals of Internal Medicine argues that just how aggressively we screen for some cancers can actually distort our understanding of the risk factors for a particular cancer, as well as how common we perceive it to be.

The authors describe ‘scrutiny-dependent’ cancers  — those subtypes of cancers often picked up with screening that are commonly referred to as slow-growing, indolent, subclinical, or even as pre-cancerous — and that often don’t progress to cause health problems or shorten lives. Prostate cancer and thyroid cancer are two such examples.

They propose two common ways in which aggressive screening can distort our understanding of these cancers:

  • The push for ‘early detection’ leads to more scrutiny-dependent cancers being found which, in turn, gives the false impression of an increased incidence of some cancers.
  • Aggressive screening of the family members of someone with cancer means more cancer will be found. This could give the impression of family history being more of a risk factor than it may actually be.
    ….
  • Breast cancer found by mammography, ultrasound, or MRI is more likely to be indolent than that found by self-examination. As we screen with more advanced technologies capable of finding smaller and smaller tumors, we will find more cases of cancer but also more cases that don’t develop into cancer. This not only represents overdiagnosis, but can also give the false impression of breast cancer being more common than it really is

“In the 80’s and 90’s the prevailing message from the media was screen, screen, screen,” said Brawley. “Only in the past 10-15 years have some reporters begun to question this. And this goes for advocacy groups too, who have an understandable emotional conflict of interest because they care about a particular disease. I know, I work for one. But, both reporters and advocates need to be truthful and accurate about screening. Because people can get hurt.

,,\…
In short, Welch and Brawley firmly believe that screening should be based on rigorously tested evidence. In some cancers that evidence is clear, while for other cancers (‘scrutiny-dependent’ ones) the evidence is lacking. Media messages about cancer screening need to do a better job communicating that uncertainty. 

January 9, 2018 Posted by | health care | , , , , | Leave a comment

Loneliness and Social Isolation as Risk Factors for Mortality A Meta-Analytic Review

From the article, Perspectives on Psychological Science, March 2015  vol. 10 no. 2 227-237

Several lifestyle and environmental factors are risk factors for early mortality, including smoking, sedentary lifestyle, and air pollution. However, in the scientific literature, much less attention has been given to social factors demonstrated to have equivalent or greater influence on mortality risk (Holt-Lunstad, Smith, & Layton, 2010). Being socially connected is not only influential for psychological and emotional well-being but it also has a significant and positive influence on physical well-being (Uchino, 2006) and overall longevity (Holt-Lunstad et al., 2010House, Landis, & Umberson, 1988Shor, Roelfs, & Yogev, 2013). A lack of social connections has also been linked to detrimental health outcomes in previous research. Although the broader protective effect of social relationships is known, in this meta-analytic review, we aim to narrow researchers’ understanding of the evidence in support of increased risk associated with social deficits. Specifically, researchers have assumed that the overall effect of social connections reported previously inversely equates with risk associated with social deficits, but it is presently unclear whether the deleterious effects of social deficits outweigh the salubrious effects of social connections. Currently, no meta-analyses focused on social isolation and loneliness exist in which mortality is the outcome. With efforts underway to identify groups at risk and to intervene to reduce that risk, it is important to understand the relative influence of social isolation and loneliness.

Living alone, having few social network ties, and having infrequent social contact are all markers of social isolation. The common thread across these is an objective quantitative approach to establish a dearth of social contact and network size. Whereas social isolation can be an objectively quantifiable variable, loneliness is a subjective emotional state. Loneliness is the perception of social isolation, or the subjective experience of being lonely, and thus involves necessarily subjective measurement. Loneliness has also been described as the dissatisfaction with the discrepancy between desired and actual social relationships (Peplau & Perlman, 1982).

March 21, 2015 Posted by | Consumer Health, Public Health | , , , , , , , , | Leave a comment

[News release] ​ Workplace Lifestyle Intervention Program Improves Health, Reduces Diabetes and Heart Disease Risks

In the past I’ve posted items that argue against workplace health programs. Perhaps some programs are better than others.

From the 6 March 2015 University of Pittsburg news release

A healthy lifestyle intervention program administered at the workplace and developed by the University of Pittsburgh Graduate School of Public Healthsignificantly reduces risk factors for diabetes and heart disease, according to a study reported in the March issue of the Journal of Occupational and Environmental Medicine.
The program was well-received by participants at Bayer Corp., who lost weight and increased the amount of physical activity they got each day, when compared with a control group in the study, which was funded by the National Institutes of Health.
“Health care expenditures associated with diabetes are spiraling, causing widespread concern, particularly for employers who worry about employee health and productivity,” said lead author M. Kaye Kramer, Dr.P.H., assistant professor in Pitt Public Health’sDepartment of Epidemiology and director of the school’s Diabetes Prevention Support Center. “This leads to an interest in workplace health promotion; however, there are very few evidence-based programs that actually demonstrate improvement in employee health. This study found that our program not only improves health, but also that employees really like it.”
This demonstration program is based on the U.S. Diabetes Prevention Program (DPP), a national study that found people at risk for diabetes who lost a modest amount of weight through diet and exercise sharply reduced their chances of developing diabetes, outperforming people who took a diabetes drug instead.

March 10, 2015 Posted by | Workplace Health | , , , , , , , | Leave a comment

[Magazine article] Reducing Lifestyle Diseases Means Changing Our Environment

 

From the 5 February 2015 Scientific American article

How and why our bodies are poorly suited to modern environments—and the adverse health consequences that result—is a subject of increasing study. A new book The Story of the Human Body by Daniel Lieberman, chair of the Department of Human Evolutionary Biology at Harvard, chronicles major biological and cultural transitions that, over the course of millions of years, transformed apes living and mating in the African forests to modern humans browsing Facebook and eating Big Macs across the planet.

“The end product of all that evolution,” he writes, “is that we are big-brained, moderately fat bipeds who reproduce relatively rapidly but take a long time to mature.”

But over the last several hundred generations, it has been culture—a set of knowledge, values and behaviors—not natural selection, that has been the more powerful force determining how we live, eat and interact. For most of our evolutionary history, we were hunter-gatherers who lived at very low population densities, moved frequently and walked up to 10 miles a day in search of food and water. Our bodies evolved primarily for and in a hunter-gatherer lifestyle.

….

 

Read the entire article here

 

February 7, 2015 Posted by | Consumer Health, Public Health | , , , , | Leave a comment

[News]Checklist devised to spot elderly patients most at risk of death — ScienceDaily

Checklist devised to spot elderly patients most at risk of death — ScienceDaily.

English: An elderly patient at St. Elizabeths ...

English: An elderly patient at St. Elizabeths Hospital in Washington, D.C. (Photo credit: Wikipedia)

Excerpt

Date:January 22, 2015
Source:BMJ-British Medical Journal
Summary:A checklist has been designed to spot elderly hospital patients likely to die within the next three months, a new article outlines. The researchers emphasize that the checklist is not intended to substitute healthcare for the elderly who are terminally ill. Instead, it is meant to “provide an objective assessment and definition of the dying patient as a starting point for honest communication with patients and families about recognizing that dying is part of the life cycle.”
From the journal article
Screen Shot 2015-01-26 at 4.26.59 AM

January 26, 2015 Posted by | health care, Medical and Health Research News | , , , , , | Leave a comment

[Press release] The Lancet: Reducing just 6 risk factors could prevent 37 million deaths from chronic diseases over 15 years

From the 2 May 2014 press release

Reducing or curbing just six modifiable risk factors—tobacco use, harmful alcohol use, salt intake, high blood pressure and blood sugar, and obesity—to globally-agreed target levels could prevent more than 37 million premature deaths over 15 years, from the four main non-communicable diseases (NCDs; cardiovascular diseases, chronic respiratory disease, cancers, and diabetes) according to new research published in The Lancet.

Worryingly, the findings indicate that not reaching these targets would result in 38.8 million deaths in 2025 from the four main NCDs, 10.5 million deaths more than the 28.3 million who died in 2010.

This is the first study to analyse the impact that reducing globally targeted risk factors will have on the UN’s 25×25 target to reduce premature deaths from NCDs by 25% relative to 2010 levels by 2025.

Using country-level data on deaths and risk factors and epidemiological models, Professor Majid Ezzati from Imperial College London, UK, and colleagues estimate the number of deaths that could be prevented between 2010 and 2025 by reducing the burden of each of the six risk factors to globally-agreed target levels—tobacco use (30% reduction and a more ambitious 50% reduction), alcohol use (10% reduction), salt intake (30% reduction), high blood pressure (25% reduction), and halting the rise in the prevalence of obesity and diabetes.

Overall, the findings suggest that meeting the targets for all six risk factors would reduce the risk of dying prematurely from the four main NCDs by 22% in men and 19% for women in 2025 compared to what they were in 2010. Worldwide, this improvement is equivalent to delaying or preventing at least 16 million deaths in people aged 30󈞲 years and 21 million in those aged 70 years or older over 15 years.

The authors predict that the largest benefits will come from reducing high blood pressure and tobacco use. They calculate that a more ambitious 50% reduction in prevalence of smoking by 2025, rather than the current target of 30%, would reduce the risk of dying prematurely by more than 24% in men and by 20% in women.

…….

 

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May 3, 2014 Posted by | Consumer Health, Medical and Health Research News | , , , , | Leave a comment

[Reblog] Progress: Diet And Lifestyle Advice For Diabetes ‘No Different’ Than General Public

From the 14 October post at Science Blogging – Science 2.0

A new paper suggests that lifestyle advice for people with diabetes should be no different from that for the general public – but diabetes may benefit more from that same advice.

In the study, the researchers investigated whether the associations between lifestyle factors and mortality risk differ between individuals with and without diabetes.

Within the European Prospective Investigation into Cancer and Nutrition (EPIC), a cohort was formed of 6,384 persons with diabetes and 258,911 EPIC participants without known diabetes. Computer modelling was used to explore the relationship (in both those with and without diabetes) of mortality with the following risk factors: body-mass index, waist/height ratio, 26 food groups, alcohol consumption, leisure-time physical activity, smoking.

The researchers found that overall mortality was 62% higher in people with diabetes compared with those without. Intake of fruit, vegetables, nuts, seeds, pasta, poultry and vegetable oil was related to a lower mortality risk, and intake of butter and margarine was related to an increased mortality risk.

While the strength of the association was different in those with diabetes versus those without, the associations were in the same direction in each case (see table 2 full paper). No differences between people with and without diabetes were detected for the other lifestyle factors including adiposity, alcohol consumption, physical activity, and smoking.

The authors say: “It appears that the intake of some food groups is more beneficial (fruits, legumes, nuts, seeds, pasta, poultry, vegetable oil) or more detrimental (soft drinks, butter, margarine, cake, cookies) with respect to mortality risk in people with diabetes. This may indicate that individuals with diabetes may benefit more from a healthy diet than people without diabetes. However, since the directions of association were generally the same, recommendations for a healthy diet should be similar for people with or without diabetes.”

 

 

October 15, 2013 Posted by | Consumer Health, Medical and Health Research News, Nutrition | , , , , , | Leave a comment

Disease and death in America: A poor bill of health | The Economist

“as Americans live longer, they are living longer with illness.”
“The top driver of disease is a bad diet.”

 

THE POLICY THINKSHOP "Think Together"

Health insurance coverage to help you fix decades of high cholesterol will probably not save your life.  This is the problem that America faces as it is found to be sick because of health behaviors it does not want to change.  We have the freedom to act very unhealthy and to get sick.  How much will increasing insurance coverage really improve our health?

“THE Affordable Care Act, or Obamacare, faces an immediate problem. The deadline for its insurance expansion is January 1st, but each week brings some new obstacle. Even if Obamacare overcomes these, a long-term challenge will remain: the law may not improve Americans’ health. And that health is dismal, as illuminated in vivid new detail on July 10th.

Christopher Murray and his colleagues at the University of Washington have new research on which ailments plague Americans, and why. Dr Murray is due to present his findings at the…

View original post 52 more words

July 17, 2013 Posted by | Consumer Health, Health News Items | , , , , | Leave a comment

Economic Environment During Infancy Linked With Substance Use, Delinquent Behavior in Adolescence

Us unemployment rates 1950 2005

Us unemployment rates 1950 2005 (Photo credit: Wikipedia)

While correlation doesn’t equate cause/effect…there just may be something here…

From the 31 December 2012 article at ScienceDaily

The larger economic environment during infancy may be associated with subsequent substance use and delinquent behavior during adolescence, according to a report published Online First by Archives of General Psychiatry, a JAMA Network publication.

“The results demonstrate a strong correlation between the unemployment rate during infancy and subsequent behavioral problems. This finding suggests that unfavorable economic conditions during infancy may create circumstances that can affect the psychological development of the infant and lead to the development of behavioral problems in adolescence,” the authors note.

According to the study results, exposure to a 1 percent deviation from mean regional unemployment rates at the age of 1 year was associated with an increase in the odds ratios of engaging in marijuana use (1.09), smoking (1.07), alcohol use (1.06), arrest (1.17), gang affiliation (1.09), and petty (1.06) and major theft (1.11). No significant associations were noted with the use of hard drugs and assaultive behavior, the results indicate.

“Although the past does not necessarily predict the future, it provides important lessons. Our findings suggest an important static risk factor that mental health professionals may want to take into account when dealing with children exposed to the current economic crisis,” the authors conclude. “We hope that the study inspires mental health professionals to look for potential causes and explore interventions that can mitigate some of these long-term consequences.”

 

 

 

Read the entire article here

January 2, 2013 Posted by | environmental health | , , , , , , | Leave a comment

[Reblog] Clustering of unhealthy behaviours over time Implications for policy and practice

 

From The Kings Fund (UK site)

Summary

People’s lifestyles – whether they smoke, how much they drink, what they eat, whether they take regular exercise – affect their health and mortality. It is well known that each of these lifestyle risk factors is unequally distributed in the population.

Less is known about how these behaviours co-occur or cluster in the population and about how these patterns of multiple lifestyle risk have been evolving over time. This paper considers this in the context of the English population and sets out the implications for public health policy and practice that flow from the findings.

It reviews the current evidence on multiple lifestyle risks and analyses data from the Health Survey for England on the distribution of these risks in the adult population and how this is changing over time.

You can also download the supporting methodology and data appendices (98 kb) [pdf]

Key points

  • The overall proportion of the English population that engages in three or four unhealthy behaviours has declined significantly, from around 33 per cent of the population in 2003, to 25 per cent in 2008.
  • These reductions have been seen mainly among those in higher socio-economic and educational groups: people with no qualifications were more than five times as likely as those with higher education to engage in all four poor behaviours in 2008, compared with only three times as likely in 2003.
  • The health of the overall population will improve as a result of the decline in these behaviours, but the poorest and those with least education will benefit least, leading to widening inequalities and avoidable pressure on the NHS.

Policy implications

More effective ways must be found to help people in lower socio-economic groups and those with the least education to improve their health behaviours.

This requires a more holistic approach to policy and practice, addressing lifestyles that encompass multiple rather than individual unhealthy behaviours.

In addition, behaviour change should be linked more closely to inequalities policy and be focused more directly on improving the health of the poorest.

More research and better use of the data already available is key. In particular, it would be helpful to know whether it is easier or harder to change the behaviour of those with multiple risks, whether it is more effective to tackle the risks in sequence or in tandem, what the most cost-effective approaches are and what we can learn from other areas of care.

 

September 6, 2012 Posted by | Public Health | , , | Leave a comment

Pollution, Crime, and Education by Mike the Mad Biologist (And a Somewhat Related Mental Health Study)

This short blog entry points to examples of how there is most likely links between air pollution and brain development and function. For example a recent study indicates schools in areas of high air pollution have higher rates of absenteeism. Crime rates have gone down in areas where lead removal was a high priority.

While it can be argued there is no cause and effect in these cases, correlations do warrant further study.

Past blogs here have included articles on the interconnection between healthy environments and healthy people. In my humble opinion, it just makes sense that if one lives in surroundings with high risk factors, one will develop conditions and diseases one is predisposed to (and perhaps more!).

A related article in the professional literature examines the links between mental health and neighborhoods.While it does not address pollution, it does have a similar holistic approach in considering the many factors which may affect a person’s health and well being.

The authors conclusion-

This study has shown that for people living in deprived areas, the quality and aesthetics of housing and neighbourhoods are associated with mental wellbeing, but so too are feelings of respect, status and progress that may be derived from how places are created, serviced and talked about by those who live there. The implication for regeneration activities undertaken to improve housing and neighbourhoods is that it is not just the delivery of improved housing that is important for mental wellbeing, but also the quality and manner of delivery.

January 30, 2012 Posted by | environmental health | , , , , , , | Leave a comment

10 (strongly suggested yet humorous) commandments for physicians when prescribing treatments

Unnecessary reliance on screening tests and the underuse of personalized medicine are two major concerns I have with the present practice of medicine. Hence the selection of this article for a blog item.

Mayo’s Dr. Victor Montori and his team argue that medical intervention success is best be measured in holistic terms as death, quality of life, and ability to function. This is in direct opposition to current industry and professional guideline standards which emphasizes narrow (and often misleading) outcomes as blood pressure reduction, lipid levels, and glucose levels.

The team’s analysis with “10 commandments” for physicians is published in the 28 December 2011 article The idolatry of the Surrogate. The article, unfortunately, is only available through paid subscription through the BMJ (British Medical Journal – Helping Doctors Make Better Decisions).***
The commandments basically encourage physicians to be careful with statistical results from clinical trials, information from industry experts, and to treat and respect the patient as individual with treatment related statistics as guides.

On a related note, I am very impressed with folks who empower themselves in treatment decisions by keeping up with biomedical breakthroughs, new treatments, and new ways of looking at diseases. I have posted related blogs as ePatients: The hackers of the healthcare world and Meet e-patient Dave – a voice of patient engagement.

Here is the abstract of the article
Easier to measure surrogate outcomes are often used instead of patient important outcomes such as death, quality of life, or functional capacity when assessing treatments. John Yudkin, Kasia Lipska, and Victor Montori argue that our obsession with surrogates is damaging patient care
Diabetes care is largely driven by surrogates. The US Institute of Medicine defines surrogates as “biomarker[s] intended to substitute for a clinical endpoint [and] expected to predict clinical benefit (or harm . . .) based on epidemiologic, therapeutic, pathophysiologic, or other scientific evidence.”1 In diabetes, concentrations of glycated haemoglobin (HbA1c) are used as a surrogate marker for outcomes that are important to patients, such as blindness or amputation. Other surrogates such as blood pressure, lipids, albumin excretion rates, and C reactive protein have been used to predict outcomes of cardiovascular disease and to guide clinical practice in people with or without diabetes. Much of the evidence for clinical interventions is based on their effect on surrogate outcomes rather than those that matter to patients such as quality of life or avoidance of vision loss or renal failure. Moreover, because these “hard” end points generally show much smaller responses to interventions than surrogate markers, many of the widely accepted strategies for diabetes may be based on artificially inflated expectations.
Recent studies have challenged the assumption that reliance on surrogates can accurately predict the effect of treatment on hard outcomes. There are the oral hypoglycaemic drugs that reduce HbA1c but increase the risk of cardiovascular events,2 antihypertensive drugs that do not reduce the risk of stroke,3 and drugs that improve cholesterol profiles but do not reduce cardiovascular events.4 Explanations for such phenomena include unwanted effects of the drug or an incomplete understanding of the pathophysiology of the disease.5 But why have …

Below are listed the the ten commandments**** with definitions and paraphrasing. I have forgotten much more than I have remembered from a college statistics class 30+ years ago! The “explanations” are a result of finding quality information on the Internet.

(For a great “translation” with less math, please go to the blog posting …Get Your Doctor to Treat You Right)

The New Therapeutics: Ten Commandments

  •     Thou shalt treat according to level of risk rather than level of risk factor.

Level of risk – these levels are experienced by everyone, not just those having the disease being treated
[good summary of risk levels (minimal, less than minimal, greater than minimal) ]

Risk factor -anything that makes it more likely you will get a disease, either something you do (smoking)or something you have no control over (as being over 50 makes it more likely you will get colon cancer.  People should be given treatments based on the risks associated with the treatment on anyone,not  individual factors (age, blood pressure, other conditions)

  • Thou shalt exercise caution when adding drugs to existing polypharmacy.



Polypharmacy – (poly is Greek for many) Whenever a person is taking a drug, any additional drugs may interact and cause bad reactions, including death.

  • Thou shalt consider benefits of drugs as proven only by hard endpoint studies.


Endpoint study – research study involving humans where the outcomes (results) directly address the question. For example, if a drug was tested on how it reduced heart disease, the hard endpoint would be the reduction of heart disease.  However, hard endpoint studies are usually not accomplished in short periods of time, because it takes time for diseases to develop.  This paragraph sums up endpoint workarounds well.
From Deciphering Media stories on Diet (Harvard.edu)
4. Did the study look at real disease endpoints, like heart disease or osteoporosis? Chronic diseases,
like heart disease and osteoporosis, often take many decades to develop. To get around waiting that
long, researchers will sometimes look at markers for these diseases, like narrowing of the arteries or
bone density. These markers, though, don’t always develop into the disease.

  •     Thou shalt not bow down to surrogate endpoints, for these are but graven images.



Surrogate endpoint – a substitute endpoint in a clinical trial. It is not the item being measured directly (as  heart disease), but an item related to what is being studied (as blood pressure). During the study these substitutes will be used to check on the health of the people in the clinical trial, the usefulness of the drug being treated, and if there are any complications. Surrogate endpoints are substitutes for (true) clinical endpoints (as survival for 5 years after the treatment).  Surrogate endpoints don’t always guarantee a clinical endpoint (just because blood pressure goes down, heart disease may not be treated). However studies with good endpoints are expensive (require testing on many people) are take long periods of time.
[Adapted from an eHow article with good references]

  •      Thou shalt not worship Treatment Targets, for these are but the creations of Committees.

Correlation doesn’t always meant causality!A treatment target is a goal of a treatment intervention.  An example would be to reduce a specific protein in order to prevent a specific cancer (Potential New Treatment Target for Retinoblastoma, 13 January 2012 Medscape article) .  The “cause/effect” relationship between something measurable (as a protein) and a disease may not truly exist.  It is also possible that the  presence of the protein and the onset of a disease may be due to other factors in a web of events.

  • Thou shalt apply a pinch of salt to Relative Risk Reductions, regardless of P values, for the population of their provenance may bear little relationship to thy daily clientele.

Relative Risk – The number of times more likely (RR > 1) or less likely (RR < 1) an event is to happen in one group compared with another. [From the BMJ glossary]
 P value – a number used to show how a variable (as a drug treatment) has a different result thano variable (no treatments). So, a high P value would seem to point to an effective drug treatment.

  • Thou shalt honour the Numbers Needed to Treat, for therein rest the clues to patient-relevant information and to treatment costs.

The Numbers Needed to Treat (NNT) tells how many patients need a specific treatment in order to prevent an additional bad outcome (as a heart attack or stroke). So if a drug has an NNT of 10, 10 people have to be treated with the drug in order to prevent one additional bad outcome.
For example, if a drug is found to reduce the risk of a bad outcome from 50% to 40%, the absolute risk .1 (the difference). And the NNT is the inverse of the absolute  or 10.  [From Numbers Needed to Treat (Patient.co.UK)

  •  Thou shalt not see detailmen, nor covet an Educational Symposium in a luxury setting.

Detailmen are pharmacy representatives who present doctors with their company’s drug information with the aim of persuading the doctor to presribe their drugs. These representatives often sponsor educational talks (often “focusing” on conditions rather than drugs) at physician meetings. These “luxury settings” may included free buffets and hospitality rooms. [From Influencing Doctors :How Pharmaceutical Companies Use Enticement to ‘Educate’ Physicians (ABC News)]

  •    Thou shalt share decisions on treatment options with the patient in the light of estimates of the individual’s likely risks and benefits.
  •  Honour the elderly patient, for although this is where the greatest levels of risk reside, so do the greatest hazards of many treatments.

*** Click here for suggestions on how to get this article for free or at low cost.
In past blogs I have posted items on initiatives for the wider sharing of scientific articles to the public with subsidies, open access, etc.
****Richard Lehman’s Journal Review – 3 January 2012

January 16, 2012 Posted by | health care | , , , , , , , , | Leave a comment

   

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