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Adults who had parents who struggled with addiction, intimate partner violence and mental illness are more than 30 times more likely to have been victims of childhood physical abuse than those whose parents did not have these problems, once age and race were taken into account.

The study by researchers at the University of Toronto's Factor-Inwentash Faculty of Social Work and Institute of Life Course & Aging was published online this week in the Journal of Interpersonal Violence. Findings indicated that between 66% and 78% of adults who grew up in homes where all three risk factors were present reported that, before the age of 18, their parent or an adult in their home had ever "hit, beat, kick, or physically hurt (them) in any way." Respondents were told not to include spanking.

"With each additional risk factor experienced, the prevalence of childhood physical abuse increased dramatically. Intimate partner violence was a strong predictor of childhood abuse, even in the absence of the other two risk factors; more than one-third of respondents who had been exposed solely to parental intimate partner violence reported that they had been physically abused" reported co-author Senyo Agbeyaka, recent MSW graduate and a social worker in health care. "Between 23% and 31% of those exposed to both parental addictions and parental mental illness, but not parental domestic violence, reported they had been physically abused as a child."

"We were so astonished by the magnitude of the association between the combination of these three risk factors and childhood physical abuse in the 2010 survey that we replicated the analysis with a different sample from a 2012 survey," says co-author Jami-Leigh Sawyer, a University of Toronto doctoral candidate in social work. "The findings in both data sets and for each gender were remarkably consistent and very worrisome."

The study was based on two representative community samples, one study conducted in 2010 with 22,862 adults and the second, in 2012, with a different sample of 29,801 adults. The data were drawn from the Brief Risk Factor Surveillance Survey (BRFSS) and separate analyses were conducted for each sex. A major limitation of the study is use of retrospective self-report of these early adversities and a lack of information on the exact timing when they occurred. The findings only indicate correlation and cannot be interpreted as causative.

The study's findings have important clinical implications for pediatricians, family doctors, social workers and other healthcare providers working with children and their families, says lead author Esme Fuller-Thomson, Sandra Rotman Chair at the University of Toronto's Factor-Inwentash Faculty of Social Work and Director of the Institute of Life Course and Aging. "It appears that children from homes with parental intimate partner violence alone, or at least two of the other risk factors are particularly vulnerable to abuse. Such knowledge will hopefully improve the targeting of screening for childhood physical abuse."

A third (34 per cent) of eczema management mobile applications provide information that does not agree with international treatment and condition guidelines, a study led by Nanyang Technological University, Singapore (NTU Singapore) has found.

While many of the apps studied came with features such as information on the available therapies and a disease tracking function, a team led by Associate Professor Josip Car from the Lee Kong Chian School of Medicine (LKCMedicine) at NTU Singapore found that none of them fulfilled the complete set of criteria for educational information, tracking functions or health information principles, as set out by international eczema management recommendations such as the UK's National Institute for Health and Care Excellence guidelines. 

The study, published online this week in the British Journal of Dermatology, highlights the need for mechanisms and guidelines to ensure app quality, and to guide personalised app selection for patients, caregivers and doctors. This is crucial for long-term conditions such as eczema, which are often managed in the community.

Eczema, characterised by itchiness and red, inflamed skin, is the top skin condition seen at the National Skin Centre in Singapore. Half the eczema patients in Singapore have to manage the condition throughout their lives . There is currently no cure for eczema, but maintenance treatments of daily moisturising can keep it under control. 

Associate Professor Josip Car, who chairs the Health Services and Outcomes Research Programme at NTU's LKCMedicine, said the field of mobile health has great potential to lead to better patient care and self-management of eczema, provided that appropriate measures are taken to improve the quality standards of eczema management apps.

He said, "Smartphone apps have emerged as a novel approach to support the self-management of conditions that require long-term care, such as eczema. Our research shows that there is a large variance in the quality of eczema apps. While the assessed eczema self-management apps had shortcomings, certain apps did provide appropriate functions with accurate information and comprehensive tracking of eczema-related factors."

Matthew Gass from the British Association of Dermatologists said, "It is important that researchers continue to test the accuracy and safety of health apps. There has been an enormous boom in the number of dermatology apps available to the public, and with this comes the risk that some will be inaccurate, and even unsafe. Similar concerns have been raised in the past regarding skin cancer apps.

"App developers should clearly label the sources of their information and should make use of existing resources such as published National Institute for Health and Care Excellence guidelines in the UK. There is no doubt that apps will play a big role in the self-management of skin conditions, but we should have high standards for any health apps."

In this study, the NTU-led team assessed 98 apps for eczema management - 67 in English, 22 in Chinese, and 9 in Spanish. The researchers evaluated these apps using international eczema guidelines from Singapore, UK, US, Argentina and China to assess eczema educational information, eczema-specific tracking functions, and compliance with health information principles.

Of the apps assessed, 84 per cent provided educational information, 39 per cent tracking functions, and 13 per cent both. Among 38 apps with a tracking function, 82 per cent measured specific symptoms, disease severity or current skin condition and 89 per cent helped users to record medication usage including application of topical treatments. 34 per cent recorded environmental or dietary allergens.

In addition to the 34 per cent of apps providing information that was not in agreement with international guidelines, only 15 per cent provided information supported by international guidelines on pharmacological therapies and 16 per cent on non-pharmacological therapies. None of the included apps complied with all criteria for educational information, tracking functions or health information principles. 11 per cent of the apps failed to mention mainstay therapies such as the use of emollients and moisturisers.

Assoc Prof Car, who is also Director of the Centre for Population Health Sciences at NTU, said, "Perhaps the most useful way to address this issue would be to publish a list of recommended apps to aid clinicians in suggesting the appropriate options for eczema patients and caregivers."

Bottom Line: Exposure to artificial light at night, especially sleeping with a light or television on in the room, was associated with increased risk of weight gain and overweight and obesity among a large group of women studied. However, researchers were quick to point out that exposure to artificial light at night can be indicative of socioeconomic disadvantage or unhealthy behaviors, which could contribute to weight gain and obesity. This observational study included nearly 44,000 women in its analysis. The women, who were enrolled in the Sister Study group, had no history of cancer or cardiovascular disease and weren't shift workers, daytime sleepers or pregnant at the study's start. Exposure to any artificial light at night while sleeping was associated with measures of obesity at the study baseline and follow-up. Exposure to artificial light at night was self-reported. Although causal inferences cannot be drawn from these results and more studies are needed to examine this association, reducing exposure to artificial light at night while sleeping could be considered in obesity prevention interventions.

Authors: Dale P. Sandler, Ph.D., and Yong-Moon Mark Park, M.D., Ph.D., of the National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, and coauthors

(doi:10.1001/jamainternmed.2019.0571)

Editor's Note: The article includes a funding/support disclosure. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

An unhealthy, inflamed gut causes breast cancer to become much more invasive and spread more quickly to other parts of the body, new research from the University of Virginia Cancer Center suggests.

Melanie Rutkowski, PhD, of UVA's Department of Microbiology, Immunology and Cancer Biology, found that disrupting the microbiome of mice caused hormone receptor-positive breast cancer to become more aggressive. Altering the microbiome, the collection of microorganisms that live in the gut and elsewhere, had dramatic effects in the body, priming the cancer to spread.

"When we disrupted the microbiome's equilibrium in mice by chronically treating them antibiotics, it resulted in inflammation systemically and within the mammary tissue," she said. "In this inflamed environment, tumor cells were much more able to disseminate from the tissue into the blood and to the lungs, which is a major site for hormone receptor-positive breast cancer to metastasize."

Hormone Receptor-Positive Breast Cancer

Most breast cancers - 65 percent or more - are hormone receptor positive. That means their growth is fueled by a hormone, either estrogen or progesterone. The good news is that these types of cancers are likely to respond well to hormone therapy.

Predicting whether such cancers will spread beyond the breast to other parts of the body (a process called metastasis) is a major challenge within the field, and is primarily driven by clinical characteristics at the time of diagnosis. Early metastasis is affected by a variety of factors, Rutkowski explained. "One of them is having a high level of [immune] cells called macrophages present within the tissue," she said. "There have also been studies that have demonstrated that increased amounts of the structural protein collagen in the tissue and tumor also lead to increased breast cancer metastasis."

Having an unhealthy microbiome prior to breast cancer increased both, and the effect was powerful and sustained. "Disrupting the microbiome resulted in long-term inflammation within the tissue and the tumor environment," Rutkowski said. "These findings suggest that having an unhealthy microbiome, and the changes that occur within the tissue that are related to an unhealthy microbiome, may be early predictors of invasive or metastatic breast cancer. Ultimately, based upon these findings, we would speculate that an unhealthy microbiome contributes to increased invasion and a higher incidence of metastatic disease."

Maintaining a Healthy Microbiome

While Rutkowski used powerful antibiotics to disrupt the mice's natural gut bacteria, she emphasized that antibiotics are not dangerous and should not be avoided by women with breast cancer or anyone who needs them to treat infections. Mice, after all, are not people, and substantially more research needs to be done to define whether an association exists between chronic antibiotics usage and cancer outcome. For this study, the antibiotics were only a means to an end, a simple way to create a long-term imbalance to the microbiome, similar to what individuals may experience with chronically unhealthy microbiomes. The effect was far, far more exaggerated than would occur in a person taking a normal course of antibiotics, or even multiple rounds.

Thanks in part to Rutkowski's research, doctors eventually may be able to manipulate the microbiome to benefit patients with breast cancer. But the key message for now, Rutkowski said, is the importance of a healthy microbiome. The finding adds to the growing evidence demonstrating that a healthy microbiome is vital for many aspects of good health.

While she is a cancer researcher rather than a medical doctor, Rutkowski noted there are things that are generally accepted to promote a healthy microbiome. "A healthy diet, high in fiber, along with exercise, sleep - all of those things that contribute to positive overall health," she said. "If you do all of those things, in theory, you should have a healthy microbiome. And that, we think, is very much associated with a favorable outcome in the long term for breast cancer."

Prior research on lithium's effects on breastfeeding are sparse, poorly designed

Study author: 'It's 2019, and we still don't have the evidence to back any of this up'

Discontinuing lithium to breastfeed could lead to greater risks for mom, baby

Until more research is done, mothers, babies should be reviewed case by case for lithium continuation

CHICAGO --- Women taking lithium to treat their bipolar disorder frequently ask if breastfeeding while on the medication will harm their babies. Those fears are largely rooted in sparse studies that have not addressed critical factors, reports a new Northwestern Medicine systematic review.

The review will be published June 10 in the International Review of Psychiatry.

The mood stabilizer lithium is the gold standard of care for treating bipolar disorder, which affects an estimated 22 million women worldwide. It is effective at preventing manic episodes and postpartum psychosis but some experts advise against taking lithium while breastfeeding because of concerns that it will transfer to the breast milk and potentially be toxic to the baby.

Prior to 2000, research on the effects of lithium exposure through breastmilk were retrospective and lacked standardization, such as not including control groups and not considering the health of the mother or her infant or the other medications the mother was taking, the review found. Studies after 2000 were better designed and suggest that lithium is low risk during breastfeeding. Still, more research is needed, the authors said.

"This is a highly controversial topic, and expert recommendations vary, but the truth is it's 2019, and we still don't have the evidence to back up any of the fears about lithium use and breastfeeding," said senior author Dr. Crystal Clark, assistant professor of psychiatry and behavioral sciences and obstetrics and gynecology at Northwestern University Feinberg School of Medicine and a practicing Northwestern Medicine psychiatrist.

The continuation of lithium, like many medications, must be considered on a case-by-case basis and personalized to the individual woman and her infant, the authors reported.

"There are few absolutes when it comes to managing illness while breastfeeding," Clark said. "It's not one size fits all."

Until more research is done, Clark and her co-authors suggest informing patients of possible risks of lithium exposure, such as restlessness, lethargy or feeding problems.

Women typically experience bipolar disorder throughout their childbearing years. Pregnancy and the postpartum period are especially vulnerable times for women with the illness, leading to an increased risk of a recurring episode or postpartum psychosis. Untreated bipolar disorder is associated with poor birth outcomes, such as preterm birth and babies who are small for their gestational age, as well as an increased risk for suicide, which is a leading cause of maternal death.

While the risks of breastfeeding on lithium are still largely unknown, the risks of interrupting lithium treatment are well established and could impact a mother's ability to care for her child or bond with her baby during a critical time, Clark said.

"I don't see the same breastfeeding fear with women taking medications for other illnesses such as seizure disorders," Clark said, referring to the many medications that have not been well studied but are not discouraged for breastfeeding. "There is some stigma related to mental illness that deters physicians from considering it as a vital treatment for the health of their postpartum mothers with mental illness."

For women taking lithium, the benefits of breastfeeding may justify the risks of breastmilk exposure, Clark said. In future studies, she plans to examine the amount of lithium in breastmilk as well as how much lithium is ingested by the breastfed infants and the effects on early childhood development.

The review authors screened 441 studies for eligibility, reviewed 230 that met their inclusion criteria and chose 12, which included a total of 37 patient case studies.

New Rochelle, NY, June 6, 2019--A new pilot study demonstrated the feasibility of using molecular tumor markers as the basis for selecting the chemotherapeutic agents to use in patients with metastatic pancreatic cancer. Based on these promising results a larger phase II clinical trial has been initiated using molecular biomarkers to guide the choice of second-line therapies. The design, results, and implications of the initial pilot study are presented in Journal of Pancreatic Cancer, a peer-reviewed open access publication from Mary Ann Liebert, Inc., publishers. Click here to read the full-text article free on the Journal of Pancreatic Cancer website.

"A Pilot Trial of Molecularly Tailored Therapy for Patients with Metastatic Pancreatic Ductal Adenocarcinoma" was coauthored by Michael Pishvaian, MD, PhD, Georgetown University, Washington, DC and colleagues from Wayne State University, Detroit, MI, Georgetown University, and Thomas Jefferson University, Philadelphia, PA.

The researchers designed a composite treatment algorithm based on three established predictive markers of response to chemotherapy. They tested tumor biopsy samples for the presence of these markers and, based on the results, assigned the patients to treatment with two chemotherapeutic agents most likely to elicit a response. The researchers reported promising progression-free survival and overall survival, with a partial response seen in 28% of patients and stable disease in 50% on completion of the study.

Journal of Pancreatic Cancer Editor-in-Chief Charles J. Yeo, MD, Department of Surgery, Thomas Jefferson University, states: "This important study solidifies the potential for a precision medicine approach to pancreatic cancer."

New Rochelle, NY, June 4, 2019--The medical use of cannabis is growing. Medical marijuana may improve symptoms including pain and anorexia. While it may improve nausea and vomiting, it can rarely cause a hyperemesis syndrome with chronic use. Because this is a rare syndrome, case reports are important. A new case study has surprisingly shown that stopping cannabis use may not be necessary to alleviate cannabis hyperemesis syndrome. The case study and a review of the current literature on cannabis hyperemesis syndrome are published in Journal of Palliative Medicine, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. Click here to read the full-text article free on the Journal of Palliative Medicine website through July 4, 2019.

Ileana Howard, MD, University of Washington and VA Puget Sound, Seattle, WA, presents the unique example of a patient with amyotrophic lateral sclerosis (ALS) receiving palliative care who was able to overcome the effects of nausea and vomiting linked to chronic cannabis use by markedly decreasing, but not discontinuing the use of cannabis. In the article entitled "Cannabis Hyperemesis Syndrome in Palliative Care: A Case Study and Narrative Review," Dr. Howard reported that the patient stopped using inhaled concentrated cannabis extracts, but continued to use oral whole plant-based edible cannabis, which eliminated the cannabis hyperemesis syndrome while sustaining the beneficial effects on other symptoms. This paper and the comprehensive literature review illustrate the challenges in diagnosis, assessment, and management of these patients by clinicians.

Charles F. von Gunten, MD, PhD, Editor-in-Chief of Journal of Palliative Medicine and Vice President, Medical Affairs, Hospice and Palliative Medicine for the OhioHealth system, states: "This case study adds to our clinical ability to respond to rare adverse effects of medical cannabis use. Given the meteoric rise in the medical use of marijuana across the U.S. and around the world, it is essential to disseminate these clinical observations."

Tuberculosis (TB) causes more deaths globally than any other infectious disease and is a top 10 cause of death worldwide. Globally in 2017, of the estimated 10 million people with TB, 3.6 million were not reported to national TB programmes, many of whom were not being diagnosed with their disease. When it is detected early and effectively treated, TB is largely curable, but in 2017, around 1.6 million people died of tuberculosis, including 300,000 people living with HIV.

Xpert MTB/RIF and Xpert Ultra, the newest version, are the only World Health Organization (WHO)-recommended diagnostic tests that rapidly and simultaneously detect TB and rifampicin resistance, in persons with signs and symptoms of TB, and are suitable for use at lower levels of the health system.

This Cochrane Review update is part of a suite of Cochrane Reviews that will inform an upcoming WHO meeting to update guidelines on these tests.

Key findings from this Cochrane Review update:

The review identified 95 studies, integrating 77 new studies since the previous Cochrane Review.

For detection of pulmonary TB, Xpert MTB/RIF sensitivity and specificity were 85% and 98%.

For detection of rifampicin resistance, Xpert MTB/RIF sensitivity and specificity were 96% and 98%.

In the one study that directly compared Xpert Ultra and Xpert MTB/RIF, Xpert Ultra yielded a higher sensitivity (88%) than Xpert MTB/RIF (83%), and a lower specificity (96%) than Xpert MTB/RIF (98%).

The review author team found Xpert MTB/RIF to be sensitive and specific for diagnosing pulmonary TB and rifampicin resistance, consistent with findings reported previously. Compared with Xpert MTB/RIF, Xpert Ultra had higher sensitivity and lower specificity for TB detection and similar sensitivity and specificity for rifampicin resistance detection (one study). Xpert MTB/RIF and Xpert Ultra provide accurate results and can allow rapid initiation of treatment for multidrug-resistant TB. The ongoing use of Xpert MTB/RIF or Xpert Ultra in TB programmes in high TB burden settings, as well as use in primary care clinics where the test provides the opportunity to begin treatment promptly, will contribute evidence on whether their use leads to improvements in patient health.

Cochrane Infectious Diseases Group (CIDG) Editor and review author Karen Steingart stated, "We hope that this Cochrane Review update will enable anyone who is interested to find high-quality information about Xpert MTB/RIF and Xpert Ultra." Lead author, Associate Professor David Horne (University of Washington, Seattle) added, "Future studies should assess the diagnostic accuracy of Xpert Ultra compared with other rapid tests for TB and drug resistance, especially in difficult-to-diagnose groups, such as children, people living with HIV, and those with extrapulmonary TB. Understanding the impact of Xpert Ultra on patient health outcomes will be important."

New Rochelle, NY, May 28, 2019--A new study has shown that popular magazines commonly feature older pregnant celebrities on their covers with no mention of the risks of advanced maternal age pregnancy or the advanced reproductive technologies and methods needed to achieve these pregnancies. By downplaying fertility decline with advancing age, these magazines likely contribute to women's belief that they can safely put off pregnancy until later ages. The study is published in Journal of Women's Health, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers. Click here to read the full-text article on the Journal of Women's Health website through June 28, 2019.

"Age is Just a Number': How Celebrity-Driven Magazines Misrepresent Fertility at Advanced Reproductive Ages" was coauthored by Stephanie Willson, MD, New York University School of Medicine and New York Presbyterian - Weill Cornell Medical Center, Allison Perelman, New York University School of Medicine, and Kara Goldman, MD, New York University Langone Fertility Center and Northwestern University Fertility and Reproductive Medicine

The researchers examined 416 magazine issues aimed at reproductive-aged women and found that fertility was highlighted on one-third of the covers, which included the mention of 240 different celebrities. More than half were of advanced maternal age (AMA), but there were only two mentions of pregnancy risks associated with (AMA). A third of the AMA pregnancies were among celebrities aged 40 or older, yet in the accompanying articles there was little or no discussion of the need for advanced interventions to achieve pregnancy, such as in vitro fertilization and the need for donor gametes.

"It's easy to get drawn in by the cover of a popular magazine featuring a happily pregnant celebrity in her late 30s or early 40s and to think that fertility is the norm at that stage in a woman's reproductive life," says Susan G. Kornstein, MD, Editor-in-Chief of Journal of Women's Health, Executive Director of the Virginia Commonwealth University Institute for Women's Health, Richmond, VA, and President of the Academy of Women's Health. "Often left unsaid though are the costly and extraordinary measures, assisted reproductive technologies, and risks associated with these later-in-life pregnancies."

Boston, MA -- As advances in the treatment of non-small cell lung cancer (NSCLC) extend patients' lives, more of these patients are facing a different threat: adverse cardiovascular events, such as heart attacks and heart failure. A new retrospective study led by investigators from Brigham and Women's Hospital and Dana-Farber Cancer Institute examined outcomes for patients after receiving treatment for locally advanced NSCLC, finding that the average radiation dose delivered to the heart was associated with an increased risk of major adverse cardiovascular events and death. Among patients who did not have preexisting coronary heart disease, risk of having a major cardiovascular event after treatment exceeded the rates of people considered at high risk of such events. The team's findings are published in the Journal of the American College of Cardiology.

"This is alarming data -- to think that one in 10 of the patients I'm treating for this type of cancer will go on to have a heart attack or other major cardiac event," said senior author Raymond Mak, MD, a thoracic radiation oncologist at the Brigham and Dana-Farber. "These cardiac events are happening earlier and more often than previously thought. More patients are living long enough to experience this risk of cardiac toxicity. We need to start paying attention to this and working together with cardiologists to help these patients."

In many cases, a dose of radiation to the heart is the only way for oncologists to treat a patient with lung cancer. Lung cancer is the leading cause of cancer deaths worldwide, and half of lung cancer patients will require radiation as part of their care. Previous studies have reported that advances in care, such as screening for lung cancer and treating the disease with targeted therapies and immunotherapies, have improved survival rates for patients. The average survival time is now more than two years for patients with locally advanced NSCLC.

"When treating patients with lung cancer, it's a balance of risks," said lead author Katelyn Atkins, MD, PhD, a resident in the Harvard Radiation Oncology Residency Program. "But we need to start thinking about where there's room for improvement in optimizing treatment for patients and room for improvement in terms of collaborating with primary care physicians and cardiologists."

To conduct their study, Mak, Atkins and colleagues analyzed data and outcomes for 748 NSCLC patients treated with thoracic radiotherapy at the Dana-Farber/Brigham and Women's Cancer Center and Dana-Farber Cancer Institute/Brigham and Women's Hospital at Milford Regional Medical Center. After treatment, a total of 77 patients (10.3 percent) experienced a major adverse cardiac event, including heart attack and heart failure. The team observed increasing risk of cardiac events with increased dosages of heart radiation exposure, especially among patients who did not have coronary heart disease before receiving radiotherapy.

Based on their findings, the authors recommend more stringent avoidance of high cardiac radiotherapy dose and suggest considering a much lower cardiac radiation therapy dose limit for patients than national guidelines currently recommend (10 Gy versus 20 Gy).

"When possible, we should be thinking about ways to minimize cardiac radiation dose," said Mak. "Recognizing that we may not always be able to do that, we're now collaborating with our cardiology colleagues to explore early interventions to help mitigate the effects of cardiac injury from radiation therapy."

Sleeping with a television or light on in the room may be a risk factor for gaining weight or developing obesity, according to scientists at the National Institutes of Health. The research, which was published online June 10 in JAMA Internal Medicine, is the first to find an association between any exposure to artificial light at night while sleeping and weight gain in women. The results suggest that cutting off lights at bedtime could reduce women's chances of becoming obese.

The research team used questionnaire data from 43,722 women in the Sister Study, a cohort study that examines risk factors for breast cancer and other diseases. The participants, aged 35-74 years, had no history of cancer or cardiovascular disease and were not shift workers, daytime sleepers, or pregnant when the study began. The study questionnaire asked whether the women slept with no light, a small nightlight, light outside of the room, or a light or television on in the room.

The scientists used weight, height, waist and hip circumference, and body mass index measurements taken at baseline, as well as self-reported information on weight at baseline and follow-up five years later. Using this information, the scientists were able to study obesity and weight gain in women exposed to artificial light at night with women who reported sleeping in dark rooms.

The results varied with the level of artificial light at night exposure. For example, using a small nightlight was not associated with weight gain, whereas women who slept with a light or television on were 17% more likely to have gained 5 kilograms, approximately 11 pounds, or more over the follow-up period. The association with having light coming from outside the room was more modest.

Also, the scientists wondered if not getting enough rest factored into the findings.

"Although poor sleep by itself was associated with obesity and weight gain, it did not explain the associations between exposure to artificial light while sleeping and weight," said corresponding author Dale Sandler, Ph.D., chief of the Epidemiology Branch at the National Institute of Environmental Health Sciences (NIEHS), part of NIH.

Co-author Chandra Jackson, Ph.D., head of the NIEHS Social and Environmental Determinants of Health Equity Group, is interested in racial disparities in sleep health. She notes that for many who live in urban environments, light at night is more common and should be considered. Streetlights, store front neon signs, and other light sources can suppress the sleep hormone melatonin and the natural 24-hour light-dark cycle of circadian rhythms.

"Humans are genetically adapted to a natural environment consisting of sunlight during the day and darkness at night," Jackson said. "Exposure to artificial light at night may alter hormones and other biological processes in ways that raise the risk of health conditions like obesity."

The authors acknowledge that other confounding factors could explain the associations between artificial light at night and weight gain. However, their findings did not change when analyses controlled for characteristics that may be associated with exposure to light at night. These factors included age, having an older spouse or children in the home, race, socioeconomic status, calories consumed, and physical activity. Also, the study did not include men.

Lead author Yong-Moon (Mark) Park, M.D., Ph.D., is a postdoctoral fellow in Sandler's group. He said the research suggests a viable public health strategy to reduce obesity incidence in women.

"Unhealthy high-calorie diet and sedentary behaviors have been the most commonly cited factors to explain the continuing rise in obesity," Park said. "This study highlights the importance of artificial light at night and gives women who sleep with lights or the television on a way to improve their health."

Researchers have mapped the most common bacterial cause of pneumonia around the world and revealed how these bacteria evolve in response to vaccination. Scientists from the Wellcome Sanger Institute, Emory University (Atlanta, USA), and the U.S. Centers for Disease Control and Prevention worked with many collaborators around the world to carry out a global genomic survey of Streptococcus pneumoniae, discovering 621 strains across more than fifty countries.

The research is published in The Lancet Infectious Diseases today (10th June), and with a sister paper in EBioMedicine, reveals which strains of S. pneumoniae (also known as the pneumococcus) are circulating around the world and explains why pneumococcal pneumonia rates are still high despite the existing vaccines. Funded by a grant from the Bill & Melinda Gates Foundation, this work will help predict which strains will be important for new pneumococcal vaccines, and shows that ongoing global genomic surveillance is vital.

Pneumonia is an infection of the lungs that is responsible for the deaths of hundreds of thousands of people a year globally and is the single largest infectious cause of death of children under 5 years old worldwide*. Streptococcus pneumoniae is the most common cause of bacterial pneumonia. Healthy people often carry these bacteria without becoming ill, but they can cause fatal infection, especially in young children and some adults.

Many countries around the world have introduced the pneumococcal conjugate vaccine (PCV)** over the last ten years. This vaccine, which targets the coat around each S. pneumoniae bacterium, has greatly reduced the number of childhood infections. However, while PCV is highly effective against up to 13 important coat types, there are over a hundred types known, and despite the vaccine, pneumococcal pneumonia rates remain very high.

To understand and help combat this infection, researchers set up the Global Pneumococcal Sequencing project (GPS) to carry out genomic surveillance of S. pneumoniae worldwide. Working with partners around the world, the researchers sequenced the DNA of over 20,000 S. pneumoniae samples from infected people from 51 countries.

Samples were collected both before and after PCV introduction, and the DNA sequences and health data were compared. This makes it possible to determine changes in the bacteria that could affect how well the vaccine protects against the pneumococcus, and whether new strains are emerging that would impact disease severity and ease of treatment.

The researchers discovered 621 genetic strains globally, each associated with one or more coat types. They also saw that the levels of non-vaccine type bacteria rose after the introduction of PCV, showing how bacteria evolve in response to the vaccine.

Professor Stephen Bentley, senior author on the papers, from the Wellcome Sanger Institute, said: "Pneumonia is a huge threat to health worldwide. We now have an unprecedented view of the global population of S. pneumoniae bacteria, the usual cause of bacterial pneumonia, and can see evolutionary changes that lead to vaccine evasion. This will give crucial information for future vaccine strategy worldwide, and help save lives."

Dr Rebecca Gladstone, joint first author on two of the papers, from the Wellcome Sanger Institute, said: "Our study gives the first genomic description of the S. pneumoniae population of the world. This has never been possible before, as previously only samples from individual populations had been studied. Now we have global data, showing which strains are present in each country, and can use this to understand pneumococcal infection on a world-wide scale."

The pneumococcus can cause disease in other areas of the body too, for example infecting the brain or blood, causing meningitis or bloodstream infections, which can all lead to sepsis. Infant vaccination with PCV protects against these pneumococcal infections too. By reducing the transmission of S. pneumoniae between children, PCV also reduces the number of adult infections through herd immunity.

Dr Lesley McGee, Co-Principal Investigator on the project from the Streptococcus Laboratory at the Centers for Disease Control and Prevention in the United States, said: "It is vital to understand the strains of S. pneumoniae present around the world, and how they respond to the introduction of PCV. This genomic study allows us to not only see the current most important global strains but also helps understand their evolution. This information will open the door to developing predictive tools to identify the strains likely to emerge in response to vaccine use."

Professor Robert Breiman, Director of the Emory Global Health Institute, and Principal Investigator for the project, added: "GPS turns a spotlight onto a new era in which the intersection of genomics and public health enables unparalleled capacity for optimizing prevention strategies, while providing an immensely valuable tool for forecasting and addressing new challenges ahead."

Professor Keith Klugman, Director of the Pneumonia team at the Bill & Melinda Gates Foundation, said: "We must continue to immunize children around the world because vaccination is the single best way of reducing the risk of pneumonia, as it prevents children passing S. pneumoniae between them and adults. However, we are fighting a battle against evolution of bacterial strains. This research shows the importance of ongoing global genomic surveillance to understand which strains are likely to cause a threat, to help reformulate the next generation of vaccines."

HUNTINGTON, W.Va. - Tart cherry reduces the musculoskeletal effects of aromatase inhibitors in patients with non-metastatic breast cancer, according to new findings from a clinical trial by researchers at Marshall University Joan C. Edwards School of Medicine and Edwards Comprehensive Cancer Center.

Aromatase inhibitors (AIs) are a standard treatment for hormone receptor-positive breast cancer in postmenopausal women. These agents can help prevent recurrence of the disease by inhibiting the action of aromatase, an enzyme responsible for conversion of androgens to estrogens. About half of patients who take AIs also suffer from joint and muscle pain known as aromatase inhibitor induced arthralgia, which, at times, can be debilitating and cause patients to not complete their treatments.

This randomized, double-blind trial compared the consumption of 1 ounce of tart cherry concentrate in 8 ounces of water daily for six weeks with a placebo group in women with stage 1, 2 or 3 non-metastatic breast cancer. A total of 60 patients were enrolled throughout the course of the clinical trial, conducted May 2016 to August 2018.

Patients documented their pain intensity at the start of the trial, weekly and at study completion. Patients who completed the trial recorded a 34.7% mean decrease in pain compared to 1.4% in the placebo group.

"The flavonoids and anthocyanins in tart cherry have anti-inflammatory properties and may be playing a role in reducing the side effects of joint pain and muscles aches, although etiology of aromatase-induced arthralgias remain unclear at this time," said principal investigator Maria Tria Tirona, M.D., professor of hematology-oncology at the Marshall University Joan C. Edwards School of Medicine and director of medical oncology at Edwards Comprehensive Cancer Center. "There was a statistically significant difference in the pain levels experienced by patients in the group that received the tart cherry concentrate compared to the placebo group."

June 10, 2019 -- A study led by Marni Sommer, DrPH, RN, associate professor of Sociomedical Sciences at Columbia Mailman School of Public Health, examined girls' transitions through puberty in Madagascar and ways in which menstruation influences their educational experiences and future sexual and reproductive health. The findings, published in the Journal of Early Adolescence, revealed gaps in the girls' knowledge and an absence of support during puberty, varying guidance received about sexuality after the onset of menstruation and the challenges of managing menstruation in school. Until this study little had been known about girls' experiences of puberty in Madagascar, which has among the highest rates of adolescent pregnancy compared with those in other parts of Africa.

"Given the significant gaps in girls' levels of knowledge and support, there was a clear need demonstrated for educational material on puberty for early adolescents, along with teacher training about puberty," said Sommer. The study also found that improved toilet facilities are critically needed to improve menstruating girls' school-going experiences.

According to latest data, there are 145 pregnancies per 1,000 girls in Madagascar compared with an average of 95 per 1,000 for girls in eastern and southern Africa. Madagascar also reports one of the highest rates of early marriage in the world -- almost 41 percent of girls are married by age 18.

Adolescents are the fastest growing population group around the world, including over 1.6 billion young people aged 10 to 19 years, the majority of whom live in low-income countries according to most recent UN data. Adolescent girls in particular are vulnerable in such contexts to negative sexual and reproductive health outcomes.

To understand the girls' experiences of early adolescence and puberty and the intersections of menstruation with their schooling, Sommer and colleagues conducted qualitative and participatory research - the latter which has been shown to empower participants.

The researchers identified the following overarching themes:

(a) gaps in knowledge and timing of guidance delivered during puberty;

(b) caution regarding sex and sexuality after menarche; and

(c) challenges managing menstruation.

The latest study, conducted in partnership with Projet Jeune Leader, confirmed earlier ongoing research by Sommer which showed that girls often receive inadequate guidance and support about their sexual and reproductive health and inadequate access to safe, hygienic water. Toilets in schools were found to hinder girls' ability to manage menstruation safely. "This, in turn, may reduce their active participation in the classroom," according to Sommer.

"Overall, we found that girls faced numerous challenges engaging actively in school while menstruating due to barriers in school environments," said Sommer. "Girls in low-resource countries such as Madagascar have been lacking adequate guidance and information. To make a real difference in their lives, it is critical that we turn global attention to the needs of girls and to early adolescence as a critical stage of transitioning to a healthy adulthood."

In the first prospective study of directly measured body fat distribution and prostate cancer risk, investigators found that higher levels of abdominal and thigh fat are associated with an increased risk of aggressive prostate cancer. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the findings may lead to a better understanding of the relationship between obesity and prostate cancer and provide new insights for treatment.

Previous studies have shown that obesity is associated with an elevated risk of advanced prostate cancer and a poorer prognosis after diagnosis. Also, emerging evidence suggests that the specific distribution of fat in the body may be an important factor.

To provide high quality evidence, Barbra Dickerman, PhD, of the Harvard T.H. Chan School of Public Health, and her colleagues analyzed body fat distribution using the gold-standard measure of computed tomography imaging and assessed the risk of being diagnosed with, and dying from, prostate cancer among 1,832 Icelandic men who were followed for up to 13 years.

During the study, 172 men developed prostate cancer and 31 died from the disease. The accumulation of fat in specific areas--such as visceral fat (deep in the abdomen, surrounding the organs) and thigh subcutaneous fat (just beneath the skin)--was associated with the risk of advanced and fatal prostate cancer. High body mass index (BMI) and high waist circumference were also associated with higher risks of advanced and fatal prostate cancer.

"Interestingly, when we looked separately at men with a high BMI versus low BMI, we found that the association between visceral fat and advanced and fatal prostate cancer was stronger among men with a lower BMI. The precision of these estimates was limited in this subgroup analysis, but this is an intriguing signal for future research," Dickerman noted.

Additional studies are needed to investigate the role of fat distribution in the development and progression of prostate cancer and how changes in fat stores over time may affect patients' health. "Ultimately, identifying the patterns of fat distribution that are associated with the highest risk of clinically significant prostate cancer may help to elucidate the mechanisms linking obesity with aggressive disease and target men for intervention strategies," said Dickerman.

An accompanying editorial notes that lifestyle interventions--such as diet and exercise--that target fat loss may also reduce the risk of prostate cancer.