Body

Clinicians can match people with type 2 diabetes to the right drug for them to improve control of blood sugar and help avoid damaging side-effects, simply by factoring in simple characteristics such as sex and BMI into prescribing decisions, new research has shown.

The study, by the University of Exeter Medical School, could dramatically improve benefits of drugs and reduce the risk of potentially harmful side-effects such as weight gain and hypoglycaemia, at no additional cost to the NHS.

Metformin is the first line of drug treatment in type 2 diabetes, but many patients will eventually need additional drugs on top of Metformin to lower their blood sugar levels. Currently, clinicians have to make prescribing decisions on these additional drug options based on limited available guidance. Recent research involving the Exeter team has revealed there is great regional variation across the UK in the prescribing of these additional drugs.

The new study, funded by the Medical Research Council and published in the journal Diabetes Care, provides a starting point for a more evidence-based approach to the prescribing of drugs after Metformin. Based on a patients' gender and BMI, the authors found important differences in the likely success of the commonly-prescribed drugs sulfonylureas and thiazolidinediones in lowering blood sugar levels, and in the risk of common side effects. For example, obese females were far more likely to have good blood glucose control on thiazolidinediones than sulfonylureas, whilst non-obese males had the opposite result - they were far more likely to have good blood glucose control on sulfonylureas than thiazolidinediones.

The Exeter team used anonymous data from more than 29,000 patients who had either taken part in trials or were treated in UK GP practices. By combining these datasets, the researchers were able to show their findings are robust and potentially applicable to many of the 3.5 million-plus people currently diagnosed with type 2 diabetes in the UK.

John Dennis, of the University of Exeter Medical School, was lead author on the study. He said "Our findings are important as they provide the first evidence that personalised or 'precision' medicine approaches in diabetes can be based on simple patient characteristics available to any doctor, rather than expensive genetics or other technology. This simple personalised approach could be implemented immediately within the NHS without any additional cost.

The study is also a powerful demonstration of how the sharing of patient data can meaningfully benefit patients - in this case helping to make sure individual patients get the best drug for them."

Professor Andrew Hattersley, a Consultant in Diabetes at the Royal Devon and Exeter Hospital and Research Professor at the University of Exeter Medical School said: "At the moment, clinicians are in the difficult position of making decisions that impact on health in type 2 diabetes based on very little evidence. Now, we can create clear guidelines to enable much more informed conversations about what these treatments will mean for people, in order to get better health outcomes and avoid harmful side effects."

Dr Richard Evans, Programme Manager for Stratified Medicine and Molecular Pathology at the MRC, said: "This research used shared clinical trial data from a large number of patients to show that simple patient characteristics can help inform the choice of therapy in diabetes; the results are likely to show real impact, and significant benefits to patients when they are implemented in patient care.

"Diabetes afflicts one in 17 people in the UK - research into precision or stratified approaches to this condition is crucial to getting patients the most appropriate treatment in the most efficient way, underpinned by solid evidence."

People who abstain from alcohol or consume more than 14 units a week during middle age (midlife) are at increased risk of developing dementia, finds a study in The BMJ today.

However, the underlying mechanisms are likely to be different in the two groups.

As people live longer, the number living with dementia is expected to triple by 2050. So understanding the impact of alcohol consumption on ageing outcomes is important.

Previous studies indicate that moderate drinking is associated with a reduced risk of dementia, whereas both abstinence and heavy drinking are associated with a risk of dementia. But the evidence is far from conclusive, and the reasons underlying these associations remain unclear.

So a team of researchers from Inserm (French National Institute of Health and Medical Research) based in France and from UCL in the UK set out to investigate the association between midlife alcohol consumption and risk of dementia into early old age. They also examined whether cardiometabolic disease (a group of conditions including stroke, coronary heart disease, and diabetes) has any effect on this association.

Their findings are based on 9,087 British civil servants aged between 35 and 55 in 1985 who were taking part in the Whitehall II Study, which is looking at the impact of social, behavioural, and biological factors on long term health.

Participants were assessed at regular intervals between 1985 and 1993 (average age 50 years) on their alcohol consumption and alcohol dependence.

Alcohol consumption trajectories between 1985 and 2004 were also used to examine the association of long term alcohol consumption and risk of dementia from midlife to early old age.

Admissions for alcohol related chronic diseases and cases of dementia from 1991, and the role of cardiometabolic disease were then identified from hospital records.

Of the 9,087 participants, 397 cases of dementia were recorded over an average follow-up period of 23 years. Average age at dementia diagnosis was 76 years.

After taking account of sociodemographic, lifestyle, and health related factors that could have affected the results, the researchers found that abstinence in midlife or drinking more than 14 units a week was associated with a higher risk of dementia compared with drinking 1-14 units of alcohol a week. Among those drinking above 14 units a week of alcohol, every 7 unit a week increase in consumption was associated with 17% increase in dementia risk.

In the UK, 14 units of alcohol a week is now the recommended maximum limit for both men and women, but many countries still use a much higher threshold to define harmful drinking.

History of hospital admission for alcohol related chronic diseases was associated with a four times higher risk of dementia.

In abstainers, the researchers show that some of the excess dementia risk was due to a greater risk of cardiometabolic disease.

Alcohol consumption trajectories showed similar results, with long term abstainers, those reporting decreased consumption, and long term consumption of more than 14 units a week, all at a higher risk of dementia compared with long term consumption of 1-14 units a week.

Further analyses to test the strength of the associations were also broadly consistent, suggesting that the results are robust.

Taken together, these results suggest that abstention and excessive alcohol consumption are associated with an increased risk of dementia, say the researchers, although the underlying mechanisms are likely to be different in the two groups.

This is an observational study, so no firm conclusions can be drawn about cause and effect, and the researchers cannot rule out the possibility that some of the risk may be due to unmeasured (confounding) factors.

The authors say their findings "strengthen the evidence that excessive alcohol consumption is a risk factor for dementia" and "encourage use of lower thresholds of alcohol consumption in guidelines to promote cognitive health at older ages." They also say these findings "should not motivate people who do not drink to start drinking given the known detrimental effects of alcohol consumption for mortality, neuropsychiatric disorders, cirrhosis of the liver, and cancer"

This study is important since it fills gaps in knowledge, "but we should remain cautious and not change current recommendations on alcohol use based solely on epidemiological studies," says Sevil Yasar at Johns Hopkins School of Medicine, in a linked editorial.

She calls for further studies and ideally a government funded randomized clinical trial to answer pressing questions about the possible protective effects of light to moderate alcohol use on risk of dementia and the mediating role of cardiovascular disease with close monitoring of adverse outcomes.

In summary, she says, "alcohol consumption of 1-14 units/week may benefit brain health; however, alcohol choices must take into account all associated risks, including liver disease and cancer."

Rochester, MN, August 1, 2018 - Sauna bathing is an activity used for the purposes of pleasure, wellness, and relaxation. Emerging evidence suggests that beyond its use for pleasure, sauna bathing may be linked to several health benefits. A new report published in Mayo Clinic Proceedings found that sauna bathing is associated with a reduction in the risk of vascular diseases, such as high blood pressure and cardiovascular disease, neurocognitive diseases, nonvascular conditions, such as pulmonary diseases, mental health disorders, and mortality. Furthermore, sauna bathing alleviated conditions such as skin diseases, arthritis, headache, and flu. The evidence also suggests that regular sauna baths are associated with a better health-related quality of life.

The research team led by scientists from the University of Jyväskylä, the University of Eastern Finland, and the University of Bristol conducted a comprehensive literature review on the effects of Finnish sauna baths on health outcomes. Finnish sauna bathing is characterized by exposure to high environmental temperature (80 degrees C-100 degrees C) for a brief period.

Findings from this comprehensive literature review also suggest that the health benefits of sauna bathing are linked to the effects of sauna on circulatory, respiratory, cardiovascular, and immune functions. Regular sauna bathing stabilizes the autonomic nervous system, reduces blood pressure, inflammation, oxidative stress, circulation of bad cholesterol, arterial stiffness, and vascular resistance. Moreover, sauna bathing contributes to beneficial levels of circulating hormones and other cardiovascular markers. The physiological responses produced by an ordinary sauna bath correspond to those produced by moderate- or high-intensity physical activity such as walking.

The same research team has published several experimental studies demonstrating the beneficial effects of short-term sauna exposure on blood pressure, specific cardiovascular biomarkers, inflammation, arterial compliance, and cardiovascular function. The feelings of relaxation and promotion of mental health and well-being associated with sauna sessions may be linked to the increased production of circulating levels of hormones such as endorphins, the research team reported. The review also reports that sauna bathing produces beneficial changes that are equivalent to those produced by physical activity. Indeed, the research team has shown in their previous studies that a combination of sauna bathing and physical activity might have added health benefits compared with each activity alone.

This review emphasized that sauna bathing has a good safety profile and can even be used in patients with stable cardiovascular disease. Hot Finnish sauna baths have been shown to be hemodynamically well tolerated without the occurrence of complex ventricular arrhythmias in patients with heart diseases.

ROCHESTER, Minn. - Despite increased attention to opioid abuse, prescriptions have remained relatively unchanged for many U.S. patients, research led by Mayo Clinic finds. The research, published in The BMJ, shows that opioid prescription rates have remained flat for commercially insured patients over the past decade. Rates for some Medicare patients are leveling but remain above where they were 10 years ago.

MULTIMEDIA ALERT: Video and audio are available for download on the Mayo Clinic News Network.

"Our data suggest not much has changed in prescription opioid use since about five years ago," says Molly Jeffery, Ph.D., lead author, who is the scientific director of the Mayo Clinic Division of Emergency Medicine Research.

A cross-specialty team of physicians and researchers from Mayo Clinic, Yale University, The University of Alabama at Birmingham and Dartmouth College collaborated to study 48 million U.S. patients who had insurance coverage between 2007 and 2016. Using deidentified insurance claims from the OptumLabs Data Warehouse, the team compared opioid prescriptions among commercially insured patients; Medicare Advantage recipients 65 and older; and Medicare Advantage beneficiaries younger than 65, who generally qualify because of long-term disability. They found that over the course of one year, 14 percent of commercially insured patients, 26 percent of Medicare Advantage patients 65 and older, and 52 percent of disabled Medicare Advantage patients received an opioid prescription.

Over the 10-year period, disabled Medicare Advantage recipients had the highest rates of use and proportion of long-term use, and the largest average daily dose. For that group, quarterly opioid use was lowest in 2007 at 26 percent, peaked in 2013 at 41 percent, and was 39 percent in 2016. The average daily dose increased from the equivalent of seven pills of 5-milligram oxycodone to a high of about nine pills in 2012. In 2016, it went back to roughly eight pills.

Among Medicare Advantage recipients 65 and older, quarterly opioid use was lowest at the start of the study period in 2007 (11 percent), increased to 15 percent in 2010, and decreased to 14 percent by the end of the 10-year period. The average daily dose, roughly three pills of 5-milligram oxycodone, remained relatively unchanged for this group.

For commercial patients, quarterly opioid use remained relatively flat at 6-7 percent for the study period, and the average daily dose, which is the equivalent of about two pills of 5-milligram oxycodone, remained the same for that group, as well.

"Based on these historical trends, there remains an unmet patient need to better target the use of prescription opioids," says W. Michael Hooten, M.D., co-author, who is a Mayo Clinic anesthesiologist and pain specialist.

The Centers for Disease Control and Prevention (CDC) has previously reported that opioid prescriptions in the U.S. increased dramatically from 1999 to 2010. The CDC says those numbers decreased from 2011 to 2015, but the 2015 total was still three times higher than the 1999 total and four times higher than amount prescribed per capita in Europe.

However, Mayo research finds that while prescriptions are leveling off, they're not decreasing in most groups.

"Our research of patient-level data doesn't show the decline that was found in previous research," Dr. Jeffery says. "Those declines were seen in the total amount of opioids prescribed across the whole market. We wanted to know how the declines were experienced by individual people. Did fewer people have opioid prescriptions? Did people taking opioids take less over time? When we looked at it that way, we found a different picture."

Adding to the urgency of addressing this issue is the steadily increasing number of deaths in the U.S. attributed to opioid overdoses. From 1999 to 2014, overdose deaths increased by 200 percent, and by 28 percent from 2015 to 2016 alone, according to the CDC.

The new Mayo research also shows:

Over the 10-year period, disabled Medicare Advantage recipients had an average daily opioid dose equaling about nine pills of 5-milligram oxycodone, compared to about three pills for Medicare Advantage recipients 65 and older, and about two pills for commercially insured patients.

Long-term opioid use made up 3 percent of commercial patients, 7 percent of Medicare Advantage recipients 65 and older, and 14 percent of the disabled Medicare Advantage recipients. However, this small group of patients made up the majority of total opioid pills dispensed: 62 percent for commercial; 70 percent for Medicare Advantage 65 and older; and 89 percent for disabled Medicare Advantage.

Commercially insured patients made up about 89 percent of those studied, while about 10 percent were Medicare Advantage recipients 65 and older, and less than 2 percent were disabled Medicare Advantage recipients. The study did not include people with Medicaid insurance, those covered by the Veterans Affairs or Tricare (military insurance), or the uninsured.

Mayo Clinic is broadly researching opioid prescribing practices to find ideal doses for individual patient needs. The researchers say the goal is to achieve the best possible patient outcomes and experience with minimal exposure to opioids. This research has been translated into opioid prescribing guidelines and tools for medical practices at Mayo and beyond, identifying patients who may not need opioids and, in some cases, cutting prescriptions in half.

Bottom Line: The global age-standardized lung cancer mortality rate among women is projected to increase by 43 percent from 2015 to 2030, according to an analysis of data from 52 countries. The global age-standardized breast cancer mortality rate is projected to decrease by 9 percent in the same time frame.

Journal in Which the Study was Published: Cancer Research, a journal of the American Association for Cancer Research.

Author: Jose M. Martínez-Sánchez, PhD, MPH, BSc, associate professor and director of the Department of Public Health, Epidemiology and Biostatistics at Universitat Internacional de Catalunya (UIC Barcelona)

Background: "While we have made great strides in reducing breast cancer mortality globally, lung cancer mortality rates among women are on the rise worldwide," said Martínez-Sánchez. "If we do not implement measures to reduce smoking behaviors in this population, lung cancer mortality will continue to increase throughout the world."

While previous work has focused on projections in lung and breast cancer mortality among women in a single country or continent, few studies have estimated trends in mortality caused by these two common cancers on a global scale, noted Martínez-Sánchez.

How the Study Was Conducted: In this study, Martínez-Sánchez and colleagues analyzed breast and female lung cancer mortality data from the World Health Organization (WHO) Mortality Database from 2008 to 2014. For inclusion in the study, countries must have reported data for at least four years between 2008 and 2014 and must have a population greater than 1 million. Fifty-two countries fulfilled these criteria: 29 from Europe; 14 from the Americas; seven from Asia; and two from Oceania. Lung and breast cancer age-standardized mortality rates in women, reported as per 100,000 person years, were calculated for each country based on the WHO World Standard Population, which allows for the comparison of countries with different age distributions, thereby eliminating age as a confounding variable in the projected rates.

Results: Globally, among women, the mortality rate for lung cancer is projected to increase from 11.2 in 2015 to 16.0 in 2030; the highest lung cancer mortality rates in 2030 are projected in Europe and Oceania, while the lowest lung cancer mortality rates in 2030 are projected in America and Asia. Only Oceania is predicted to see a decrease in lung cancer mortality, which is projected to fall from 17.8 in 2015 to 17.6 in 2030.

"Different timelines have been observed in the tobacco epidemic across the globe," said Martínez-Sánchez. "This is because it was socially acceptable for women to smoke in the European and Oceanic countries included in our study many years before this habit was commonplace in America and Asia, which reflects why we are seeing higher lung cancer mortality rates in these countries."

Globally, the mortality rate for breast cancer is projected to decrease from 16.1 in 2015 to 14.7 in 2030. The highest breast cancer mortality rate is predicted in Europe with a decreasing trend overall, while the lowest breast cancer mortality rate is predicted in Asia with an increasing trend overall.

"Breast cancer is associated with many lifestyle factors," Martínez-Sánchez explained. "We are seeing an increase in breast cancer mortality in Asia because this culture is adapting a Westernized lifestyle, which often leads to obesity and increased alcohol intake, both of which can lead to breast cancer. On the other hand, we are witnessing a decrease in breast cancer mortality in Europe, which may be related to the awareness of breast cancer among this population, leading to active participation in screening programs and the improvement of treatments."

Compared to middle-income countries, high-income countries have the highest projected age-standardized mortality rates for both lung and breast cancer in 2030. However, high-income countries are more likely to have decreasing breast cancer mortality rates. Furthermore, the first to witness lung cancer mortality rates surpass breast cancer mortality rates are mostly developed countries, noted Martínez-Sánchez.

Author's Comments: "This research is particularly important because it provides evidence for health professionals and policymakers to decide on global strategies to reduce the social, economic, and health impacts of lung cancer among women in the future," said Martínez-Sánchez.

Study Limitations: Limitations of the study include the assumption that recent trends in lung and breast cancer mortality will continue for the next two decades; however, certain habits, such as switching from conventional cigarettes to electronic cigarettes may alter lung cancer mortality trends, Martínez-Sánchez said. Future screening technology and therapeutics may lower mortality rates, he added. Additionally, due to small population size and lack of data, no countries from Africa were included in this study.

Funding & Disclosures: This study was sponsored by the Ministry of Universities and Research of the Government of Catalonia. Martínez-Sánchez declares no conflict of interest.

July 31, 2018 - For patients with Poland syndrome - a rare congenital condition affecting the chest muscle - computer-aided design (CAD) techniques can be used to create custom-made silicone implants for reconstructive surgery of the chest, reports a paper in the August issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons(ASPS).

The new technique provides good cosmetic outcomes and improves quality of life for patients with chest deformities related to Poland syndrome, according to the study by Jean-Pierre Chavoin, MD, of University Hospital Rangueil, Toulouse, France, and colleagues. They write, "The technique is simple, reliable, and yields high-quality results, and 3D CAD has optimized our reconstruction."

Custom-Made Implants Provide New Alternative for Treating Chest Deformity

Poland syndrome is a rare malformation that causes varying chest abnormalities, often with accompanying malformations of the hand. In these patients, largest muscle of the chest (pectoralis major) is absent or underdeveloped on one side, causing visible deformity. Poland syndrome occurs in about 1 out of 30,000 births; about three-fourths of affected patients are male.

Chest reconstruction in patients with Poland syndrome poses complex challenges for the surgeon. A wide range of procedures have been used, such as muscle flaps or silicone implants made from plaster molds. In recent years, Dr. Chavoin and colleagues have developed an innovative, minimally invasive approach: using 3D modeling with CAD technology to create customized silicone implants.

The implants are prepared according to a four-step process. A thin-section computed tomography scan of the patient's chest is obtained. The digital data are used to create a 3D CAD model of the implant, "virtually correcting" the patient's chest deformity. A prototype of the CAD model is prepared using 3D machining and used to cast a rubber silicone elastomer implant.

After sterilization, the customized implant can be placed under the patient's skin by a relatively simple surgical procedure. The article on the Plastic and Reconstructive Surgery website® illustrates the implant design and surgical procedure.

Since 2007, Dr. Chavoin and colleagues have used 3D CAD silicone implants to treat chest deformities in 68 patients with Poland syndrome: 46 males and 22 females, average age 26 years. To optimize the cosmetic results, most patients underwent additional procedures such as fat transfer (lipofilling) or, in women, breast implants.

Both men and women reported high satisfaction rates - more than 90 percent of patients rated their cosmetic outcomes as good or excellent. On a standard questionnaire, patient ratings indicated improvement in social and emotional aspects of quality of life. Some patients said they felt discomfort related to the implant during intense sporting activities. The implants and patient outcomes remained stable during long-term follow-up in 41 patients.

While most of their patients were operated on as adults, the researchers note that the procedure could be performed at younger ages - just after puberty - helping to avoid some of the psychological difficulties that can occur in adolescence and young adulthood. If the patient outgrows the implant, it can be replaced, or other procedures can be performed to improve the appearance of the chest.

Dr. Chavoin and colleagues previously reported the successful use of custom-made implants in patients with pectus excavataum ("sunken" or "funnel chest") deformity. Since developing their CAD implant approach, the researchers have "completely abandoned" other procedures for Poland syndrome, each of which has disadvantages and limitations. They conclude, "Obtaining an excellent result remains difficult in patients with Poland syndrome, but 3D CAD has optimized our reconstructions."

UK doctors think Britain's exit from the European Union (EU), dubbed Brexit, will be very bad for the NHS, reveal the results of an anonymised survey of their political beliefs and voting patterns, published online in the Journal of Epidemiology & Community Health.

As a group, they are predominantly left-wing and liberal-minded. But high earners tend to lean more to the right of the political spectrum, while surgeons are twice as likely as other specialties to express right-wing views, the responses show.

Against a backdrop of major upheavals in health and social care as well as the political landscape in the UK, the researchers wanted to find out about the political beliefs and voting behaviours of this publicly trusted and highly influential group of professionals.

To reach as representative a sample of the UK medical workforce as possible, the researchers collaborated with the online professional network, Doctors.net.uk, and validated proportionality of respondents against records from the professional regulator, the General Medical Council.

Those logging on to their Doctors.net accounts were directed to the survey link, which was open for a week following the 2017 UK general election. This link was also sent to a wide range of specialty associations and relevant Facebook groups.

In all, 1172 respondents, representing 0.4 percent of the 282,304 doctors licensed to practice in the UK in 2016, were included in the final analysis. Nearly half (45%) were women. Most respondents had qualified in the UK, lived in England, and worked in the NHS.

One in three (36%) was a consultant; around one in five was a GP. Just under 30 percent were junior doctors.

When respondents rated their political beliefs on a scale of 0 (extremely left wing) to 10 (extremely right wing), the average score was 4. But the higher the income bracket, the more likely was the respondent to lean to the right.

Surgeons were twice as likely to register a right wing score, while psychiatrists and public health doctors were half as likely to do so. And junior doctors at specialty training entry level (ST3) and above were less likely to express right wing views relative to all other grades.

Nearly two thirds (just over 62%) of respondents described themselves as liberal while nearly one in four (23.6%) said they were conservative.

There was a shift to the left between the 2015 and 2017 elections, with the proportion of doctors voting Labour rising from just over 29 percent to just over 46 percent, while the proportion voting Conservative fell from just over 26 percent to just under 20 percent.

Among those who were ineligible/unable to vote in 2017, nearly a third (just under 30%) said they would have opted for a Labour candidate. Voter turnout among doctors for both elections was significantly higher than among the electorate.

Doctors overwhelmingly backed staying in the EU, with nearly eight out of 10 voting to remain in the 2016 referendum. Among those ineligible/unable to vote, more than 85 percent said they would have voted to remain in the bloc. Only 2 percent of respondents didn't vote compared with nearly 28 percent of the electorate.

Virtually all respondents agreed that EU nationals working in the NHS should be allowed to stay in the UK after Brexit. And most thought Brexit would be very bad for the NHS, irrespective of grade, income, or specialty, giving it an average score of 2 on a 0 (worst outcome) to 10 (best) scale. Nearly 83 percent scored it below 5.

In terms of their views on health policy, most backed minimum unit pricing for alcohol (74%); charging patients not eligible for NHS treatment for non-urgent care (71%); and protected funding for the NHS (87%). And two thirds (just under 66%) thought there was too much private sector care funded by the NHS: only surgeons were half as likely to agree.

This is the first large scale study look at the political opinions of UK doctors, say the authors, but they acknowledge that despite their best efforts, the sample may not be fully representative, so should be taken as an indication only of the views of the UK medical workforce.

"Further work is essential to obtain a better understanding of UK doctors' political identities, particularly the economic and societal differences," write the authors. "This is important as the political ideology of doctors has been shown to influence clinical decisions on contentious issues in other contexts," they conclude.

Parental ill health, especially depression, is linked to heightened use of health services, including emergency care, among their children, finds research published today in the online journal BMJ Paediatrics Open.

Family context may be an influential driver of healthcare needs and use, suggest the researchers.

Survey data have pointed to a link between parents' use of health services and patterns of use among their children. To explore this issue further, the researchers reviewed the electronic health records of more than 25,000 patients registered with one family doctor (GP) practice in London, covering a period of 12 months.

They created 'household' groups of patients living at the same address and then calculated the impact of parents' long term conditions and use of health services on their children's health seeking behaviour in four domains of care: GP appointments; emergency department attendance; hospital admissions; and outpatient appointments.

The children were divided into three age groups: 0-5; 6-10; and 11-15, and potentially influential factors, such as deprivation levels, derived from postcode; parental age; and gender were taken into account.

Some 6738 children up to the age of 15, living in 3373 households with parents aged 18-55 were included in the final analysis. Nearly 2500 (41%) children lived in a single parent household; the same proportion lived with two parents; and nearly one in five (19%) lived with three or more adults.

The most common long term condition their parents had was depression. Nearly 1000 (16%) children had a parent who had been diagnosed with this.

After taking account of parents' use of healthcare, the analysis showed that parental depression was associated with increased odds of a child's use of health services.

The odds of attendance at an emergency department rose by 41 percent; while odds of admission to hospital and an outpatient appointment rose by 47 percent and 67 percent, respectively. And the risk of a GP appointment rose by 28 percent.

Parental GP consultations were associated with a 7 percent greater risk of the child seeing the GP as well, while the parent's attendance at an emergency care department was associated with 27 percent greater odds of the child also seeking emergency care.

This is an observational study, and as such, can't establish cause. What's more, given that the study focused on one general practice, the findings might not readily apply elsewhere, say the researchers. Nor was it possible to assess the degree of social support these families had from relatives, such as grandparents, who didn't live in the same household.

But there are several possible explanations for the findings, they suggest, including parents' perception that their children might be more susceptible to health problems, or that parental depression might be a consequence of prolonged illness in a child.

"The results presented in this paper suggest that a holistic assessment of family needs, particularly parental mental health and social support, may be an effective approach to improving the health and wellbeing of [children and young people]," they conclude.

In a series of experiments with mice, Johns Hopkins investigators have used an experimental compound to successfully reverse hair loss, hair whitening and skin inflammation linked by previous studies to human diets heavy in fat and cholesterol.

The investigators say the compound halts the production of certain fats called glycosphingolipids, or GSLs, that are major components of skin and other cell membranes. Current research shows that mice fed a diet high in fat and cholesterol are more likely to have hair discoloration from black to gray to white, extensive hair loss and inflammation of skin exhibited by multiple wounds. Feeding these animals the compound, however, appears to reverse such symptoms.

The Hopkins investigators caution that such results in mice do not mean that the same effects would occur in people, and there is no evidence at this time that the compounds they used would be safe in people. But the findings, they say, do shed light on possible pathways for addressing hair loss and skin wounds in humans with oral or topical medications.

A report on the findings was published July 30 in Scientific Reports.

"Further research is needed, but our findings show promise for someday using the drug we developed for skin diseases such as psoriasis, and wounds resulting from diabetes or plastic surgery," says Subroto Chatterjee, Ph.D., M.S., M.Sc., professor of pediatrics and medicine at the Johns Hopkins University School of Medicine. Chatterjee conducts research as part of Johns Hopkins Children's Center.

More specifically, previous studies showed that GSLs are prevalent in the cells that make up the uppermost layer of the skin, as well as in cells called keratinocytes that help regulate pigmentation of the eyes, skin and hair.

To determine how disrupting GSLs might affect skin appearance and color, and whether treatment with D-threo-1-phenyl-2-decanoylamino-3-morpholino-1-propanol (D-PDMP) -- a man-made compound that halts GSL production -- would reverse any negative effects, Chatterjee and his colleagues first genetically modified a group of mice to have atherosclerosis, a disease in which arteries are clogged by fat deposits.

The researchers then fed one group of these mice a Western diet high in fat and cholesterol, and a second group standard chow. All mice were fed their assigned diets from 12 weeks of age to 20 weeks.

Compared to those fed standard chow, the mice that ate a Western diet lost hair, formed skin lesions and suffered from hair whitening. These results became more severe when the mice continued eating a Western diet for 36 weeks, with 75 percent of the mice having skin, hair loss and multiple skin lesions.

From 20 to 36 weeks of age, mice in both groups were given varying amounts of D-PDMP, either in a capsule or as a liquid, while they ate the same diet. Mice that received 1 milligram and 10 milligrams of D-PDMP in a capsule per kilogram of body weight from 20 to 36 weeks while eating a Western diet started regaining hair and hair color, and their skin inflammation lessened. Treatment with 1 milligram of D-PDMP in a capsule per kilogram of body weight was as effective as 10 milligrams per kilogram as a liquid. This suggests that an encapsulated form of D-PDMP is a better method of drug delivery.

The research team then looked at the skin of the mice's under a microscope and found that mice eating the Western diet experienced an infiltration of neutrophils, a type of white blood cell implicated in inflammation, in various skin areas. Treatment with D-PDMP in a capsule significantly reduced the number of neutrophils, implying reduced skin inflammation and wounding.

Next, the researchers used mass spectrometry analysis, a method of identifying and quantifying the chemical composition of a mixture, to determine ceramide, glucosylceramide and lactosylceramide levels in the mice. Ceramides are a type of lipid, or fat, that helps protect the skin's moisture, and glucosylceramide is the first derivative of ceramide, whereas lactosylceramide, a later derivative of ceramide, activates inflammation.

Compared to mice fed normal chow, those fed a Western diet had decreased total ceramide levels, decreased glucosylceramide and nearly three times more lactosylceramide. Treatment with 1 milligram of D-PDMP in a capsule per kilogram of body weight or 10 milligrams of D-PDMP as a liquid per kilogram of body weight, however, noticeably increased ceramide levels to normal.

"Our findings show that a Western diet causes hair loss, hair whitening and skin inflammation in mice, and we believe a similar process occurs in men who lose hair and experience hair whitening when they eat a diet high in fat and cholesterol," says Chatterjee.

More animal research needs to be done to confirm and expand on the findings, and to determine how well and what amount of D-PDMP might heal wounds and activate hair growth.

"Hopefully someday in the future this can mean faster, more effective recovery from baldness, hair whitening in aging populations and wound healing," says Chatterjee.

ARLINGTON HEIGHTS, IL - (JULY 30, 2018) - An increase in the Lone Star tick population since 2006, and the ability to recognize the ticks as the source of "alpha gal" allergy to red meat has meant significantly more cases of anaphylaxis being properly identified.

A new study in Annals of Allergy, Asthma and Immunology, the scientific publication of the American College of Allergy, Asthma and Immunology (ACAAI) showed that at the University of Tennessee Health Science Center, alpha-gal ( a complex sugar found in red meat from beef, pork, venison, etc.) was the most common known cause of anaphylaxis. In previous studies of anaphylaxis, researchers were often unable to identify the source of the severe allergic reaction.

"Of the 218 cases of anaphylaxis we reviewed, 33 percent were from alpha gal," says Debendra Pattanaik, MD, lead author of the study. "When we did the same review in 1993, and again in 2006, we had a great many cases where the cause of the anaphylaxis couldn't be identified. That number of unidentified cases dropped from 59 percent in 2006 to 35 percent in this report - probably from the number of identified alpha gal cases. Our research clearly identified alpha gal as the cause of anaphylaxis in the majority of cases where the cause was detected. Food allergies were the second leading cause, accounting for 24 percent."

The people in the study were seen between 2006 and 2016. The study notes that alpha gal allergy was first identified in 2008, so previous reviews wouldn't have taken it into consideration. Due to increased awareness of red meat allergy, and more diagnostic testing available, alpha gal allergy went from an unknown entity to the most commonly identified cause of anaphylaxis at this center.

"We understand that Tennessee is a state with a big population of Lone Star ticks, and that might have influenced the large number of alpha gal cases we identified," says allergist Jay Lieberman, MD, vice chair of the ACAAI Food Allergy Committee and a study co-author. "The Lone Star tick is predominantly found in the southeastern United States and we would expect a higher frequency of anaphylaxis cases in this region would be due to alpha gal. However, the tick can be found in many states outside this region and there are already more cases being reported nationwide."

The remainder of the cases of anaphylaxis in the study were attributed to insect venom (18 percent) exercise (6 percent) systemic mastocystosis (6 percent) medications (4 percent) and other (3 percent).

A bite from the Lone Star tick can cause people to develop an allergy to red meat, including beef, pork and venison. The allergy is best diagnosed with a blood test. Although allergic reactions to foods typically occur rapidly, within 60 minutes of eating the food, in the case of allergic reactions to alpha-gal, symptoms often take several hours to develop. Because of the significant delay between eating red meat and the appearance of an allergic reaction, it can be a challenge to connect the culprit foods to symptoms. Therefore, an expert evaluation from an allergist familiar with the condition is recommended.

Allergists are specially trained to test for, diagnose and treat allergies. To find an allergist near you who can help create a personal plan to deal with your allergies and asthma, use the ACAAI allergist locator.

DALLAS, July 30, 2018 -- Even as a young adult, being overweight may cause higher blood pressure and thicken heart muscle, setting the stage for heart disease later in life, according to new research in the American Heart Association's journal Circulation.

The study is the first to explore if higher body mass index (BMI) - a weight-for-height index - results in adverse effects on the cardiovascular system in young adults.

While observational studies can suggest associations between risk factors or lifestyle behaviors and heart disease, they cannot prove cause-and-effect. Here, investigators triangulated findings from three different types of genetic analysis to uncover evidence that BMI causes specific differences in cardiovascular measurements.

"Our results support efforts to reduce body mass index to within a normal, healthy range from a young age to prevent later heart disease," said Kaitlin H. Wade, B.Sc., Ph.D., lead author of the study and a research associate at the Medical Research Council Integrative Epidemiology Unit at the University of Bristol Medical School in the United Kingdom.

Researchers used data on several thousand healthy 17-year-olds and 21-year-olds who have participated in the ongoing Children of the 90s study (also known as the Avon Longitudinal Study of Parents and Children) since they were born in the Bristol area of the United Kingdom.

The researchers' findings suggest that higher BMI:

caused higher systolic (top number) and diastolic (bottom number) blood pressure; and

caused enlargement of the left ventricle, the heart's main pumping chamber.

"Thickening of vessel walls is widely considered to be the first sign of atherosclerosis, a disease in which fatty plaques build up within the arteries and lead to heart disease. However, our findings suggest that higher BMIs cause changes in the heart structure of the young that may precede changes in blood vessels," Wade said.

Two of the analyses used in the study (Mendelian randomization and recall-by-genotype) take advantage of the properties of genetic variation. Recall-by-genotype is novel and exploits the random allocation of genes at conception.

"At a population level, this provides a natural experiment analogous to a randomized trial where we can compare differences in an outcome (such as heart structure and function) with differences in BMI, without the relationship being skewed by other lifestyle and behavioral factors," Wade said.

Most participants in the longitudinal studies were white, limiting the generalizability of the findings to other ethnic groups.

The researchers plan to investigate the relationship between higher BMI and other possible disease mechanisms, such as the abundance and diversity of microbes living in the gut. They also hope to explore the relationship between BMI and cardiac structure and function in a population now in their 70s.

July 27, 2018--Inhaled vaporized cannabis does not appear to improve or worsen exercise performance and activity-related breathlessness in patients with advanced chronic obstructive pulmonary disease (COPD), according to a randomized controlled trial published online in the Annals of the American Thoracic Society.

In "Effect of Vaporized Cannabis on Exertional Breathlessness and Exercise Endurance in Advanced COPD: A Randomized Controlled Trial," Sara J. Abdallah, a PhD candidate in exercise physiology at McGill University, and co-authors report that the trial did not find a difference between vaporized cannabis and placebo on lung volumes or heart rate at rest or during exercise. Nor did the study find that cannabis affected cognitive function, mood or psycho-activity.

The burden of breathlessness in patients with COPD is high. Even when on optimal medication for their lung disease, many patients with COPD continue to suffer from disabling breathlessness at rest and while performing basic activities of daily living.

"We first became aware of the therapeutic potential of cannabis in managing COPD symptoms from patients themselves," Ms. Abdallah said. "We decided to pursue this study because patients were reporting symptomatic relief of their COPD symptoms after cannabis use."

In the 1970s, controlled studies reported that smoking cannabis opened the airways of adults with and without asthma. More recently, a large observational study found a positive association between cannabis use and forced expiratory volume (the amount of air that can be forcefully exhaled in one second) and forced vital capacity (the total amount of air that can be exhaled after taking a deep breath).

In the current crossover study of 16 patients with advanced COPD, all the patients were taking optimal medication for their lung disease: dual or triple inhalation therapy (long-acting muscarinic antagonist and long-acting beta2-agonist bronchodilator with or without an inhaled corticosteroid).

Participants were randomly selected to inhale a single dose of vaporized cannabis or a placebo before exercising on a stationary bike. Participants then "crossed over" to the other arm of the trial. Neither the researchers nor the patients knew when they were receiving the vaporized cannabis or the placebo.

Although the study did not find a clinically meaningful negative or positive effect of vaporized cannabis on breathlessness during exercise or on exercise performance, the researchers noted variability in responsiveness to the cannabis.

After inhaling vaporized cannabis, breathlessness during exercise improved in 4 of the 16 patients. In the remaining 12 patients, breathlessness during exercise did not change, or worsened.

Senior study author Dennis Jensen, PhD, associate professor of kinesiology and physical education and a scientist in the Translational Research in Respiratory Diseases Program at McGill University, said that trial results may not be generalizable because the number of participants was small and represented a relatively homogenous group of patients with stable, but advanced, COPD.

In addition to the fact that all the participants were on optimal COPD therapy, Dr. Jensen, who is also director of the McGill Research Centre for Physical Activity and Health, suggested a number of factors that may have limited the therapeutic benefit of cannabis in the study, including the dose of cannabis used, that it was inhaled rather than taken orally and that it was administered only once and not repeated.

"Future clinical trials are warranted and should evaluate the therapeutic potential of various doses of vaporized and oral cannabis, including oils and pills, administered over longer periods of time in patients with mild to moderate COPD," he said.

A new study shows promising real-world outcomes for patients receiving a stent retriever thrombectomy six hours after they experience an acute ischemic stroke (AIS). The study was presented today at the Society of NeuroInterventional Surgery's (SNIS) 15th Annual Meeting.

Real-World Stent Retriever Thrombectomy for Acute Ischemic Stroke Beyond 6 Hours of Onset: Analysis of the Combined NASA and TRACK Registries evaluates the real-world outcomes of patients who receive care six hours after experiencing a stroke and proves that similar results seen in randomized trials can be replicated in everyday practice.

"The study's results are promising because it shows us that a wider range of patients are eligible for endovascular therapy," said Dr. Maxim Mokin, lead author of the study and a neurointerventionalist at Tampa General Hospital. "Patients who may not fit the criteria of randomized clinical trials or current guidelines can still experience positive outcomes with a thrombectomy."

The study analyzed 830 patients with AIS from two large real-world clinical registries. Of this group, 32.7 percent (271 patients) underwent a thrombectomy six hours after stroke onset. Both groups of patients had similar thrombectomy approaches using the Solitaire or Trevo stent retrievers. The study showed the following rates of successful recanalization in patients: 79.4 percent between zero and six hours after having a stroke, 75.6 percent between six and 16 hours after having a stroke, and 85 percent between 16 and 24 hours after having a stroke.

Bottom Line: A diet that encourages both healthy eating and physical activity and discourages alcohol consumption was associated with a reduced overall cancer risk, as well as lower breast, prostate, and colorectal cancer risks.

Journal in Which the Study was Published: Cancer Research, a journal of the American Association for Cancer Research.

Authors: Mathilde Touvier, MSc, MPH, PhD, head of the Nutritional Epidemiology Research Team (EREN) of the French National Institute of Health and Medical Research (Inserm), University of Paris 13, and Bernard Srour, PharmD, MPH, and PhD candidate in nutritional epidemiology at EREN-Inserm.

Background: "Among all risk factors for cancer (besides tobacco), nutrition and physical activity are modifiable lifestyle factors which can contribute to cancer risk," said Touvier.

"The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) estimated that in developed countries, around 35 percent of breast cancers and 45 percent of colorectal cancers could be avoided by better adherence to nutritional recommendations. It is, therefore, very important to investigate the role of nutrition in cancer prevention," added Srour.

In order to encourage healthy eating, many organizations have issued dietary recommendations, and this study evaluated three previously validated nutritional recommendations: The WCRF/AICR score; the Alternate Healthy Eating Index; and the French Nutrition and Health Program-Guidelines Score, plus one relatively new index, the MEDI-LITE score, which measures adherence to a Mediterranean diet. Researchers found that all the diets were associated with some reduced risk, but the WCRF/AICR recommendations, developed specifically with cancer prevention in mind, had the strongest association with reduced risk.

How the Study Was Conducted and Results: In order to examine links between the four nutritional indices and cancer risk, Srour, Touvier, and colleagues drew data from the NutriNet-Santé study, launched in 2009 to investigate associations between nutrition and health in a French cohort. This study included a large sample of 41,543 participants aged 40 or older, who had never been diagnosed with cancer prior to inclusion in the study. The participants completed web-based dietary records every six months, in which they detailed all foods and beverages consumed during a 24-hour period. The researchers then calculated their adherence to each of the four nutritional scores in the study.

Between May 2009 and Jan. 1, 2017, 1,489 cancer cases were diagnosed in the study participants, including 488 breast cancers, 222 prostate cancers, and 118 colorectal cancers. The researchers used multivariable Cox proportional hazard models to characterize the associations between each nutritional score and cancer risk.

The study showed that a one-point increase in the WCRF/AICR score was associated with a 12 percent decrease in overall cancer risk; a 14 percent decrease in breast cancer risk, and a 12 percent decrease in prostate cancer risk.

Adherence to the other diets was also associated with reduced cancer risk, but the WCRF/AICR index demonstrated greater statistical strength and a better predictive performance, Srour and Touvier said. For that reason, and because the other three diets were not specifically designed for cancer prevention, the researchers conducted further analysis on the WCRF/AICR scores, excluding certain components to evaluate the relative importance of each one.

Author Comment: The researchers concluded that the "synergistic contribution" of a healthy diet was more significant than any single dietary recommendation. For example, antioxidants from fruits and vegetables may contribute to counteract some of the oxidative damage to the DNA caused by red meat and processed meat, and exercise could lower blood pressure, partly counteracting the effects of high-sodium foods.

"This emphasizes the role of an overall healthy lifestyle--nutrition and physical activity and alcohol avoidance--in cancer prevention," Srour said. "It is, therefore, important to keep in mind that every lifestyle factor counts and it is never too late to adopt a healthy lifestyle."

Srour and Touvier said the WCRF/AICR recommendation to avoid alcohol most likely contributed to that diet's role in reducing cancer risk. They said the findings in this study augment recent research that implicates alcohol as a risk factor in many cancers.

"In its last report, the WCRF stated that there is now strong, convincing evidence that alcohol consumption increases the risks of oropharyngeal, esophagus, liver, colorectal, and post-menopausal breast cancers," Touvier said, adding that there are also apparent links to stomach and premenopausal breast cancers.

Limitations: Because it is based on volunteer participation, this study may have overrepresented women, people with health-conscious behaviors, and those with higher socioeconomic and educational levels. As a result, some unhealthy behaviors may have been underrepresented, and the associations between healthy diets and cancer prevention may be stronger than indicated.

Because previous research has shown that the French consume more fruits and vegetables and fewer sugary beverages and processed foods than the American population, the authors said adhering to the WCRF/AICR recommendations would likely yield more dramatic results in an American population.