Thursday, January 19, 2017

Work-related stress linked to an increased likelihood of cancer and lymphoma


For men, prolonged exposure to work-related stress has been linked to an increased likelihood of lung, colon, rectal, and stomach cancer and non-Hodgkin lymphoma. The findings are among the results obtained by researchers at INRS and Université de Montréal who conducted the first study to assess the link between cancer and work-related stress perceived by men throughout their working life. The research results were recently published in Preventive Medicine.

On average, the study participants had held four jobs, with some holding up to a dozen or more during their working lifetime. Significant links to five of the eleven cancers considered in the study were revealed. These links were observed in men who had been exposed to 15 to 30 years of work-related stress, and in some cases, more than 30 years. A link between work-related stress and cancer was not found in participants who had held stressful jobs for less than 15 years.

The most stressful jobs included firefighter, industrial engineer, aerospace engineer, mechanic foreman, and vehicle and railway-equipment repair worker. For the same individual, stress varied depending on the job held. Researchers were able to document changes in perceived work-related stress.

The study also shows that perceived stress is not limited to high work load and time constraints. Customer service, sales commissions, responsibilities, the participant's anxious temperament, job insecurity, financial problems, challenging or dangerous work conditions, employee supervision, interpersonal conflict, and a difficult commute were all sources of stress listed by the participants.

"One of the biggest flaws in previous cancer studies is that none of them assessed work-related stress over a full working lifetime, making it impossible to determine how the duration of exposure to work-related stress affects cancer development. Our study shows the importance of measuring stress at different points in an individual's working life," explain the authors of the study.

The results obtained raise the question of whether chronic psychological stress should be viewed as a public health issue. But these results are as yet unsubstantiated because they are based on a summary assessment of work-related stress for a given job. There is now a need for epidemiological studies based on reliable stress measurements, repeated over time and that take all sources of stress into account.


Wednesday, January 18, 2017

Managing pain and function associated with hip or knee osteoarthritis


No intervention, whether patient-based, provider-based, or a combination of the two, provided improvements over usual care for patients with knee osteoarthritis. These findings contradict conclusions from an earlier study suggesting that a combined intervention provided modest improvements in function and activity compared with usual care. The results of a cluster randomized trial are published in Annals of Internal Medicine.

Managing pain and function associated with hip or knee osteoarthritis requires both medical and behavioral strategies, but recommended therapies are underused. A single-site study conducted in a Department of Veterans Affairs medical center showed that a combined patient and provider intervention improved outcomes for patients with knee osteoarthritis, but it did not assess separate effects of the interventions.

To examine whether patient-based, provider-based, and patient-provider interventions improve osteoarthritis outcomes, researchers randomly assigned 537 outpatients with symptomatic hip or knee osteoarthritis at 10 Duke University Health System community-based primary care clinics to receive care using one of the three interventions. The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved delivery of patient-specific osteoarthritis treatment recommendations to primary care providers through electronic medical records. The patient-provider intervention combined both approaches.

At 12 months, none of the osteoarthritis intervention groups showed greater improvements in outcomes compared with usual care. The authors note that the intervention was low-intensity. The authors suggest that higher-intensity interventions are needed to make more meaningful improvements in outcomes.


Initiate treatment in adults 60 years old and older with persistent systolic blood pressure at or above 150 millimeters


The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) have published an evidence-based clinical practice guideline on the appropriate systolic blood pressure (the top number in a reading) target for adults 60 years old and older with hypertension. The physicians' groups say that a less aggressive target provides a good balance of benefits and harms for older adults who are otherwise healthy. The joint guideline is published in Annals of Internal Medicine and a summary of the guideline will be published in Annals of Family Medicine.

ACP and AAFP recommend that physicians initiate treatment in adults aged 60 years old and older with persistent systolic blood pressure at or above 150 millimeters of mercury (mmHg) to reduce the risk of mortality, stroke, and cardiac events. The evidence suggests that any additional benefit from aggressive blood pressure control is small, with a lower magnitude of benefit and inconsistent results across outcomes. Some patients may have falsely elevated readings in clinical settings, which is known as "white coat hypertension," therefore, it is important for physicians to ensure that they are accurately measuring blood pressure before initiating or changing treatment. The most accurate measurements come from multiple blood pressure measurements made over time in clinical settings or at home.

The guidelines recommend that physicians consider initiating or intensifying drug therapy in adults aged 60 years old and older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk of recurrent stroke. Physicians should also consider initiating or intensifying pharmacological treatment in some adults aged 60 years old and older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk of stroke or cardiac events.

Hypertension, an elevation of systemic arterial blood pressure, is one of the most common chronic diseases in the United States. About 65 percent of adults in the U.S. over the age of 60 have hypertension, and the disease affects about 29 percent of all adults in the nation. ACP and AAFP are two of the largest physician organizations in the U.S. representing primary care doctors. Their combined 420,900 members, including internal medicine physicians (internists) and family physicians, treat the majority of patients in the U.S. with hypertension.

Red yeast rice supplement may carry both benefits and risks associated with statins


Red yeast rice (RYR) is contained in dietary supplements that are often used by patients with high cholesterol, and it is often proposed as an alternative therapy in those who experience side effects from statins. A new study found that it is not a good choice for statin-intolerant patients: RYR was linked with muscle and liver injury, which can also occur with statin use.

The beneficial effects of RYR are ascribed to monacolins, which are chemically related to statins.

The study's authors note that statins are prescribed under medical control, and blood tests are periodically performed so that statin use can be stopped as soon as abnormal results are identified. On the contrary, RYR is used as self-prescription, without medical advice and monitoring, so patients risk experiencing toxic effects that may go unnoticed.

"The proportion of serious reports (27%), the relatively rapid time to onset and the lack of concomitant drugs and/or predisposing medications in several cases warrants regulatory consideration and call for: 1) continuous monitoring of "natural" dietary supplements safety through spontaneous reports; 2) appropriate information to clinicians and consumers, who should timely submit suspect reports to regulatory Agencies," wrote the authors of the British Journal of Clinical Pharmacology study.


Experts urge for wider prescription of statins in treatment and prevention


World-renowned researchers from the Charles E. Schmidt College of Medicine at Florida Atlantic University as well as Harvard Medical School address the possible but unproven link between statins and diabetes, as well as the implications of prescription of statins for clinicians and their patients, in a commentary published in the prestigious American Journal of Medicine. The editor-in-chief of the journal published the commentary and an editorial he wrote online ahead of print.

Charles H. Hennekens, M.D, Dr.P.H., the first Sir Richard Doll professor and senior academic advisor to the dean, the Charles E. Schmidt College of Medicine at FAU; Bettina Teng, BA, a recent pre-med honors graduate of the Harriet L. Wilkes Honors College at FAU; and Marc A. Pfeffer, M.D., Ph.D., the Dzau professor of medicine at HMS, emphasize to clinicians that the risk of diabetes, even if real, pales in comparison to the benefits of statins in both the treatment and primary prevention of heart attacks and strokes.

"The totality of evidence clearly indicates that the more widespread and appropriate utilization of statins, as adjuncts, not alternatives to therapeutic lifestyle changes, will yield net benefits in the treatment and primary prevention of heart attacks and strokes, including among high, medium and low risk patients unwilling or unable to adopt therapeutic lifestyle changes," said Hennekens.

In the accompanying editorial, Joseph S. Alpert, M.D., editor-in-chief and a renowned cardiologist and professor of medicine at the University of Arizona School of Medicine, reinforces these important and timely clinical and public health challenges in treatment and primary prevention.

"There is no threshold for low density lipoprotein cholesterol below which there are no net benefits of statins either in the treatment or primary prevention of heart attacks and strokes," said Alpert.

The authors and editorialist express grave concerns that there will be many needless premature deaths as well as preventable heart attacks and strokes if patients who would clearly benefit from statins are not prescribed the drug, refuse to take the drug, or stop using the drug because of ill-advised adverse publicity about benefits and risks, which may include misplaced concerns about the possible but unproven small risk of diabetes.

"These public health issues are especially alarming in primary prevention, particularly among women, for whom cardiovascular disease also is the leading cause of death, and for whom there is even more underutilization of statins than for men," said Hennekens.

At its national meeting in November 2013, the American Heart Association, in collaboration with the American College of Cardiology, presented and published its new guidelines for the use of statins in the treatment and primary prevention of heart attacks and strokes, in which the organizations also recommended wider utilization in both treatment and prevention.

According to the United States Centers for Disease Control and Prevention, heart disease is the leading killer among men and women, causing approximately 600,000 deaths each year.


Too much sitting, too little exercise may accelerate biological aging


Researchers at University of California San Diego School of Medicine report that elderly women who sit for more than 10 hours a day with low physical activity have cells that are biologically older by eight years compared to women who are less sedentary.

The study, publishing online January 18 in the American Journal of Epidemiology, found elderly women with less than 40 minutes of moderate-to-vigorous physical activity per day and who remain sedentary for more than 10 hours per day have shorter telomeres -- tiny caps found on the ends of DNA strands, like the plastic tips of shoelaces, that protect chromosomes from deterioration and progressively shorten with age.

As a cell ages, its telomeres naturally shorten and fray, but health and lifestyle factors, such as obesity and smoking, may accelerate that process. Shortened telomeres are associated with cardiovascular disease, diabetes and major cancers.

"Our study found cells age faster with a sedentary lifestyle. Chronological age doesn't always match biological age," said Aladdin Shadyab, PhD, lead author of the study with the Department of Family Medicine and Public Health at UC San Diego School of Medicine.

Shadyab and his research team believe they are the first to objectively measure how the combination of sedentary time and exercise can impact the aging biomarker.

Nearly 1,500 women, ages 64 to 95, participated in the study. The women are part of the larger Women's Health Initiative (WHI), a national, longitudinal study investigating the determinants of chronic diseases in postmenopausal women. The participants completed questionnaires and wore an accelerometer on their right hip for seven consecutive days during waking and sleeping hours to track their movements.

"We found that women who sat longer did not have shorter telomere length if they exercised for at least 30 minutes a day, the national recommended guideline," said Shadyab. "Discussions about the benefits of exercise should start when we are young, and physical activity should continue to be part of our daily lives as we get older, even at 80 years old."

Shadyab said future studies will examine how exercise relates to telomere length in younger populations and in men.

Comparing beach umbrella vs. SPF 100 sunscreen to protect beachgoers from sun


How did sun protection compare for people who spent 3½ hours on a sunny beach with some under an umbrella and others wearing SPF 100 sunscreen? A new article published online by JAMA Dermatology reports neither method used alone completely prevented sunburn, although the SPF 100 sunscreen was more efficacious in the randomized clinical trial.

Hao Ou-Yang, Ph.D., of Johnson & Johnson Consumer, Inc., Skillman, N.J., and coauthors used actual conditions to monitor the sun protection of a standard beach umbrella compared with the high SPF sunscreen. Johnson & Johnson Consumer Inc. is the parent company of Neutrogena Corp. and manufacturer of the sunscreen tested in this study.

Seeking shade is a widely used practice to avoid direct sun exposure. People often assume their skin is fully protected as long as they are under the shade of an umbrella. Few clinical studies have examined the UV protectiveness of a beach umbrella or compared it directly with sunscreen.

The study - conducted over a few days in August 2014 in Lake Lewisville, Texas - included 81 participants, with 41 who used an umbrella and 40 who used SPF 100 sunscreen for protection on a sunny beach at midday. The beachgoers were examined for sunburn on their bodies (face, back of neck, upper chest, arms and legs) about a day after sun exposure.

Authors report 78 percent of participants who were under the shade of a beach umbrella developed sunburn compared with 25 percent of participants who used SPF 100 sunscreen. There were 142 sunburn incidences in the umbrella group and 17 in the sunscreen group, according to this side-by-side study.

Limitations of the study include that only one type of beach umbrella was evaluated.

"Umbrella shade alone may not provide sufficient sun protection during extended exposure to UV rays. Although the SPF 100 sunscreen was more efficacious than the umbrella, neither method alone prevented sunburn completely under actual use conditions, highlighting the importance of using combinations of sun protection practices to optimize protection against UV rays," the article concludes.